Elbow and Arm Flashcards
in what age group are supracondylar fractures most common and what is the main mechanism of injury
most common in aged 5-7 yrs.
most common paediatric injury and are almost never seen in adults
main mechanism is FOOSH with elbow in extension
supracondylar fractures are associated with a high risk of neurovascular injury, what nerves are essential to examine post fracture
median nerve
anterior interosseous nerve (deep motor branch of the median nerve)
radial nerve
ulnar nerve
what is the sensory and motor distribution of the median nerve
sensory = skin over the anterolateral surface of the hand (thumb and first 2 and a half digits)
motor = thumb flexion and opposition, wrist flexion, forearm pronation and flexion of digits 2 and 3
what is the sensory and motor distribution of the radial nerve
motor = arm, wrist and finger extension, forearm supination
sensory = most of the back of the hand
what is the sensory and motor distribution of the ulnar nerve
sensory = medial forearm, medial wrist and medial one and a half digits
motor = wrist flexion, finger adduction and abduction, flexion of digits 4 and 5
what are the 2 nerves of the hand
median nerve - supplies thumb and digits 2 and 3 (flexion and sensory)
ulnar nerve - supplies digits 4 and 5 (flexion and sensory)
Radial nerve (extension)
what are some signs of vascular compromise in the hand post supracondylar fracture
cool temp
delayed cap refill time
absent pulses
what is the classification system used in supracondylar fractures
Gartland classification system
what type of supracondylar fractures can be managed conservatively
type I and minimally displaced type II
management of supracondylar fractures with associated neurovascular compromise
immediate closed reduction
reduction then secured with K wires - which are removed in clinic after 4 weeks
what is a Volkmann’s contracture and how do they happen
occurs following vascular compromise with a supracondylar fracture
ischaemia and subsequent necrosis of the flexor muscles of the forearm - begin to fibrose and form a contracture
this results in the wrist and hand being held in permanent flexion as a claw-like deformity
what does the olecranon articulate with
trochlea of the humerus
what muscle inserts onto the olecranon
triceps brachii
where is the site of insertion for the triceps brachii muscle
olecranon
what main neurovascular function should you check that will indicate a olecranon fracture
extension of the elbow against gravity
disruption of the triceps mechanism
management of an olecranon fracture
conservative - for minimally displaced fractures, immobilise arm in 60-90 degrees elbow flexion and physio
surgical - for displaced fractures, tension band wiring or olecranon plating
what bony structure does the radial head articulate with to form the elbow joint
capitulum of the humerus
main mechanism of radial head fractures
FOOSH with arm in pronation
the radial head is pushed against the capitulum of the humerus
what is an Essex-Lopresti fracture
a fracture of the radial head with disruption of the distal radio-ulnar joint
will always require surgical intervention
what system is used to classify radial head fractures
classified according to degree of displacement and intra-articular involvement using the Mason classification system
Mason type 1 - non displaced
mason type 2 - partial articular fracture with minimal displacement
mason type 3 - comminuted fracture and displacement
management of radial head fractures
mason type 1 = short period of immobilisation in sling followed by early mobilisation
mason type 2 = if no mechanical block then treated as per type 1, if mechanical block is present then ORIF
mason type 3 = ORIF or radial head excision or replacement
when might a ‘sail sign’ be seen on lateral X-ray
radial head fracture
what is the most common type of elbow dislocation
90% are posterior dislocations
what muscles, tendons, ligaments stabilise the elbow joint
medial and collateral ligaments
common flexor and extensor origin tendons
anconeus, brachialis and triceps brachii
what is the most common nerve to be damaged in elbow fractures and dislocations
ulnar nerve
management of an elbow dislocation
closed reduction with sufficient analgesia
then apply an above elbow backslab to keep the elbow at 90 degrees (5-14 days)
early rehab
what is the terrible triad in elbow dislocations
refers to an elbow dislocation with (1) lateral collateral ligament injury (2) radial head fracture (3) coronoid fracture
results in a very unstable elbow
requires surgical fixation
mechanism of olecranon bursitis
due to repetitive flexion-extension movements at the elbow
less common non-infective causes can be gout and rheumatoid arthritis
how is the range of movement affected in olecranon bursitis
it isn’t
the joint capsule is not involved and as such the ROM remain intact
what is the blood test if you suspect gout
serum urate levels
what do you need to make a definitive diagnosis of olecranon bursitis
aspiration of fluid - then send off for microscopy and for culture and to assess for presence of crystals
management of infective olecranon bursitis
if systemic symptoms present then IV antibiotics
and surgical drainage
what is epicondylitis
chronic symptomatic inflammation of the forearm tendons at the elbow
overuse syndrome caused by microtears in the tendons attaching to the epicondyles of the elbow
what are the 2 common types of epicondylitis called
lateral epicondylitis - tennis elbow (more common)
medial epicondylitis - golfers elbow
what tendons attach to the lateral epicondyle of the elbow
common extensor tendon (common attachment for the superficial extensor muscles of the forearm)
pathophysiology of epicondylitis
repetitive overuse of the tendons can cause microtears in the tendon at their origin
the tendon adapts to the multiple tears, leading to the formation of granulation tissue, fibrosis and eventually tendinosis
specific test for lateral epicondylitis
Cozen’s test - patients elbow is held flexed at 90 degrees, with examiners one hand over the lateral epicondyle, whilst the other hand holds the patients forearm in a pronated position, the patient is then asked to flex their wrist against the resistance from the examiner
investigations into lateral epicondylitis
diagnosis is mainly clinical
but US and MRI can be used to aid diagnosis
management of epicondylitis
Conservative;
modify the activity that caused it in the first place
analgesia and NSAIDs and if symptoms persist then corticosteroid injections
physiotherapy
surgical;
open or athroscopic debridement of tendinosis
