Upper Limb Flashcards
What causes forearm fractures?
Direct or indirect trauma
What are the 3 main fracture patterns of a forearm fracture?
Galeazzi, Monteggia, Nightstick
What is a Galeazzi fracture?
Fracture over distal 3rd of radius
Dislocation of distal radioulnar joint
What is a Monteggia fracture?
Fracture of proximal third of ulna with dislocation of proximal head of radius
What is a Nightstick fracture?
Isolated ulna shaft fracture?
How do forearm fractures present?
Pain and swelling, loss of arm and hand function
Gross deformity
How are forearm fractures investigated and how are they managed?
X-ray- AP and lateral
Assessment of pulses and nerve fractures
Managed with casting or ORIF depending on severity
What causes elbow dislocation
FOOSH
What are the types of elbow fractures
Dependent on direction:
Posterior, anterior, lateral, medial, divergent
How do elbow fractures present
How are they managed and treated?
Pain and swelling over elbow
X-ray AP lat
Needs reduction, closed under sensation usually works (traction and pressure over olecranon)
2 weeks in sling with some rehab
What is an olecranon fracture and what causes it
olecranon= site of insertion of triceps tendon, responsible for elbow extension
Common when falling onto elbow
How does an olecranon fracture present and how is it investigated and managed?
Pain- well localised to posterior elbow
Displacement indicated by palpable defect
Inability to extend elbow (discontinuity of triceps mechanism)
X-ray- AP lat
Can be casted, or tension band wiring/ORIF plating if severe
What causes a supracondylar humeral fracture
FOOSH
Very common in children
How do supracondylar humeral fractures present?
Pain and refusal to move elbow
Gross deformity, swelling, Ecchymosis
Limited elbow motion
How are supracondylar humeral fractures investigated and how are they treated
What are the potential complications?
X-ray AP Lat-
Assess humerocapitellar alignment
Posterior fat pad sign- lucency on lateral view along posterior distal humerus and olecranon fossa suggests hidden fracture of elbow
Managed with casting or ORIF (pins) if needed
Can damage brachial artery and median nerve, causing long term damage if missed
What is lateral epicondylitis and what causes it?
Tennis elbow- repeat supination and pronation eg tennis players
Overuse injury of extensor carpi radialis brevis which originate in the lateral humeral epidcondyle
How does tennis elbow present?
Pain and tenderness over lateral epicondyle
Exacerbated with stretching muscles eg opening a jar
Only 10-20% are bilateral
How is tennis elbow investigated and managed?
Mainly clinical, can do USS and MRI if needed Nerve conduction studies if there are any nerve symptoms
Self limiting- treat conservatively. Can use steroid injections
Surgical release in recurring cases
What is medial epicondylitis?
Golfers elbow- repeat strain of flexor origin
Overuse of flexor tendons that originate in medial humeral epicondyle
How does golfers elbow present?
Medial elbow pain
Tender point over origin of flexors at medial epicondyle
Exacerbated by wrist flexion and pronation, and grasping
How is golfers elbow investigated and managed?
Mainly clinical, can do USS and MRI if needed Nerve conduction studies if there are any nerve symptoms
Self limiting- treat conservatively. Can use steroid injections
Surgical release in recurring cases
What is cubital tunnel syndrome?
Ulnar nerve compression at elbow- behind medial epicondyle
Who gets cubital tunnel syndrome, and what causes it?
More common in men
Over 30
Can be caused post trauma, by direct pressure, or arthritis
How does cubital tunnel syndrome present?
Parasthesia in ulnar two fingers
Pain, clumsiness
Numbness and weakness is late sign
Tinels test over cubital tunnel positive
Ulnar clawing of ring and small fingers
