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2 MSK Clinical Conditions > Elbow Disorders (Session 8) > Flashcards

Elbow Disorders (Session 8) Flashcards

1
Q

How might someone acquire a supracondylar fracture of the distal humerus?

A

1-Falling from moderate height w./ elbow hyperextended (e.g. child falling off monkey bars) 2- Falling on flexed elbow

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2
Q

In what age groups are supracondylar fractures most common?

A

Children <10yrs (more common in boys)

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3
Q

How may a child who has suffered a supracondylar fracture of the distal humerus present?

A

Pain, deformity, loss of function

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4
Q

In which direction is the distal fragment usually displaced?

A

Posteriorly

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5
Q

What are the 3 main complications following a supracondylar fracture of the distal humerus?

A

1, Malunion- results in cubits varus (gunstock deformity)

2, Damage to median/radial/ulnar nerve

3, Ischaemic contracture

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6
Q

What is an Ischaemic contracture? i.e. How does it come about if a patient has suffered a supracondylar fracture of the distal humerus?

A
  1. Brachial artery damaged/occluded by displaced fracture-
  2. reflex spasm of collateral circulation
  3. ischaemia in anterior compartment of forearm
  4. oedema + rise in pressure- compartment syndrome
  5. dead muscle tissue- replaced- scar tissue
  6. flexion contracture- Volkmann’s ischaemic contracture
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7
Q

How can Volkmann’s ischaemic contracture be characterised?

A
  • Wrist=flexed
  • Fingers=extended at metacarpophalangeal joints
  • Forearm pronated
  • Elbow flexed
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8
Q

What measures can be taken to minimise the risk of complications following a suprachondylar fracture of the distal humerus?

A

Prompt examination- neurovascular system- if compromise to supply- emergency reduction and fixation of fracture

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9
Q

Explain the common mechanism for elbow dislocation?

A

FOOSH with elbow partially flexed

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10
Q

Why is a dislocation of the elbow more likely if the elbow is is in mid-flexion?

A

Configuration of elbow mean that:

  • Bone most stable in full extension and flexion
  • Stabilty in mid-flexion=more reliant on ligaments
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11
Q

Which joint is the most common to dislocate in children?

A

Elbow

(2nd most common in adults)

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12
Q

What % of elbow dislocations do sports injuries account for?

A

50%

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13
Q

What % of elbow dislocations are posterior?

A

90%

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14
Q

Which way do the bones at the elbow joint move in a posterior dislocation?

A
  • Distal end of humerus- driven through joint capsule anteriorly
  • Ulnar collateral ligament (usually torn)
  • (Often) Fracture/ulnar nerve involvement
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15
Q

What’s the usual mechanism for anterior dislocations (<10% of anterior dislocations)?

A

Direct blow to posterior aspect of flexed elbow

Remember: displacement of distal fragments (ulnar and radius) in the type of dialocation (anterior/posterior)

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16
Q

What fracture is commonly associated with an anterior dislocation of the elbow (due to the force required)?

A

Olecranon fracture

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17
Q

What’s another name for a ‘pulled elbow’?

A

‘nursemaids elbow’

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18
Q

What has occured if a patient has a ‘pulled elbow’?

A

Subluxation of radial head

(Subluxation= partial disruption of joint with some remaining but ABNORMAL opposition of articular surfaces = incomplete dislocation)

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19
Q

In which age group does a ‘pulled elbow’ most commonly occur?

A

Children age 2-5

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20
Q

How will a child with a pulled elbow present?

A
  1. Reduced movement of elbow
  2. Pain over lateral aspect of proximal forearm
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21
Q

What are the mechanisms of injury for a pulled elbow?

A
  1. Longitudinal traction applied to arm with forearm pronated (eg swinging child by their arms) (50%)
  2. Falls
  3. Over-reaching for an object
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22
Q

Why does a pulled elbow more commonly occur when the forearm is pronated?

A
  • Annular ligament taut in supination
  • Annular ligament more relaxed in pronation

Logitudinal traction on radial head- tears annular ligament from radius

Radial head displaced distally through torn ligament

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23
Q

Why does a ‘pulled elbow’ injury become less common as the child ages?

A

Annular ligament natural strengthens

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24
Q

Radial head and neck fractures are the commonest type of elbow fracture.

What is their usual mechanism of injury?

A

FOOSH

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25
Q

If a patient has a radial head or neck fracture, how do they present?

A
  • Pain in lateral aspect of proximal forearm
  • Loss of range of movement
  • Swelling (relatively modest)
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26
Q

What is the ‘sail sign’?

A
  • Due to displacement of anterior fat pad
  • Indicates effusion
  • Likely due to haemarthrosis secondary to intra-articular fracture
  • Appears black on x-ray

(can also be on the posterior surface)

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27
Q

Why is osteoarthritis of the elbow relatively uncommon?

A
  • Well-matched joint surfaces
  • Strong stabilising ligaments
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28
Q

In which population is OA of the elbow more common?

A
  • More commonly men than women (4:1 ratio)
  • Manual workers
  • Athletes
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29
Q

If a patient has OA in their elbow- how wil they present?

A
  1. Crepitus
  2. Locking (due to loose fragements of cartilage)
  3. Paresthesia (due to compression of the ulnar nerve by osteophytes)
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30
Q

What is rheumatoid arthritis?

A
  • Autoimmune disease
  • Autoantibodies- rheumatoid factor- attack synovial membrane
  • Inflamed synovial cells- proliferate- form PANNUS
  • (Pannus=abnormal layer of fibrovascular tissue or granulation tissue)
  • PANNUS- penetrates through cartilage and bone- causing erosion and deformity
31
Q

Which joints are most commonly affected by rheumatoid arthritis?

A
  • MCPJs- Hands and feet
  • PIPJs- Hands and feet
  • Cervical spine
32
Q

What other complications can be caused by rheumatoid arthritis?

A
  • Damage to:
    • Eyes
    • Skin
    • Lungs
    • Heart
    • Blood vessels
    • Kidney
  • Anaemia of chronic disease
33
Q

What % of the population is affected by osteoarthritis?

A

1%

(Peak onset= 40-50yrs)

(Women more commonly affected 2:1)

34
Q

What are the x-ray features of rheumatoid arthritis? (LESS)

A
  1. Loss of joint space
  2. Erosion (of not cartilage protected bone)
  3. Soft tissue swelling
  4. Subluxation and deformity
35
Q

How is rheumatoid arthiritis managed?

A
  1. Disease modifying medication
  2. if severe Surgery required
36
Q

What is another name for Lateral elbow tendinopathy?

A

Tennis elbow

37
Q

What is tendinopathy?

A

Chronic overuse of tendons

38
Q

What is the prevalence of lateral elbow tendinopathy?

A

3% in 40-60 years

39
Q

In tennis elbow the tendon of which muscle is affected?

A

Common extensor tendon at lateral epicondyle

of Extensor carpi radialis brevis

(Weakened in overuse, microscopic tears form where is attaches)

40
Q

What does the extensor carpi radialis brevis stabilise when the elbow is straight?

A

The wrist

41
Q

Apart from tennis players, who else is at is prone to acquiring ‘tennis elbow’?

A

Painters, plumbers, carpenters

42
Q

How is ‘tennis elbow’ managed?

A
  1. Activity modification- give tendon oppourtunity to heal
  2. Physiotherapy
  3. Bracing
  4. Injections/surgery

Disorder=usually self limiting –>90% patients recover within 1year

43
Q

What is another name for medial elbow tendinopathy (MET)?

A

Golfer’s elbow

44
Q

What part of the arm/forearm is affected by Medial elbow tendinopathy?

A

Common flexor origin at medial epicondyle

45
Q

How common is Medial elbow tendinopathy compared to Lateral elbow tendiopathy?

A

MET= 10x less likely that LET

46
Q

Apart from golfer’s, who else might suffer from MET?

A

Bowlers, archers, weightlifters

47
Q

Where is the most common site of pathology for Medial elbow tendinopathy?

A

Interface between pronator teres and flexor carpi radialis

48
Q

When and where will a patient experience pain with Medial elbow tendinopathy?

A
  • Over medial elbow
  • Pain produced:
    • Resisted flexion
    • Pronation of wrist

Ulnar nerve symptoms present in 20% cases

49
Q

How is Medial elbow tendinopathy treated?

A

Same as LET

50
Q

What does the cubital tunnel allow passage for?

(Behind medial epicondyle of humerus)

A

Ulnar nerve

51
Q

The ulnar nerve passes under a tendinous arch to enter the cubital tunnel which is made up of the two heads of which muscle?

A

Flexor carpi unaris

52
Q

What is cubital tunnel syndrome?

A

Compression of ulnar nerve in cubital tunnel

53
Q

Where is the parasthesia felt in cubital tunnel syndrome?

A

Cutaneous territory of ulnar nerve

54
Q

How can the cubital tunnel syndrome be treated?

A

Decompress nerve

Surgical release and transposition anterior to medial epicondyle

55
Q

What are 3 common causes of swellings around the elbow?

A
  1. Olecranon bursitis
  2. Rheumatoid nodules
  3. Gouty tophi
56
Q

What is olecranon bursitis?

A

Inflammation of olecranon bursa

57
Q

What may cause olecranon bursitis?

A

Repeated minor trauma

(STUDENT’S ELBOW)

-Contents- filled with serous fluid

58
Q

How does a patient with olecranon bursitis present?

A
  • Swelling= soft , cystic, transilluminates
  • Cosmetic concern
59
Q

How is olecranon bursitis treated?

A

Conservatively:

  1. Compression- bandage
  2. Aspiration
  3. Hydrocortisone injection if chronic
  4. Antibiotics (if due to infection)(may require Surgical drainage)
60
Q

What is the most common extra-articular manifestation of rheumatoid arthritis?

(affects 20% of those w./ rheumatoid arthritis)

A

Rheumatoid nodules

(tend to be smokers+ have more aggressive joint disease)

61
Q

Where do rheumatoid nodules appear?

A

Over exposed regions- subject to repeated minor trauma

62
Q

Other than the elbow, where else can rheumatoid nodules affect?

A

FIngers, forearms, back of heel

63
Q

How are ‘rheumatoid nodules’ treated?

A

Improving medical control of underlying rheumatoid arthritis

64
Q

What is gout?

A
  • Inflammatory condition
  • Defective purine metabolism
  • Increased production of uric acid
  • Urate crystals form in:
    • Synovial cavity of joints
    • in Tendons
    • in Surrounding tissues
  • Urate crystals trigger Acute inflammation
65
Q

How should gout be treated?

A
  1. Anti-inflammatory drugs in acute phase
  2. Xanthine oxidase inhibitors eg allopurinol- reduces production of uric acid
66
Q

What does gout increase the risk of?

A

Long-term secondary osteoarthritis due to damage to articular cartilage

67
Q

What are Gouty tophi?

A

Nodular masses of urate crystals deposited in soft tissues

68
Q

What causes gouty tophi?

A
  1. Late complication of hyperurocaemia
  2. Untreated gout
69
Q

What are some complications of Gouty tophi?

A

Pain

Soft tissue damage

Deformity

Joint destruction

Nerve compression

70
Q

Where are Gouty tophi usually found?

A

Fingers

Ears

Olecranon bursa

Subcutaneous tissue of elbow

71
Q

What is Froment’s sign?

A

Test for ulnar nerve palsy:

Paralysis of adductor pollicis

72
Q

Why is injury to the musculocutaneous nerve uncommon?

A

Well protected by axilla

73
Q

How might the musculocutaneous nerve become damaged?

A
  • Stabbing
  • Anterior dislocation of shoulder
  • Shoulder surgery
74
Q

What functions will be affected if the musculocutaneous nerve is damaged?

A
  • Coracobrachialis
  • Biceps brachii
  • Brachialis
    • ​=paralysed

Motor Functions

Flexion at shoulder and elbow= weakened

(remain possible due to pectoralis major and brachioradialis)

Supination= weakened

Sensory Functions

Loss of sensation- over radial (lateral side) of forearm

2 MSK Clinical Conditions (10 decks)

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