Disorders Of The Elbow Flashcards
What can be seen on an x-ray of a radial head fracture?
Fat pad
What is the most common paediatric elbow fracture?
Supracondylar fracture of distal humerus
Mechanism of supracondylar fracture of distal humerus
Fall onto outstretched hand
Main complications of supracondylar fracture of distal humerus
- Malunion
- Damage to median (most common), radial or ulnar nerve
- Volkmann’s Ischaemic contracture
- Damage to brachial artery
Explain how supracondylar fracture of distal humerus can casue Volkmann’s ischaemic contracture
- if fracture causes damage to brachial artery, ischaemia of anterior muscles will occur
- this causes oedema + compartment pressure increase»_space; compartment syndrome
- due to lack of O2, muscles undergo infarction
- in repair, muscle tissues are replaced by scar tissue through fibrosis
- myofibroblasts in fibrosis contracts
What nerve is most commonly damaged in supracondylar fractures of distal humerus?
Median nerve
Assessment of supracondylar fracture of distal humerus
- Examine + document media nerve - ‘ok sign’ or ask to make a fist - last three fingers with flex only
- Examine and document brachial artery - radial pulse + capillary refill time
What is the test to determine median nerve damage?
Ok sign
If patient cant form ok sign»_space; possible median nerve injury
Ask to make a fist
Can’t flex 2nd + 3rd digits
What are the tests to determine brachial artery damage?
Radial pulse
Capillary refill time
Management of supracondylar fracture of distal humerus
1- Closed reduction with percutaneous pinning
2- Hold in position with plaster
- if this doesn’t restore nerve function > surgery
Close - without making a cut
Reduce - put back in position
What is reduction of a fracture
Putting bone back into position
What group of people is a pulled elbow most common in?
2-5 years old
Weak annular ligament
What happens in a pulled elbow?
Radial head subluxes from annular ligament
Presentation of a subluxed radial head
Pain
Child not using elbow
Mechanism of subluxation of radial head
Longitudinal traction with extended arm + forearm pronated
e.g. parent swinging child around by arms
Treatment of subluxation of radial head
Reverse the forces - flex elbow
- supinate forearm
Why does a pulled elbow happen more commonly in pronation than supinate
Annular ligament is relaxed in pronation
Easier for subluxation to occur
What is nursemaid’s elbow?
Pulled elbow - subluxation of radial head
Mechanism of posterior elbow dislocation
Fall onto outstretched arm
What dislocation is most common in the elbow?
Posterior
Mechanism of anterior elbow dislocation
Direct blow to posterior aspect of flexed elbow
What other injury is often associated with anterior elbow dislocations?
Fractures of olecranon
Due to force needed to dislocate joint anteriorly
What is a complex dislocation?
Fracture associated with dislocation
What is a simple dislocation?
No associated fractures
What presentations raise suspicion for radial head + neck fracture?
Lateral elbow pain
Restricted ROM - especially pronation + supination
What is elbow osteoarthritis due to?
Wear and tear - bones rubbing together
Degenerative disease of articular cartilage
X ray features of osteoarthritis
**LOSS*
Loss of joint space
Osteophytes
Subcondral sclerosis
Subcondral cysts
Presentation of osteoarthritis
Pain on activity
Pain eases with rest
Morning pain < 1 hour
How does rheumatoid arthritis occur?
Systemic inflammatory disease
- autoantibodies attack synovium
- synovial cells proliferate to form pannus
- pannus erodes cartilage + bone > joint deformity
X ray feature of rheumatoid arthritis
LESS
Loss of joint space
Erosion of bone
Soft tissue swelling
See through bone - osteopenia
Presentation of rheumatoid arthritis
Morning stiffness > 1 hour
Malaise
Speed of onset of rheumatoid arthritis
Weeks - months
Speed of onset of osteoarthritis
Years
What is froment’s sign?
What does it test for?
- tests for ulnar nerve palsy
- ask patient to grasp paper with thumb + index finger and pull paper
- flexion at IPJ if palsy dye to paralysis of adductor pollicis
What is another name for Lateral tendinopathy?
Tennis elbow
What is another name for medial elbow tendinopathy?
Golfer’s elbow
Presentation of lateral elbow tendinopathy/Tennis elbow
Pain at common extensor origin during extension of wrist
What is lateral elbow tendinopathy/Tennis elbow due to?
Extensor carpi radialis brevis becomes weakened from overuse > microscopic tears at lateral epicondyle > inflammation + pain
Who does lateral elbow tendinopathy/tennis elbow commonly affect?
Tennis players
Painters
Plumbers
Carpenters
Presentation of medial elbow tendinopathy/golfer’s elbow?
aching pain over medial elbow on resisted flexion or pronation
Who is medial elbow tendinopathy/golfer’s elbow commonly seen in?
Golfing
Throwing sports
Archers
Weight lifters
3 causes of elbow swelling
Olecranon bursitis
Rheumatoid nodules
Gouty tophi
Treatment of elbow tendinopathy
Activity modification
What is another name for olecranon bursitis?
Student’s elbow
What is olecranon bursitis/student’s bursitis?
Inflammation of olecranon bursa
Presentation of olecranon bursitis/student’s elbow?
Soft swelling
Cystic > transilluminates
Treatment of olecranon bursitis
- compression bandaging +/- aspiration
- antibitoics if infectious cause
- hydrocortisone injection - chronic causes
Causes of olecranon bursitis
- friction
- infection of bursa > septic bursitis
What is the commonest extra articular manifestation of RA?
Rheumatoid nodules
Presentation of rheumatoid nodules
- slow onset
- mobile/non tethered
- firm
- doesnt transilluminate
Who are rheumatoid nodules more common in?
Smokers
Those with more aggressive joint disease
Treatment of rheumatoid nodules
Improve underlying RA
What are gouty tophi?
Nodular patchy white masses of monosodium urate crystals deposited in soft tissue - often in fingers, ears + elbows
Describe gout
- Inflammatory condition due to hyperuricaemia
- forms monosodium urate crystals
- causes innate immune response > acute inflammation
What is cubital tunnel syndrome?
Compression of ulnar nerve in cubital tunnel - often between 2 heads of FCU
Presentation of cubital tunnel syndrome
- sensory lost first - numbness + tingling to medial 1 1/2 digits
- motor lost later
Diagnosis of cubital tunnel syndrome
Nerve conduction studies
Forment’s sign
Treatment of cubital tunnel syndrome
Analgesia
Surgery
Splinting at right 45°
Contents of the cubital fossa
Really Need Beer To Be At My Nicest
- Radial Nerve
- Biceps Tendon
- Brachial Artery
- Median Nerve
