Session 9 Clinical Flashcards

1
Q

What comprise up to 75% of all elbow injuries

A

Supracondylar fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most common mechanism of supracondylar fracture

A

Falling from moderate height onto outstretched hand with elbow hyperextended

Presents with pain, deformity and loss of function

Fracture line is usually extra-articular (joint not involved) distal fragment displaced posteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

3 main complications of supracondylar fracture

A

Malunion resulting in cubitus varus gunstock deformity)

Damage to median nerve, or radial or ulnar nerve

(Volkmann’s) Ischaemic contracture (brachial artery) or compartment syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Usual mechanism of dislocated elbow

A

Fall onto outstretched hand with elbow partially flexed

Usually posterior (displacement of distal fragment- radius and ulna, is posterior)

Distal end of humerus driven through joint capsule anteriorly, ulnar collateral ligament usually torn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Mechanism of anterior dislocation of elbow

A

Direct blow to posterior of a flexed elbow

Often with associated fractures of the olecranon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is pulled elbow/nursemaids elbow

A

Subluxation of the radial head (incomplete dislocation)

Children 2-5

Reduced movement of elbow and pain over lateral aspect of proximal forearm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Classic mechanism of pulled elbow

A

Longitudinal traction with forearm pronated (annular ligament torn as weak in kiddies)

Falls or over-reaching for an object

Most commonly in pronation as annular ligament is relaxed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Mechanism of radial head and neck fractures

A

Fall on outstretched hand when radial head impacts on the capitellum of humerus

Pain in lateral aspect of proximal forearm and loss of ROM

Modest swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Radial head and neck fracture x ray

A

Difficult to see
Fat pad sign/sail sign indicates an effusion is present
Likely due to haemarthrosis secondary to an intra-articular fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Features of OA of elbow

A

Uncommon
More common in men - manual workers or athletes
Crepitus and locking
Osteophytes can impinge on ulnar nerve and cause Parasthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

RA basic principles

A

Autoantibodies known as rheumatoid factor attack the synovial membrane

Inflamed synovial cells proliferate to form a pannus

This penetrated through the cartilage and adjacent bone leading to joint erosion and deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

RA particularly affects

A

MCPJ and PIPJ of hands, feet and cervical spine

Autoimmune process leads to damage to other organs and anaemia of chronic disease

Women more affected by men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

X ray features of RA

A

Joint space narrowing
Periarticular osteopenia
Juxta-articular (marginal) bony erosions (in non-cartilage protected bone)
Subluxation and gross deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Management of RA

A

Medically- prescription of disease modifying medication

Can have surgery for joint replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is lateral elbow tendinopathy/tennis elbow

A

Chronic over use
Pain at site of common extensor origin at lateral epicondyle
Extensor carpi radialis brevis weakened from overuse
Microscopic tears form
Inflammation and pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Typical LET presentation

A

Pain over lateral epicondyle during extension

Tennis players, painters, plumbers and carpenters

17
Q

LET treatment

A

Asked to modify activity, can have physio or bracing, or injections and surgery

18
Q

What is medial elbow tendinopathy (golfers elbow)

A

Less common than LET
Affects common flexor origin at medial epicondyle
Associated with sports that place valgus stress on the elbow

Most common site of pathology is interface between Pronator teres and flexor carpi radialis

19
Q

MET presentation

A

Aching pain over medial elbow,
Often noticed during acceleration phase of throwing
Pain produced on resisted flexion or pronation

Can have ulnar nerve symptoms

20
Q

MET treatment

A

Usually activity mods

Same as LET

21
Q

3 common causes of swelling around the elbow

A

Olecranon bursitis
Rheumatoid nodules
Gouty tophi

22
Q

What is olecranon bursitis (students elbow)

A

Inflammation of olecranon bursa
Situated between the skin and olecranon process of ulna
Due to repeated minor trauma
Contents will be serous fluid

23
Q

Olecranon bursitis presentation and treatment

A

Usually present due to cosmetic concern

Conservative with compression bandaging and aspiration

Hydrocortisone injection is sometimes needed

Can be a result of infection in which case aspiration, compression and antibiotics are needed and maybe even surgical drainage and washout

24
Q

What are rheumatoid nodules

A

Commonest extra-articular manifestation of RA

Tend to be smokers or have more aggressive joint disease

Occur over exposed regions subject to repeated minor trauma

Usually non tender although overlying skin can ulcerate and become infected

25
Presentation and treatment of Rheumatoid nodules
Present due to cosmetic concerns Improve medial control of RA Response variable
26
What is gout
Inflammatory condition Defective purine metabolism Increased Uric acid Crystals form in cavity of joints, tendons and tissues Urate crystals trigger immune response and lead to acute inflammation
27
Gout treatment
NSAIDs in actue Xanthine oxidase inhibitors such as allopurinol can be prescribed to reduce production or uric acid and reduce risk of future attacks
28
What does gout increase risk of
Secondary OA due to damage of articular cartilage
29
What are tophi
Nodular masses of mono sodium urate crystals deposited in soft tissues Late complication of hyperuricaemia Contain white pasty material and as they enlarge work their way towards skin surface to drain either forming sinus tract or continuously draining ulcer
30
Complications of gouty tophi
Pain, soft tissue damage, deformity, joint destruction and nerve compression
31
Most common site of tophi
Fingers and ears Olecranon bursa and subcutaneous tissues of elbow Can resemble rheumatoid nodules
32
What is cubital tunnel syndrome
Ulnar nerve passes behind medial epicondyle of the humerus to enter the forearm Common site for ulnar nerve compression- two heads of flexor carpi ulnaris unified by tendinous arch (ulnar nerve passes beneath)
33
What happens when you capture funny bone
Minor trauma to ulnar nerve in cubital tunnel
34
Result of compression of ulnar nerve in cubital tunnel
Parasthesia in cutaneous territory of ulnar nerve Weakness in muscles Treatment is to decompress the nerve (surgically release it and transpose it anterior to medial epicondyle)