Disorders of the elbow

Question 1

Pain in the elbow can be

Answer 1

Referred pain - cervical spondylosis
Peri-articular disorders - Epicondylitis, nerve entrapment,
Articular disorders - RA, OA, joint stiffness

Question 2

Management of elbow pain

Answer 2

Investigate (X-ray, CT, MRI, Arthroscopy) and examine (Look, feel, move)

Question 3

Causes of lateral elbow pain

Answer 3

Lateral epicondylitis
Lateral ulnar collateral ligament injury (LUCL)/instability
Radial nerve entrapment

Question 4

Medial elbow pain

Answer 4

Medial epicondylitis
medial collateral ligament injury
Ulnar neuropathy

Question 5

Lateral epicondylitis

Answer 5

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

Question 6

Treatment of Lateral epicondylitis

Answer 6

Usually conservative - physiotherapy or local injections

May require surgery

Question 7

Medial epicondylitis

Answer 7

Golfer’s elbow - less common than tennis
Common flexor origin –> pain on resisted wrist flexion/pronation –> similar pathology and treatment as lateral epicondylitis

Question 8

Ulnar neuritis

Answer 8

A palsy of the ulnar nerve due to compression, friction or traction - can be treated conservatively or by surgical decompression

Question 9

Instability of the elbow

Answer 9

Most commonly posterior lateral due to LUCL tears or laxity –> progressive disruption which starts laterally and moves medially

Question 10

Treatment of elbow instability

Answer 10

Acute reduction of any dislocation
Mobilization and physiotherapy
Ligament reconstruction if recurrent

Question 11

Causes of elbow stiffness

Answer 11

Intrinsic stiffness –> intra-articular

Extrinsic stiffness –> peri-articular

Question 12

Treatment of elbow stiffness

Answer 12

Can be conservative or surgical (open or arthroscopic)

Question 13

Olecranon Bursitis

Answer 13

‘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

Question 14

Treatment of elbow RA

Answer 14

First line is treat medically (methotrexate) but if there is severe joint destruction may require surgical intervention (replacement or osteotomy)

Question 15

Treatment of elbow OA

Answer 15

Focus on early conservative and expectant management

If severe attempt arthroscopic debridement and eventually replacement

Question 16

Cubital tunnel syndrome

Answer 16

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.

Question 17

Radial tunnel syndrome

Answer 17

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

Question 18

Radial nerve palsies

Answer 18

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