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MSK Clinical conditions > CONDITIONS OF THE ELBOW > Flashcards

CONDITIONS OF THE ELBOW Flashcards

1
Q

Describe supracondylar fractures of the distal humerus

A

-Comprise up to 75% of all elbow injuries
-90% of supracondylar fractures seen in children younger than 10 years of age.
-Peak age 5-7 years. (occuring more commonly in boys)

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2
Q

What is the MOI of supracondylar fractures of the distal humerus?

A

-Common mechanism= falling from a moderate height onto to outsretched hand with elbow hyperextended.
e.g. fallling of ‘monkey bars’

-Less common mechanism= falling onto a flexed elbow (more common in elderly)

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3
Q

Presentation of supracondylar fractures of the distal humerus?

A

-Child present with:
>Pain, Deformity , Loss of function

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4
Q

Desribe appearance of fracture in supracondylar fractures of the distal humerus

A

-Fracture line is usually extraarticular (i.e. joint is not involved) and the distal fragment is usually displaced posteriorly.

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5
Q

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

A
  1. Malunion resulting in cubitus varus known as gunstock deformity (resembles stock of gun).
  2. Damage to the median nerve (most common), radial nerve, ulnar nerve.
  3. Ischaemic contracture, damage to the brachial artery, can lead to compartment syndrome and then Volkman’s ischaemic contracture.
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6
Q

Descibe appearance of arm in Ischaemic volkman’s contracture.

A

-Wrist is typically flexed, MCPJ extended, flexion at IPJ, forearm is pronated, elbow is flexed.

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7
Q

Describe MOI elbow dislocations (general)

A

-Occur when a person fall on their outstetched hand with the elbow partially flexed.

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8
Q

What are the features of posterior elbow dislocations?
(named by displacement of distal fragment)

A

-90% of elbow dislocations
-distal end of humerus dirven through the joint capsule anteriorly
-ulnar collateral ligament is usually torn, ulnar nerve may damaged

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9
Q

What are the features of anterior elbow dislocations?

A

-<10% of elbow dislocations
-Usually caused by direct blow to the posterior apsect of the flexed elbow
-associated with fracture of olecranon (due to degree of force required to dislocate joint)

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10
Q

What is Pulled elbow ‘nursemaids elbow’

A

-Subluxation of the radial head
-Most commonly occurs in children aged 2-5 years

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11
Q

What is the presentation of pulled elbow?

A

-Reduced movement of the elbow
-Pain over the lateral aspect of the proximal forearm
-Described as ‘not using their arm’ (by parents)

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12
Q

What is the MOI of pulled elbow?

A

-Longitudional traction applied to the arm with forearm pronated
e.g. tugging an uncooperative child or swinging child by the arms.

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13
Q

Why does injury occur most commonly in pronation?

A

-In pronation, the annular ligament is lax
(taut in supination)
-easier for subluxation to occur

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14
Q

What is MOI radial head and neck fractures?

A

-Commonest type of elbow fracture in adults
-Result from FOOSH when radial head impacts on the capitellum of the humerus.

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15
Q

Presentation of radial head and neck fractures?

A

-Pain in the lateral aspect of their proximal forearm
-Loss of range of movement
-Swelling is usually modest in comparison with e.g. supraconcylar fractures

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16
Q

What are the X-ray signs in radial head and neck fractures?

A

-Fat pad sign/sail sign: indicates presence of effusion.
-likely due to trauma, haemoarthrosis secondary to intra-articular fracture.
-displacement of the fat pad is relatively radio-leucent so appears black on X-ray

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17
Q

Describe OA of the elbow?

A

-Relatively uncommon (due to well matched joint surfaces and strong stabilising ligaments
-Elbow can tolerate large forces without becoming unstable so less wear and tear with age.

18
Q

Presentation of OA of the elbow?

A

-Grating sensation (crepitus)
-Locking of the elbow (caused by loose fragments of cartilage)
-Swelling due to effusion (relatively late)
-LOSS (radiological signs)

19
Q

What are some complciations of OA of the elbow?

A

-Osteophytes can impinge on ulnar nerve causing paraesthesia, muscle weakness.
-Stiffness of the elbow (tolerated by patients)

20
Q

Describe RA of the elbow?

A

-Autoantibodies known as rheumatoid factor attack the synovial membrane.
-Inflammed synovial cells proliferative to form a pannus whihc leads to joint erosion + derformity.

21
Q

What are the Xray features of RA (elbow)

A

-Joint space narrowing
-Periarticualr osteopenia
-Juxtaarticular bony erosions
-Subluxation + gross deformity

22
Q

Describe management of RA

A

-Managed medically rather than surgically through prescription of disease-modifying medication.
-Surgery in severe cases to releive pain + improve mobility (total elbow replacement)

23
Q

What is lateral elbow tendinopathy (‘tennis elbow’)?

A

-called lateral epicondylitis
-chronic overuse disorders in tendons
-Pain at the site of common extensor tendon at the lateral epicondyle.

24
Q

What is the MOI of tennis elbow?

A

-Extensor carpi radialis brevis (ECRB) weakened from overuse, microscopic tears form in the tendon.
-Leads to inflammation and pain.

25
Q

What are the symptoms of tennis elbow?

A

-Pain over the lateral epicondyle during extension of the wrist.

26
Q

What is the treatment of tennis elbow?

A

-Activity modification
-Physiotherapy
-Bracing of the elbow
-Injections/surgery

27
Q

What is Medial elbow tendinopathy ‘golfers elbow’?

A

-‘medial epicondylitis’
-Chronic overuse of the common flexor origin at the medial epicondyle
-Most common site of pathology= interface between pronator teres and FCR origins/
-Treatment similar to LET

28
Q

What is the MOI for golfers elbow?

A

-sports that place valgus stress on the elbow

29
Q

What is the presentation for golfers elbow?

A

-Aching pain over the medial elbow
-Pain is produced on resisted flexion or pronation of the wrist
-Ulnar nerve symptoms due to close proximity to the medial epicondyle.

30
Q

What is olecranon bursitis (‘students elbow’)?

A

-inflammation of the olecranon bursa situated between the skin and olecranon process of the ulna

31
Q

What causes olecranon bursitis? (+features of the swelling)

A

-Repeated minor trauma e.g. students leaning of their elbow when studying
-serous fluid
-Swelling is soft, cystic (fluid-filled) and transilliminates i.e. light can be shined through it.

32
Q

What is the treatment of olecranon bursitis?

A

-Patients often present due to cosmetic reasons
-compression bandaging
-Aspiration
-Hydrocortisone injection
-Surgical drainage

33
Q

What are rheumatoid nodules?

A

-commonest extra-articular manifestation of RA, affect 20% of patients
-Patients tend to be smokers + more aggresive joint disease
-Usually occur over exposed regions that are subject to repeated minor trauma.

34
Q

Where can rheumatoid nodules be seen?

A

-Seen in fingers and forearms and occasionally over the back of the heel.
-non tender although overlying skin can ulcerate and become infected.

35
Q

Treatment of rheumatoid nodules

A

-Patients may present for cosmetic concerns
-Control of underlying rheumatoid disease

36
Q

What is gouty tophi?

A

-Gout= inflammatory condition leading to increased production of uric acid and urate crystals
-Tophi= nodular masses of monosodium urate crystals deposited in the soft tissues.

37
Q

Presentation of gouty tophi?

A

-Commonly seen in fingers and ears
-Contain white ‘pasty’ material as they enlarge they work their way towards skin surface to drain.
-Can also be found in olcranon bursa and subcutaneous tissue of the elbow.

38
Q

What are some complciations of gouty tophi?

A

-Pain
-Soft tissue damage
-Deformity
-Joint destruction
-Nerve compression

39
Q

What is cubital tunnel syndrome?

A

-Ulnar nerve compression
-The ulnar nerve lies in the cubital tunnel behind the medial epicondyle.

40
Q

Presentation of cubital tunnel syndrome?

A

-Minor trauma to ulnar nerve in the cubital tunnel causes a sharp transient pain ‘hit funny bone feeling’
-Paraesthesia
-Muscle weakness

41
Q

Treatment of cubital tunnel syndrome

A

-Decompress the nerve

MSK Clinical conditions (8 decks)

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