Elbow Pathologies

Question 1

of medial epicondyle treatment

Answer 1

Surgery if fragment in joint or ulnar nerve compression

Question 2

of lateral epicondyle complications

Answer 2

Cubital valgus and ulnar nerve palsy

Question 3

T-shaped intercondylar humerus # management

Answer 3

Difficult to fix surgically, requires rigid fixation to allow early mobilisation

Question 4

Radial head # presentation

Answer 4

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

Question 5

Radial head # treatment

Answer 5

Undisplaced with collar and cuff sling

Displaced/fragment prevents supination/pronation then internal fixation or excision of radial head may be needed

Question 6

Radial head # complications

Answer 6

Terrible triad: Radial head #, elbow dislocation + coronoid process #
Results in joint instability and post trauma complications

Question 7

Elbow dislocation presentation

Answer 7

90% dislocate posteriorly, result of fall on elbow flexed hand

Question 8

Elbow dislocation treatment

Answer 8

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

Question 9

Elbow dislocation complications

Answer 9

Stiffness/instability
Radioulnar joint disruption
Neurovascular compromise

Question 10

Olecranon # presentation

Answer 10

Occur after direct blow/avulsion from tricep contraction during fall on semiflexed supinated arm

Question 11

Olecranon # treatment

Answer 11

ORIF e.g. tension band wiring if displaced #

Question 12

When is elbow joint replacement used

Answer 12

RA mainly

Used more in complex fractures, post-traumatic instability + OA

Question 13

Paediatric upper limb # types

Answer 13

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 #

Question 14

Salter Harris classification of physeal injury

Answer 14

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

Question 15

Supracondylar # presentation

Answer 15

Most common # in children, rarer in adults

95% due to hyperextension

Question 16

Supracondylar # classification

Answer 16

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.

Question 17

Supracondylar # management

Answer 17

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

Question 18

Supracondylar # complications

Answer 18

Cubitus varus from malunion

Question 19

Lateral epicondylitis presentation

Answer 19

Tennis elbow, repetitive strain at common extensor tendon in front of lateral condyle
Pain worst in wrist and finger flexion with hand pronated

Question 20

Lateral epicondylitis management

Answer 20

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

Question 21

Medical epicondylitis presentation

Answer 21

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

Question 22

Medical epicondylitis management

Answer 22

Same as tennis elbow

Question 23

Olecranon bursitis presentation

Answer 23

Bursitis following pressure on elbows, pain and swelling behind olecranon
Can be caused by gout

Question 24

Olecranon bursitis complications

Answer 24

Overlying skin cellulitis

Abscess formation rarely, septic bursitis IV antibiotics/surgical draining by ortho

Question 25

Elbow OA presentation

Answer 25

Flexion, extension + rotation of forearm may be impaired due to loose bodies impairing movement

Question 26

Elbow OA treatment

Answer 26

Surgery for pain/stiffness not responding to conservative management, or if there is locking
Total elbow replacement less effective in OA than RA

Question 27

Ulnar neuritis cause

Answer 27

OA/RA narrowing of ulnar groove and constriction/friction on ulnar n. as it passes behind medical epicondyle
Results in ulnar fibrosis/neuropathy

Question 28

Ulnar neuritis presentation

Answer 28

Sesnsory symptoms first, dec sensation in ulnar areas
Clumsiness of hand + weakness of small muscles
Can be confirmed with nerve conduction studies

Question 29

Ulnar neuritis treatment

Answer 29

Surgical decompression

Question 30

Pulled elbow presentation

Answer 30

Subluxation of radial head, typically 1-4 year old lifted by arm, radial head slips out of annular lig
Arm slightly flexed and twisted inwards

Question 31

Pulled elbow management

Answer 31

Reduction: hold elbow with thumb and forefingers over radial head, hyperpronate/supinate and flex elbow
Caution parents not to pull arm, 25% recurrence