Elbow injuries

Dr. Ravi Chandra

 Objectives
• Revise a wee bit anatomy
• Learn elbow movements
• Know common injuries
• Know management of those injuries
Anatomy
 Examination
• Inspection
• Palpation
• Movements
• Neurovascular status
 Inspection
• Position
– Swollen elbow always semi-flexed
• Swelling
• Deformity
 Palpation
• Tenderness
• Crepitus
• Fluid eg bursitis
• Heat
 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
 Most common injuries
• Supra-condylar fracture
• Radial head fracture
• Olecranon fracture
• Dislocation
• Fracture dislocation
• Pulled elbow
 Supra-condylar fracture
• Usually from fall onto
elbow when flexed
• More common in children
• Often displaced/angulated
• Generally swollen restricted
movement
• Look for complications
 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
 Radial head fractures
• Fall onto outstretched
hand
• Female>male
• 20% all elbow injuries
• Associated with 10%
dislocations
 Signs and symptoms
• Pain on outside of
elbow
• Swelling in elbow joint
• Unable to fully flex or
extend
• Pain
pronation/supination
 Fracture radial head
• Fracture may not be visible on initial 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
 Fracture over olecranon
• Mechanism
-fall on point of elbow
-sudden triceps
contraction

Don’t forget epiphyses

 Olecranon fractures
• Hairline and undisplaced
fractures can be treated in
long arm cast for 3-4 weeks
in children and 6-8 weeks in
adults
• If fragment large/displaced
will require fixation e.g.
tension band wiring
 Elbow dislocation
• Usually fall onto
outstretched hand
• Severe pain at elbow
and swelling
• Minimal movement
• Check sensation/pulses
 Dislocation of elbow
• Posterior lateral dislocation reduction by
traction in line of the limb under analgesia and
sedation
• Check x-ray
• Crepe bandages and sling 2 weeks
• Fracture clinic
 Elbow Dislocations
• BEWARE
ASSOCIATED
FRACTURES
• BEWARE
COMPLICATIONS
• Median nerve injury
• Ulna nerve injury
• Brachial artery injury
 Supra-condylar fracture
• Usually from fall onto
elbow when flexed
• More common in children
• Often displaced/angulated
• Generally swollen restricted
movement
• Look for complications
 Lateral Epicondylitis
• Commonly known as tennis
elbow
• Occurs in mostly 30-50
years age group
• Due to degeneration of the
tendon fibres over the
lateral epicondyle which are
involved in wrist extension
 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
 Medial Epicondylitis
• Commonly called Golfer’s
elbow
• Similar to Tennis elbow
• Most common in men 20-50
years
• Pain medial elbow may
radiate down inner forearm
• Pain worse when make
fist/shake hands
 Treatment
• Mostly self limiting
• Analgesia -NSAIDS
• Avoid activities which produce symptoms
• Orthotics
• Should improve in 6-8 weeks if not consider steroid
injection
• Physiotherapy
• Surgery
 Olecranon Bursitis
• Infection/inflammation
of bursa
• Causes-
• Trauma
• Prolonged pressure
• Infection
• Medical conditions
e.g.rheumatoid
arthritis/gout
 Symptoms/Treatment
• Swelling
• Pain
• Erythema/heat if infected
• Infection may spread
• R.I.C.E.
• NSAIDS
• ?Antibiotics
• ?Aspiration
• ?Surgery
 Remember kids
• C-capitulum 2yrs
• R-radial head 4yrs
• I-internal(medial
epicondyle) 6yrs
• T-trochlea 8yrs
• O-olecranon 10yrs
• L-lateral epicondyle
12yrs
 Pulled Elbow
• Usually aged 18months-4years
• History of pulling
• Won’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.