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
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
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
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”
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)
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
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
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
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
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
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
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
13
Q
What is the most common fracture in the elbow
A
- radial head fracture
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
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
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
