Elbow Problems.

Transcription

1 Elbow Problems

2 Anatomy Hinged joint formed by humerus and ulna produces flexion and extension Rotation producing pronation and supination from radial head and humerus

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4 Assessment History/Mechanism of injury Examination LOOK FEEL MOVE X-ray?

5 Most common injuries Supra-condylar fracture Radial head fracture Olecranon fracture Dislocation Fracture dislocation

6 Supra-condylar fracture Usually from fall onto elbow when flexed More common in children Often displaced/angulated Generally swollen restricted movement Look for complications

7 Supra-condylar fracture Complications vascular complications: brachial artey Volkmann s ischaemic contracture median nerve palsy Management some may require manipulation if displaced arterial obstruction off-ending of fracture <50% bony contact Long arm plaster fixation

8 Radial head fractures Fall onto outstretched hand Female>male 20% all elbow injuries Associated with 10% dislocations

9 Signs and symptoms Pain on outside of elbow Swelling in elbow joint Unable to fully flex or extend Pain pronation/supinatio n

10 Fracture radial head Fracture may not be visible on initial x-x rays- look for effusions Type 1 fractures undisplced treated with collar and cuff Type 2 fractures slghtly displaced treated conservatively may require surgery if large pieces Type 3 fractures comminuted causes poor healing may require excision radial head/prothesis

11 Fracture over olecranon Mechanism -fall on point of elbow -sudden triceps contraction Don t t forget epiphyses

12 Olecranon fractures Hairline and undisplaced fractures can be treated in long arm cast for 3-43 weeks in children and 6-88 weeks in adults If fragment large/displaced will require fixation e.g. tension band wiring

13 Elbow dislocation Usually fall onto outstretched hand Severe pain at elbow and swelling Minimal movement Check sensation/pulses

14 Dislocation of elbow Posterior lateral dislocation reduction by traction in line of the limb under analgesia and sedation Check x-rayx Crepe bandages and sling 2 weeks Fracture clinic

15 Elbow Dislocations BEWARE ASSOCIATED FRACTURES BEWARE COMPLICATIONS Median nerve injury Ulna nerve injury Brachial artery injury

16 Complications Complications damage to Ulnar nerve Median nerve Brachial artery uncommon

17 Median Nerve Injury Occasionally damaged in supracondylar fractures More commonly in wrist lacerations Produces loss of sensation as shown High injuries produce decreased strength in wrist flexion, loss ofulna deviation and thumb opposition

18 Ulna nerve injuries Loss of sensation as shown Motor supply to small muscles of hand except thenar muscle and 1 st two lumbricals Produces decreased grip strength

19 Lateral Epicondylitis Commonly known as tennis elbow Occurs in mostly years age group Due to degeneration of the tendon fibres over the lateral epicondyle which are involved in wrist extension

20 Symptoms severe burning pain on outside of elbow Pain worse on gripping or lfting objects and with direct pressure over lateral epicondyle Pain may radiate down forearm

21 Treatment Mostly self limiting Analgesia -NSAIDS Avoid activities which produce symptoms Orthotics Should improve in weeks if not consider steroid injection Physiotherapy Surgery

22 Medial Epicondylitis Commonly called Golfer s s elbow Similar to Tennis elbow Most common in men years Pain medial elbow may radiate down inner forearm Pain worse when mke fist/shake hands

23 Treatment R.I.C.E. Analgesia Physiotherapy Steroid injection Surgery

24 Ulna neuritis Due to entrapment of the ulna nerve at the elbow Produces paraesthesia of ring and little finger Aching pain on inside of elbow and difficulty Weakness of grips/poor finger coordination Muscle wasting if chronic

25 Treatment Avoid frequent use with the arm bent Avoid pressure over the area Keep elbow straight when sleeping NSAIDS Physiotherapy Steroid injections Surgery

26 Olecranon Bursitis Infection/inflamma tion of bursa Causes- Trauma Prolonged pressure Infection Medical conditions e.g.rheumatoid arthritis/gout

27 Symptoms/Treatment Swelling Pain Erythema/heat if infected Infection may spread R.I.C.E. NSAIDS?Antibiotics?Aspiration Surgery

28 Remember kids C-capitulum 2yrs R-radial head 4yrs I-internal(medial epicondyle) ) 6yrs T-trochlea 8yrs O-olecranon 10yrs L-lateral epicondyle 12yrs