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ESA 2 Clinical Conditions > Common Elbow Conditions > Flashcards

Common Elbow Conditions Flashcards

1
Q

What is the main cause of elbow dislocation?

A

FOOSH

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2
Q

What are the symptoms of elbow dislocation?

A
  1. Pain
  2. Deformity
  3. Loss of function
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3
Q

In which direction does the elbow usually dislocate?

A

Posterior (movement of ulna relative to humerus)

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4
Q

Describe the initial and definitive management of elbow dislocations.

A

Initial management

  • sling or splintage
  • analgesia
  • NVT (nerve vessel tendon) assessment distally
  • X-ray (to confirm diagnosis)

Definitive management

  • closed reduction under sedation/anaesthesia
  • reassess NVT and stability
  • POP imobilisation (if required)
  • re-X-ray (to ensure concentric reduction and check for bony fragments)
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5
Q

What is the prognosis of elbow dislocations?

A
  • Good outcome if ‘simple’

- May be stiffness/recurrent instability

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6
Q

Which ligament is usually torn in posterior elbow dislocations?

A

Ulnar collateral ligament (as distal end of humerus is driven through weakest part of capsule - anterior side)

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7
Q

What is a pulled elbow (or nursemaid’s elbow)? How is it often caused?

A
  • Subluxation (partial dislocation) of radial head - slips under annular ligament.
  • Longitudinal traction along extended arm.
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8
Q

In which population is subluxation of radial head common? Why?

A
  • 2-5 yrs

- Annular ligament is weaker (more easily torn) and bones are smaller

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9
Q

What are the symptoms of radial head subluxation?

A
  • reduced movement
  • lateral pain
  • ‘not using it’
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10
Q

What is the treatment for subluxation of radial head?

A
  • Closed reduction

- Sling - spontaneous resolution

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11
Q

Which nerves and vessels can be damaged during elbow dislocation?

A 
Ulnar and median nerves
Brachial artery (look for pulse)
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12
Q

What kind of elbow fracture is common if 5-7 yrs due to FOOSH? What are the symptoms?

A

Supracondylar fracture of distal humerus

  • pain
  • marked swelling
  • bruising
  • no function
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13
Q

How is neurovascular compromise due to supracondylar fracture assessed?

A
  1. Check for paraesthesiae (tingling)
  2. ‘OK’ sign
  3. Radial pulse
  4. Capillary return
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14
Q

What are the treatment options for supracondylar fracture of distal humerus?

A
  1. If undisplaced: collar and cuff, +/- POP backslab
  2. If very unstable/displaced, surgery:
    - manipulation under anaesthesia (MUA) +/- K wire stabilisation
    - percutaneous/open reduction
  3. In some cases, traction can be used
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15
Q

What are the 3 main complications of supracondylar fracture of distal humerus?

A
  1. Malunion resulting in cubitus varus
  2. Late neuropathy: damage to ulnar (most common), median or radial nerve
  3. Damage/occlusion of brachial artery (causing ischaemic contracture)
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16
Q

What is the most common elbow fracture, how is it caused and what are the symptoms?

A

Radial head/neck fractures, caused by FOOSH. Symptoms:

  • lateral pain
  • modest swelling
  • loss of range
17
Q

What sign would indicate an occult elbow fracture?

A

Fat pad/sail sign: dark triangle around elbow caused by displacement of fat pad (swelling due to acute effusion/haemarthrosis from bone)

18
Q

What are the treatment options for radial head/neck fractures?

A
  1. If minimally displaced
    - sling and early range of motion
  2. If severely displaced
    - ORIF (open reduction and internal fixation)
    - partial excision
    - replacement
19
Q

What is elbow osteoarthritis? In which population is is more common?

A

Degenerative disease of articular cartilage. Can be primary or secondary (post-traumatic).

M>F 4:1. Manual workers.

20
Q

What are the symptoms of elbow osteoarthritis?

A

Symptoms relatively rare. Often stiffness rather than pain, tolerated well esp loss of extension.

21
Q

What are the treatment options for elbow OA?

A
  • Surgical debridement - removal of mechanical blocks/loose bodies. Never perfect but some pain relief.
  • Rarely total elbow replacement as not very effective.
22
Q

What is elbow rheumatoid arthritis? How common is is and what are the symptoms?

A
  • Systemic autoimmune disease in which synovial pannus causes joint destruction.
  • Commonest inflammatory arthropathy (M=F).
  • Symptoms: symmetric polyarthropathy with morning stiffness (>1hr).
23
Q

What treatment options may be considered in elbow RA?

A

Joint replacement (more effective than for OA)

24
Q

What is the difference between lateral and medial elbow tendinopathy? Which is most common?

A

Lateral = degenerative tendinopathy of common extensor origin (‘tennis elbow’).
- most common cause of elbow pain (manual workers, sports - repetitive activity), 5-6th decades

Medial = degenerative tendinopathy of common flexor origin (‘golfer’s elbow’)
- 10x less common than LET

25
Q

What are the treatment options for lateral or medial elbow tendinopathies?

A
  1. Activity modification / brace / physiotherapy

2. Injections (various) / surgery

26
Q

What is an important differential diagnosis for lateral elbow tendinopathy?

A

radiating pain from neck or shoulder

27
Q

What are the 3 main types of swelling around the elbow?

A
  1. rheumatoid nodules
  2. olecranon bursitis
  3. gouty tophi
28
Q

What are rheumatoid nodules and how are they treated?

A
  • Commonest extra-articular manifestation of rheumatoid arthritis - in 20% of RA (more aggressive disease)
  • Cosmetic concerns
  • Involves treatment of underlying diseases: disease-modifying antirheumatic drugs (DMARDs) or biologics (e.g. TNF)
29
Q

What is olecranon bursitis and how can this be treated?

A

= inflammation of the bursa due to trauma/friction (‘student’s elbow’).

  • Soft, cystic and transilluminates.
  • Mainly cosmetic concern but can become infected.
  • Treatment (though not usually necessary): aspiration +/- steroid infection, or surgery
30
Q

What is gouty tophi and how can this be treated?

A
  • Disorder of nucleic acid metabolism (primary or secondary) leading to hyperuricaemia and urate crystal deposition.
  • Can occur in joints (recurrent attacks of arthritis) or soft tissues (ear, elbow and achilles tendon).
  • Treatment = medication (rarely surgery)
31
Q

What are cubitus varus and cubitus valgus?

A

Cubitus varus = deformity in which extended forearm deviates towards midline of body. Purely cosmetic concern.
Cubitus valgus = deformity in which extended forearm deviates away from the body. Concern as ulnar nerve can get trapped, causing delayed ulnar nerve palsy.

ESA 2 Clinical Conditions (8 decks)

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