Disorders Of The Elbow Flashcards
What are common elbow disorders
• Acute / Traumatic
– Dislocations / Fractures / Fracture Dislocations
• Chronic / Degenerative / Overuse
– Arthritis / Tendinopathies
• Features of Systemic disease
• Referred Pain?
Think Local / Regional / Systemic
What is elbow dislocation
• 2nd most common dislocation • Fall onto out-stretched hand – ‘FOOSH’ • Children and young adults • Pain / deformity / loss of function • Usually Posterior +/- Fractures • Reduce and splint – NVT assessment • Prognosis – Good outcome if ‘simple’ – Stiffness / Recurrent instability
What is. Supracondylar fracture of dista humerus
• FOOSH • 5-7 yrs • Pain / Swelling / Bruising / Loss of function • Neurovascular compromise – Paraesthesiae / ‘OK’ sign / Radial pulse / Capillary return • Displaced v Undisplaced • Collar & Cuff +/- POP backslab • Surgery – MUA +/- K wire stabilisation • Neurovascular injury • Late deformity • Late neuropathy
What are radial head and neck fractures
Radial Head / Neck Fractures • FOOSH • Commonest elbow fracture • Lateral pain / mild swelling / loss of range • Occult (hidden) fracture – Haemarthrosis – ‘Fat pad’ / ‘Sail’ signs – Displaced fat looks ‘black • Sling and early ROM – if minimally displaced • Surgery
How can you tell the difference between ossification centres and fractures
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What is subluxation of radial head
• ‘Pulled elbow’ / ‘Nursemaid’s Elbow’ • Subluxation from annular ligament • Traction along extended arm • Pre-school (but not <1yr!) - they cant walk (non accidental??) • Reduced movements / pain / ‘Not using it’ • Closed reduction • Sling & spontaneous resolution Usually sorts itself out
What is elbow osteoarthritis
• Degenerative disease of articular cartilage - 3% of arth • Primary or Secondary • M>F 4:1 Manual workers • Symptoms may be minor • Stiffness tolerated well • Treatment only if Symptomatic – Injections – Surgical Debridement – Rarely Total Elbow Replacement
What is elbow rheumatoid arthritis
• Systemic Autoimmune disease • Inflammatory arthropathy – Sero-positive for RhF – Symmetric – Morning stiffness – Small & large joints • Synovial pannus → joint destruction • Early Medical treatment – DMARDs – ‘Biologics’ • Surgery
What is lateral elbow tendinopathy
• ‘Lateral Epicondylitis’ / ‘Tennis Elbow’ • Degenerative tendinopathy – Common Extensor Origin • Commonest cause of elbow pain – Manual workers – 40-60 yrs – Sports (BMJ 2 1883!) • Activity modification / Physiotherapy • Injections • Surgery ?Radiating pain from neck or shoulder
What is medial elbow tendinopathy
• ‘Medial Epicondylitis’ / ‘Golfer’s Elbow’ • Degenerative tendinopathy
– Common Flexor Origin • 10x less common than LET • Presentation - similar to LET • Treatment options - similar to LET • Outcome – less good than LET
What is olecranon bursitis
• ‘Student’s Elbow’ • Inflammation of bursa due to trauma or friction • Soft & cystic • Transilluminates • Cosmetic concerns • Can become infected • Treatment – Leave alone – Aspiration ± Injection – Surgery
What are rheumatoid nodules
• Commonest extra-articular manifestation of Rheumatoid Arthritis • 20% of RhA • More aggressive disease • Also fingers / forearm • Cosmetic concerns • Treatment – Underlying disease – Surgery
What is gouty tophi
• Disorder of nucleic acid metabolism
leading to Hyperuricaemia • Urate crystal deposition
• Primary & Secondary
• Joints
– Recurrent attacks of acute ‘Arthritis’
• Soft tissue deposition
– Ear, elbow, fingers and Achilles tendon
• Treatment
– Underlying condition
What is ulnar nerve neuropathy
• ‘Cubital Tunnel Syndrome’ • Compressive neuropathy of the Ulnar Nerve at Elbow • Paraesthesiae / numbness / weakness – Ulnar 1½ digits – Hypersensitive ‘funny bone’ – +/- Subluxation – ? At Wrist or Neck • Nerve Conduction Studies • Treatment – Splintage – Surgical Decompression
