Elbow problems Flashcards
Describe a supracondylar fracture.
- common in children, caused by FOOSH.
- presentation : pain, swelling, deformity, bruising.
- damage/ compression of median or radial nerve.
- blood supply from brachial artery at risk.
- assess NV status : can they palmar abduct, flex index finger, check radial pulse and capillary refill time.
- management : reduce (put back into position) and hold, closed reduction and percutaneous pinning (CRPP), if nerve function compromised surgery might be needed.
describe a pulled elbow complication (subluxation of radial head).
- common in 1-4 age group as radial head not fully ossified, presentation with pain and not using elbow.
- caused by longitudinal traction with extended arm and pronated forearm which causes radial head to sublux from annular ligament.
- treatment : reverse the forces so flex elbow and supinate.
describe elbow dislocation.
- FOOSH with arm in extension causes dislocations being posterior and lateral.
- causes major soft tissue disruption in capsule and ligaments, leading to pain, loss of function and deformity.
CHECK NV STATUS. AND FRACTURES.
describe the features of radial head and neck fractures.
- in presents with trauma, lateral elbow pain, restricted ROM in pronation and supination suspect,
- evaluate mechanical blocking.
- XR shows fat pad elevated out of fossa as haemarthrosis displaces it.
*management if minimal displacement conservative and early ROM exercises.
differentiate between osteoarthritis and rheumatoid arthritis.
- RA mostly in 20-40 whereas OA older.
- RA onset rapid whereas OA over many years.
- RA affects joints symmetrically and polyarticular way whereas OA often unilateral and limited to one set of joints.
- RA pain improves with usage and OA worsens with use of the joint.
- RA presents with systemic symptoms like fatigue and malaise whereas OA doesn’t.
describe features of elbow OA and features seen on an XR. think LOSS.
- attacks articular hyaline cartilage of joint, leads to progressive loss of cartilage which leads to bone on bone rubbing and pain.
- XR : Loss of joint space, Osteophytes (abnormal bone growth), Subchondral sclerosis (as a result of bone rub), Subchondral cysts.
*treatment : analgesia, intra-articular injection, replacement.
describe features of elbow RA.
also mention XR features LESS.
- a systemic inflammatory disease affecting many systems including joint, and at elbow synovial line of joint capsule targetted.
- synovial cells attacked proliferate forming a pannus that erodes cartilage and bone via secretions causing deformity.
- morning stiffness more than 1h, systemic features of malaise/fatigue, weight loss, low grade fever.
- XR : Loss of joint space, Erosion of bone, Soft tissue swell, See through bones. in severe subluxation of joints.
describe features of lateral epicondylitis.
tennis elbow
- tendonopathy of common extensor origin, precipitated by repetitive wrist extension and forearm pronation.
- pain in extensor origin on resisted wrist/ finger extension with elbow fully extended.
- activity modified, physio.
describe medial epicondylitis (golfers elbow).
- tendonopathy in common flexor origin.
- micro-trauma to insertion of flexor-pronator by repetitive wrist flex/forearm pronation.
- jobs involving lifting, forceful grip, elbow vibration.
- pain over medial epicondyle worse with wrist and forearm motion and gripping.
- shoes tenderness anterior to medial epicondyle and pain with resisted pronation and wrist flexion.
*treatment activity modifies and physio.
how would you approach the history taking in elbow swellings to narrow it down?
- trauma vs spontaneous.
- timing.
- well/ unwell?
- past medical history.
- occupation.
describe olecranon bursitis.
students elbow
- friction to bursa over olecranon causing sterile inflammation or septic if infected.
- joint not involved, superficial swelling so ROM intact unless large.
- transilluminates.
- fluctuant swell.
*spontaneous resolution, antibiotics if infected, rarely drained.
describe rheumatoid nodules.
- common in fingers, forearms, over elbows with slow onset.
- within skin, mobile over deep structures, firm to touch, no transillumination.
- cause : cosmetic.
*may resolve, treat RA, surgery if extreme.
what is gouty tophi?
- pathognomonic findings in skin found with patients who have gout (urate crystals in joints).
- crystals form due to high uric acid in blood and they deposit in skin as tophi.
- common in ear, elbow, fingers and achilles tendon.
what is cubital tunnel syndrome?
- compression of ulna nerve in cubital tunnel causes numbness, tingling and sensory changes of ring and little finger progressing over time.
- nerve conduction studies would confirm.
*splinting at night 45 degrees, analgesia, surgery.
