Elbow Disorders Flashcards
What is most common mechanism of injury for a Supracondylar Fracture of the Distal Humerus?
What is a less common mechanim?
For each mechanism, state what patient groups they are more common in?
Falling onto outstretched hand with elbow hyperextended- More common in children< 10, especially boys
Falling onto a flexed elbow- More common in the elderly
Falling onto outstretched hand with elbow hyperextended can lead to Supracondylar Fracture of the Distal Humerus
What are 3 ways this presents in children
- Pain
- Loss of function
- Deformity
Falling onto a flexed elbow can lead to Supracondylar Fracture of the Distal Humerus
What are 3 possible complications
- Malunion-> Cubital Varus (Gunstock deformity)
- Damage to Median (most common), Radial or Ulnar nerve
- Ischaemic contracture (Brachial artery damaged-> Infarction-> Fibrosis-> Fibrous scar contracts
What is the usual cause of Elbow Dislocation
Why?
When a person (often a child) falls on their outstretched hand with elbow partially flexed
During mid-flexion of elbow, stability is reliant more on ligaments (than bone during full flexion/ extension)
What is the most common type of elbow dislocation
Identify 3 features
Posterior
- Posterior displacement of distal fragment (Radius and ulna)
- Torn ulnar collateral ligament
- Fracture and/or ulnar nerve involvement
What is the usual cause of an Anterior Elbow Dislocation?
State 1 feature of this type
Usually due to direct blow to posterior of flexed elbow
- Olecranon fractures (large forced needed for dislocation)
What is Pulled/ nursemaids Elbow?
Most commonly occurs in 2-5 year olds
What are 3 ways it presents in children?
Subluxation (Incomplete dislocation) of radial head
- Reduced elbow movement
- Pain over lateral aspect of proximal forearm
- Parent says “not using their arm”
What are the 3 mechanisms of injury that cause Pulled/ nursemaids Elbow?
- Longitudinal traction applied to arm when pronated
- Falls
- Over reaching for an object
Why is Pulled/ nursemaids Elbow more common during Pronation?
Describe how this happens
During pronation annular ligament is relaxed, so easier for subluxation of radial head to occur
Longitudinal traction on radial head, tears attachment of annular ligament to radial neck. Radial head is displaced distally
What are the commonest types of elbow fractures in adults?
What do they usually result from?
What are 2 ways elbow fractures present?
Radial head fractures
Radial neck fractures
Usually due to a fall on an outstretched hand, when radial head impacts the capitellum of humerus
- Reduced range of motion
- Pain in lateral proximal forearm
How do you see an elbow fracture on an X-ray?
What does this indicate?
Look for a Fat Pad/ Sail sign, which indicates an effusion
effusion could be due to haemarthrosis caused by intra-articular fracture
Why is Elbow Osteoarthritis uncommon
What are 3 patient groups who are more likely to get it
Uncommon because of;
- Well-matched joint surfaces
- Strong stabilising ligaments
- Men
- Manual workers
- Athletes in sports that involve throwing (Baseball, javelin)
What are 5 clinical signs of Osteoarthritis of Elbow
- Crepitus (grating sensation)
- Locking (Due to loose cartilage fragments)
- Late swelling (Due to effusion)
- Parasthesia +/- muscle weakness (Osteophytes impinge on ulnar nerve)
- Elbow stiffness (Usually tolerated well by patient)
What is Rheumatoid arthritis?
Describe it
An autoimmune disease in which autoantibodies (Rheumatoid Factor) attack the synovial membrane.
Inflamed synovial cells proliferate-> Pannus, which penetrates through cartilage and adjacent bone-> Joint erosion and deformity
What are 4 X-ray features of Rheumatoid Arthritis?
- Joint space narrowing
- Periarticular osteopenia
- Subluxation and gross deformity
- Juxta articular bony erosion
What is Lateral Elbow Tendinopathy (LET) also called?
Describe how it comes about
How does it present?
Also called Tennis Elbow
When ECRB (Extensor carpi radialis brevis) is weakened, microscopic tears form in tendon where it attaches to lateral epicondyle-> Inflammation and pain
- Pain at site of Common Extensor Origin (lateral epicondyle), typically during wrist extension
Name 4 occupations where people are more at risk of getting Tennis Elbow (Lateral Elbow Tendinopathy)
- Tennis players
- Plumbers
- Painters
- Carpenters
What is Medial Elbow Tendinopathy (MET) also called?
What is affected?
Name 4 sports that its common in
Also called Golfer’s elbow
Affects the common flexor origin at medial epicondyle
Sports that place valgus stress on elbow;
- Golf
- Bowling
- Archery
- Weightlifters
Is golfers elbow or tennis elbow more common
Tennis elbow is more common
What is the most common site of pathology of Golfers elbow (medial elbow tendinopathy)
What are 3 ways it present
Interface between pronator teres and flexor carpi radialis
- Aching pain over medial elbow
- Pronation/ Flexion of wrist against resistance causes pain
- May get ulnar nerve symptoms
What are 3 common causes of swellings around the elbow
- Olecranon bursitis
- Rheumatoid nodules
- Gouty tophi
What is Olecranon bursitis?
What is the usual cause?
What are 3 features of the swelling produced
Inflammation of the olecranon bursa
- Usually due to repeated minor trauma (Contents of swelling will be serous fluid)
- (Can also be due to infection)
- Soft
- Cystic (Fluid-filled)
- Transilluminates (Light can be shone through it)
Describe the treatment of Olecranon Bursitis if its not caused by infection
Conservative;
- Compression bandaging
- Aspiration
May need hydrocortisone injection if chronic
Describe the treatment of Olecranon Bursitis if its caused by infection
Aspiration
Compression
Antibiotics
Occasionally, surgical drainage and washout under anaesthetic
