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MSK UPPER LIMBS (S8) > Disorders of the elbow > Flashcards

Disorders of the elbow Flashcards

1
Q

What is the common mechanism for a supracondylar fracture of distal humerus?

A

FOOSH (fall onto outstretched hand) e.g. child falling off monkey bars

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2
Q

What are the common clinical presentation of a supracondylar fracture of distal humerus and what is the usual age?

A
  • Pain
  • Swelling
  • Bruising
  • Loss of function
  • 10 years and below
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3
Q

What are the three main complications of a supracondylar fracture?

A
  • Malunion (fracture not healing properly) leading to a cubitus varus/gunstock deformity
  • Damage to the median nerve (most common), radial nerve or ulnar nerve
  • Ischaemic contracture
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4
Q

What is a Volkmann’s ischaemic contracture and how does it come about?

A

A flexion contracture resulting in a claw like hand from fibrotic tissue contraction

  • Brachial artery damage and collateral arteries spasm
  • Oedema causes rise in compartment pressure (compartment syndrome)
  • Ischaemia and necrosis
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5
Q

What is the common mechanism for an elbow dislocation?

A

-FOOSH (fall onto outstretched hand) with mid-flexion

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6
Q

Which elbow dislocation is more common?

A

Posterior (ulnar ligament is usually torn as well)

-may have associated fractures and ulnar nerve damage

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7
Q

Which elbow dislocation is least common?

A

Anterior dislocation (with associated olecranon fracture)

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8
Q

Describe what a pulled elbow/nursemaids elbow is

A

Subluxation (an incomplete dislocation) of the radial head

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9
Q

What is the common mechanism for a pulled elbow/nursemaids elbow and at what age does it usually occur?

A

Longitudinal traction when the forearm is pronated (e.g. tugging an uncooperative child or swinging them)
-usually at 2-5 years old

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10
Q

Why is a pulled elbow/handmaids elbow more common in pronation?

A

Annular ligament is taut in supination and more relaxed in pronation = easier for subluxation
-radial head displaced distally through torn ligament

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11
Q

How does a pulled elbow clinically present?

A
  • Reduced movement of the elbow
  • Pain over lateral proximal forearm
  • Patient describes “not using their forearm”
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12
Q

What is the common mechanism for a radial head and neck fractures?

A

FOOSH (fall onto outstretched hand)

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13
Q

How does a radial head or neck fracture clinically present?

A
  • Pain in lateral aspect of their proximal forearm
  • Loss of range of movement
  • Swelling
  • Sail sign (displacemnt of the anterior fat pad)
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14
Q

Describe elbow osteoarthritis

A

Degenerative disease of articular cartilage from wear and tear
-Commonly seen in men than women (4:1), manual workers and athelets

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15
Q

How does elbow osteoarthritis clinically present?

A
  • Grating sensation (crepitus)
  • Locking in their elbow
  • Swelling from effusion
  • Paraesthesia and muscle weakness from osteophyte impingement
  • Stiffness (tolerated)
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16
Q

Describe what rheumatoid arthritis is and a brief pathology

A
  • Autoimmune disease
  • Autoantibodies attack synovial membrane
  • Inflamed synovial cells proliferate to form a pannus
  • Penetration through cartilage and bone causing erosion and deformity
17
Q

What are the systemic symptoms of rheumatoid arthritis?

A
  • Fatigue
  • Low grade fever
  • Weight loss
  • Anaemia of chronic disease
18
Q

What are the radiological features of rheumatoid arthritis?

A

-Joint space narrowing
-Periarticular osteopenia
Juxta-articular bony erosions
-Subluxation and gross deformity

19
Q

What are some treatments for rheumatoid arthritis?

A
  • Corticosteroids
  • DMARDs e.g. methotrexate
  • Biologics
  • Surgery e.g. anti-TNFa
20
Q

Describe what an elbow tendinopathy is

A

Inflammation and pain caused by chronic overuse (microscopic tears from ECRB)

21
Q

How does a lateral elbow tendinopathy clinically present and who are most likely to develop this?

A
  • Pain at lateral epicondyle (common extensor origin) = during extension of wrist, especially with resistance
  • Tennis player, painters, plumbers, carpenters
22
Q

How does a medial elbow tendinopathy/golfer’s elbow clinically present and who are most likely to develop this?

A
  • Pain in medial epicondyle (common flexor origin)

- Bowlers, Archers and weightlifters

23
Q

How are elbow tendinopathies treated?

A
  • Activity modification
  • Physiotherapy and bracing
  • Surgery
24
Q

What are the three most common causes of swellings around the elbow?

A
  • Olecranon bursitis
  • Rheumatoid nodules
  • Gouty trophi
25
Q

Describe what an olecranon bursitis (student elbow) is and where its from

A
  • Inflammation of the olecranon bursa from repeated minor trauma (e.g. students leaning on their elbows)
  • Transilluminates
26
Q

How does olecranon bursitis clinically present?

A
  • Cosmetic concern

- Soft and cystic

27
Q

Treatment for an olecranon bursitis

A
  • Compression bandaging
  • Aspiration +Injection (if infected)
  • Surgical drainage
28
Q

What are rheumatoid nodules?

A

Most common extra-articular manifestation of rheumatoid arthritis
-usually occur over exposed regions subject to repeated minor trauma e.g. elbows, fingers and forearms

29
Q

How are rheumatoid nodules treated?

A

Treat/better management of rheumatoid arthritis

30
Q

Describe what gouty tophi is

A

-Nodular masses of monosodium urate crystals deposited in soft tissues

31
Q

What are some complications of gouty tophi?

A
  • Pain
  • Sodt tissue damage
  • Deformity
  • Joint destruction
  • Nerve compression
32
Q

Where can gouty tophi occur?

A
  • Fingers and ears (common)
  • Olecranon bursa
  • Subcutaneous tissues of the elbow
33
Q

What is cubital tunnel syndrome?

A

Ulnar nerve compression in the cubital tunnel

34
Q

How does cubital tunnel syndrome present?

A

Paraesthesia/ numbness/ weakness:

  • Ulnar 1 1/2 digits
  • Ulnar aspect of the palm and dorsum
  • hypersensitive ‘funny bone’
35
Q

How is cubital tunnel syndrome treated?

A
  • Splintage

- Surgical decompression

MSK UPPER LIMBS (S8) (6 decks)

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