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Differential Diagnosis/Imaging > Elbow Imaging and Complaints > Flashcards

Elbow Imaging and Complaints Flashcards

1
Q

Red flags for elbow, wrist, and hand fractures

A
  • recent fall or trauma
  • history of osteoporosis
  • extended use of steroids
  • pathologies with improper bone remodeling
  • pain, tenderness, swelling, ecchymosis
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2
Q

Red flags for elbow, wrist, and hand radial head fracture

A
  • fall onto an outstretched arm that is supinated
  • anterolateral pain & tenderness at the elbow
  • inability to supinate & pronate forearm
  • elbow held against the side with 70º of flexion & slightly supinated
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3
Q

Red flags for elbow, wrist, and hand distal radius (Colles) fracture

A
  • fall onto outstretched arm with forceful wrist extension
  • Age >40 yr
  • women affected more than men
  • history of osteoporosis
  • wrist held in neutral resting position, wrist swelling
  • movements into wrist extension are painful
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4
Q

Red flags for elbow, wrist, and hand scaphoid fracture

A
  • fall onto outstretched arm
  • wrist swelling
  • wrist held in neutral position
  • pain in the “anatomic snuff box”
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5
Q

Red flags for elbow, wrist, and hand lunate fracture or dislocation

A
  • fall onto outstretched arm
  • diffuse synovitis
  • generalized wrist swelling & pain
  • decreased motion
  • decreased grip strength (rule out capitate fracture)
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6
Q

Red flags for elbow, wrist, and hand triangular fibrocartilaginous complex tear (TFCC)

A
  • traumatic fall after slipping or tripping on outstretched hand with forearm pronated
  • commonly associated with Colles fracture
  • ulnar sided wrist pain
  • tenderness & clicking with wrist movement (passive ulnar deviation)
  • weakness with grip strength
  • dorsal ulnar head subluxation
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7
Q

Red flags for elbow, wrist, and hand long flexor tendon rupture

A
  • Hx of rheumatoid arthritis
  • Hx of corticosteroid use for chronic respiratory problems
  • Hx of trauma
  • Grade I & II muscle tear: local tenderness, swelling, muscle spasms, hematoma, pain with motion & with passive stretch
  • Grade III muscle rupture: total loss of motion & palpable defect in the muscle, swelling, tenderness, ecchymosis of overlying skin
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8
Q

Red flags for elbow, wrist, and hand space infection of the hand

A
  • recent puncture of skin
  • recent insect bite
  • presence of an abscess
  • purulent tenosynovitis of tendons that go through a space
  • typical signs of inflammation: swelling in palm, dorsal of hand, or finger tips
  • pain, tenderness, warmth, erythema
  • signs of long standing infection: high fever, chills, weakness, malaise
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9
Q

Red flags for elbow, wrist, and hand Raynaud’s phenomenon or Raynaud’s disease

A
  • past medical history significant for rheumatoid arthritis, occlusive vascular disease, smoking, or use of beta blockers
  • hands or feet that blanch, go cyanotic & then red when exposed to cold or emotional stress
  • pain & tingling in hands or feet when they turn red
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10
Q

Red flags for elbow, wrist, and hand complex regional pain syndrome (CRPS)

A
  • trauma including fracture, dislocation, or surgery
  • pain does not respond to typical analgesics
  • severe aching, stinging, cutting, or boring pain that is not typical of injury; hypersensitivity
  • area swollen (pitting edema), warm, & erythematous
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11
Q

Differential diagnosis for elbow imaging

A
  • Radiography: acute/initial injury, screen for fx (FOOSH), dislocation, calcific tendonitis
  • MRI/MRA: intra-articular osteocartilaginous body/chondral injury, soft tissue mass, chronic epicondylitis, collateral ligament tear, tendon lesion/bursitis, nerve abnormality, osseous tumor
  • CT: complex fractures, HO, osteophytosis
  • Ultrasound (comparable to MRI): chronic epicondylosis, tendon lesion/bursitis, collateral ligament tear, nerve abnormality
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12
Q

Routine radiography evaluation for the elbow

A
  • AP view
  • Lateral with elbow flexed to 90º
  • Oblique with external rotation
  • Trauma requires additional views of the forearm
  • Elbow extension test for acute fracture screening
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13
Q

What is the most common fracture in the elbow

A
  • radial head fracture
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14
Q

Carrying angle that may indicate fracture or post traumatic deformity

A
  • carrying angle more than 5-15 degrees may indicate fracture or post traumatic deformity
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15
Q

Describe children elbow ossification

A
  • the elbow changes significantly during childhood due to the presence of 6 secondary ossification centers
  • remember the mnemonic CRITOE
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16
Q

What is the mnemonic CRITOE

A
  • Capitulum: 1-3 y/o
  • Radial head: 5-7 y/o
  • Internal (medial ) epicondyle: 5-7 y/o
  • Trochlea: 9-11 y/o
  • Olecranon: 9-11 y/o
  • External (lateral) epicondyle: 10-12 y/o
17
Q

Elbow MRI indications

A
  • Collateral, radial, or annular ligament tears
  • Epicondylitis
  • Distal biceps or triceps tendon tears
  • Osteochondral besoins
  • Intra-articular loose bodies
  • Olecranon & bicipitoradial bursitis
  • Marrow abnormalities: edema & stress fractures
  • Ulnar nerve compression in the cubital tunnel
  • Neoplasms or bone/joint/soft tissue infections
  • Abnormalities of the proximal forearm interosseous membrane & neuromuscular structures
18
Q

MRI ABCDS

A
  • Alignment of anatomy: look for bony disruption at sites of tendon attachment
  • Bone signal: assess for bone bruises or marrow edema, stress Fx, or osteochondral
  • Cartilage (especially capitulum): assess for articular cartilage abnormalities at the joint surfaces
  • eDema: edema is the footprint of injury on MRI
  • Soft tissue/synovial tissue: anterior (biceps), posterior (triceps), medial (UCL tear, epicondylitis), & lateral (epicondylitis, RCL tears ) compartments
19
Q

Describe CT scan alignment of anatomy of the elbow

A
  • Axial & coronal slices note the humeroulnar & humeroradial articulations, & proximal radioulnar articulation
  • Sagittal slices note the ulnar trochlear notch & assess the radial ahead and its articulation with the capitulum
20
Q

Describe CT scan bone density of the elbow

A
  • Cortical bone its most dense seen axially in the cortical shells of the humerus, ulna, & radius
  • Cancellous bone is less dense seen in the medullary cavities
21
Q

Describe CT scan cartilage/joint space of the elbow

A
  • asses the humeroradial & humeroulnar joint spaces for smooth chondral surfaces
  • Osteochondral lesions are most common at the capitulum & radial head
22
Q

Describe CT scan soft tissues of the elbow

A
  • Anterior tissues: biceps, brachialis
  • Posterior tissues: triceps, anconeous
  • Lateral tissues: common extensor tendon on lateral epicondyle, extensor supinator group, flexor brachioradialis muscle
  • Medial tissues: common flexor tendon on medial epicondyle, flexor pronator group of muscles
23
Q

Describe Monteggia’s fracture/dislocation

A
  • fracture of the proximal 1/3 of the ulna combined with dislocation of the radial head
  • MOI: FOOSH with forearm in hyperpronation
  • Imaging: Radiographs are sufficient for diagnosis
  • all Monteggia’s fractures are considered unstable & require intervention
24
Q

Describe an elbow dislocation

A
  • 90% of dislocations at the elbow involve the dislocation of both forearm bones in posterior or posteriolateral direction
  • MOI: FOOSH with elbow extended
  • Imaging: AP & lateral radiographs are diagnostic; forearm and wrist or required to also be radiographed due to high association injuries
25
Q

Describe epicondylitis

A
  • Overuse injury characterized in the acute stage by tendinitis; repetitive stress that prevents the tendon from healing
  • MOI: Medial = repetitive action of flexor muscles exerting stress at the common flexor tendon insertion; Lateral = repetitive action of the extensor muscles exerting stress at the common extensor tendon insertion
  • Imaging: radiographs rule out associated disorders; MRI or MSUS can demonstrate specific tissue inflammation & tendon degeneration
26
Q

Describe osteochondritis dissecans (OCD) of the capitulum

A
  • separation of a piece of cartilage & subchondral bone from the articular surface; presents in adolescent athletics with open growth plates
  • Symptoms: dull pain, joint swelling, perhaps locking
  • MOI: repetitive valgus compressive forces on medial side of joint (throwing/UE weight bearing in gymnastics)
  • Imaging: MRI for vascularity & stability of lesion; US can detect localized flattening of the capitulum early in diagnosis
27
Q

Describe a nightstick fracture

A
  • Isolated fractures of the ulna
  • Typically transverse & located in the lid-diaphysis
  • Usually resulting from a direct blow
  • Characteristic defensive fracture when the patient tries to ward off an overhead blow from an assailant branding a bar-like weapon
28
Q

Describe a Galeazzi fracture

A
  • Fracture of distal radius & corresponding dislocation of the ulnar head from wrist
  • Patient should be placed in a sugar-tong splint while waiting consult
  • Conservative management for children and surgery typically for adults
29
Q

Describe a Colles fracture

A
  • Very common extra-articular fractures of the distal radius
  • Occurs as a result of FOOSH
  • Relationship between Colles fracture & osteoporosis is strong enough that an older male patient who presents with a Colles fracture should be investigated for osteoporosis
  • MOI: FOOSH on palm of hand
30
Q

Describe a Smith fracture

A
  • Referred to as a reverse Colles fracture
  • Tends to be more unstable than a Colles fracture
  • MOI: FOOSH on dorsal side of hand
31
Q

Describe Torus fracture

A
  • Also termed Buckle fracture
  • Commonly in children
  • One side of the distal radius bends but does not break
32
Q

What is “T” sign indicative of

A
  • indicative of an UCL tear
33
Q

How should trauma to the elbow be screened

A
  • Should be screened with a valgus stress tests

Differential Diagnosis/Imaging (20 decks)

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