MSK 19 - Common Elbow Conditions Flashcards
Describe the cause, anatomy + clinical presentation of a supracondylar elbow fracture?
- Caused by FOOSH from height, typical in children (5-7 YO)
- Fracture above the condyles, usually displaced posteriorly
- Presents with pain, swelling, deformity + bruising
- Damage/compression of the median or radial nerve common
What are the 3 main complications associated with supracondylar fractures?
1) Malunion
2) Damage to median nerve (most common), radial nerve or ulnar nerve.
3) Ischaemic contracture - brachial artery passes close to fracture site and can be damaged/occluded, leads to compartment syndrome and contracted fibrotic tissue (Volkmann’s ischaemic contracture).
- Minimise by doing neurovascular examination (capillary refill time) or OK sign.
What is “pulled elbow” + how is it caused?
In who does it typically occur in?
- Subluxation of the radial head (partial disruption of joint), caused by longitudinal traction with arm extended.
- Distal attachment of radial head subluxes from annular ligament holding it (as it hasn’t ossified fully in children)
- Children aged 1-4, rare after age 5 due to size of radial head.
How do elbow dislocations often occur + in which direction?
- FOOSH in extension
- 90% are posterior, 10% are anterior (usually a direct blow to posterior aspect of fixed elbow)
How do radial head + neck fractures occur?
What does the patient present with?
What is the typical X-ray sign?
- Typicaly FOOSH when radial head impacts with capitulum of humerus.
- Pain in lateral aspect of proximal forearm
- Fat pad sign, indicates effusion is present, likely due to a fracture.
How does elbow OA lead to pain?
What are the characteristic X-ray features of OA?
What do patients often present with?
- Degeneration of articular cartilage, bone rubs on bone.
- Loss of joint space, Osteophytes, Subchondral sclerosis, Subchondral cysts
- Grating sensation (crepitus), osteophytes can impinge ulnar nerve leading to paraesthesia, stiffness.
What is RA of the elbow?
Who is it common in?
How does it present?
What are the common X-ray presentations?
- Autoimmune disease where autoantibodies attack synovial membrane. Synovial cells proliferate and form pannus, which penetrates through cartilage and adjacent bone.
- F>M (2:1), 40-50 YO’s
- Morning stiffness, fatigue, weight loss
- Use LESS
1) Loss of joint space 2) Erosion of bone 3) Soft tissue swelling 4) See through bones (osteopenia).
What is lateral epicondylitis (tennis elbow)?
Who is it common in?
What region is affected?
- Tendinopathy of common extensor origin (especially extensor carpi radialis brevis), precipitated by repetitive wrist extension + forearm pronation (backhand in tennis)
- 35-50 year olds - labourers with heavy tools/lifting tasks
- Common extensor region (extensor carpi radialis brevis, carpi ulnaris, digitorum + digiti minimi)
What is medial epicondylitis (golfers elbow)?
Who is it common in?
What region is affected?
- Tendonopathy of common flexor origin, caused by repetitive wrist flexion + forearm pronation
- Less common than tennis elbow, common in jobs involving heavy lifting or constant vibration at elbow
- Common flexor origin (pronator teres, flexor carpi radialis, carpi ulnaris, digitorum superficialis + palmaris longus)
What 3 conditions cause swelling of the elbow + how are they caused?
1) Olecranon bursitis (students elbow) - Inflammation of bursa overlying olecranon, caused by friction.
2) Rheumatoid nodules - manifestation of extra-articular RA, occurs within skin.
3) Gouty tophi - deposition of MSU crystals within joints, the tophi are findings in patients with gout. Gout caused by high uric acid levels in blood.
What is cubital tunnel syndrome?
How does it present?
- Compression of ulna nerve in the cubital tunnel of elbow
- Numbness, tingling + sensory changes of ring and little finger (innervated by ulnar nerve), progresses slowly over time.
