Conditions affecting the elbow Flashcards
Supracondylar fracture of distal humerus
- FOOSH is most common mechanism
- 5-7 yo, boys most likely
- Pain, deformity and loss of function
- Less common mechanism = fall of flexed elbow = elderly
- Fracture line = extra articular
- Distal fragment displaced posteriorly
3 main complications of supracondylar fracture of distal humerus
- Malunion = cubitus varus
- Damage to median nerve, radial and ulnar nerve
- Ischaemic contracture
Volkmann’s isachaemic contracture
- Brachial artery damaged or occluded by displaced fracture
- Reflex spasm of collateral circuits of elbow = ischaemia of anterior compartment of forearm
- Oedma = rise in compartment pressure = compartment syndrome
- Impedes arterial flow = ischaemia worse
- Muscle bellies = infarction and replaced by scar tissue = Fibrotic tissue contracts = flexion contracture
- Wrist flexed, fingers extended at MCPJ, forearm promoted and elbow flexed
How do you minimise complications of supracondylar fractures
- Neurovascular examination
- Compromise = emergency reduction and fixation of fracture
Dislocated elbow
- FOOSH w considerable force = sports injury
- Most are posterior and displacement of distal fragment - ulna and radius
- Ulnar collateral ligament torn and there can also be associated fracture and ulnar nerve involvement
- Anterior dislocation less common and due to direct blow to posterior elbow - fractures of olecranon
Pulled elbow
Subluxation of radial head = incomplete dislocation.
- 2-5 yo
- Reduced movement of elbow, pain over lateral aspect, not using arm
- Pulling of forearm
Annular ligament in pulled elbow
Annular ligament taut in supination and more relaxed in pronation so easier for subluxation to occur. Tear of distal attachment of annular ligament from neck of radius.
Radial head then displaced distally.
As child age annular ligament strengthens so condition is less common.
Radial head and neck fractures
- FOOSH
- Pain in lateral aspect of proximal forearm and loss of range of movement
- Swelling usually modest
- Effusion = haemarthrosis
- Displacement of anterior fat pad
OA of elbow
Quite uncommon as the elbow is a well matched joint and has strong stabilising ligaments.
- Men > women
- Manual workers and athletes that throw
- Grating sensation or locking
Why does OA occur?
- Swelling is late due to effusion
- Osteophytes impinge on ulnar nerve, causing and maybe muscle weakness
- Stiffness of elbow is tolerated relatively well by patients, esp loss of extension
Rheumatoid arthritis of elbow
- Autoantibodies attack synovial membrane
- Inflamed synovial cells proliferate to form panes which penetrates cartilage and adjacent bone
- Leading to joint erosion and deformity
- Peak age of onset is 40-50 yo
- Women more affected than men
X ray features of RA
- Joint space narrowing
- Periarticular osteopenia
- Juxta-articular bony erosions
- Subluxation and gross deformity
Management of RA
- Prescription of disease modifying medication
- Surgery if severe cases
Lateral elbow tendinopathy
Chronic over use disorder in tendons also known as tennis elbow.
Pain at common extensor origin at lateral epicondyle during wrist extension.
Extensor carpi radialis brevis normally stabilises wrist when elbow straight but if weakened from overuse microscopic tears at origin = inflammation and pain.
Treatment of tennis elbow
Activity modification - disorder self-limiting. In some cases physio and bracing needed.
Medial elbow tendinopathy
Also called golfers elbow, associated w this and other throwing sports.
Common flexor origin at medial epicondyle effect but main is interference w pronator teres and flexor carpi radialis origins.
Pain on resisted flexion and pronation of wrist.
3 common causes for swellings around elbow
- Olecranon bursitis
- Rheumatoid nodules
- Gouty trophi
Olecranon bursitis
Inflam of olecranon bursa due to repeated micro trauma.
Filled w serous fluid.
Normally due to students leaning on desk when studying but also could be septic bursitis due to infection.
Treatment of olecranon bursitis
Compression bandaging and maybe aspiration.
If due to infection then aspiration, compression and antibiotics.
Rheumatoid nodules
Patients tend to be smokers w aggressive joint disease. Also extra-articular manifestations of rheumatoid disease eg. vasculitis and lung disease.
Seen in elbow, fingers and forearms.
Non-tender but overlying skin can ulcerated and become infected.
Treatment - medical control of rheumatoid disease.
What causes Gout?
Increased production of uric acid forming rate crystals in synovial cavity of joints, tendons and surrounding tissues.
This triggers and immune response causing acute inflammation.
Gouty tophi
Nodular masses of rate crystals deposited in soft tissues. Normally painless but complications = pain, soft tissue damage and deformity, joint destruction and nerve compression.
Common sites and appearance of tophi
- Fingers and ears
- Olecranon bursa and subcutaneous tissue of elbow
- White pasty material in ulcer
Cubital tunnel
Ulnar nerve passes behind medial epicondyle of humerus to enter forearm close to elbow joint - cubital tunnel.
Cubital tunnel syndrome
Ulnar nerve passes beneath a tendinous arch to enter cubital tunnel = common site of ulnar nerve compression - syndrome.
Pain of cubital tunnel syndrome
Sharp pain radiating from elbow to cutaneous ulnar nerve territory.
- Paraesthesia
- Weakness in muscles supplied by ulnar nerve
Treatment of cubital tunnel syndrome
Decompression of nerve
