Conditions Of the Elbow Flashcards
Supracondylar fracture of distal humerus cause, what, who, symptoms, complications, treatment
FOOSH from moderate height with elbow hyperextended <10yrs boys
Less common falling flexed elbow, elderly
Pain, deformity, loss of function, fracture line usually extra-articulate and distal fragment displaced posteriorly
Malunion -> cubits varus ‘gunstock deformity’, damage to median N most/ radial/ ulnar N, ischaemic contracture (brachial artery damaged/occluded -> oedema -> compartment syndrome -> infarction -> replaced by scar tissue which contracts -> Volkman’s ischaemic contracture (wrist/ interphalangeal/ elbow flexed, metacarpophalangeal extended, forearm prom tatted)
✅ any compromise to neurovascular supply emergency reduction and fixation of fracture
Dislocated elbow types, cause
FOOSH elbow partially flexed (stability reliant on ligaments)
> 90% posterior (displacement of distal fragment ulna and radius) distal end of humerus driven through joint capsule anteriorly, ulna collateral ligament usually torn, associated fracture and ulnar N damage
Anterior - direct blow to posterior flexed elbow, fractures of olecranon common
Pulled elbow what, causes, who, symptoms
‘Nurse aids elbow’ subluxation of radial head
Children 2-5yrs (as age annular ligament strengthens) reduced movement, pain lateral proximal forearm
Longitudinal traction forearm pronated (annular ligament more relaxed) -> tears distal attachment annular ligament -> radial head displaced dismally through torn ligament, fall, overreaching
Radial head and neck fractures cause, symptoms
FOOSH radial head impacts on capitellum of humerus
Pain lateral proximal forearm, loss range motion, swelling, fat pad sign (sail sign) effusion (haemarthrosis secondary to intra-articular fracture) caused displacement anterior fat pad appears black X-ray
Osteoarthritis of elbow who, symptoms
Uncommon, men, manual workers, athletes throwing, primary or secondary
Grating sensation (crepitus), locking (loose cartilage fragments), swelling late, osteophytes impinge ulnar N -> paraesthesia/ muscle weakness, stiffness, loss extension
X-ray 4 signs: loss of joint space, osteophytes, subchondral sclerosis, bone cysts
Rheumatoid arthritis cause, symptoms, who, treatment
Autoimmune autoantibodies (rheumatoid factor) attack synovial membrane -> inflamed synovial cells proliferate to form pannus which lent rates through cartilage/ adjacent bone -> joint erosion & deformity. Particularly mCPJ and PIPJ hands & feet & cervical spine
Damage other organs (eyes, skin, lungs, heart, blood vessels, kidneys) anaemia of chronic disease common
40-50yrs, juvenile form too, women
X-ray features: narrowing joint space, periarticular osteopenia, juxta-articular bing erosions (in non-cartilage protected bone), subluxation and gross deformity
✅ disease- modifying meds, severe surgery
Lateral elbow tendinopathy who, symptoms, cause, treatment
‘Tennis elbow’ 40-yrs tennis players, painters, plumbers
Pain common extensor tendon at lateral epicondylitis. Extensor carpi radialis muscle is weak from overuse -> microscopic tears tendon attaches to lateral epicondylitis -> inflammation and pain over lateral epicondyle during extension of wrist
✅activity modification, 90% recover within one year, physiotherapy, bracing, injections, surgery
Medial elbow tendinopathy who, where, symptoms
‘Golfer’s elbow’ golfing, throwing sports valgus stress
Common flexor origin at medial epicondyle, interface between pronator Teres and flexor carpi radialis origins.
Aching pain over medial elbow, associated acceleration phase throwing/ resisted flexion or pronation of wrist, some ulnar N symptoms
Olecranon bursitis what, cause, treatments
Inflammation of olecranon bursa between skin and olecranon process of ulna
Repeated microtrauma ‘student’s elbow’ serous fluid, soft, cystic, transilluminates OR septic bursitis ✅aspiration, compression, antibiotics, surgical drainage and washout
✅Compression bandaging, aspiration, hydrocortisone injection if chronic
Rheumatoid nodules who, complications, treatment
20% of ppl with rheumatoid arthritis, smokers, more prone to extra-articular manifestations (vasculitis, lung disease)
Over exposed regions subject to repeated micro trauma
Overlying skin can ulcerate and become infected
✅improving control rheumatoid arthritis
Gout cause and treatment
Gout- inflammatory defective purine metabolism -> increased Uris acid-> crystals of monosodium urate in synovial cavities joints/tendons/ surrounding tissue-> innate immune response-> acute inflammation ✅anti-inflammatories acute phase, xanthine oxidase inhibitors (allopurinol) reduced production Uric acid
Gouty tophi what, symptoms
Modular masses monosodium urate crystals deposited in soft tissues, late complication of hyperuricaemia, >50% untreated gout
Usually painless, pain, soft tissue damage, deformity, joint destruction, nerve compression
Fingers/ ears/ olecranon bursa/ subcutaneous tissue resemble rheumatoid nodules, white pasty material and work their way towards skin surface to drain (sinus tract or continuously draining ulcer)
Cubital tunnel syndrome what, symptoms, treatment, where
Compression of ulna nerve in cubital tunnel -> paraesthesia cutaneous territory, weakness muscles supplied
✅decompress nerve (surgically release and transpose it anterior to medial epicondyle)
UN passes being medial epicondyle of humerus, also passes under tendionous arch of two heads of flexor carpi ulnaris.
