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Orthopaedic Surgery > Conditions Of The Elbow And Surgery > Flashcards

Conditions Of The Elbow And Surgery Flashcards

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1
Q

What is olecranon bursitis?

A

Inflammation + swelling of the olecaranon bursa

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2
Q

What can cause bursitis?

A
  • repetitive movements > friction
  • trauma
  • inflammatory conditions (gout or RA)
  • infection (septic bursitis)
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3
Q

Presentation of olecranon bursitis

A
  • pain + swelling over the alecranon
  • swollen, warm, tender, fluctuant
  • normal ROM
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4
Q

Investigations of olecranon bursitis

A
  • routine bloods
  • Rf if suggestion of rheumatolgoical cause
  • serum urate if suggestive of gout
  • X-ray to rule out bony injury
  • aspiration of fluid > microscopy + culture
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5
Q

What appearance could aspiration of bursa have?
What would this indicate?

A
  • pus: infection
  • straw coloured: infection less likely
  • blood strained: trauma, infection or inflammatory cause
  • milky: gout or pseudo gout
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6
Q

Management of olecranon bursitis

A
  • RICE
  • NSAIDs
  • protect elbow from pressure or trauma
  • aspiration of fluid
  • washout in theatre
  • if infected: abx *flucloxacillin first line + surgical drainage
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7
Q

What abx is first line in an infected bursa?

A

*flucloxacillin
clarithromycin if allergic

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8
Q

What could swelling on the elbow be?

A

Gouty tophi
Rheumatoid nodules
Olecranon bursitis

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9
Q

What is epicondylitis?

A

Inflammation at the point where the tendons of the forearm insert into the epicondyle at the elbow

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10
Q

Types of epicondylitis

A
  • Lateral epicondylitis - tennis elbow (more common)
  • Medial epicondylitis - Golfer’s elbow
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11
Q

Pathophysiology of epicondylitis

A

Repetitive overuse of the tendons can cause micro tears in the tendon at the origin > formation of granulation tissue, fibrosis + tendinosis

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12
Q

Outline lateral epicondylitis
Presentation
What are the special tests for it?

A
  • common extensor origin
  • tennis elbow
  • pain + tenderness at lateral epicondyle
  • worse on wrist extension + pronation
  • radiation down forearm > weakness in grip strength
  • Mill’s test + Cozen’s test
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13
Q

What are the special tests for lateral epicondylitis

A

Mill’s test
Cozen’s test

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14
Q

What is Mill’s test?
What is it used for?

A
  • pt lateral epicondyle is palpated by examiner whilst pronating the forearm, flexing the wrist + extending the elbow - arm out like a zombie
  • pain > positive test
  • lateral epicondylitis
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15
Q

What is Cozen’s test?
What is it used for?

A
  • pt elbow is flexed at 90
  • examiner places hand over lateral epicondyle
  • other hand holds patietns hand in radially deviated position with forearm pronated
  • pt extends wrist against resistance
  • like a swan neck
  • pain > positive test
  • lateral epicondylitis
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16
Q

Outline medial epicondylitis
Presentation
What test is used for it?

A
  • common flexor origin
  • golfer’s elbow
  • pain + tenderness at medial epicondyle
  • worse on wrist flexion + pronation
  • radiates down forearm > weakness in grip strength
  • golfer’s elbow test
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17
Q

What is golfer’s elbow test?
What is it used for?

A
  • stretching flexor muscles of forearm whilst palpating medial epicondyle
  • extension of elbow, wrist + fingers, with forearm pronated
  • pain > positive
  • medial epicondylitis
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18
Q

Management of epicondylitis

A
  • activity modifications
  • simple analgesia
  • Physiotherapy
  • corticosteroid injections
  • orthotics e.g. elbow braces or straps
  • open or arthroscopic debridement
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19
Q

What certain activities increase the risk of repetitive strain injuries?

A
  • vibrations e.g. power tools
  • awkward positions e.g. painting ceiling
  • small repetitive activities e.g. scrolling on phone
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20
Q

Management of repetitive strain injuries

A
  • RICE
  • activity adaptations
  • analgesia
  • Physiotherapy
  • steroid injections
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21
Q

Most common type of elbow dislocation

A

Posterior

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22
Q

What factors contribute to the stability of the elbow joint?

A
  • primary static stabilisers: humeroulnar joint capsule, medial + collateral ligaments
  • secondary static stabilisers: radiocapetellar joint + joint capsule, common flexor + extensor origin tendons
  • dynamic stabilisers: surrounding musculature
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23
Q

What should be suspected when a child has a deformed + painful elbow?

A

Supracondylar type fracture

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24
Q

Presentation of elbow dislocation

Study These Flashcards
A
  • painful + deformed joint
  • swelling
  • decreased function
  • ulnar nerve damage
25
Investigations of elbow dislocation
- X-ray AP + lateral - CT if associated fractures
26
X-ray findings of elbow dislocation
Loss of radiocapitellar + ulnartrochlea congruence
27
Managment of elbow dislocation
- closed reduction via in line traction or manipulation of olecranon - analgesia - above elbow backslab to keep elbow at 90 - repeat X-ray after reduction - short period of immobility then early rehabilitation - if fracture dislocation, open injury or NV compromise: ORIF
28
Complications of elbow dislocation
- early stiffness - stretching of ulnar nerve - recurrent instability
29
What is the terrible triad?
Elbow dislocation with: - lateral collateral ligament injury - radial head fracture - coronoid fracture
30
Management of terrible triad
Radial head ORIF Or Arthropalsty with LCL reconstruction + coronoid ORIF
31
Demographic of subluxation of radial head (pulled elbow)
Young children 2-5 due to weak annular ligament
32
Cause of subluxation of radial head
Longitudinal traction with extended arm + forearm pronated Causes radial head to sublux from annular ligament *parents swinging child by arms*
33
Management of subluxation of radial head
Analgesia Reverse the forces - flex elbow + supinate
34
What is the most common paediatric elbow fracture?
Supracondylar humeral fracture
35
Mechanism of supracondylar humeral fracture
FOOSH with elbow in extension
36
Presentation of supracondylar fracture
- young child - gross deformity - swelling - limited ROM secondary to pain - ecchymosis in anterior cubital fossa
37
Investigations of supracondylar fracture
- X-ray AP + lateral - CT imaging if comminuted - neurovascular exam
38
X-ray findings of supracondylar humeral fracture
- posterior fat pad sign - displacement of anteior humeral line
39
Classification of supracondylar fracture
**Gartland classification** - **type I**: undisplaced - **type II**: displaced with intact posterior cortex - **type III**: displaced in 2 or 3 planes - **type IV**: displaced with complete periosteal disruption
40
Management of supracondylar fracture
- immediate closed reduction - above elbow cast in 90 degrees flexion is undisplaced or minimally displaced - if displaced: **closed reduction + percutaneous K wire fixation** - open fracture: open reduction with percutaneous pinning
41
What structure is most at risk during surgery for supracondylar fracture?
Ulnar nerve
42
What nerve is most commonly damaged by supracondylar fracture?
Anterior interosseous nerve
43
Complications of supracondylar fractures
- damage to anterior interosseous nerve - damage to ulnar nerve post op - Malunion > cubitus varus deformity (gunstock deformity) - Volkmann’s ischaemic contracture
44
What deformity can occur due to Malunion of supracondylar fracture ?
Cubital varus deformity (Gunstock deformity)
45
What is the most common elbow fracture?
Radial head fractures
46
Pathophysiology of radial head fractures
- Via indirect trauma - axial loading of the forearm - casues the radial head to be pushed against the Capitulum of the humerus - most commonly when arm is extended + pronated FOOSH
47
Articulation of radial head
Capitulum of humerus Proximal ulnar
48
Presentation of radial head fractures
- tenderness on palpation over lateral aspect of elbow + radial head - pain + crepitation on supination + pronation - limited supination + pronation
49
Investigations of radial head fractures
- routine bloods incl clotting + G+S - AP + lateral X ray +/- joints above + below - CT if more complex - MRI if associated ligament injuries
50
Classification of radial head fractures
**Mason classification** - **type I**: non displaced or minimally displaced <2mm - **type II**: partial articular fracture + displacement >2mm or angulation - **type III**: comminuted fracture + displacement
51
Management of radial head fractures
- neurovascular exam - mason type 1: short period of immobilisation with sling > early mobilisation - mason type 2: ORIF - mason type 3: ORIF or raidal head excision or replacement
52
What is a Essex-Lopresti fracture?
Fracture of radial head with dislocation of radio-ulnar joint
53
Presentation of olecranon fracture
- history of FOOSH - elbow pain - swelling - lack of mobility - tenderness on posterior elbow - inability to extend elbow against gravity
54
Investigations of olecranon fractures
- routine bloods incl clotting, G+S - X-ray AP + lateral - CT if more complex
55
Classification of olecranon fractures
Mayo classification Schatzker classification
56
Management of olecranon fractures
- analgesia - displacement <2mm: immobilisation in 90 elbow flexion - displacement >2mm: tension band wiring or olecranon plating
57
What is cubital tunnel syndrome?
Compression of ulnar nerve in cubital tunnel between the two heads of flexor carpi ulnaris
58
Presentation of cubital tunnel syndrome
- numbness in ring + little finger - worse with elbow flexion + at night - hand pain
59
Treatment of cubital tunnel syndrome
- splinting at night 45 degrees - analgesia - nerve gliding exercises - adapting activities - elbow pad

Orthopaedic Surgery (10 decks)

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