ELBOW Flashcards
What are supracondylar fractures and how do they arise?
Common in kids; rare in adults
Cause: FOOSH with elbow in extension
How do supracondylar fractures present?
What is present on examintion?
What should you be sure to examine?
Presentation: sudden-onset severe pain and reluctance to move the affected arm
Examination: signs of gross deformity, swelling, limited range of elbow movement, and ecchymosis of the anterior cubital fossa
Be sure to examine:
- median nerve, radial nerve, and the ulnar nerve
- Check the hand for features of vascular compromise, such as a cool temperature, pallor, delayed capillary refill time, or absent pulses
What signs are visible on supra condylar fractueres?
- Ix: X-rays – AP and lateral elbow view
- Posterior fat pad sign - lucency visible on the lateral view -
- Displacement of the anterior humeral line
How are supracondylar fractures managed?
- +Associated neurovascular compromise/ displaced: immediate closed reduction secured with K wire fixation
- Non displaced fracture: place the arm in a 90 degree flexion cast
- Kids: cast
How does olecranon bursitis present?
- Prsentation: pain and swelling over the olecranon
- As the joint capsule is not involved, range of motion is preserved, with minimal discomfort
How is olecrannon bursisits ixd?
How is it managed?
FBC and CRP. ? rheumatological causes may warrant further specialised tests; serum urate levels (gout), joint aspiration + MSU
Mx:
- analgesia (ideally NSAIDs) and rest, splinting of the elbow
- Patients can undergo a washout in theatre
- Infection may need antibiotic or surgical drainage
- Most cases will resolve spontaneously
What is lateral epicondylitis?
What causes it?
- Chronic symptomatic inflammation of the forearm tendons at the elbow. Overuse syndrome caused by microtears in tendons following repetitive injury
- Cause: occupation and hobbies
What muscles nerves are affected in each type of epicondylitis?
- Lateral epicondylitis – tennis – extensor – radial N – MORE COMMON
- Medial epicondylitis – Golfer – Flexors – Median N
how does lateral epicondylitis present?
- Sx:
- Pain on elbow which radiates down the forearm which worsened over week to months – typically affects dominant arm
- Examination: local tenderness on palpation over (or distal to) the lateral epicondyle and common extensor tendon.
- Possible reduced grip strength 2o to pain and full ROM
How is lateral epicondylitis investigated and managed?
Special tests:
- Cozen
- Mills
- Ix: clinical, USS MRI
- Mx: Conservative: reduce repetitive actions and modify activity
- 1st: Topical NSAIDs.
- 2nd: corticosteroid injections 3-6 months. Physio
- Surgery: if sx not controlled: open or arthroscopic debridement of tendinosis +/- release and repaid of damaged tendon
- 1st: Topical NSAIDs.
How does a radial head fracture present?
- Tenderness on palpation over the lateral aspect of elbow and radial head,
- Pain and crepitation on supination and pronation.
- Other: elbow effusion or limited supination and pronation movements.
How are radial head fractures Ixd and Mxd?
Ix: routine bloods: clotting + G+S
X ray: Plain AP and lateral – sail sign – elevation of anterior fat pad
Mx: analgesia, assess NV compromise
- Mason 1 – non operative mx – immobilise with sling for <1 week + early mobilisation
- Mechanical block: ORIF
How do elbow dislocations arise?
How do they present?
- Following high energy fall
- Pain, deformity, swelling, reduced function.
- Complete neurovascular examination required - ulnar nerve susceptible to damage
How are elbow dislocations investigated?
- Plain radiographs: AP and lateral. Radio-capitellar and ulnotrochlea congruence
