Common Elbow Conditions Flashcards
What is the main cause of elbow dislocation?
FOOSH
What are the symptoms of elbow dislocation?
- Pain
- Deformity
- Loss of function
In which direction does the elbow usually dislocate?
Posterior (movement of ulna relative to humerus)
Describe the initial and definitive management of elbow dislocations.
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)
What is the prognosis of elbow dislocations?
- Good outcome if ‘simple’
- May be stiffness/recurrent instability
Which ligament is usually torn in posterior elbow dislocations?
Ulnar collateral ligament (as distal end of humerus is driven through weakest part of capsule - anterior side)
What is a pulled elbow (or nursemaid’s elbow)? How is it often caused?
- Subluxation (partial dislocation) of radial head - slips under annular ligament.
- Longitudinal traction along extended arm.
In which population is subluxation of radial head common? Why?
- 2-5 yrs
- Annular ligament is weaker (more easily torn) and bones are smaller
What are the symptoms of radial head subluxation?
- reduced movement
- lateral pain
- ‘not using it’
What is the treatment for subluxation of radial head?
- Closed reduction
- Sling - spontaneous resolution
Which nerves and vessels can be damaged during elbow dislocation?
Ulnar and median nerves Brachial artery (look for pulse)
What kind of elbow fracture is common if 5-7 yrs due to FOOSH? What are the symptoms?
Supracondylar fracture of distal humerus
- pain
- marked swelling
- bruising
- no function
How is neurovascular compromise due to supracondylar fracture assessed?
- Check for paraesthesiae (tingling)
- ‘OK’ sign
- Radial pulse
- Capillary return
What are the treatment options for supracondylar fracture of distal humerus?
- If undisplaced: collar and cuff, +/- POP backslab
- If very unstable/displaced, surgery:
- manipulation under anaesthesia (MUA) +/- K wire stabilisation
- percutaneous/open reduction - In some cases, traction can be used
What are the 3 main complications of supracondylar fracture of distal humerus?
- Malunion resulting in cubitus varus
- Late neuropathy: damage to ulnar (most common), median or radial nerve
- Damage/occlusion of brachial artery (causing ischaemic contracture)
What is the most common elbow fracture, how is it caused and what are the symptoms?
Radial head/neck fractures, caused by FOOSH. Symptoms:
- lateral pain
- modest swelling
- loss of range
What sign would indicate an occult elbow fracture?
Fat pad/sail sign: dark triangle around elbow caused by displacement of fat pad (swelling due to acute effusion/haemarthrosis from bone)
What are the treatment options for radial head/neck fractures?
- If minimally displaced
- sling and early range of motion - If severely displaced
- ORIF (open reduction and internal fixation)
- partial excision
- replacement
What is elbow osteoarthritis? In which population is is more common?
Degenerative disease of articular cartilage. Can be primary or secondary (post-traumatic).
M>F 4:1. Manual workers.
What are the symptoms of elbow osteoarthritis?
Symptoms relatively rare. Often stiffness rather than pain, tolerated well esp loss of extension.
What are the treatment options for elbow OA?
- Surgical debridement - removal of mechanical blocks/loose bodies. Never perfect but some pain relief.
- Rarely total elbow replacement as not very effective.
What is elbow rheumatoid arthritis? How common is is and what are the symptoms?
- Systemic autoimmune disease in which synovial pannus causes joint destruction.
- Commonest inflammatory arthropathy (M=F).
- Symptoms: symmetric polyarthropathy with morning stiffness (>1hr).
What treatment options may be considered in elbow RA?
Joint replacement (more effective than for OA)
What is the difference between lateral and medial elbow tendinopathy? Which is most common?
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
What are the treatment options for lateral or medial elbow tendinopathies?
- Activity modification / brace / physiotherapy
2. Injections (various) / surgery
What is an important differential diagnosis for lateral elbow tendinopathy?
radiating pain from neck or shoulder
What are the 3 main types of swelling around the elbow?
- rheumatoid nodules
- olecranon bursitis
- gouty tophi
What are rheumatoid nodules and how are they treated?
- 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)
What is olecranon bursitis and how can this be treated?
= 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
What is gouty tophi and how can this be treated?
- 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)
What are cubitus varus and cubitus valgus?
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.
