elbow disorders Flashcards
what is a supracondylar fracture?
what is the common age?
common mechanism behind fracture?
what will they complain of?
what to look out for?
how to test ofr these?
a fracture of the distal humerus
children (5-7)
FOOSH - fall onto outstreatched hand - arm extended
pin, swelling, bruising, deformity
damage to median and radial nerve and brachial artery
median nerve = Ok sign and sense tip of index finger
radial nerve = thumbs up and dorsal web space
brachial artery = radial pulse and capillary refill time
how to manage a supracondylar fracture?
reduce - put back in position and plaster cast
closed reduction and percutaneous pinning - manipulate boen and add wires to hold in place
if there is nerve damage then surgery is needed
also if elblow is very deformed = surgery
what is sublaxtion of the radial head?
what ages does it commonly occur in and why?
what would the person present like?
what is the mechanism of injury?
treatment?
aka pulled elbow - when the radial head subluxes from the normal postion that the annular ligament holds it in
children below 5 as the radial head is still small and not fully grown
pain and not using elbow
longatudinal traction on a extended and pronated arm e.g. swinging child around
reverse the forces - flex elbow and supinate - should pop back in
what is the most common direction of elbow dislocation?
common mechanism of injury?
what do they present like?
what does longer time in dislocated position mean?
what to be aware of?
treat?
posterior and lateral
FOOSH
pain, deformity and loss of function
more damage to soft tissues e.g. ligamnets and capsule
neurovascular components
pop back in and have sling where arm is at 90 degrees + for 2weeks
what is an esaily missed fracture?
what would raise suspicion ?
what is mechanical blocking to movement?
what would you see on an X ray?
treatment?
radial head and neck fracture
trauma, lateral elbow pain, reduced ROM on pronation and supination
when something physical e.g. fragemnt of bone prevents movement at joint
fat pad/sail sign and blood bleeds into joint capsule and displaces the fat pad creating a darker circle rounf elbow
conervative management and ROM exercises
OA vs RA
what are DMARDS?
Disease-modifying antirheumatic drugs comprise a category of drugs for rheumatoid arthritis to slow down disease progression
what is elbow OA?
what is seen on Xray?
treatment?
degernerative diseaseof articular cartillage where bone rubs on bone
LOSS
analgaesia, intra articular steriodal or pain relief injections, replacement - elbow is used loads so will improve QoL
what is elbow RA?
who is mor affected?
common age?
what are common symptoms?
what is seen on Xray?
systemic inflammatory disease where auto antibodies attatck synovium within elbow - errodes cartillage and bone
women
40-50 years
mornign stiffness, fatigue, weightloss, low grade fever, all inflammtion signs
LESS - Loss of joint space, Erosion of bone, Soft tisseu swelling, See through bones (oetsopenia) - usually periarticualr
and sublaxation of joints - abnormal position e.g. metaphalageal joint deviates towards unlar
end point og both OA and RA?
joint replacement
what is lateral epicondylitis?
most common tendon effected?
what causes it?
who gets it?
how to treat?
when is pain felt?
tennis eblow - tendonopathy of tendons of the common extensor origin
extensor carpi radialis brevis
repetitive wrist extension and forarm pronation - back hand in tennis
age 35-50, tennis, heavy tool users, gripping and lifting tatsts e.g. barista
modify activities, physio - most recover within 1 year
reistsed finger and wrist extension with elbow flexed
what is medial epicondylitis?
what causes it?
who gets it?
when does pain get worse?
treatment?
golfers elbow - oppostite to tennis elbow
tendonopathy of tendons from common flexor origin
repetitive wrist flexsion and pronation
heavy lifting jobs, fircefuk grips, constant vibration of elbow
pain over medial epicondyle resisted wrist flexsion and pronation
same as tennis elbow - physio
what is olecranon bursitis?
common cause
what are the 2 types?
what is characteristic about the swelling?
treatment?
students elbow
inflammation of bursa overlying olecranon
friction
sterile or septic (when infected)
doesnt restrict movement as it is superficial to the joint, transilluminates if sterile, fluctuant swelling (can move if palpated)
spontaneous resolution if sterile, anribitotics if infected, dont drain often
what are rheumatoid nodules?
where are common sites?
how fast is the onset?
are they mobile?
how do they feel?
how to treat?
an extra artiular non boney manifestaion of rhuematoid arthiritis
fingers, forearms, elbow - can be anywhere
slow - unlike the fast bursitis onset
yes it is mobile as it its within the skin and its untethered
firm to touch and no transillumination (not like bursitis)
treat underlying cause - RA and it may resolve
surgery no common as its cosmetic issue bu t can get knocked nd irritated so then surgery
what is gouty tophi?
common sites?
how to treat?
a common manifestation of gout - it is when urate crystals are found in the skin due to hyperiricaemia
ear, elbow, fingers, achillies tendon - often have a white calcifed appearence
diet modificationa nd drugs to reduce uric acid in body
what is cubital tunnel syndrome?
where is the most common site?
what are the symptoms?
how to confirm diagnosis?
treatment?
compression of the ulna nerve in the cubital tunnel of the elbow (compressive neuropathy)
where the 2 heads of FCU are (Flexor Carpi Ulnaris tendon)
sensory chnages in ring and little fingers that progresses
later onset = loss of flexsion of ring anfd little finger (motor)
nerve conduction study - follow unla nerve and see where compression is
splint at 45 dgrees to take soft tissue stretch off ulna nerve, analgaesia, surgery
