Elbow pathology

Question 1

Olecranon fracture

Answer 1

High energy in the young (falling backwards onto elbow)
Low energy in the elderly

check neuromuscular - ulnar nerve and triceps mechanism

Question 2

Investigations and management

Answer 2

X ray

Conservative - if undisplayed - 2 weeks in cast
Surgical - displaced - use tension wire unless very old

Question 3

Radial head fracture

Answer 3

Often happens during to FOOSH

Examine forearm for tenderness
- if tender, the interosseous membrane is disrupted 0 radio ulnar joint disruption

Presents with pain, limited supination/pronation

Question 4

Investigations and Management

Answer 4

X ray

Conservative - if small fragments and no block to elbow rotation - aspirate haemarthrosis, inject steroids, collar and cuff

Surgery - ORIF +/- radial head replacement

Question 5

Elbow dislocation

Answer 5

90% posterior dislocation due to a FOOSH

Check ulnar and brachial artery

Question 6

Ix Mx

Answer 6

X ray

Conservative - closed recuction

Surgery - ORIF if elbow unstable or if epicondylar fracture

Question 7

Lateral epicondylitis

Answer 7

Tennis elbow

Pain on lateral epicondyle on RESISTED WRIST EXTENSION

Clinical diagnosis

Management
Conservative - acitivy modification, NSAID, ice, physio steroid injections
Surgical - very rare

Question 8

Medial epicondylitis

Answer 8

Golfers elbow

Pain on RESISTED WRIST FLEXION

Conservative - NSAIDs, physio, ice

Question 9

Olecranon bursitis

Answer 9

inflammation of the bursa, leading to swelling, redness and pain at the tip of the elbow

Management
Conservative - compression bandage, NSAID
Surgical - aspiration if infection or very painful

Question 10

Cubital tunnel syndrome

Answer 10

Ulnar nerve entrapment, compressive neuropathy

Parasthesias in ulnar nerve distribution, night symptoms

Confirm with Tinnel positive sign over cubital tunnel and elbow flexion test

Ix - EMG

Mx - Conservative - NSAID, activity modification, night bracing
Surgical - ulnar nerve decompression