Elbow Pain Flashcards
What is tennis elbow - give features.
Lateral epicondylitis
Pain and tenderness localised to the lateral epicondyle
Pain worse on resisted wrist extension with the elbow extended or supination of the forearm with the elbow extended
Episodes typically last between 6 months and 2 years. Patients tend to have acute pain for 6-12 weeks
What is golfers elbow?
Medial epicondylitis
Pain and tenderness localised to the medial epicondyle
Pain is aggravated by wrist flexion and pronation
Symptoms may be accompanied by numbness/tingling in the 4th/5th finger due to ulnar nerve involvement
What is radial tunnel syndrome?
Compression of the posterior interosseous branch of the radial nerve from overuse
Symptoms similar to lateral epicondylitisPain tends to be 4-5cm distal to the lateral epicondyle
Symptoms may be worsened by extending the elbow and pronating the forearm
What is cubital tunnel syndrome
Compression of the ulnar nerve
Intermittent tingling in the 4th and 5th finger
May be worse when elbow is resting on firm surface or flexed for extended periods
Later numbness in4th/5th fingers is associated with weakness
Olecranon bursitis
Swelling over posterior aspect of elbow - may be associated pain, warmth, erythema
Describe the olecranon
Proximal ulna from its tip to the corned process
Articulates with the trochlea of the distal humerus
Insertion site for triceps brachii
What causes olecranon fracture?
Indirect trauma when patients falls on outstretched arm resulting in sudden pull of the triceps muscle.
Triceps will act to further distract the fractures
In younger patients high energy injuries resulting from direct trauma can cause olecranon fracture.
How does olecranon fracture present?
Hx of falling on outstretched hand
Elbow pain, swelling and lack of mobility
OE, tenderness over posterior elbow with potential palpable defect
Inability to extend the elbow against gravity if disruption of triceps mechanism
NV status
Examine shoulder and wrist
What investigations for potential olecranon fracture?
Routine bloods, clotting screen, group and save
plain AP and lateral radiographs of affected joint, above and below
Usually a degree of displacement on plain radiograph due to pull of triceps
How to manage olecranon fracture?
A-E resus
Adequate analgesia
Non-operative indicated for displacement <2mm with immobilisation in 60-90 degrees elbow flexion and early introduction of range of motion at 1-2 weeks
Operative management if displacement >2mm requiring techniques such as tension band wiring (if fracture is proximal to coronoid process) or olecranon plain (if at level of or distal to the coronoid process
Describe the radial head
Proximal radius, articulates with he capitulum of the humerus and the proximal ulna
How do radial head fractures occur?
Indirect trauma with axial loading of the forearm causing the radial head to be pushed against the capitulum of the humerus, commonly occurring with the arm in extension and pronation.
How do radial head fractures present? What do you see on examination?
Hx of falling on outstretched hand followed by elbow pain - swelling and bruising at elbow
OE tenderness on palpation over lateral aspect of elbow and radial head with pain and crepitating on supination and pronation.
Elbow effusion or limited supination/pronation movements
What investigations for radial head fracture?
Routine bloods - clotting screen, group and save
Plain AP and lateral radiographs including joints above and below
Sail sign of elbow effusion in radial head fracture
CT for more complex injuries and comminution
How are radial head fractures classified?
Mason 1 - non-displaced or minimally displaced fracture (<2mm)
Mason 2 - Partial articular fracture with displacement >2mm or angulation
Mason 3 - comminuted fracture and displacement (complete articular fracture).
