Cortex - adult orthopaedics spine and upper limb (upper limb) 4

Question 1

Where does the common extensor origin in the forearm arise from?

Answer 1

The lateral epicondyle

Question 2

Where does the common flexor origin in the foreaem arise from ?

Answer 2

The medial epichondyle

Question 3

What is the attachment of the common extensor and flexor origins to the medial and lateral epichondyles called ?

Answer 3

The enthesis

Question 4

When the attachments of the extensor and flexor origins to the medial and lateral epichondyles become painful what is this called ?

Answer 4

Enthesopathy

Question 5

What area does tennis elbow affect ?

Answer 5

The lateral epichondyle

Question 6

How does tennis elbow arise ?

Answer 6

• Can occur as a repetitive strain injury in tennis players and others whom regularly perform resisted extension at the wrist.
• It can also be a degenerative enthesopathy (inflammation of the origin or insertion of a tendon or ligament into bone).

Question 7

What is the pathological feature of Tennis elbow (Lateral epicondylitis)?

Answer 7

Micro-tears in the common extensor origin

Question 8

What are the clinical features of tennis elbow (lateral epichondylitis)?

Answer 8

• A painful and tender lateral epicondyle
• Pain on resisted middle finger and wrist extension

Question 9

How is tennis elbow (lateral epichondylitis) diagnosed ?

Answer 9

On clinical examination

Question 10

What is the treatment of tennis elbow (lateral epichondylitis)?

Answer 10

1st line: rest + ice + NSAID + brace/strap

If no response after 6 weeks:

1st line: physiotherapy ± local anaesthetic injection

Question 11

What is golfers elbow (medial epichondylitis)?

Answer 11

A consequence of repeated strain or degeneration of the common flexor origin

Question 12

What is the treatment/diagnosis of medial epichondylitis ?

Answer 12

Basically the same as lateral epichondylitis

• Diagnosis - clinical examination
• Treatment - physio, rest and NSAIDs are the mainstay, injection carries risk of injury to the ulnar nerve

Question 13

What arthritic condition is the elbow commonly affected by ?

Answer 13

RA - primary OA is uncommon but secondary OA can occur after trauma

Question 14

What is the treatment of arthritic changes of the radiocapitellar joint which has failed 1st line non operative managemeant ?

Answer 14

Can be treated with surgical excision of the radial head

Question 15

What is the treatment of an elbow severely afected by RA or OA at the humero-ulnar joint which isn’t satisfactorily treated with 1st line conservative management ?

Answer 15

Can be treated surgically with a Total Elbow Replacement - however limits patients to only lifting 2.5kg postoperatively