KIN 428 Final Flashcards
Where does elbow bursitis usually occur?
Primarily in the olecranon bursa
What are the causes of elbow bursitis?
Trauma, accumulation of small trauma, sustained pressure on the elbow, contusion fills with fluid
What are symptoms of elbow bursitis?
large swelling, tenderness, fever (if due to infection), pain at elbow tip, minor decreases in elbow ROW
Conservative treatment for elbow bursitis?
Elbow pads for protection (especially for machinists), inflammation treatment (antibiotics, cortisone shot)
Surgical treatment for elbow bursitis?
fluid draining (remove pressure), bursa removal (same general idea to remove pressure)
What is Panner’s Disease?
Disruption of the capitellum growth plate
What causes Panner’s disease?
Several theories: hereditary, repeated trauma (Little League Arm or compromised vascularization)
Symptoms of Panner’s Disease?
Elbow tenderness (exacerbated by activity) and inability to achieve full extension (bony damage)
Diagnosis of Panner’s disease?
radiographs to find bony abnormalities
Nonsurgical treatment of Panner’s disease?
Reduction of sports activities (pitch count in Little League) and anti-inflammatories.
Surgical treatment of Panner’s disease?
Very rare because kids heal well and it usually self resolves
WHat is osteoarthritis of the elbow?
damage to cartilage/joint articulating surface
What causes osteoarthritis at the elbow?
subsequent to injury (altered mechanics = different wear), age-related degeneration, strenuous manual labour, untreated instability such as ligament damage and laxity (also alters mechanics)
Symptoms of osteoarthritis of the elbow?
pain, loss of ROM< locking sensation, joint swelling, finger numbness, visible osteophyte formation
Non-surgical treatment of osteoarthritis at the elbow?
anti-inflammatory drugs, physical therapy, activity modification, steroidal injections
What is the main point of treatments for osteoarthritis at the elbow?
To reduce pain because it is pretty much impossible to “fix” osteoarthritis
Surgical treatments for osteoarthritis at the elbow?
elbow fusion (rare), interposition athroscpoy, arthroscopic loose body removal, joint replacement
What is interposition arthroplasty?
Arthritic joint surfaces areremoved and fascia is placed between the bones. Healing creates scar tissue as a false joint surface. “surrogate cartilage”
Why is the elbow a trochoginglymus joint?
3 articulations in same articular capsule
Locations of fractures at the elbow?
olecranon, radial head, supracondylar
Risk factors for elbow fractures?
advancing age, decreased muscle mass, osteoporosis, participations in contact sports
Elbow fractures are caused by trauma in the form of…
FOOSH, direct fall on elbow, direct blow to elbow, hypermotion (outside normal ROM, mostly from hyperextension because more bones are in contacnt so more likely to fracture)
Symptoms of an elbow fracture?
severe pain, tenderness, bruising around the elbow, swelling, numbness in fingers, hand or forearm. Decreased ROM. A lump or visible deformity over the fracture site.
Classification of elbow fractures focuses on?
fracture displacements, fracture line direction, articular comminution, articular involvement, % of joint involved in fracture (comorbidities)
2 types of olecranon fractures?
Comminuted (direct blow, 2+ parts). transverse (traction lesion from triceps, 1 part)
Causes of olecranon fractures?
direct blow to elbow, fall on flexed blow
Symptoms of olecranon fractures?
sudden intense pain, bruising, numbness in fingers, pain with joint movement
Classification/treatment for Type I olecranon fracture?
little displacement, conservative splint/sling
Classification/treatment for Type II olecranon fractures?
Most common, relatively stable, usually surgical ORIF and immediate PT after
Classification/treatment for Type III olecranon fractures?
> 50% articulating surface (the more proximal on the humerus the humerus the more unstable it is), always ORIF
General treatment of olecranon fractures?
If no displacement of the bone: alignment in a proper position with use of a splint (no elbow flex/ext because it uses the triceps and you don’t want any triceps activation). If displacement of the bone exists: surgery/
Secondary pathologies of olecranon fractures?
Nonunion (due to traction by triceps), and loss of motion may result
Occurrence/causes of radial head fractures?
20% of traumatic elbow injuries, women»_space; men, 30-40, approx. 10% of dislocations
Symptoms of radial head fractures?
pain on outside of elbow, swelling, decreased ROM in pronation and supinationC
Classification/treatment of Type I radial head fracture?
usualyl cracks, undisplaced. Conservative treatment with slings and early motion
Type II radial head fracture classification/treatment?
larger displacement, but repairable, Surgically remove small fragments, ORIF if possible, radial head removal (elderly)
Type III radial head fracture classification/treatment?
More than 3 bone fragments, Usually other joint damage (fracture/dislocation), surgery required.
As the type number of radial head fractures increases, what happens to the enery needed for hte fracture?
It increases
Secondary pathologies of radial head fractures?
a loss of elbow extension and rotation (pro.supination) of forearm
What is a supracondylar fracture?
fracture through the lower end of the humeral shaft
Two types of suparcondylar fractures, and which is most common?
flexion and extension (most common)
Type I supracondylar fracture?
non-displace
Type II supracondylar fracture?
displaces with intact posterior cortex
Type III supracondylar fracture?
displaced with no cortical contact
Supracondylar fracture treatment?
If no displacement: immobilize arm by use of a splint. If displacementL bones need to be reduced and a pin will be used to hold the bones in place
Secondary pathologies of a supracondylar fracture?
transcondylar fracture, intercondylar fracture, condylar fractures
What is a transcondylar fracture?
loss of motion can result from callus formation in the olecranon or coronoid fossae
What is an intercondylar fracture?
a loss of joint function may result
What is a condylar fracture?
Non-union, arthritis, cubitus carus or valgus deformity, and lateral transposition of the forearm may occur. If coronoid process fractures are untreated, they may lead to instability of the joint.
Why are there so many possibilities for different injury patterns at the elbow?
Because there is so much allowed movement
What is the “arc of injury” at the elbow?
different angles of the elbow joint yield different fractures under the same direction of force.
What does the radial head articulate with?
the capitellum
Pronation =
maximal contact of radial head with capitellum + minimal rension of interosseous membrane
FOOSH for a radial head fracture?
forearm pronated + the elbow partially flexed. Radial head will absorb the indirect force of the fall and impacts on the capitellum (severity based on contact)
In what range do radial implications usually occur?
0-80 degrees of flexion
What does the olecranon articulate with?
the trochlea
In what range do most olecranon fractures occur?
60-110 degrees flexion…“mid range”
How does the olecranon fracture during hyperextension?
Acts as a fulcrum and fractures due to bending load
How does the olecranon fracture during full flexion?
load passes through point of elbow (tip of olecranon has to support humerus)
In what range of flexion do the humeral condyles usually fracture?
115-145, direct, humeral condyles are exposed
In what range of extension do the humeral condyles usually fracture?
40-60 degrees, indirect, 45 degrees incline
2 cumulative mechanisms for humeral condylar fractures?
hyperextension and overhead throwing
How does overhead throwing lead to condylar fractures at the elbow?
Throwing = high valgus stress on medial aspect of joint. Forces > tensile strength of the ligament and produces tears/avulsions. Continued throwing can lead to alteration of rupture of the ligament. Olcranon stress fracture and loose bodies because if you lose ligaments, you lose stability, the bones grind, and then you get a stress fracture.
Radial head ORIF general technique?
Lateral incision from lateral epicondyle to distal radial neck. Internal between anconeous and ECU. Incision along parallel fibers of LCL. Fracture exposed. Temporarily reassembled with K-wires. Herbert Screws and mini plates fix radial head to shaft.
What is the point of olecranon tension band wiring?
Put in a figure 8 configuration to stop the triceps from pulling the joint apart.
What is nursemaid’s elbow?
s a dislocation of the elbow joint caused by a sudden pull on the extended pronated arm, such as by an adult tugging on an uncooperative child or by swinging the child by the arms during play. The technical term for the injury is radial head subluxation
How are elbow dislocations defined?
defined as radial and/or ulnar deviation with respect to the humerus
Types of elbow dislocations?
anterior, posterior, lateral, medial, divergent
2nd most common dislocation joint within adults?
Elbow
Most elbow fractures happen between what ages?
5-25
Do men or women get more elbow fractures?
Men
Why are elbow dislocations happen less in children, and what types of injuries do they more commonly have?
There ligaments are more elastic, so there is greater movement allowed. Tend to have supracondylar fractures and radial head subluxations (nurse’s maid)
What type of dislocations make up >90% of elbow dislocations?
posterior dislocations
Symptoms of elbow dislocation?
intense pain, clear deformity, hand numbness, changes in hand color (blood supply interrupted)
Acute elbow dislocations are caused by?
Traumatic forces (FOOSH, car accident)
Chronic elbow dislocation is caused by?
Laxity of the elbow joint (LCL). Diseased joint: arthritis (very advanced stages), osteoporotic bones, and degeneration of articular cartilage
Optimal conditions for posterior elbow dislocation?
Pathological External Forearm Rotation. 1) Axial loading along forearm (FOOSH) 2) Varus stress 3) 30 degrees flexoim 4) External rotation (PEFR)
Simple dislocation classification at the elbow?
Damage to ligaments and soft tissue only. No major bones injury…may have resulting muscle avulsion and neurovascular damage
Complex dislocation classification at the elbow?
Ligament damage, soft tissue damage, bone damage (may be severe)…may have resulting muscle avulsion and neurovascular damage
Secondary pathologies of elbow dislocation?
Brachial artery disruption, median nerve entrapment, ulnar nerve entrapment, Monetggia fracture, coronoid/olecranon/radial head fracture, avulsion of triceps (anterio dislocations), entrapment of bone fragments, joint stiffness
Pathology of brachial artery disruption?
Rare, 5-13%, hand will be cool on palpitation and have a white or purple hue
Pathology of median nerve entrapment?
complications often occur in skeletally immature people, patient will experience weakness and paraesthia
Why do brachial artery disruption and median nerve entrapment happen together?
anatomic position within the cubital fossa predisposed concomitant median nerve injury with the brachial artery
What is the terrible triad?
Posterior dislocation with radial head and coronoid fracture. High force causes the fracture.Callled the “terrible triad” because of the propensity for complications related to instability, arthrosis and stiffness
What is a Monteggia Fracture?
fracture of the foreaem with dislocation of the proximal RADIOULNAR joint
How are elbow dislocations diagnosed?
Straightforward assessment for elbow dislocation, normally found on examination. With a posterior radiograph a dislocated elbow, a straight line appear when normally a triangle is seen