Disorders of the elbow Flashcards
What is the common mechanism for a supracondylar fracture of distal humerus?
FOOSH (fall onto outstretched hand) e.g. child falling off monkey bars
What are the common clinical presentation of a supracondylar fracture of distal humerus and what is the usual age?
- Pain
- Swelling
- Bruising
- Loss of function
- 10 years and below
What are the three main complications of a supracondylar fracture?
- 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
What is a Volkmann’s ischaemic contracture and how does it come about?
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
What is the common mechanism for an elbow dislocation?
-FOOSH (fall onto outstretched hand) with mid-flexion
Which elbow dislocation is more common?
Posterior (ulnar ligament is usually torn as well)
-may have associated fractures and ulnar nerve damage
Which elbow dislocation is least common?
Anterior dislocation (with associated olecranon fracture)
Describe what a pulled elbow/nursemaids elbow is
Subluxation (an incomplete dislocation) of the radial head
What is the common mechanism for a pulled elbow/nursemaids elbow and at what age does it usually occur?
Longitudinal traction when the forearm is pronated (e.g. tugging an uncooperative child or swinging them)
-usually at 2-5 years old
Why is a pulled elbow/handmaids elbow more common in pronation?
Annular ligament is taut in supination and more relaxed in pronation = easier for subluxation
-radial head displaced distally through torn ligament
How does a pulled elbow clinically present?
- Reduced movement of the elbow
- Pain over lateral proximal forearm
- Patient describes “not using their forearm”
What is the common mechanism for a radial head and neck fractures?
FOOSH (fall onto outstretched hand)
How does a radial head or neck fracture clinically present?
- Pain in lateral aspect of their proximal forearm
- Loss of range of movement
- Swelling
- Sail sign (displacemnt of the anterior fat pad)
Describe elbow osteoarthritis
Degenerative disease of articular cartilage from wear and tear
-Commonly seen in men than women (4:1), manual workers and athelets
How does elbow osteoarthritis clinically present?
- Grating sensation (crepitus)
- Locking in their elbow
- Swelling from effusion
- Paraesthesia and muscle weakness from osteophyte impingement
- Stiffness (tolerated)
Describe what rheumatoid arthritis is and a brief pathology
- Autoimmune disease
- Autoantibodies attack synovial membrane
- Inflamed synovial cells proliferate to form a pannus
- Penetration through cartilage and bone causing erosion and deformity
What are the systemic symptoms of rheumatoid arthritis?
- Fatigue
- Low grade fever
- Weight loss
- Anaemia of chronic disease
What are the radiological features of rheumatoid arthritis?
-Joint space narrowing
-Periarticular osteopenia
Juxta-articular bony erosions
-Subluxation and gross deformity
What are some treatments for rheumatoid arthritis?
- Corticosteroids
- DMARDs e.g. methotrexate
- Biologics
- Surgery e.g. anti-TNFa
Describe what an elbow tendinopathy is
Inflammation and pain caused by chronic overuse (microscopic tears from ECRB)
How does a lateral elbow tendinopathy clinically present and who are most likely to develop this?
- Pain at lateral epicondyle (common extensor origin) = during extension of wrist, especially with resistance
- Tennis player, painters, plumbers, carpenters
How does a medial elbow tendinopathy/golfer’s elbow clinically present and who are most likely to develop this?
- Pain in medial epicondyle (common flexor origin)
- Bowlers, Archers and weightlifters
How are elbow tendinopathies treated?
- Activity modification
- Physiotherapy and bracing
- Surgery
What are the three most common causes of swellings around the elbow?
- Olecranon bursitis
- Rheumatoid nodules
- Gouty trophi
Describe what an olecranon bursitis (student elbow) is and where its from
- Inflammation of the olecranon bursa from repeated minor trauma (e.g. students leaning on their elbows)
- Transilluminates
How does olecranon bursitis clinically present?
- Cosmetic concern
- Soft and cystic
Treatment for an olecranon bursitis
- Compression bandaging
- Aspiration +Injection (if infected)
- Surgical drainage
What are rheumatoid nodules?
Most common extra-articular manifestation of rheumatoid arthritis
-usually occur over exposed regions subject to repeated minor trauma e.g. elbows, fingers and forearms
How are rheumatoid nodules treated?
Treat/better management of rheumatoid arthritis
Describe what gouty tophi is
-Nodular masses of monosodium urate crystals deposited in soft tissues
What are some complications of gouty tophi?
- Pain
- Sodt tissue damage
- Deformity
- Joint destruction
- Nerve compression
Where can gouty tophi occur?
- Fingers and ears (common)
- Olecranon bursa
- Subcutaneous tissues of the elbow
What is cubital tunnel syndrome?
Ulnar nerve compression in the cubital tunnel
How does cubital tunnel syndrome present?
Paraesthesia/ numbness/ weakness:
- Ulnar 1 1/2 digits
- Ulnar aspect of the palm and dorsum
- hypersensitive ‘funny bone’
How is cubital tunnel syndrome treated?
- Splintage
- Surgical decompression
