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MSK (Clinical Conditions) -MIMI > Elbow > Flashcards

Elbow Flashcards

1
Q

Suparcondylar fracture of the dsital humerus mechaism

A

falling form height onto outstreached arm with elbow hyperextended

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2
Q

most common age people get supracondylar fractures

A

children

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3
Q

what is a less common mechaism of obtaining a supracondylar fracture of the distal hymerus

A

falling onto a flexed elbow - seen in elderly

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4
Q

in supracondylar fractures the distal fragment is usually displaced anteriorly or posteriorly

A

Posteriorly

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5
Q

3 main complications with supracondylar fracture

A

Malunion
Nerve Damage
Volkmann’s ischaemic contracure

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6
Q

malunion of the distal humerus results in

A

Cubitus Varus - gunstick defomity

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7
Q

Which nerves can be damnaged in a supracondylar fracture

A

Median nerve is most common, radial nerve and ulnar nerve

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8
Q

Volksmann’s ischamic contracture

A

Brachial artery damanged
ischemia of muscles in anterior compartment of forearm
odema
increase in compartment pressure (conpartment syndrome) - making ischemia worse
during repair dead muscle replaced by scar tissue through fibrosis
sibrotic tissue contracts - resulting in flexion contracture

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9
Q

Volksmann’s ischamic contracture the fingers are extended at what joint

A

metacarpophlngeal joint

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10
Q

treatment is volksmann’s ischamia

A

emeregency reduction and fixation of the fracture

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11
Q

Mechaism of elbow dislocation

A

fall on outstretched arm slightly flexed

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12
Q

why id elbow dsilaction more likely to occur mis flexion and extention

A

as stablilty of the elbow is more reliant on ligament during this period

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13
Q

90% of elbow dislocation’s are ..

remember elbow disolactions are named as the distal fragment e.g the radius and the ulnar

A

posterior

i.e the distl end of the humerus is driven through the joint capsule anteriorly

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14
Q

common ligament to tear in elbow dislocation

A

ulnar collateral ligament

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15
Q

Anterior dislocation’s (10%) mechanism

A

direct blow to the posterior aspect of a flexed elbow

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16
Q

associated fractures scenes with anterior dislocation and why?

A

Fracture of the olecranon

due to the degree of force required to dislocate the joint

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17
Q

Pulled elbow (nursemaids elbow)

A

Subluxation of the radial head

subluxation = partical disruption of a joint with some remaining but abnormal apposition of the articular surface

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18
Q

Children aged 2-5 present with pulled elbow how do they present

A

reduced movement of elbow

pain over the lateral aspect of proximal forearm

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19
Q

common mechanism of pulled elbow

A

longitudinal traction is applied to the arm with forearm pronated
(tugging an uncoopertive child or swinging a child by their arms during play)

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20
Q

why does pulled elbow occur in pronation

A

annular ligament is relaxed in pronation - easier for sublaxion to occur

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21
Q

pulled elbow how it occures

A

longitudinal traction on the radial head tears the distal attachment of annular ligament from radius.
radial head is then displaced dsially through the torn ligament

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22
Q

radial head and neck fractures mechaniim of injury

A

fall on a outstrahced hand when the raidal head impacts the capitellum of the humerus

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23
Q

radial head and neck fracture how paients present

A

pain in lateral aspect of their proximal forearm

loss of range of movement

24
Q

radial head and neck fractures on X-ray

A

difficult of see, however a fat pad sign indicates and effusion is present.
sail sign - caused by the displacement of the anterior fat pad is radio-lucent and therefore appears black on the X-ray

25
Q

Osteoarthrits of the elbow how common is it

A

uncommon because of the well-matched joint surface and strong stabilising ligaments. elbow can tolerate large forces without becoming unstable so less wear and tear with age

26
Q

who presents more with osteoarthirsis of the shoulder

A

men: women 4:1

manual workers athlets who throw things in sports

27
Q

what does patents report with OA of the elbow

A

grating sensation
locking
swelling occurs later due to effusion
ostephytes can impinge ulnar nerve causing paraetheis and muscle weakness

28
Q

Rheumatoid Arthritis basics

A

autoimmune disease in which autoantibodies known as rheumatoid factor, attack the synovial membrane, leading to inflammation which penetrates through the artilage and adjacent bone, leading to joint erosion and deformity

29
Q

X-ray features of rheumatoid arthritus

A

joint space narrowing
sofe tissue sweeling
marginal boney erosions
sublaxation and gross deformity

30
Q

How to manage Rheumatoid Arthritis

A

managed medically rather than surgically

31
Q

Lateral elbow tendinopathy is AKA

A

tennis elbow

32
Q

Lateral elbow tendinopathy

A

pain due to tendionpathy of the common extensor tendon at the lateral epicondyle (common extensor origin)
Extensor carpi radialis brevis muscle - helps stabilise wrist when elbow is stright

33
Q

Lateral elbow tendinopathy patients present with

A

pain over the lateral epicondyle during extension of the writst

34
Q

Medial elbow tendinopathy AKA

A

golfers elbow

35
Q

Meical elbow tendinopathy effects

A

common flexor origin at the medial epicondyle

36
Q

Medial elbow tendinopathy muscles effects

A

interface between the protantor teres and the flexor carpi radialis origins

37
Q

How patients present with medial elbow tendinopathy

A

aching pain over the medial elbow

psin produced on resisted flexion or pronation of the wrist

38
Q

3 common causes of swelling around the elbow

A

> olecranon bursitis
rheumatoid nodules
gouty tophi

39
Q

olecranon bursitis AKA

A

students bursitis

40
Q

olecranon bursi is located where

A

between the skin and the olecranon process of the ulna

41
Q

Treatment of olecranono bursitis

A

treaemtn is conservative with compression bandaging with or without aspiration.

42
Q

how would you treat chronic olecranono bursitis

A

hydrocortisone injection

43
Q

how to treat septic bursitis

A

asprition, compression and antibiotics are required

44
Q

rheumatoid nodules

A

seen in 20% of rheumatoid arthritis a

usually non tender although the overlying skin can occasionally ulcerate and become infected

45
Q

What is Gout

A

gout is an inflammatory condition resulting from defective purine metabolism leading to an increased producion of uric acid. As the uric acid concentrstion increases in the blood, supersaturation and precipitation occures, forming crystals on monosodium urrate in the synovial cavity of joints, in tendons and in the surrounding tissues

46
Q

How to treat gout

A

anti-inflammatories for acute phase
Xanthine oxidase inhibitors such as allopurionol (purine analogue) can then be prescribed to reduce the production of uric acid and reduce the rick of further attacks

47
Q

gout Trophi

A

nodular masses of monosodium urate crytals deposited in the soft tissue
late complication of hyperuricaemia

48
Q

complactions of gout

A

pain, soft tissue damange and deformity, joint destruction and nerve compression

49
Q

most common sites of gout trophi

A

fingers and ears
trohi can be found fin olecranon bursa and the cubcutaneous tissues of the elbow where they can resemble rheumatoid nodules in appearance. they work there way towards the skin surface to drain, either forming a sinus tract or a continuously draining ulcer

50
Q

Cubital tunnel syndrome which nerve does it effect

A

the ulnar nerve passes behind the medial epicondyle of the humerus to enter the forearm. lies in cubital tunnel

51
Q

cuital tunnel sydrome borders

A

ulnar nerve passes beneath this tendinous arch to entre the cubital tunnel. forms a common site for ulnar nerve compression

52
Q

What does the tendionous arch join

A

the two heads of the flexor carpi ulnaris muscle

53
Q

where do the two heads of the flexor carpi ulnarisi muscle originate from

A

common flxor origin on the medial epicondyle

second medial margin of the olecranon

54
Q

what is hitting your funny bone

A

minor trauma to the ulnar nerve in the cubital tunnel, shape transient pain radiating from the elbow to the cutaneous ulnar nerve territory.

55
Q

compression of the ulnar nerve in cubital tunnel may result in

A

paraesthesia in cutaneous territories of the ulnar nerve
weakness in muscle supplied by the ulnar nerve
treatment is to decompress the nerve

MSK (Clinical Conditions) -MIMI (7 decks)

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