Elbow Pathologies Flashcards
of medial epicondyle treatment
Surgery if fragment in joint or ulnar nerve compression
of lateral epicondyle complications
Cubital valgus and ulnar nerve palsy
T-shaped intercondylar humerus # management
Difficult to fix surgically, requires rigid fixation to allow early mobilisation
Radial head # presentation
Swollen and tender over radial head
Flexion and extension may be possible but pronation + supination painful
Effusion detected on radiograph but minor fractures often missed
Radial head # treatment
Undisplaced with collar and cuff sling
Displaced/fragment prevents supination/pronation then internal fixation or excision of radial head may be needed
Radial head # complications
Terrible triad: Radial head #, elbow dislocation + coronoid process #
Results in joint instability and post trauma complications
Elbow dislocation presentation
90% dislocate posteriorly, result of fall on elbow flexed hand
Elbow dislocation treatment
Closed reduction ±GA: Flex elbow from behind, fingers around epicondyles and push forwards on olecranon with thumbs + down on forearm
Immobilize in backslab for 10 days
Elbow dislocation complications
Stiffness/instability
Radioulnar joint disruption
Neurovascular compromise
Olecranon # presentation
Occur after direct blow/avulsion from tricep contraction during fall on semiflexed supinated arm
Olecranon # treatment
ORIF e.g. tension band wiring if displaced #
When is elbow joint replacement used
RA mainly
Used more in complex fractures, post-traumatic instability + OA
Paediatric upper limb # types
Greenstick - cortex fails and develops partial transverse crack
Torus - Buckle of cortex as it fails in compression, bulge seen on x-ray
Plastic deformation - bone bends, no evidence of #
Salter Harris classification of physeal injury
I- Straight across growth plate
II- Above plate, coming into it from metaphysis
III- Lower from growth plate down through epiphysis
IV- Through metaphysis, physis and epiphysis
V- All - crush
Supracondylar # presentation
Most common # in children, rarer in adults
95% due to hyperextension
Supracondylar # classification
Gartland classification using lateral XR for displacement
Type I - Anterior humeral line through middle of capitulum
Type II - Anterior humeral line anterior to middle of capitulum, distal fragment angulated with intact posterior cortex
Type IIIa - Posteromedial, threatens radial n.
Type IIIb - posterolateral, threatens median n.
Supracondylar # management
Neurovascular status
Keep elbow in extension to prevent brachial a. injury
Type I Gartland with above elbow back slab + sling
II may need reduction under sedation/GA
III normally GA and IF with K-wires
Supracondylar # complications
Cubitus varus from malunion
Lateral epicondylitis presentation
Tennis elbow, repetitive strain at common extensor tendon in front of lateral condyle
Pain worst in wrist and finger flexion with hand pronated
Lateral epicondylitis management
Most resolve within a year with rest of tendon straining activities
Physio (eccentric loading exercises, acupuncture, deep friction massage)
Novel therapies e.g. platelet rich plasma injections (expensive)
Surgical tendon release only for very severe therapies
Medical epicondylitis presentation
Golfer’s elbow, pain at medial epicondyle, forearm flexor origin
5x rarer than tennis elbow
Pain worse with pronation + forearm flexion
Occasionally associated with ulnar neuropathy
Medical epicondylitis management
Same as tennis elbow
Olecranon bursitis presentation
Bursitis following pressure on elbows, pain and swelling behind olecranon
Can be caused by gout
Olecranon bursitis complications
Overlying skin cellulitis
Abscess formation rarely, septic bursitis IV antibiotics/surgical draining by ortho
