Elbow management

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Elbow management
2012-02-05 04:37:07

Elbow management
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  1. What is the MOI of radial head / neck fractures
    • Direct blow
    • FOOSH
  2. What movements may still be normal with a radial head / neck fracture
    • Supination
    • Pronation
  3. what is the management of a radial head / neck fracture
    • C&C
    • Fracture clinic
  4. What is the MOI of an olecranon fracture
    Direct blow onto the olecranon
  5. What is the management of a fractured olecranon
    • Refer to orthos - same day
    • C&C
  6. What is the MOI of a supracondylar fracture
  7. Which age groups are most likely to suffer a supracondylar fracture
    • Young
    • Elderly
  8. What is the management of supracondylar fracture
    • Above elbow back slab
    • Refer orthos
  9. With supracondylar fractures, which nerve is most likely to be damaged
    Medial nerve
  10. In which direction are dislocations most likely to present
  11. What structures are at risk with dislocations
  12. How is diagnosis of dislocation confirmed
  13. What drugs should be used during reduction of dislocations
    • Sedatives
    • Not entonox alone
  14. If the elbow has been relocated, what may not be present on X-ray and why
    • Fat pads
    • Complete rupture of the capsule
  15. What is a monteggia injury
    • Ulna shaft fracture
    • Dialocation of radial head
  16. Why is an angulated ulna fracture always associated with a radial head
    • If the ulna is angulated it becomes shorter
    • If the ulna attachment to the radius at the wrist is intact, the radial head HAS to be dislocated
  17. What is a galeazzi injury
    • Fractured radius
    • Dislocated distal ulna
  18. What is the MOI of an isolated ulna fracture
    • Direct blow - night stick fracture
    • Defence injury
  19. What does a pop-eye deformity indicate
    Ruptured bicep
  20. In which groups are ruptured biceps most common
    • Strength athletes
    • Heavy manual workers
    • Males > 35 years
  21. Where do people presenting with ruptured biceps complain of pain
    • Front of elbow
    • Proximal upper arm
  22. What may patients with ruptured biceps describe at the time of injury
    A pop and then pain
  23. What is the treatment for ruptured biceps
    • Ruptured head is treated with physio
    • Ruptured distal attatchment needs surgical repair
    • Refer orthos
  24. What are non trauma elbow problems caused by
    • Repetitive movement
    • DIY
    • sport
    • Manual work
  25. What the technical term for tennis elbow
    Lateral epicondylitis
  26. What is lateral epicondylitis / tennis elbow caused by
    • Over use of the extensor muscle of the forearm, where they attach to the lateral epicondyle
    • Any activity with repetitive backwards movement of the wrist
  27. How do patients with lateral epicondylitis / tennis elbow present
    • Tenderness over the lateral epicondyle
    • Increased pain on passive wrist flexion with the elbow in extension
  28. What is the technical term for golfers elbow
    Medial epicondylitis
  29. What is medial epicondylitis / golfers elbow caused by
    • Over use of the flexor muscles of the forearm, where they attach to the medial epicondyle
    • Any activity causing fingers to be curved, to type or grasp, whilst the wrist is curled palm wards
  30. How do patients with medial epicondylitis / golfers elbow present
    Increased pain on passive wrist extension, with the elbow extended
  31. What is the management of medialepicondylitis / golfers elbow
    • Rest
    • NSAID
    • GP
  32. What is the treatment of lateral epicondylitis / tennis elbow
    • Rest
    • NSAID
    • GP
  33. What is the management of non displaced elbow fractures with elevated fat pads
    • C&C
    • fracture clinic
  34. What is the management of displaced fracture or neurovascular deficit
    Refer orthos
  35. What is the management of an elbow dislocation
    Refer to ED for reduction
  36. What is olecranon bursitis caused by
    • Repetitive friction or minimal trauma at tip of the elbow
    • Causing an inflammatory response
  37. What are the differential diagnoses for olecranon bursitis
    • Septic bursitis
    • Gout
    • Arthritis
  38. What is the management of olecranon bursitis
    • NSAID
    • C&C
    • GP or ED follow up
  39. With olecranon bursitis, how are elbow movements
    Usually ok
  40. How does infected olecranon bursitis present
    • Possible wound over the olecranon
    • Bursitis not settling with NSAIDS
    • localised redness, pain and swelling
  41. When does infected olecranon bursitis need referring
    • Systemically unwell
    • Ascending lymphangitis
  42. What is the management of infected bursitis
    • Flucloxacillin or erythromycin 500mg
    • May need aspirating
    • ED referral
  43. What are the differential diagnoses for warm swollen joints
    • Septic arthritis
    • Gout / pseudo gout
    • Arthritis
    • Insect bite /cellulitis
  44. What are the clinical features of cellulitis
    • Increased pain on movement
    • Gradual loss of movement and stiffness
    • Joint swelling due to excess fluid caused by inflammation
  45. What are the clinical features of septic arthritis
    • Joint is warm and swollen
    • No history of trauma
    • Sudden onset
    • Pyrexia
    • Systemically unwell
    • Diffuse joint tenderness
    • Reduced ROM
  46. Which age groups are most prone to septic arthritis
    • Adolescent
    • Elderly
  47. What are the clinical features of gout
    • Warm swollen joint
    • No history of trauma
    • Sudden onset
    • Systemically well
    • Diffuse joint tenderness
    • Normal ROM
    • possible diuretic therapy for high BP
  48. Which groups are most prone to gout
    • Overweight
    • Diuretic therapy
  49. What is the management of septic arthritis
  50. What is the management of arthritis and gout
    • Rest
    • Ice
    • NSAIDS
    • Review to ensure symptoms have resolved
  51. Which age group is most likely to present with a pulled elbow
    • 2-4 years
    • Can occur anywhere between 1 and 8 years
  52. What is a pulled elbow
    Subluxation of the radial head through the fibres of the annular ligament
  53. What is the MOI of a pulled elbow
    • Pulling the arm against resistance
    • Ie falling whilst hand in hand with an adult
  54. How do pulled elbows present
    • Arm limp and slightly pronated
    • Or
    • Partly flexed with the child holding the wrist to stop extension and supination which is painful
  55. With a pulled elbow, where is the child most tender
    Radial head
  56. When may a child with a pulled elbow be manipulated without and X-ray
    • Clear history
    • Tenderness to the radial head
    • No other bony tenderness
  57. When is an X-ray needed before attempting manipulation of a ? Pulled elbow
    • Unclear history
    • Bony tenderness other than the radial head
  58. How is a pulled elbow manipulated
    • Thumb at the radial head, elbow flexed
    • Supinate the forearm as far as possible and flex the elbow untill the hand touches the shoulder
  59. What is the management of a pulled elbow after manipulation
    Observe for use of the arm - 15-20 mins
  60. With a pulled elbow, if after manipulation and observation, the arm is still not being used, what is the management
    • Outside C&C 2-3 days
    • ED clinic appointment for 2-3 days, to be cancelled if symptoms resolve
  61. Where does a supracondylar fracture occur
    • Distal third of humerus
    • Proximal to the articular surface
  62. Why does the olecranon become displaced when fractured
    The triceps attach to the olecranon and may pull the fragment away from the rest of the bone
  63. Following a pulled elbow, what should parents be advised of
    • May reoccur
    • Avoid pulling on arms