Elbow injuries.

Transcription

1 Elbow injuries

2 Objectives Revise a wee bit anatomy Learn elbow movements Know common injuries Know management of those injuries

3 Anatomy

4 Examination Inspection Palpation Movements Neurovascular status

5 Inspection Position Swollen elbow always semi-flexed Swelling Deformity

6 Palpation Tenderness Crepitus Fluid eg bursitis Heat

7 Movements Extension (to 0 degrees) Gravity plus triceps Flexion (145 degrees) Biceps and brachialis Pronation (75 degrees) Pronator teres and pronator quadratus Supination (80 degrees) Biceps and supinator

8 Most common injuries Supra-condylar fracture Radial head fracture Olecranon fracture Dislocation Fracture dislocation Pulled elbow

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

10 Supra-condylar fracture Complications vascular complications: brachial artery 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

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

12 Signs and symptoms Pain on outside of elbow Swelling in elbow joint Unable to fully flex or extend Pain pronation/supination

13 Fracture radial head Fracture may not be visible on initial x-raysx 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

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

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

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

17 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

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

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

20 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

21 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

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

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

24 Olecranon Bursitis Infection/inflammation of bursa Causes- Trauma Prolonged pressure Infection Medical conditions e.g.rheumatoid arthritis/gout

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

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

27 Pulled Elbow Usually aged 18months-4years History of pulling Won t t use arm Not usually very distressed Pronation/supination +/- flexion/extension causes a click Wait 10 minutes play area If not settled, think about x-ray. x