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Y1 - MSK > Common Elbow Conditions > Flashcards

Common Elbow Conditions Flashcards

1
Q

What does the capitulum articulate with?

A

Radius

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2
Q

What does the trochlea articulate with?

A

Ulna

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3
Q

Which bone moves in pronation and supination?

A

Radius rotates around the fixed ulna

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4
Q

In a normal elbow joint, if you draw a line down the anterior surface of the humerus and the middle of the radius where should the lines cross?

A

The capitulum

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5
Q

What type of membrane surrounds the joint capsule of the elbow?

A

Synovial membrane

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6
Q

What are the 3 ligaments of the elbow joint?

A

Radial collateral ligament
Ulnar collateral ligament
Annular ligament

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7
Q

What is the function of the Radial collateral ligament?

A

Resists force applied from the medial side

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8
Q

What is the function of the ulnar collateral ligament?

A

Resists force applied from the lateral side

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9
Q

What is the function of the Annular ligament?

A

Holds head of the radius in place

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10
Q

What are the general presentations of an elbow condition?

A

Pain
Swelling
Restriction of movement
Deformity

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11
Q

Where does the fracture usually take place in a supracondylar fracture?

A

Fracture line extra articular so doesn’t involve the joint
Above the condyles

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12
Q

In a supracondylar fracture, what direction is the distal fragment usually displaced?

A

Posteriorly

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13
Q

What sort of trauma leads to a supracondylar fracture?

A

Fall onto an outstretched hand (FOOSH) with arm normally EXTENDED

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14
Q

What nerves and blood vessels are at risk of damage from a supracondylar fracture?

A

Median nerve
Radial nerve
Brachial artery

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15
Q

What can happen as a result of a supracondylar fracture damaging the brachial artery?

A

Oedema (Compartment syndrome)
Ischaemia
Muscle infarction leading to Volkmann’s Ischaemic contracture

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16
Q

How does muscle infarction lead to Volkmann’s Ischaemic contracture?

A

Dead muscle tissue undergoes repair
Scar tissue replaces dead tissue via fibrosis
Myofibroblasts in fibrotic tissue contract

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17
Q

What branch of the median nerve is most at risk with a supracondylar fracture?

A

Anterior interosseous branch

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18
Q

How can injury to the brachial artery be assessed?

A

Detect capillary re-fill time, press on the nails and see how long it takes for them to go from white back to pink

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19
Q

What nerve is likely damaged if the patient cant make an OK sign with their fingers properly?

A

Anterior interosseous branch of median nerve

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20
Q

What the possible ways a supracondylar fracture can be managed?

A

Closed reduction and held in position with a plaster

Closed reduction and percutaneous pinning

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21
Q

What is a pulled elbow?

A

Subluxation of the radial head from the annular ligament

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22
Q

What is subluxation?

A

Partial dislocation of a joint with some abnormal apposition of the articulating surfaces

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23
Q

Why is subluxation of the radial head/pulled elbow common in children?

A

Annular ligament is weaker in children

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24
Q

How is subluxation of the radial head/pulled elbow normally caused?

A

Longitudinal traction with arm extended and forearm pronated

(Swinging a child around in circles)

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25
How is a pulled elbow/subluxation of the radial head treated?
Flex the elbow and supinate (REVERSE THE FORCES THAT CAUSED)
26
How are elbow dislocations usually caused?
Fall Onto Outs Stretched Hand (FOOSH) So arm in extension
27
What way is the elbow normally dislocated in a fall onto an outstretched hand?
Posterior and Lateral (Posterolateral)
28
Why are elbow dislocations more common when the joint is partially flexed?
Here elbow stability relies more on the ligaments When fully extended or flexed the bone configurations contribute to stability the most
29
What may be damaged as a result of an elbow dislocation?
Ulnar nerve Ulnar collateral ligament
30
How are dislocations described in terms of direction?
Depends on the displacement of the distal fragment So in an elbow dislocation the ulna and radius normally have moved posterior and laterally
31
How do you treat an elbow dislocation when theres no associated neurovascular damage?
Analgesics then reduce back into place
32
How do patients with radial head or neck fractures usually present?
Previous trauma Lateral elbow pain Restricted Range of Motion (especially on pronation/supination)
33
How may you detect a radial head or neck fracture on an X-ray?
Presence of fat pad/sail sign
34
What is a fat pad sign indicating a radial head fracture?
Darker denser region surrounding the elbow As a result of Haemarthosis, this pushes the fat out from the coracoid and olecranon fossa producing the darker region
35
What is haemarthrosis?
When blood is in the joint
36
How is a radial head or neck fracture treated if it minimally displaced?
Conservative management and early Range Of Motion exercises
37
Compare Osteoarthritis to Rheumatoid arthritis: When are they the worst and when do they get better?
Rheumatoid = Early morning joint stiffness improves with movement Osteoarthritis = Gets more painful as day goes on/ prolonged activities
38
Compare Osteoarthritis to Rheumatoid arthritis: What joints are affected?
RA = Symmetrical and poly articular OA = Starts Uniaterally and limited to one set of joints (fingers)
38
Compare Osteoarthritis to Rheumatoid arthritis: What joints are affected?
RA = Symmetrical and poly articular OA = Starts Uniaterally and limited to one set of joints (fingers)
39
Compare Osteoarthritis to Rheumatoid arthritis: Do you get systemic symptoms?
RA = Yes fatigue and malaise OA = None
40
What is Osteoarthrits?
Degenerative disease of articular cartilage, the progressive loss of cartilage leads to Bone on bone rubbing and pain with use
41
What is the Pneumonic for remembering how Osteroarthritis appears on an X-ray? What are the features of an osteoarthritic x-ray?
LOSS Loss of joint space Osteophytes Subchondral sclerosis Subchondral cysts
42
How is an osteoarthritic elbow treated?
Analgesia Intra-articular injections (only 2 or 3 times effective) Replacement of joint
43
What is Rheumatoid arthritis?
A systemic inflammatory diseases which can affect joints
44
What happens in Rheumatoid arthritis?
Autoimmune antibodies attack synovial membrane Inflamed synovial cells proliferate and form a pannus Pannus erodes and penetrates the cartilage and bone leading to joint deformity
45
What will be raised in the blood in an individual with Rheumatoid arthritis?
cRP Platelet potentially
46
Who are at an increased risk of RA?
Female 40-50yrs
47
What are some systemic features of elbow RA?
Malaise Fatigue Weight loss Low grade fever
48
What is the pneumonic used to remember the features of a Rheumatoidal arthritic x-ray?
LESS
49
What does the LESS mnemonic for Rheumatoid arthritis stand for?
Loss of joint space Erosions of bone Soft tissue swelling See through bones (osteopenia) near the joint space
50
With severe RA what may happen to the joints particularly at the fingers?
Subluxation of joints Metacarpophalangeal and proximal interphalangeal joints particularly affected so fingers start too deviate to ulnar side
51
What is Lateral Epicondylitis/tennis elbow?
Tendonopathy of the common extensor origin (particularly extensor carpi radialis brevis
52
What movement leads to the tendonopthy of the common extensor origin leading to lateral epicondylitis/tennis elbow?
Repetitive wrist extension and forearm pronation (BACKHAND IN TENNIS)
53
What can be examined in a patient with lateral epicondylitis /tennis elbow?
Pain in extensor origin on resisted wrist/finger extension when the elbow is fully extended
54
What 4 muscles originate on the common extensor origin (Lateral epicondyle)?
Extensor carpi radialis brevis Extensor carpi ulnaris Extensor digitorum Extensor digiti minimi
55
What is Medial Epicondylitis/golfers elbow?
Tendonopathy of the common flexor origin
56
What can cause medial epicondylitis/golfers elbow?
Micro trauma to the medial epicondyle caused by repetitive activities like wrist Flexion and forearm pronation Forceful grip Exposures to constant vibration at elbow
57
How do patients with medial epicondylitis/golfers elbow present?
Pain over medial epicondyle Pain with resisted forearm pronation and wrist Flexion
58
How is lateral epicondylitis/tennis elbow and medial epicondylitis/golfers elbow treated?
Physiotherapy Activity modification
59
What muscles originate at the common flexor origin?
Pronator Teres Flexor carpi radialis Palmaris longus Flexor carpi ulnaris Flexor digitorum superficialis
60
How can you remember the 4 superificial anterior forearm muscles?
Pass, Fail, Pass, Fail Thumb under medial epicondyle then palm with 4 fingers going across the top of the forearm Index = Pronator Teres Middle = Flexor carpi radialis Ring = Palmaris longus Little = Flexor carpi ulnaris
61
Compare Osteoarthritis to Rheumatoid arthritis: How fast is the onset?
RA = Rapid (weeks - months) OA = Many years
62
What drugs are used to treat Rheumatoid Arthritis?
DMARDs (Disease Modifying Anti-Rheumatic Drugs)
63
What is Olecranon Bursitis?
Inflammation of the bursa overlying the olecranon normally caused by friction
64
What is the alternate name to Olecranon Bursitis?
Students elbow
65
What is it called if a bursa has become infected?
Septic bursitis
66
What should happen if a light is shone onto a sterile olecranon bursitis? What about septic bursitis?
Light should shine through due to fluid just being serous fluid Not going to transluminate in septic bursitis
67
How is a sterile olecranon bursitis normally treated?
Normally sorts itself Very rarely drainage
68
How is a septic olecranon bursitis treated?
ANTIBIOTICS
69
What are rheumatoid nodules?
Hard nodules that are a common manifestation of extra-articular Rheumatoid Arthritis
70
How do rheumatoid nodules appear with a light shone on them? How are rheumatoid nodules treated?
Treat the Rheumatoid Arthritis (DMARDs) Possibly surgery (mainly a cosmetic problem)
71
What is gout?
Inflammatory condition caused by hyperuricaemia leads to deposition of mono sodium Urate crystals in the synovial cavity of joints Triggers innate immune response leading to acute inflammation of the joints
72
How is gout normally treated?
NSAIDs (Non steroidal anti inflammatory drugs)
73
What are gouty tophi?
When monosodium Urate (MSU) crystals are deposited into soft tissues like the skin and tendons White looking crystals
74
Once the high initial levels of uric acid in the blood have been treated, what prophylactic drug can be given to reduce production of uric acid and reduce the risk of gouty tophi?
Allopurinol or febuxostat
75
What is cubital tunnel syndrome?
When the ulna nerve in the cubital tunnel of the elbow gets compressed
76
How do you treat cubital tunnel syndrome?
Decompress the ulnar nerve in the cubital tunnel Splinting at 45º at night Analgesia Surgery
77
What does the overlying tendon of the roof of the cubital tunnel run between?
The 2 heads of flexor carpi ulnaris
78
What may a patient with Cubital tunnel syndrome present with?
Parasthesia (numbness and tingling) in the cutaneous territory of the ulnar nerve and maybe muscle weakness in muscles supplied by ulnar

Y1 - MSK (36 decks)

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