Disorders of the elbow

Question 1

Lateral Elbow Tendinopathy more commonly known as

Answer 1

‘Tennis elbow’, is tendinopathy of the common extensor tendon at the lateral epicondyle (particularly the tendon of extensor carpi radialis brevis).

Question 2

tennis elbow is common in

Answer 2

It is common in people aged 40-60 years, especially tennis players (back hand- out laterally), plumbers and carpenters. It can be remembered that lateral elbow tendinopathy is ‘tennis elbow’ because they both have ‘t’s in.

Question 3

presentation of tennis elbow

Answer 3

This condition presents with pain over the lateral epicondyle during extension of the wrist.

Question 4

management of lateral elbow tendinopathy

Question 5

Medial elbow tendinopathy more commonly known as

Answer 5

‘Golfer’s elbow’, is tendinopathy of the common flexor origin at the medial epicondyle (most commonly between the origin of pronator teres and flexor carpi radialis). It is less common than lateral elbow tendinopathy, but usually occurs in golfers and those who play throwing sports as they place valgus stress on the elbow.

Question 6

presentation of golfers elbow

Answer 6

This condition presents with pain over the medial epicondyle during resisted flexion or pronation of the wrist, as well as ulnar nerve symptoms.

Question 7

prognosis of Medial elbow tendinopathy

Answer 7

self-limiting condition, so it usually resolves without treatment if the arm is rested. Oral painkillers, topical NSAIDS and ice can be used to relief pain during this time.

Question 8

Elbow Dislocation

Dislocated elbows are divided into two categories:

Answer 8

Posterior

Anterior

Question 9

posterior elbow dislocation

Answer 9

This type of dislocation is where the trochlear notch of the ulnar is posterior to the humerus. 90% of elbow dislocations are posterior dislocations

Question 10

cause of posterior elbow dislocation

Answer 10

usually caused by a fall onto an outstretched hand with a partially flexed elbow. This is the most common dislocation seen in children.

Question 11

presentation of posterior elbow dislocation

Answer 11

It presents with a popping sensation on immediate injury, pain, swelling and the olecranon may be prominent.

Question 12

complication of posterior elbow dislocation

Answer 12

Complications can include tearing of the ulnar collateral ligament and damage to the ulnar nerve.

Question 13

Anterior elbow dislocsation

Answer 13

This type of dislocation is where the trochlear notch is anterior to the humerus.10% of elbow dislocations are anterior dislocations

Question 14

cause of anterior elbow dislocation

Answer 14

usually caused by a direct blow to the posterior elbow when it is flexed.

Question 15

presentation of anterior elbow dislocation

Answer 15

It presents with a popping sensation on immediate injury, pain and swelling.

Question 16

complication of anterior elbow dislocation

Answer 16

A common complication of an anterior elbow dislocation is an olecranon fracture.

Question 17

Treatment of anterior elbow dislocationinvolves

Answer 17

reduction, followed by a splint or a sling, and then a range of exercises for 4-6 weeks to prevent stiffness.

Question 18

Pulled Elbow also known as

Answer 18

‘Nursemaid’s elbow’, is an incomplete dislocation where there is subluxation of the radial head.

Question 19

pulled elbow most commonly affects

Answer 19

It most commonly affects 2-5 year olds following a fall whilst holding an adult’s hand.

Question 20

cause of pulled elbow

Answer 20

Pulled elbows are often caused by longitudinal traction being applied to the arm when the forearm is pronated, and this is why it commonly affects young children.
It is important to note, however, that this may be a presentation of a non-accidental injury, especially if it occurs in a child that is less than one (because they are generally not able to walk).

Question 21

presentation of a pulled elbow

Answer 21

This condition presents with pain over the lateral aspect of the proximal forearm and reduced movement of the elbow. Associated annular ligament tears are common.

Question 22

treatment of pulled elbow

Answer 22

Treatment for a pulled elbow is reduction, and most children will start using their arm normally again after around 20 minutes.

Question 23

Radial Head and Neck Fractures

Answer 23

Radial head and neck fractures are the most common elbow fractures in adults.

Question 24

presentation of radial head and neck fractures

Answer 24

They present with pain in the lateral aspect of the forearm and reduced movement of the elbow. There is usually modest swelling, however, a ‘fat pad sign’/‘sail sign’ on an X-Ray indicates an effusion is present.

Question 25

management of radial head and neck fracture

Answer 25

Non-displaced fractures can be treated with a sling or splint followed by motion exercises. Displaced fracture treatment is dependent on the extent of displacement and the size of the fragments, but surgery may be involved to realign the fragments.

Question 27

Olecranon Bursitis

Answer 27

Olecranon bursitis, also known as ‘Student’s elbow’, is inflammation of the olecranon bursa.

Question 28

cause of olecranon bursitis

Answer 28

It is often due to repeated micro-trauma such as leaning on the elbow whilst studying. The swelling is usually soft, filled with serous fluid and transilluminates (unless it is septic bursitis).

Treatment involves avoiding direct pressure on the olecranon bursa or wearing a pad to cushion the bursa, as well as taking NSAIDS such as ibuprofen to reduce pain and swelling. It is however often only a cosmetic abnormality and causes no pain. If septic bursitis is present, antibiotics need to be given, possibly with an aspiration of the fluid.

Question 29

Treatment of olecranon bursitis

Answer 29

involves avoiding direct pressure on the olecranon bursa or wearing a pad to cushion the bursa, as well as taking NSAIDS such as ibuprofen to reduce pain and swelling. It is however often only a cosmetic abnormality and causes no pain. If septic bursitis is present, antibiotics need to be given, possibly with an aspiration of the fluid.

Question 30

Cubital Tunnel Syndrome

Answer 30

Cubital tunnel syndrome is the compression of the ulnar nerve by the tendinous arch between the two heads of flexor carpi ulnaris.

Question 31

cubital tunnel syndrome presents with

Answer 31

It presents with:

• Paraesthesia of the medial hand.
• Reduced abduction, flexion and opposition of the 5th digit.
• Reduced adduction of the 1st digit.
• Reduced abduction and adduction of metacarpophalangeal joints of digits 2-5.
• Reduced flexion and adduction of the wrist.

Question 32

treatment of cubital tunnel syndrome

Answer 32

Treatment involves avoiding pressure on the nerve as this increases symptoms, but in some cases surgery may be required to relieve the pressure on the nerve.