Disorders of the elbow Flashcards
Lateral Elbow Tendinopathy more commonly known as
‘Tennis elbow’, is tendinopathy of the common extensor tendon at the lateral epicondyle (particularly the tendon of extensor carpi radialis brevis).
tennis elbow is common in
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.
presentation of tennis elbow
This condition presents with pain over the lateral epicondyle during extension of the wrist.
management of lateral elbow tendinopathy
Medial elbow tendinopathy more commonly known as
‘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.
presentation of golfers elbow
This condition presents with pain over the medial epicondyle during resisted flexion or pronation of the wrist, as well as ulnar nerve symptoms.
prognosis of Medial elbow tendinopathy
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.
Elbow Dislocation
Dislocated elbows are divided into two categories:
Posterior
Anterior
posterior elbow dislocation
This type of dislocation is where the trochlear notch of the ulnar is posterior to the humerus. 90% of elbow dislocations are posterior dislocations
cause of posterior elbow dislocation
usually caused by a fall onto an outstretched hand with a partially flexed elbow. This is the most common dislocation seen in children.
presentation of posterior elbow dislocation
It presents with a popping sensation on immediate injury, pain, swelling and the olecranon may be prominent.
complication of posterior elbow dislocation
Complications can include tearing of the ulnar collateral ligament and damage to the ulnar nerve.
Anterior elbow dislocsation
This type of dislocation is where the trochlear notch is anterior to the humerus.10% of elbow dislocations are anterior dislocations
cause of anterior elbow dislocation
usually caused by a direct blow to the posterior elbow when it is flexed.
presentation of anterior elbow dislocation
It presents with a popping sensation on immediate injury, pain and swelling.
complication of anterior elbow dislocation
A common complication of an anterior elbow dislocation is an olecranon fracture.
Treatment of anterior elbow dislocationinvolves
reduction, followed by a splint or a sling, and then a range of exercises for 4-6 weeks to prevent stiffness.
Pulled Elbow also known as
‘Nursemaid’s elbow’, is an incomplete dislocation where there is subluxation of the radial head.
pulled elbow most commonly affects
It most commonly affects 2-5 year olds following a fall whilst holding an adult’s hand.
cause of pulled elbow
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).
presentation of a pulled elbow
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.
treatment of pulled elbow
Treatment for a pulled elbow is reduction, and most children will start using their arm normally again after around 20 minutes.
Radial Head and Neck Fractures
Radial head and neck fractures are the most common elbow fractures in adults.
presentation of radial head and neck fractures
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.
management of radial head and neck fracture
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.
Olecranon Bursitis
Olecranon bursitis, also known as ‘Student’s elbow’, is inflammation of the olecranon bursa.
cause of olecranon bursitis
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.
Treatment of olecranon bursitis
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.
Cubital Tunnel Syndrome
Cubital tunnel syndrome is the compression of the ulnar nerve by the tendinous arch between the two heads of flexor carpi ulnaris.
cubital tunnel syndrome presents with
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.
treatment of cubital tunnel syndrome
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.
