Conditions Of The Elbo Joint Flashcards
How does a supracondylar fracture occur
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
What is a supracondylar fracture
Fracture line is extraarticular i.e joint int involved. The distal fragment is often displaced (look at pic)
Presentation of a supracondylar fracture
Pain, deformity and loos of function
Complications of a supracondylar fracture
- Malunion - results in cubitus varus where arm is held at a a carrying angle 5 degrees towards body
- Damage to median, radial or ulnar nerve
- 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
How to prevent these complications of supracondylar fracture
Prompt and thorough neurovascular exmination is conducted in all patients. If there is damage emergency fixation or reduction of the fracture is required
How does elbow dislocation occur
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
Types of elbow dislocation
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
What is a pulled elbow (nursemaids elbow)
= subluxation of radial head (subluxation is partial disruption of joint)
When does nursemaids elbow occur
Usually in children 2-5 years. Happens when longitudinal traction is applied to the arm with forearm pronated. Also happens during falls
What does a child with nursemaids elbow present with
Reduced movement of elbow, pain ad not using arm
Why does nursemaids elbow occur during pronation
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
What is a radial head and neck fracture
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
How does a Patient with a radial head and neck fracture present
Pain in lateral aspect of proximal forearm and loss of range of movement. Swelling usually modest in comparison to supracondylar fracture
How to identity a radial head and neck fracture on an X-ray
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
Discuss the prevalence osteoarthritis of the elbow
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)
Effects of osteoarthritis o the elbow
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
What is rheumatoid arthritis
Autoimmune disease where antibodies attack the synovial membrane. Inflamed cells proliferate forming pannus which penetrates cartilage and bone causing erosion and deformity
X-ray features of RA
Joint space narrowing Periartciular osteopenia (very very close metcarpalphalanegal joints) Juxtra articular bony erosions Subluxation (misalignment of vertebrae) and gross deformity
How is RA managed
Medically managed rather than surgically. BUT in severe causes to relieve pain and improve mobility surgery is undertaken
Describe what would be seen in RA of the elbow
Extensive erosion of humeralulnar joint. Most of trochlear of humerus destroyed. Sigmoid fossa enlarged
Patient would be candidate for elbow replacement
What is lateral elbow tendinopathy (tennis elbow)
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
Patient presentation of tennis elbow
Pain of lateral epicondyle during extension of wrist especially with resistance
Treatment of tennis elbow
Modify activities to give tendon opportunity to heal.
Most patients recover within 1 year.
Physiotherapy and injections can help small number of patients
What is medial elbow tendinopathy (golfers elbow)
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.
Presentation of patients with golfers elbow
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
Treatment of golfers elbow
Modify activity
What cause swelling around the elbow
Olecranon bursitis
Rheumatoid nodules
Gouty tophi (gout)
What is olecranon bursitisi (students elbow)
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
Presentation of olecranon bursitis
Cosmetic concern of unsightly swelling
Treatment of olecranon bursitis
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
presentation of rheumatoid nodules
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
treatment of rheumatoid nodules
control of underlying rheumatoid disease
what are gouty tophi
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
what is cubital tunnel syndrome
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
minor trauma to ulnar nerve in cubital tunnel?
causes sharp transient pain radiating from elbow = funny bone
what does compression of ulnar nerve in cubital tunnel cause?
parasthesia in cutaneous territory of cubital tunnel. weakness to muscles supplied by ulnar nerve.
treatment of cubital tunnel syndrome
decompress by surgically releasing it and moving it to the anterior medial epicondyle
