ELBOW

Question 1

What are supracondylar fractures and how do they arise?

Answer 1

Common in kids; rare in adults

Cause: FOOSH with elbow in extension

Question 2

How do supracondylar fractures present?

What is present on examintion?

What should you be sure to examine?

Answer 2

Presentation: sudden-onset severe pain and reluctance to move the affected arm

Examination: signs of gross deformity, swelling, limited range of elbow movement, and ecchymosis of the anterior cubital fossa

Be sure to examine:

• median nerve, radial nerve, and the ulnar nerve
• Check the hand for features of vascular compromise, such as a cool temperature, pallor, delayed capillary refill time, or absent pulses

Question 3

What signs are visible on supra condylar fractueres?

Answer 3

• Ix: X-rays – AP and lateral elbow view
• Posterior fat pad sign - lucency visible on the lateral view -
• Displacement of the anterior humeral line

Question 4

How are supracondylar fractures managed?

Answer 4

• +Associated neurovascular compromise/ displaced: immediate closed reduction secured with K wire fixation
• Non displaced fracture: place the arm in a 90 degree flexion cast
• Kids: cast

Question 5

How does olecranon bursitis present?

Answer 5

• Prsentation: pain and swelling over the olecranon
• As the joint capsule is not involved, range of motion is preserved, with minimal discomfort

Question 6

How is olecrannon bursisits ixd?

How is it managed?

Answer 6

FBC and CRP. ? rheumatological causes may warrant further specialised tests; serum urate levels (gout), joint aspiration + MSU

Mx:

• analgesia (ideally NSAIDs) and rest, splinting of the elbow
• Patients can undergo a washout in theatre
• Infection may need antibiotic or surgical drainage
• Most cases will resolve spontaneously

Question 7

What is lateral epicondylitis?

What causes it?

Answer 7

• Chronic symptomatic inflammation of the forearm tendons at the elbow. Overuse syndrome caused by microtears in tendons following repetitive injury
• Cause: occupation and hobbies

Question 8

What muscles nerves are affected in each type of epicondylitis?

Answer 8

• Lateral epicondylitis – tennis – extensor – radial N – MORE COMMON
• Medial epicondylitis – Golfer – Flexors – Median N

Question 9

how does lateral epicondylitis present?

Answer 9

• Sx:
  
  • Pain on elbow which radiates down the forearm which worsened over week to months – typically affects dominant arm
• Examination: local tenderness on palpation over (or distal to) the lateral epicondyle and common extensor tendon.
• Possible reduced grip strength 2o to pain and full ROM

Question 10

How is lateral epicondylitis investigated and managed?

Answer 10

Special tests:

• Cozen
• Mills
• Ix: clinical, USS MRI
• Mx: Conservative: reduce repetitive actions and modify activity
  
  • 1st: Topical NSAIDs.
    
    • 2nd: corticosteroid injections 3-6 months. Physio
    • Surgery: if sx not controlled: open or arthroscopic debridement of tendinosis +/- release and repaid of damaged tendon

Question 11

How does a radial head fracture present?

Answer 11

• Tenderness on palpation over the lateral aspect of elbow and radial head,
• Pain and crepitation on supination and pronation.
• Other: elbow effusion or limited supination and pronation movements.

Question 12

How are radial head fractures Ixd and Mxd?

Answer 12

Ix: routine bloods: clotting + G+S

X ray: Plain AP and lateral – sail sign – elevation of anterior fat pad

Mx: analgesia, assess NV compromise

• Mason 1 – non operative mx – immobilise with sling for <1 week + early mobilisation
• Mechanical block: ORIF

Question 13

How do elbow dislocations arise?

How do they present?

Answer 13

• Following high energy fall
• Pain, deformity, swelling, reduced function.
• Complete neurovascular examination required - ulnar nerve susceptible to damage

Question 14

How are elbow dislocations investigated?

Answer 14

• Plain radiographs: AP and lateral. Radio-capitellar and ulnotrochlea congruence

Question 16

How are elbow fractures managed?

Answer 16

• Closed reduction + analgesia/ sedation.
• Above elbow backslab post reduction to keep elbow at 90
• If simple + no fracture: short immobilisation, early rehab
• Complication: operative fixation required + ORIF

Question 17

How do olecranon fractures arise?

Answer 17

Hx: FOOSH, elbow pain, lack of mobility, tenderness on palpation of posterior aspect of elbow. Inability to extend elbow. Check NVS

Question 18

How are olecranon fractures investigated?

Answer 18

Ix: bloods including clotting., G+s. X ray: plain AP and lateral

Question 19

How are olecranon fractures managed?

Answer 19

• Non operative – if displacement < 2mm
• If displacement > 2mm: operative – tension band wiring, olecranon plating