Conditions Of The Elbo Joint

Question 1

How does a supracondylar fracture occur

Answer 1

Most commonly by FOOSH - falling onto outstretched hand, with elbow hyperextended.Mainly happens in children and young adults. Can also happen in old people when they fall onto flexed elbow

Question 2

What is a supracondylar fracture

Answer 2

Fracture line is extraarticular i.e joint int involved. The distal fragment is often displaced (look at pic)

Question 3

Presentation of a supracondylar fracture

Answer 3

Pain, deformity and loos of function

Question 4

Complications of a supracondylar fracture

Answer 4

1. Malunion - results in cubitus varus where arm is held at a a carrying angle 5 degrees towards body
2. Damage to median, radial or ulnar nerve
3. Ischamic contracture. Happens if brachial artery is damaged causing ischaemia and muscles undergo infarction. During repair tissue replaced by scar tissue which contraction resulting in volkmanns ischaemic contracture. Wrist is flexed and fingers are extended at the metacapophalangeal joints and flexed at the interphalngeal joints. Elbow is also flexed

Question 5

How to prevent these complications of supracondylar fracture

Answer 5

Prompt and thorough neurovascular exmination is conducted in all patients. If there is damage emergency fixation or reduction of the fracture is required

Question 6

How does elbow dislocation occur

Answer 6

Often by child falling onto outstretched hand with elbow partially flexed - this is because mid-flexion more reliant on ligaments rather than the configuration of the ones

Question 7

Types of elbow dislocation

Answer 7

Most common is posterior dislocation (as in distal fragment (radius and ulna) are displaced posteriorly)
Humerus is driven through joint capsule anteriorly and ulnar collateral ligament is usually torn

Anterior dislocation are more uncommon and result from direct blow to posterior flexed elbow. Often also have fractured olecranon due to degree of force neeeded

Question 8

What is a pulled elbow (nursemaids elbow)

Answer 8

= subluxation of radial head (subluxation is partial disruption of joint)

Question 9

When does nursemaids elbow occur

Answer 9

Usually in children 2-5 years. Happens when longitudinal traction is applied to the arm with forearm pronated. Also happens during falls

Question 10

What does a child with nursemaids elbow present with

Answer 10

Reduced movement of elbow, pain ad not using arm

Question 11

Why does nursemaids elbow occur during pronation

Answer 11

The annular ligament is more relaxed in pronation so its easier for it to occur. Traction tears annular ligament and then the radial head is displaced dismally from the torn ligament

Question 12

What is a radial head and neck fracture

Answer 12

Commonest type of elbow fracture in adults caused by falling on an outstretched hand when the radial head impacts on the capitellum of the humerus

Question 13

How does a Patient with a radial head and neck fracture present

Answer 13

Pain in lateral aspect of proximal forearm and loss of range of movement. Swelling usually modest in comparison to supracondylar fracture

Question 14

How to identity a radial head and neck fracture on an X-ray

Answer 14

Pretty difficult. BUT sail sign indicates effusion due to haemarthrosis (blood in joint secondary to intra-articular fracture- break that crosses surface of a joint). It is caused by displacement of anterior fat pad and shows up dark on the X-ray

Question 15

Discuss the prevalence osteoarthritis of the elbow

Answer 15

Relatively uncommon because well-matched joint surfaces and strong stabilising ligaments - joint can tolerate large forces without becoming unstable
Seen in men more than women (sports and manual labour)

Question 16

Effects of osteoarthritis o the elbow

Answer 16

Grating sensation or locking due to lose fragments in their elbow
Late swelling (due to an effusion)
Parasethsia and muscle Alness.
Stiff elbow tolerated pretty well as doesn’t limit daily activities

Question 17

What is rheumatoid arthritis

Answer 17

Autoimmune disease where antibodies attack the synovial membrane. Inflamed cells proliferate forming pannus which penetrates cartilage and bone causing erosion and deformity

Question 18

X-ray features of RA

Answer 18

Joint space narrowing 
Periartciular osteopenia (very very close metcarpalphalanegal joints) 
Juxtra articular bony erosions 
Subluxation (misalignment of vertebrae) and gross deformity

Question 19

How is RA managed

Answer 19

Medically managed rather than surgically. BUT in severe causes to relieve pain and improve mobility surgery is undertaken

Question 20

Describe what would be seen in RA of the elbow

Answer 20

Extensive erosion of humeralulnar joint. Most of trochlear of humerus destroyed. Sigmoid fossa enlarged
Patient would be candidate for elbow replacement

Question 21

What is lateral elbow tendinopathy (tennis elbow)

Answer 21

Common in those of 40-60 years. Presents with pain due to tendinopathy of the common extensor tendon of the lateral epicondyle. The extensor carpi radialis brevis muscle helps to stabilise the wrist when elbow is straight (tennis ground stroke) but when this is weakened you get microscopic tears in the tendon leading to inflammation and pain

Question 22

Patient presentation of tennis elbow

Answer 22

Pain of lateral epicondyle during extension of wrist especially with resistance

Question 23

Treatment of tennis elbow

Answer 23

Modify activities to give tendon opportunity to heal.
Most patients recover within 1 year.
Physiotherapy and injections can help small number of patients

Question 24

What is medial elbow tendinopathy (golfers elbow)

Answer 24

Much less common than tennis elbow and affects flexor origin at medial epicondyle. Associated with golf and throwing because of vagus stress on elbow. Inflammation occurs between pronation teres and flexor carpi radialis origins.

Question 25

Presentation of patients with golfers elbow

Answer 25

Aching pain over medial elbow often during throwing acceleration. Pain is produced of resisted flexion or pronation of wrist.
Ulnar nerve symptoms present in 20% because its so close to ulnar nerve

Question 26

Treatment of golfers elbow

Answer 26

Modify activity

Question 27

What cause swelling around the elbow

Answer 27

Olecranon bursitis
Rheumatoid nodules
Gouty tophi (gout)

Question 28

What is olecranon bursitisi (students elbow)

Answer 28

Inflammation of olecranon bursa (between skin and olecranon) due to repeated minor trauma e.g leaning with elbows on desk for many hours. Swelling is soft, cystic and transilluminates

Question 29

Presentation of olecranon bursitis

Answer 29

Cosmetic concern of unsightly swelling

Question 30

Treatment of olecranon bursitis

Answer 30

Compression bandaging and aspiration (injection that removes fluid to see if its infective or not)
Hydrocortisone injection needed in chronic cases
Also sometimes maybe from infection of bursae (sepsis) in which case need AB and aspiration
Ocassionally drainage and washout under anaesthetic needed to resolve infection

Question 31

presentation of rheumatoid nodules

Answer 31

tend to be smokers. found in areas which are subject to repeated minor trauma e.g elbows or fingers. sometimes become ulcerated and infected. patents present because of cosmetic concerns

Question 32

treatment of rheumatoid nodules

Answer 32

control of underlying rheumatoid disease

Question 33

what are gouty tophi

Answer 33

monosodium urate crystals deposited in the soft tissues. complication of hyperuricaemia and appear in patients with gout. present with pain, soft tissue damage and deformity, joint destruction and nerve compression. common sites are ears, olecranon bursa and subcutaneous tissue of elbow

Question 34

what is cubital tunnel syndrome

Answer 34

ulnar nerve lies in the cubital tunnel posterior to the medial epicondyle. the flexor carpi tendon overlies the ulnar nerve. cubital tunnel syndrome is when the ulnar nerve is compressed here

Question 35

minor trauma to ulnar nerve in cubital tunnel?

Answer 35

causes sharp transient pain radiating from elbow = funny bone

Question 36

what does compression of ulnar nerve in cubital tunnel cause?

Answer 36

parasthesia in cutaneous territory of cubital tunnel. weakness to muscles supplied by ulnar nerve.

Question 37

treatment of cubital tunnel syndrome

Answer 37

decompress by surgically releasing it and moving it to the anterior medial epicondyle