Elbow articular conditions Flashcards
Elbow arthritis OCD of elbow little league elbow olecranon stress fx elbow stffness and contractures
1
Q
Describe the epidemiology of elbow arthritis?
A
- M 4:1 F
- Middel ages labourers
- assoc with dominant hand
- pathophysiology
-
RA
- most prevalent form 50% pt affected
- post-trauamtic arthritis
-
primary OA
- rare
- common middle aged labourers
- HIstory of osteochondritis dissecans
- MUCL or ligmanetous insuffuciency
-
RA
2
Q
Name the stabilisers of the elbow?
A
Primary static
- anterior band of MCL
- Coronoid
- Lateral ulna collateral lig
Secondary stabilisers
- Radial head- valgus stability
- Capsule- full extension
- LCL, aconeus, lateral capsule- varus force
- Aconeus- varus force
3
Q
What is the presentaiton of elbow arthritis?
A
- Porgressive pain
- loss of terminal extension
- painful lock of elbow
O/E
- Loss of elbow rom
- ligamentous incompetence seen -esp RA
- Ulna neuropathy
4
Q
What is seen on imaging of elbow arthritis?
A
- Xray
- elbow joint space narrowing
- osteophytes found at
- coronoid porcess and fossa
- olecranon tip and posteromedial olecranon fossa
- loose bodies
- Ct scan
- can help better define osteophytes/ loose bodies
5
Q
How is elbow arthritis treated
A
Non operative
- Nsaids, cortisone injections, resting splints, activity modificiation
- mild -mod symptoms
Operative
-
Arthroscopic debridement & capsular release
- mild disease with bone spurs
-
Ulnohumeral distraction interposition arhropplasty
- pt v limited rom 60-100 should unergo ulnar n decompression
-
Olecranon fossa debridment-Outerbridge- Kashiwagi procedure
- young pt with reduced rom
- blurr hole thru olecranon fossa
- remove osteophytes/arthritic bone
- increased rom
-
Total elbow arthoplasty
- older pt >65 yrs w severe arthritis
-
unconstrained TEA
- used with competent elbow ligaments w adequate bone stock
-
contrained TEA
- ussed with incompetent elbow ligaments
6
Q
What is this?
A
- Unconstrained TEA
- unlinked
- e.g. Ewarld capitella
- requires competent collateral ligaments & bone quality
- instability is the most common complx
7
Q
What is this?
A
- A Constrained linked total elbow replacement
- e.g. Coonrad Moorey
8
Q
What are the indications for a TEA?
A
-
RA
- highest surviorship
- for pain. loss of motion, instability
-
Primary OA
- pt >65 yrs
- posttraumatic OA ( advanced)
-
Fx
- complex intra-articular
- Chronic instability
9
Q
what are the contraindications for TEA?
A
- Absolute
- infection
- Charcot joint
- Relative
- poor neurological control of affected limb
- active pt <65 yrs
10
Q
Describe the technique for TEA?
A
- Triceps splitting approach or posterior sparing approach
- usually preform ulnar transposition
- radial head resection common
- http://www.orthobullets.com/video/view?id=781
post op
- life long weight lifting restriction of 10 lbs
11
Q
What are the outcomes of TEA in RA and post-traumatic arthritis?
A
- RA
- 10 yr surviorship 92.4%
- v high complx rate
- triceps avulsion
- deep infection
- periprsothetic fx
- aseptic loosening
- Post traumatic
- 5 yr surviorship
- most achieve funational rom adn pt satisfaction
- High compx rate 27-43%
- High reop rate 25%
- 5 yr surviorship
12
Q
Discuss the complx of TEA?
A
- Aseptc loosening
-
infection 8%
- acute- serial irrigation/debridment/antib
- chronic- 2 stage reimplantation
- Instability
- Bushing wear- notice varus/valgus angle on AP >10 degree is a concern
- wound healing
- ulnar neuropathy
- triceps insufficiency
13
Q
What is osteochondritis dissicans of elbow?
A
- localised injury of articular cartilage and chondral bone of the capitellum
- usally occirs after 10 yrs
- typically in capitellum in dominant arm
- risk factors
- repetitive overhead activities- gymnastics/throwers
- pathology
- repeititve compression of imature capetillum
14
Q
Name any assoc condition with osteochondritis dissicans of elbow?
A
-
Panner disease
- pesent similar symptoms but in 1st decade of life
- self limiting condition
15
Q
What is the presentation of osteochondritis dissicans of elbow?
A
- elbow pain
- insidious
- locking/clicking
- tenderness over elbow
- loss of motion
18
Q
What is an olecranon stress fx?
A
- A rare injury that effects throwing athletes
- predominantly involves eiphyseal plate
- fx line ay be transverse/oblique
- pathology
- olecranon posteriomedial impingment
- triceps tractio force
- valgus extension overload
- assoc injuries: Ulnar collat lig tears, medial epicondyle avulsion fx
- PC: posteriomedial pain on throwing arm
- Tx- non op- nsaids, rest +temporary splinting 4-6 wks
- operative if delayed fx union- large compression screw
