Elbow Flashcards
Suparcondylar fracture of the dsital humerus mechaism
falling form height onto outstreached arm with elbow hyperextended
most common age people get supracondylar fractures
children
what is a less common mechaism of obtaining a supracondylar fracture of the distal hymerus
falling onto a flexed elbow - seen in elderly
in supracondylar fractures the distal fragment is usually displaced anteriorly or posteriorly
Posteriorly
3 main complications with supracondylar fracture
Malunion
Nerve Damage
Volkmann’s ischaemic contracure
malunion of the distal humerus results in
Cubitus Varus - gunstick defomity
Which nerves can be damnaged in a supracondylar fracture
Median nerve is most common, radial nerve and ulnar nerve
Volksmann’s ischamic contracture
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
Volksmann’s ischamic contracture the fingers are extended at what joint
metacarpophlngeal joint
treatment is volksmann’s ischamia
emeregency reduction and fixation of the fracture
Mechaism of elbow dislocation
fall on outstretched arm slightly flexed
why id elbow dsilaction more likely to occur mis flexion and extention
as stablilty of the elbow is more reliant on ligament during this period
90% of elbow dislocation’s are ..
remember elbow disolactions are named as the distal fragment e.g the radius and the ulnar
posterior
i.e the distl end of the humerus is driven through the joint capsule anteriorly
common ligament to tear in elbow dislocation
ulnar collateral ligament
Anterior dislocation’s (10%) mechanism
direct blow to the posterior aspect of a flexed elbow
associated fractures scenes with anterior dislocation and why?
Fracture of the olecranon
due to the degree of force required to dislocate the joint
Pulled elbow (nursemaids elbow)
Subluxation of the radial head
subluxation = partical disruption of a joint with some remaining but abnormal apposition of the articular surface
Children aged 2-5 present with pulled elbow how do they present
reduced movement of elbow
pain over the lateral aspect of proximal forearm
common mechanism of pulled elbow
longitudinal traction is applied to the arm with forearm pronated
(tugging an uncoopertive child or swinging a child by their arms during play)
why does pulled elbow occur in pronation
annular ligament is relaxed in pronation - easier for sublaxion to occur
pulled elbow how it occures
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
radial head and neck fractures mechaniim of injury
fall on a outstrahced hand when the raidal head impacts the capitellum of the humerus
radial head and neck fracture how paients present
pain in lateral aspect of their proximal forearm
loss of range of movement
radial head and neck fractures on X-ray
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
Osteoarthrits of the elbow how common is it
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
who presents more with osteoarthirsis of the shoulder
men: women 4:1
manual workers athlets who throw things in sports
what does patents report with OA of the elbow
grating sensation
locking
swelling occurs later due to effusion
ostephytes can impinge ulnar nerve causing paraetheis and muscle weakness
Rheumatoid Arthritis basics
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
X-ray features of rheumatoid arthritus
joint space narrowing
sofe tissue sweeling
marginal boney erosions
sublaxation and gross deformity
How to manage Rheumatoid Arthritis
managed medically rather than surgically
Lateral elbow tendinopathy is AKA
tennis elbow
Lateral elbow tendinopathy
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
Lateral elbow tendinopathy patients present with
pain over the lateral epicondyle during extension of the writst
Medial elbow tendinopathy AKA
golfers elbow
Meical elbow tendinopathy effects
common flexor origin at the medial epicondyle
Medial elbow tendinopathy muscles effects
interface between the protantor teres and the flexor carpi radialis origins
How patients present with medial elbow tendinopathy
aching pain over the medial elbow
psin produced on resisted flexion or pronation of the wrist
3 common causes of swelling around the elbow
> olecranon bursitis
rheumatoid nodules
gouty tophi
olecranon bursitis AKA
students bursitis
olecranon bursi is located where
between the skin and the olecranon process of the ulna
Treatment of olecranono bursitis
treaemtn is conservative with compression bandaging with or without aspiration.
how would you treat chronic olecranono bursitis
hydrocortisone injection
how to treat septic bursitis
asprition, compression and antibiotics are required
rheumatoid nodules
seen in 20% of rheumatoid arthritis a
usually non tender although the overlying skin can occasionally ulcerate and become infected
What is Gout
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
How to treat gout
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
gout Trophi
nodular masses of monosodium urate crytals deposited in the soft tissue
late complication of hyperuricaemia
complactions of gout
pain, soft tissue damange and deformity, joint destruction and nerve compression
most common sites of gout trophi
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
Cubital tunnel syndrome which nerve does it effect
the ulnar nerve passes behind the medial epicondyle of the humerus to enter the forearm. lies in cubital tunnel
cuital tunnel sydrome borders
ulnar nerve passes beneath this tendinous arch to entre the cubital tunnel. forms a common site for ulnar nerve compression
What does the tendionous arch join
the two heads of the flexor carpi ulnaris muscle
where do the two heads of the flexor carpi ulnarisi muscle originate from
common flxor origin on the medial epicondyle
second medial margin of the olecranon
what is hitting your funny bone
minor trauma to the ulnar nerve in the cubital tunnel, shape transient pain radiating from the elbow to the cutaneous ulnar nerve territory.
compression of the ulnar nerve in cubital tunnel may result in
paraesthesia in cutaneous territories of the ulnar nerve
weakness in muscle supplied by the ulnar nerve
treatment is to decompress the nerve
