Elbow Pathology Flashcards
Who are supracondylar fractures common in?
Occur chiefly during childhood but may occur in adults
What are features of olecranon fractures?
- Result of FOOSH or direct blow
- Fracture commonly displaced
Tx → Requires ORIF with K-wire fixation
What is the most common elbow fracture in adults?
RADIAL HEAD #
- Elbow swollen + tender over radial head
- Flexion/extension may be possible but pronation + supination hurt
- 3-14% associated w/ ‘terrible triad’ → radial head fracture, elbow dislocation + coronoid process fracture
- Results in joint instability + post traumatic complications
What are features of medial epicondylar fractures?
- Often missed
- Especially in young children
- Often intra-articular
- Need careful examination followed by ORIF w/ K-wires
What are features of lateral condylar fractures?
- Most commonly associated w/ preschool children
- If significant displacement → ORIF
- Fractures can cause growth arrest, mal-union, stiffness and ulnar palsy
How does elbow dislocation present?
- Commonly posterior (90%)
- Result from a fall on a not yet fully outstretched hand, with elbow flexed
- Causes posterior ulnar displacement on humerus + swollen elbow, FIXED IN FLEXION
- Associated → fractures / brachial artery + nerve injury
What is the management for elbow dislocation?
- Closed reduction +/- GA
- Stand behind pt, flex elbow to relax biceps brachii
- With fingers around epicondyles, push forwards on olecranon with thumbs and down on forearm
- Post-reduction image needed to exclude fractures
- Immobilise in a backslab for 10 days
What are possible complications of elbow dislocation?
- Stiffness
- Instability
- Radio-ulnar joint disruption
What is tennis elbow?
- AKA lateral epicondylitis (TE-LE)
- Inflammation where common extensor tendon arises from lateral epicondyle of humerus
- Often clear hx of repetitive strain
- Pain + tenderness localised to lateral epicondyle
- Pain worse on wrist extension against resistance with elbow extended
What is the treatment for tennis elbow?
- Most cases naturally resolve through restriction of activities which overload tendons
- Typically last 6-24 months + 90% recover within 1yr
- Physio in motivated pts is most effective non-surgical treatment
- Steroid injections NO longer recommended
What is golfer’s elbow?
- AKA medial epicondylitis
- Inflammation of forearm flexor muscle at their origin on medial epicondyle
- Most common cause of medial elbow pain
- Pain exacerbated by pronation + forearm flexion
- Occasionally associated w/ ulnar neuropathy as ulnar nerve runs behind epicondyle
Treatment similar to tennis elbow
What is olecranon bursitis?
- AKA student’s elbow
- Traumatic bursitis following pressure on elbows
- Pain + swelling behind olecranon
- If there is overlying skin cellulitis then consider Abx
- Rare complication of olecranon brusitis is abscess formation; septic bursitis should be formally drained by ortho team + will need IV abx
- Send aspirate fluid for MC+S for crystals
What causes ulnar nerve entrapment (cubital tunnel syndrome)?
- OA or RA narrowing of ulnar groove + constriction of ulnar nerve as it passes behind medial epicondyle
- Or friction of ulnar nerve due to cubitus valgus (possible sequel to childhood supracondylar fractures) can cause fibrosis of ulnar nerve and ulnar neuropathy
What are clinical features of ulnar nerve entrapment?
- Sensory symptoms occur first → Reduced sensation over little finger and medial half of ring finger
- Pts may experience clumsiness of hand + weakness of four small muscles of hand innervated by ulnar nerve
What is the management of ulnar nerve entrapment?
- Diagnosis → nerve conduction studies
- Treatment → surgical decompression
