Ses 9 Elbow Injuries Flashcards
Supracondylar fracture of the distal humerus notion
Mechanism - falling from a moderate height onto an outstretched hand with the elbow hyperextended.
fracture line is usually extra- articular and the distal fragment is usually displaced posteriorly.
Who - children 5-7yrs (boys)
Symptoms- pain, deformity and loss of function.
Complications-
Malunion, resulting in cubitus varus - gunstock deformity
Damage to the median nerve (most common), radial nerve or ulnar nerve.
Volkmann’s ischaemic contracture - brachial artery damaged - reflex spasm of collateral circulation- ischaemia of anterior muscles - oedema (compartment syndrome) - muscle infarction - fibrosis - typical position on notion.
Management:
neurovascular examination
Reduce and plaster or emergency reduction and fixation
Dislocated elbow
Falls on their outstretched hand with the elbow partially flexed.
Named by displacement of of distal fragment - posterior - ulnar collateral ligament is usually torn.
Anterior is direct blow to posterior flexed elbow - Associated fractures of the olecranon
Pulled elbow (‘nursemaids elbow’)
subluxation of the radial head.
longitudinal traction is applied with forearm pronated (annular ligament more relaxed in this position so easier).
radial head is displaced distally through the torn ligament.
Who - children aged 2-5 years. annular ligament strengthens as children grow up so less common.
Symptoms- reduced movement and pain over the lateral aspect of the proximal forearm. The parent often states that they are ‘not using their arm’.
Radial head and neck fractures notion
fall on an outstretched hand when the radial head impacts on the capitellum of the humerus.
Symptoms- pain in the lateral aspect of their proximal forearm and loss of range of movement. The swelling is more modest than supracondylar fractures
fat pad sign’ (or ‘sail sign’) indicates an effusion - haemarthrosis secondary to an intra-articular fracture.
Osteoarthritis of the elbow
Notion
uncommon because of the well-matched joint
surfaces and strong stabilising ligaments - less wear and tear.
men more than women (ratio 4:1).
manual workers and athletes who engage in throwing.
grating sensation’ (crepitus) or locking (caused by
loose fragments of cartilage)
Swelling - late - effusion
Osteophytes can impinge on the ulnar nerve, causing
paraesthesia + muscle weakness.
Rheumatoid arthritis
Mechanism - autoantibodies, called rheumatoid factor, attack the synovial membrane.
The inflamed synovial cells proliferate to form a pannus.
Penetrates through cartilage and bone, leading to joint erosion.
Affects MCPJ + PIPJ + cervical spine + feet
Complications:
Damage to eyes, skin, lungs, heart and blood vessels and the kidneys.
Anaemia of chronic disease.
Risk factors
Women more than men - 2:1
40-50yrs
X-ray:
Joint space narrowing
Periarticular osteopenia
Juxta-articular (also called marginal) bony erosions (in non-cartilage protected bone)
Subluxation and gross deformity
Treatment:
DMARDs
Surgical - total elbow replacement
Lateral elbow tendinopathy (‘tennis elbow’)
Mechanism- extensor carpi radialis brevis (ECRB) muscle is weakened from overuse,
microscopic tears form in the tendon where it attaches to the lateral epicondyle.
This leads to inflammation and pain.
Symptoms- pain at common extensor origin at the lateral epicondyle during extension of the wrist
Risk factors:
tennis players, painters, plumbers and carpenters - repetitive activity
40-60 years
Treatment:
modify activities
physiotherapy and bracing
injections or surgery
Medial elbow tendinopathy (‘golfer’s elbow’)
Mechanism- valgus
stress on the elbow.
Affects common flexor origin at the medial epicondyle.
Pathology is at the interface between pronator teres and the flexor carpi radialis (FCR) origins.
Symptoms- pain at medial elbow - during the acceleration phase of throwing - Pain is produced on resisted
flexion or pronation of the wrist.
Ulnar nerve symptoms due to proximity to medial epicondyle.
Treatment:
modify activities
physiotherapy and bracing
injections or surgery
Swellings around the elbow
3
• Olecranon bursitis
Mechanism- repeated minor trauma eg students leaning their elbows on the desk.
Serous fluid, soft, cystic (fluid-filled) and transilluminates (light can shine through it).
Treatments- compression bandage + aspiration.
Hydrocortisone injection
In septic bursitis -aspiration, compression, antibiotics, surgical drainage.
• Rheumatoid nodules
Mechanism- manifestation of RA
Risk factors - smokers
Complications- ulcerate and become infected
Treatment - control RA
• Gouty tophi
Mechanism - Tophi are nodular masses of monosodium urate crystals deposited in the soft tissues.
Can be in the olecranon bursa and the subcutaneous tissues of the elbow.
forming a sinus tract or a continuously draining ulcer.
Risk factor - untreated gout
Complication - pain, soft tissue damage and deformity, joint destruction and nerve compression.
Treatment- NSAIDS(acute), xanthine oxidase
inhibitors (reduce production of uric acid)
Cubital tunnel syndrome
Minor trauma to the ulnar nerve in the cubital tunnel (e.g. banging your elbow on the desk) causes a sharp transient pain and paraesthesia radiating from the elbow to the cutaneous ulnar nerve territory.
may also result in weakness in the muscles supplied by the ulnar nerve.
Decompress nerve - move it anterior.
Palpating pulses
The brachial pulse can be palpated in the cubital fossa, immediately medial to
the tendon of the biceps brachii. When measuring blood pressure, this is also
the location in which the stethoscope must be placed to hear the Korotkoff
sounds.
The radial pulse can be palpated at the wrist, immediately radial (lateral) to
the prominent tendon of the flexor carpi radialis muscle.
The ulnar pulse can also be palpated at the wrist, immediately radial (lateral)
to the tendon of flexor carpi ulnaris and proximal to the pisiform bone.
