Elbow Conditions

Question 1

Describe the cause and presentation of supracondylar fracture of distal humerus

Answer 1

• Falling on outstretched hand with elbow hyperextended
• Pain, marked swelling, bruising, no function
  Commonly damages median nerve causing hand of benediction

Question 2

What structures are commonly damaged in supracondylar fracture

Answer 2

• Commonly damages median nerve causing hand of benediction
• Can damage brachial artery - perform neurovascular check
  
  • Neurovascular check - capillary return, warm hand, ‘ok’ sign
    
    • If neurovascular damage suspected, emergency reduction and fixation of fracture needed to prevent ischaemia of muscles

Question 3

Describe the cause and presentation of dislocated elbow

Answer 3

• Falling on outstretched hand with elbow partially flexed
  
  • Configuration of bones only provides strong stability during full flexion or extension, thus stability during partial flexion relies only on ligaments
• Pain, deformity, loss of function
• Damaged capsule and ligaments to certain degree
• 90% or elbow dislocations are posterior

Question 4

Describe subluxation/pulled elbow and presentation

Answer 4

• Subluxation of radial head
• Presents with reduced movement of the elbow and pain over the lateral aspect of the forearm
  
  • Child ‘not using’ arm
• Commonly due to longitudinal traction is applied to the arm with forearm pronated (tugging child, or swinging child)
  - Annular ligament which encircles radial head may sublux

Question 5

Describe the cause and presentation of radial head and neck fractures

Answer 5

• Falling on outstretched hand where the radial head impacts on the capitulum
• Presents with pain in the lateral aspect of their proximal forearm and loss of range of movement

Question 6

Describe the x-ray of radial head and neck fractures

Answer 6

• Fracture often difficult to see on x-ray (red arrow)
• Fat pad sign - collection of fluid within synovial joint
• Indirect sign of fracture (yellow arrow)

Question 7

Describe osteoarthritis of the elbow and and its cause and presentation

Answer 7

• Rarer osteoarthritis compared with other joints due to well-matched joint surfaces and strong stabilising ligaments
• More common in manual workers or athletes who engage in sports involving throwing
• Patients report crepitus or locking in their elbow

Question 8

What are x-ray features of rheumatoid arthritis

Answer 8

• Joint space narrowing
• Periarticular osteopenia (measuring shaft to bone mineral density)
• Juxta-articular bony erosions
• Subluxation and gross deformity

Question 9

Describe tennis elbow and its presentation

Answer 9

• Degenerative tendinopathy of the common extensor tendon at the lateral epicondyle
• Commonest cause of elbow pain - (manual workers, sports - repetitive activity)
• Pain over the lateral epicondyle during extension of the wrist

Question 10

Describe golfer’s elbow and its presentation

Answer 10

• Degenerative tendinopathy of the common flexor origin at the medial epicondyle
• Presents with aching pain over medial elbow
• Often enhanced on resisted flexion or pronation of the wrist

Question 11

Describe student’s elbow and its presentation

Answer 11

• Olecranon bursitis
• Inflammation of olecranon bursa due to repeated minor trauma
• Soft, cystic, transilluminates - lights up when light shone behind
• Can become infected and inflamed

Question 12

Describe the presentation of rheumatoid nodules

Answer 12

Firm (non-tender) swellings seen in elbows, fingers and forearms

Question 13

Describe gouty trophi

Answer 13

• Disorder of nucleic acid metabolism leading to hyperuricaemia
• Urate crystal deposition in soft tissues
• Soft tissues - ear, elbow, achilles tendon

Question 14

Describe cubital tunnel syndrome and its presentation

Answer 14

• Cubital tunnel between the two heads of flexor carpi ulnaris and contains the ulnar nerve
  
  • Located next to the medial epicondyle
• Minor trauma can result in sharp transient pain or numbness radiating down the cutaneous ulnar nerve region
• Compression of the ulnar nerve in the cubital tunnel results in paraesthesia in the cutaneous ulnar nerve region and possible ulnar nerve muscle weakness
  - Treatment involves decompression of ulnar nerve

Question 15

Describe common conditions of the elbow

Answer 15

• Supracondylar fracture of distal humerus
• Dislocated elbow
• Subluxation of elbow
• Radial head/neck fractures
• Osteoarthritis of elbow
• Rheumatoid arthritis
• Tennis elbow
• Golfer’s elbow
• Student’s elbow
• Rheumatoid nodules
• Gouty trophi
• Cubital tunnel syndrome