Chapter 29 - The elbow

Question 1

Commonest cause of cubitus varus

Answer 1

Supracondylar fracture

Question 2

Commonest cause of cubitus valgus

Answer 2

Previous lateral condyle fracture

Question 3

Causes of fixed flexion deformity in the elbow

Answer 3

• Previous elbow fracture
• Synovitis
• Elbow arthritis

Question 4

What makes up the joint margin of the elbow joint

Answer 4

• Lateral epicondyle
• Tip of the olecranon
• radial head

Question 5

Typical history of lateral epicondylitis

Answer 5

• Pain sited at the lateral epicondyle and radiates down the extensor muscles
• Pain is aggravated on lifting objects such as a tea cup and with a hand shake

Question 6

Examination findings of lateral epicondylitis

Answer 6

• Tenderness over the lateral epicondyle
• Pain on resisted extension of the wrist with elbow extended and forearm pronated
• Pain on passive flexion of the wrist

Question 7

Treatment of lateral and medial epicondylitis

Answer 7

• Rest and NSAIDs
• Extension wrist brace in severe acute case
• Counterforce brace
• Injection with cortisone and local anaesthetic
• Physiotherapy
• Surgical release (less than 5 percent require this)
• Shock wave therapy?
• Injections of platelet derived growth factors?

Question 8

Typical history of medial epicondylitis

Answer 8

• Pain sited over the medial epicondyle and radiates down the forearm
• may be associated ulna nerve entrapment (symptoms of ulna neuritis

Question 9

Examination findings of medial epicondylitis

Answer 9

• Tender over the medial epicondyle
• pain on resisted flexion of the wrist with elbow extended and forearm supinated
• pain on passive extension of the wrist

Question 10

Where is the pain sited in biceps tendonitis

Answer 10

-Over the biceps tuberosity 2 cm distal to the cubital crease over the radius and radiated up the biceps and/or down the forearm

Question 11

Examination findings of biceps tendinitis

Answer 11

Tenderness of the biceps tuberosity
Positive yergason test
Positive Speed test

Question 12

Treatment of biceps and triceps tendinitis

Answer 12

• Rest and NSAIDs
• Injection with cortisone and local anaesthetic
• Physiotherapy

Question 13

Where is the pain sited in triceps tendinitis

Answer 13

Over the olecranon/ distal triceps

Question 14

Examination findings of triceps tendinitis

Answer 14

Tenderness over the olecranon tip

Pain on resisted extension of the elbow flexed

Question 15

Causes of olecranon bursitis

Answer 15

• Chronic irritation
• Inflammatory arthritis
• Gout
• Septic bursitis

Question 16

Treatment of olecranon bursitis

Answer 16

• Treat underlying cause
• Anti-inflammatories
• Compression bandage with tubigrip for three weeks
• Aspiration and cortisone injection if not septic
• Septic - treat with antibiotics
• Surgical excision if does not settle

Question 17

Examination findings of posterior olecranon impingement

Answer 17

• Slight loss of extension
• tenderness over the olecranon tip and fossa
• Pain on full extension
• No pain on resisted extension

Question 18

What may be seen on Xray in posterior olecranon impingement

Answer 18

small fracture or osteophyte of olecranon tip

Question 19

Types of arthritis in the elbow joint

Answer 19

• Infective: pyogenic, TB
• Inflammatory: RA, gout
• Post traumatic OA
• Degenerative OA

Question 20

Investigations for arthritis of the elbow

Answer 20

XRay
CT scan seldom necessary
MRI in selected cases
FBC, ESR, CRP and arthritis screen where indicated

Question 21

Treatment of infective arthritis of the elbow

Answer 21

• Washout/ debridement/ biopsy/ culture/ appropriate antibiotics

Question 22

Treatment of non- infective arthritis of the elbow

Answer 22

• NSAIDs/ Analgesics/ Intra-articular steroid
• Synovectomy
• Debridement- open/ arthroscopic
• Arthroplasty- interposition for younger patients
• Total elbow replacement
• Arthrodesis as last resort