Elbow

Question 1

Suparcondylar fracture of the dsital humerus mechaism

Answer 1

falling form height onto outstreached arm with elbow hyperextended

Question 2

most common age people get supracondylar fractures

Answer 2

children

Question 3

what is a less common mechaism of obtaining a supracondylar fracture of the distal hymerus

Answer 3

falling onto a flexed elbow - seen in elderly

Question 4

in supracondylar fractures the distal fragment is usually displaced anteriorly or posteriorly

Answer 4

Posteriorly

Question 5

3 main complications with supracondylar fracture

Answer 5

Malunion
Nerve Damage
Volkmann’s ischaemic contracure

Question 6

malunion of the distal humerus results in

Answer 6

Cubitus Varus - gunstick defomity

Question 7

Which nerves can be damnaged in a supracondylar fracture

Answer 7

Median nerve is most common, radial nerve and ulnar nerve

Question 8

Volksmann’s ischamic contracture

Answer 8

Brachial artery damanged
ischemia of muscles in anterior compartment of forearm
odema
increase in compartment pressure (conpartment syndrome) - making ischemia worse
during repair dead muscle replaced by scar tissue through fibrosis
sibrotic tissue contracts - resulting in flexion contracture

Question 9

Volksmann’s ischamic contracture the fingers are extended at what joint

Answer 9

metacarpophlngeal joint

Question 10

treatment is volksmann’s ischamia

Answer 10

emeregency reduction and fixation of the fracture

Question 11

Mechaism of elbow dislocation

Answer 11

fall on outstretched arm slightly flexed

Question 12

why id elbow dsilaction more likely to occur mis flexion and extention

Answer 12

as stablilty of the elbow is more reliant on ligament during this period

Question 13

90% of elbow dislocation’s are ..

remember elbow disolactions are named as the distal fragment e.g the radius and the ulnar

Answer 13

posterior

i.e the distl end of the humerus is driven through the joint capsule anteriorly

Question 14

common ligament to tear in elbow dislocation

Answer 14

ulnar collateral ligament

Question 15

Anterior dislocation’s (10%) mechanism

Answer 15

direct blow to the posterior aspect of a flexed elbow

Question 16

associated fractures scenes with anterior dislocation and why?

Answer 16

Fracture of the olecranon

due to the degree of force required to dislocate the joint

Question 17

Pulled elbow (nursemaids elbow)

Answer 17

Subluxation of the radial head

subluxation = partical disruption of a joint with some remaining but abnormal apposition of the articular surface

Question 18

Children aged 2-5 present with pulled elbow how do they present

Answer 18

reduced movement of elbow

pain over the lateral aspect of proximal forearm

Question 19

common mechanism of pulled elbow

Answer 19

longitudinal traction is applied to the arm with forearm pronated
(tugging an uncoopertive child or swinging a child by their arms during play)

Question 20

why does pulled elbow occur in pronation

Answer 20

annular ligament is relaxed in pronation - easier for sublaxion to occur

Question 21

pulled elbow how it occures

Answer 21

longitudinal traction on the radial head tears the distal attachment of annular ligament from radius.
radial head is then displaced dsially through the torn ligament

Question 22

radial head and neck fractures mechaniim of injury

Answer 22

fall on a outstrahced hand when the raidal head impacts the capitellum of the humerus

Question 23

radial head and neck fracture how paients present

Answer 23

pain in lateral aspect of their proximal forearm

loss of range of movement

Question 24

radial head and neck fractures on X-ray

Answer 24

difficult of see, however a fat pad sign indicates and effusion is present.
sail sign - caused by the displacement of the anterior fat pad is radio-lucent and therefore appears black on the X-ray

Question 25

Osteoarthrits of the elbow how common is it

Answer 25

uncommon because of the well-matched joint surface and strong stabilising ligaments. elbow can tolerate large forces without becoming unstable so less wear and tear with age

Question 26

who presents more with osteoarthirsis of the shoulder

Answer 26

men: women 4:1 | manual workers athlets who throw things in sports

Question 27

what does patents report with OA of the elbow

Answer 27

grating sensation locking swelling occurs later due to effusion ostephytes can impinge ulnar nerve causing paraetheis and muscle weakness

Question 28

Rheumatoid Arthritis basics

Answer 28

autoimmune disease in which autoantibodies known as rheumatoid factor, attack the synovial membrane, leading to inflammation which penetrates through the artilage and adjacent bone, leading to joint erosion and deformity

Question 29

X-ray features of rheumatoid arthritus

Answer 29

joint space narrowing sofe tissue sweeling marginal boney erosions sublaxation and gross deformity

Question 30

How to manage Rheumatoid Arthritis

Answer 30

managed medically rather than surgically

Question 31

Lateral elbow tendinopathy is AKA

Answer 31

tennis elbow

Question 32

Lateral elbow tendinopathy

Answer 32

pain due to tendionpathy of the common extensor tendon at the lateral epicondyle (common extensor origin) Extensor carpi radialis brevis muscle - helps stabilise wrist when elbow is stright

Question 33

Lateral elbow tendinopathy patients present with

Answer 33

pain over the lateral epicondyle during extension of the writst

Question 34

Medial elbow tendinopathy AKA

Answer 34

golfers elbow

Question 35

Meical elbow tendinopathy effects

Answer 35

common flexor origin at the medial epicondyle

Question 36

Medial elbow tendinopathy muscles effects

Answer 36

interface between the protantor teres and the flexor carpi radialis origins

Question 37

How patients present with medial elbow tendinopathy

Answer 37

aching pain over the medial elbow | psin produced on resisted flexion or pronation of the wrist

Question 38

3 common causes of swelling around the elbow

Answer 38

>olecranon bursitis >rheumatoid nodules >gouty tophi

Question 39

olecranon bursitis AKA

Answer 39

students bursitis

Question 40

olecranon bursi is located where

Answer 40

between the skin and the olecranon process of the ulna

Question 41

Treatment of olecranono bursitis

Answer 41

treaemtn is conservative with compression bandaging with or without aspiration.

Question 42

how would you treat chronic olecranono bursitis

Answer 42

hydrocortisone injection

Question 43

how to treat septic bursitis

Answer 43

asprition, compression and antibiotics are required

Question 44

rheumatoid nodules

Answer 44

seen in 20% of rheumatoid arthritis a | usually non tender although the overlying skin can occasionally ulcerate and become infected

Question 45

What is Gout

Answer 45

gout is an inflammatory condition resulting from defective purine metabolism leading to an increased producion of uric acid. As the uric acid concentrstion increases in the blood, supersaturation and precipitation occures, forming crystals on monosodium urrate in the synovial cavity of joints, in tendons and in the surrounding tissues

Question 46

How to treat gout

Answer 46

anti-inflammatories for acute phase Xanthine oxidase inhibitors such as allopurionol (purine analogue) can then be prescribed to reduce the production of uric acid and reduce the rick of further attacks

Question 47

gout Trophi

Answer 47

nodular masses of monosodium urate crytals deposited in the soft tissue late complication of hyperuricaemia

Question 48

complactions of gout

Answer 48

pain, soft tissue damange and deformity, joint destruction and nerve compression

Question 49

most common sites of gout trophi

Answer 49

fingers and ears trohi can be found fin olecranon bursa and the cubcutaneous tissues of the elbow where they can resemble rheumatoid nodules in appearance. they work there way towards the skin surface to drain, either forming a sinus tract or a continuously draining ulcer

Question 50

Cubital tunnel syndrome which nerve does it effect

Answer 50

the ulnar nerve passes behind the medial epicondyle of the humerus to enter the forearm. lies in cubital tunnel

Question 51

cuital tunnel sydrome borders

Answer 51

ulnar nerve passes beneath this tendinous arch to entre the cubital tunnel. forms a common site for ulnar nerve compression

Question 52

What does the tendionous arch join

Answer 52

the two heads of the flexor carpi ulnaris muscle

Question 53

where do the two heads of the flexor carpi ulnarisi muscle originate from

Answer 53

common flxor origin on the medial epicondyle | second medial margin of the olecranon

Question 54

what is hitting your funny bone

Answer 54

minor trauma to the ulnar nerve in the cubital tunnel, shape transient pain radiating from the elbow to the cutaneous ulnar nerve territory.

Question 55

compression of the ulnar nerve in cubital tunnel may result in

Answer 55

paraesthesia in cutaneous territories of the ulnar nerve weakness in muscle supplied by the ulnar nerve treatment is to decompress the nerve