CONDITIONS OF THE ELBOW Flashcards
Describe supracondylar fractures of the distal humerus
-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)
What is the MOI of supracondylar fractures of the distal humerus?
-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)
Presentation of supracondylar fractures of the distal humerus?
-Child present with:
>Pain, Deformity , Loss of function
Desribe appearance of fracture in supracondylar fractures of the distal humerus
-Fracture line is usually extraarticular (i.e. joint is not involved) and the distal fragment is usually displaced posteriorly.
What are 3 main complications of supracondylar fractures of the distal humerus?
- Malunion resulting in cubitus varus known as gunstock deformity (resembles stock of gun).
- Damage to the median nerve (most common), radial nerve, ulnar nerve.
- Ischaemic contracture, damage to the brachial artery, can lead to compartment syndrome and then Volkman’s ischaemic contracture.
Descibe appearance of arm in Ischaemic volkman’s contracture.
-Wrist is typically flexed, MCPJ extended, flexion at IPJ, forearm is pronated, elbow is flexed.
Describe MOI elbow dislocations (general)
-Occur when a person fall on their outstetched hand with the elbow partially flexed.
What are the features of posterior elbow dislocations?
(named by displacement of distal fragment)
-90% of elbow dislocations
-distal end of humerus dirven through the joint capsule anteriorly
-ulnar collateral ligament is usually torn, ulnar nerve may damaged
What are the features of anterior elbow dislocations?
-<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)
What is Pulled elbow ‘nursemaids elbow’
-Subluxation of the radial head
-Most commonly occurs in children aged 2-5 years
What is the presentation of pulled elbow?
-Reduced movement of the elbow
-Pain over the lateral aspect of the proximal forearm
-Described as ‘not using their arm’ (by parents)
What is the MOI of pulled elbow?
-Longitudional traction applied to the arm with forearm pronated
e.g. tugging an uncooperative child or swinging child by the arms.
Why does injury occur most commonly in pronation?
-In pronation, the annular ligament is lax
(taut in supination)
-easier for subluxation to occur
What is MOI radial head and neck fractures?
-Commonest type of elbow fracture in adults
-Result from FOOSH when radial head impacts on the capitellum of the humerus.
Presentation of radial head and neck fractures?
-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
What are the X-ray signs in radial head and neck fractures?
-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
Describe OA of the elbow?
-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.
Presentation of OA of the elbow?
-Grating sensation (crepitus)
-Locking of the elbow (caused by loose fragments of cartilage)
-Swelling due to effusion (relatively late)
-LOSS (radiological signs)
What are some complciations of OA of the elbow?
-Osteophytes can impinge on ulnar nerve causing paraesthesia, muscle weakness.
-Stiffness of the elbow (tolerated by patients)
Describe RA of the elbow?
-Autoantibodies known as rheumatoid factor attack the synovial membrane.
-Inflammed synovial cells proliferative to form a pannus whihc leads to joint erosion + derformity.
What are the Xray features of RA (elbow)
-Joint space narrowing
-Periarticualr osteopenia
-Juxtaarticular bony erosions
-Subluxation + gross deformity
Describe management of RA
-Managed medically rather than surgically through prescription of disease-modifying medication.
-Surgery in severe cases to releive pain + improve mobility (total elbow replacement)
What is lateral elbow tendinopathy (‘tennis elbow’)?
-called lateral epicondylitis
-chronic overuse disorders in tendons
-Pain at the site of common extensor tendon at the lateral epicondyle.
What is the MOI of tennis elbow?
-Extensor carpi radialis brevis (ECRB) weakened from overuse, microscopic tears form in the tendon.
-Leads to inflammation and pain.
What are the symptoms of tennis elbow?
-Pain over the lateral epicondyle during extension of the wrist.
What is the treatment of tennis elbow?
-Activity modification
-Physiotherapy
-Bracing of the elbow
-Injections/surgery
What is Medial elbow tendinopathy ‘golfers elbow’?
-‘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
What is the MOI for golfers elbow?
-sports that place valgus stress on the elbow
What is the presentation for golfers elbow?
-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.
What is olecranon bursitis (‘students elbow’)?
-inflammation of the olecranon bursa situated between the skin and olecranon process of the ulna
What causes olecranon bursitis? (+features of the swelling)
-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.
What is the treatment of olecranon bursitis?
-Patients often present due to cosmetic reasons
-compression bandaging
-Aspiration
-Hydrocortisone injection
-Surgical drainage
What are rheumatoid nodules?
-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.
Where can rheumatoid nodules be seen?
-Seen in fingers and forearms and occasionally over the back of the heel.
-non tender although overlying skin can ulcerate and become infected.
Treatment of rheumatoid nodules
-Patients may present for cosmetic concerns
-Control of underlying rheumatoid disease
What is gouty tophi?
-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.
Presentation of gouty tophi?
-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.
What are some complciations of gouty tophi?
-Pain
-Soft tissue damage
-Deformity
-Joint destruction
-Nerve compression
What is cubital tunnel syndrome?
-Ulnar nerve compression
-The ulnar nerve lies in the cubital tunnel behind the medial epicondyle.
Presentation of cubital tunnel syndrome?
-Minor trauma to ulnar nerve in the cubital tunnel causes a sharp transient pain ‘hit funny bone feeling’
-Paraesthesia
-Muscle weakness
Treatment of cubital tunnel syndrome
-Decompress the nerve
