Disorders of the elbow Flashcards
Pain in the elbow can be
Referred pain - cervical spondylosis
Peri-articular disorders - Epicondylitis, nerve entrapment,
Articular disorders - RA, OA, joint stiffness
Management of elbow pain
Investigate (X-ray, CT, MRI, Arthroscopy) and examine (Look, feel, move)
Causes of lateral elbow pain
Lateral epicondylitis
Lateral ulnar collateral ligament injury (LUCL)/instability
Radial nerve entrapment
Medial elbow pain
Medial epicondylitis
medial collateral ligament injury
Ulnar neuropathy
Lateral epicondylitis
Tennis elbow - Common extensor origin - pain on resisted extension of wrist
Common –> due to overuse and microtears which heal and form fibrosis and granulation tissue –> angiofibroblastic hyperplasia
Treatment of Lateral epicondylitis
Usually conservative - physiotherapy or local injections
May require surgery
Medial epicondylitis
Golfer’s elbow - less common than tennis
Common flexor origin –> pain on resisted wrist flexion/pronation –> similar pathology and treatment as lateral epicondylitis
Ulnar neuritis
A palsy of the ulnar nerve due to compression, friction or traction - can be treated conservatively or by surgical decompression
Instability of the elbow
Most commonly posterior lateral due to LUCL tears or laxity –> progressive disruption which starts laterally and moves medially
Treatment of elbow instability
Acute reduction of any dislocation
Mobilization and physiotherapy
Ligament reconstruction if recurrent
Causes of elbow stiffness
Intrinsic stiffness –> intra-articular
Extrinsic stiffness –> peri-articular
Treatment of elbow stiffness
Can be conservative or surgical (open or arthroscopic)
Olecranon Bursitis
‘Students’ elbow –> inflamed, tender, erythematous and swollen bursa due to pressure and irritation –> usually conservatively managed but can be excised surgically. typically middle aged men
Treatment of elbow RA
First line is treat medically (methotrexate) but if there is severe joint destruction may require surgical intervention (replacement or osteotomy)
Treatment of elbow OA
Focus on early conservative and expectant management
If severe attempt arthroscopic debridement and eventually replacement
Cubital tunnel syndrome
Compression of the ulnar nerve which will start with tingling of the 4th and 5th fingers and may be worse when the elbow is resting on a firm surface or flexed for an extended period of time. Eventually leads to numbness of the 4th and 5th fingers with weakness.
Radial tunnel syndrome
Compression of the posterior interosseous branch of the radial nerve due to overuse. Presents similarly to lateral epicondylitis but pain is 4-5cm distal, and is worsened by extending the elbow and pronating the forearm
Radial nerve palsies
If damage in the axilla –> weak triceps, wrist drop and may involve the median and ulnar nerves too
If in the upper arm –> triceps and brachioradialis may be spared
At the elbow –> radial tunnel syndrome
At the writs –> cause finger drop without wrist drop
