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Trauma + Orthopaedics > 2: Joint Disorders Of The Elbow > Flashcards

2: Joint Disorders Of The Elbow Flashcards

1
Q

What is the most common cause of medial epicondyle pain

A

Medial epicondylitis

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2
Q

What is medial epicondylitis also known as

A

Golfer’s Elbow

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3
Q

What age is the peak incidence of medial epicondylitis

A

30-40y

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4
Q

What causes medial epicondylitis

A

Repetitive use of the fore-arm flexors

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5
Q

How will medial epicondylitis present clinically

A
  • Pain on flexion of the fore-arm
  • Tenderness over the medial epicondyle
  • Potentially parasthesia of 4+5th finger (ulna.N)
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6
Q

What muscles originate at the medial epicondyle

A

Pronator teres and fore-arm flexors

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7
Q

Explain the pathophysiology of medial epicondylitis

A

Repetitive use of fore-arm flexors leads to micro-trauma and subsequent inflammation.

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8
Q

How is medial epicondylitis managed

A

Conservatively:

  • Brace/Strap
  • NSAIDs
  • Ice
  • Rest
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9
Q

When is surgery for medial epicondylitis indicated

A

Refractory to medial treatment for 6-12m and severely impacting QOL

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10
Q

What surgery can be offered for medial epicondylitis

A

Open debridement and excision of under surface of pronator mass

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11
Q

What is lateral epicondylitis also referred to as

A

tennis elbow

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12
Q

What is a good mnemonic to remember lateral epicondylitis

A

LET

Lateral epicondylitis
Extensors
Tennis elbow

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13
Q

What causes lateral epicondylitis

A

Repetitive use of fore-arm extensors

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14
Q

What is a risk factor for lateral epicondylitis

A

tennis

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15
Q

How will lateral epicondylitis present

A
  • pain on gripping
  • reduced grip strength
  • pain on forearm extension
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16
Q

Which muscle in particular often leads to tennis elbow

A

extensor carpi radialis brevis

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17
Q

How is tennis elbow diagnosed

A

clinically

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18
Q

What is first-line management for lateral epicondylitis

A

Conservative:

  • NSAIDs
  • Rest
  • Ice
  • Strap/Brace
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19
Q

What is second line for lateral epicondylitis

A

Open debridement of extensor carpi radialis brevis (ERCB)

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20
Q

When is surgical debridement of extensor carpi radialis brevis indicated

A

If symptoms persist 6-12m following and impact QOL

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21
Q

What is olecranon bursitis also referred to as

A

Student’s elbow

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22
Q

What is olecranon bursitis

A

Inflammation of bursa surrounding the elbow

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23
Q

What is the typical demographic of olecranon bursitis

A

Middle-aged male patients

24
Q

What causes olecranon bursitis

A

Continual pressure on the elbow. Eg. due to occupation or trauma

25
Q

What are two risk factors for olecranon bursitis

A
  • Gout

- Rheumatoid arthritis

26
Q

How will olecranon bursitis present

A
  • Swelling over posterior aspect of the elbow
  • Pain
  • Warmth and erythema
27
Q

What investigations are performed for olecranon bursitis

A

Clinical diagnosis.

If septic arthritis is suspected, take an aspirate

28
Q

What is first-line management of olecranon bursitis

A

Conservative:

  • Rest
  • Ice
  • Compression bandaging
  • Analgesia
29
Q

If olecranon bursitis is large and painful, what may be performed

A

Aspiration

30
Q

What should be prescribed if septic bursitis is suspected

A

Flucloxacillin

31
Q

What is a complication of olecranon bursitis

A

Abscess formation (septic bursitis)

32
Q

What is cubital tunnel syndrome

A

entrapment of the ulna nerve at the elbow

33
Q

If the ulna nerve is trapped at the following what is it termed

a. wrist
b. elbow

A

a. Guyon’s canal syndrome

b. Cubital tunnel syndrome

34
Q

What can cause cubital tunnel syndrome

A
  • Prolonged elbow flexion
  • Medial epicondyle fracture
  • Non-union of medial epicondyle
  • Diabetes
35
Q

What are 3 situations may there be prolonged elbow flexion

A
  • Leaning on a desk
  • Post-surgical operation
  • Athletes
36
Q

Where will individual with cubital tunnel syndrome feel pain

A

Referred pain to the forearm

37
Q

What are the 3 motor signs of ulna nerve damage

A
  1. Claw hand
  2. Wartenberg sign
  3. Froment sign
38
Q

What is ulna claw hand

A

There is loss of flexion at the MCP and extension at the PIPs

39
Q

What is wartenberg sign

A

Persistent abduction of the little finger caused by weak third interoessi muscle

40
Q

What is froment sign

A

Thumb flexes when pinching a piece of paper to compensate for a weak abductor polices muscle

41
Q

How is sensation affected in cubital tunnel syndrome

A

parasthesia or loss of sensation over 5th and half of 4th finger

42
Q

How can sensory deficits in cubital tunnel syndrome be tested for

A

parasthesia when tapping over the medial epicondyle

43
Q

Which cord of the brachial plexus is the ulna nerve derived from

A

Medial cord (C8-T1)

44
Q

Explain the passage of the ulna nerve into the wrist

A
  • Ulna.N arises from the medial cord
  • It passes the medial epicondyle between the heads of the flexor carpi ulnaris
  • It passes into the wrist via Guyon’s canal
45
Q

What 5 muscles does the ulna nerve innervate

A
  • 3rd and 4th Interoessi
  • Lumbricals
  • Flexor carpi ulnaris
  • Adductor polices
  • Abductor digiti minimi
46
Q

What is the action of the third and 4th lumbricals

A
  • Flex at the MCP

- Extend at the PIPs

47
Q

What is the function of adductor policies

A

Adducts the thumb

48
Q

What is the function of abductor policies

A

Abducts the thumb

49
Q

What is the function of abductor digiti minimi

A

Abducts the little finger

50
Q

What is the action of interoessi muscle

A

Finger abduction and adduction

51
Q

Explain the ulna paradox

A
  • Ulna nerve innervates half of the flexor digitorum profundus
  • If the Ulna is injured more proximal (cubital tunnel.s) it looses it’s innervation
  • Loss of FDP weakens flexion at the PIP. Meaning patient only presents with extension at the MCP joints
  • The hand therefore presents less claw-like (and therefore less severe) despite being a more severe injury
52
Q

What is first-line investigation for suspected cubital tunnel syndrome

A

Electromyography (EMG)

53
Q

What is first-line management for cubital tunnel syndrome

A

Conservative:

  • NSAIDs
  • Behaviour modification
  • Night bracing
54
Q

What is second-line management for cubital tunnel syndrome

A

Surgery

55
Q

What surgeries can be performed for cubital tunnel syndrome

A
  1. Surgical decompression

2. Medial epicondylectomy

Trauma + Orthopaedics (11 decks)

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