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Soft tissue elbow disorders (Elbow OA (Clinical presentation Elbow pain,…
Soft tissue elbow
disorders
Olecranion bursitis
(student's elbow)
Diagnosis
History: studying over book
Examination: swollen, tender elbow
Investigations: Obs (nil), bloods (CRP/ESR, FBC,
blood cultures), synovial aspirate (MCS, crystals)
Clinical presentation
Elbow pain
Swelling behind elbow
Management
Conservative: rest (aspetic)
Medical: abx (septic)
Surgical: I+D (abscess), excision
Pathophysiology
Bursa is a sac with potential space
Allows movement of tendond/ligaments over joints
Inflammation following elbow pressure, can get infected
Elbow OA
Clinical presentation
Elbow pain, stiffness
Diagnosis
History: repetitive strain
Examination: reduced flex, extend and rotation (active=passive), osteophytes/bony deformity
Investigations: X-ray (reduced joint space,
osteophytes, sclerosis, cysts)
Pathophysiology
Repetitive strain or trauma
Management
Conservative: RICE, physio, brace/splint
Medical: analgesia (NSAIDs, CS injections)
Surgery: athroscopy with debridement (loose bodies),
total elbow replacement (painful, not responsive to medical)
Epidemiology
Middle aged (40-60y)
Manual job, male
Ulnar neuritis
(cubital tunnel
syndrome)
Clinical presentation
Reduced sensation, pain in hand,
muscle weakness in hand
Diagnosis
History: intemittent sensation loss/pain
Examination: ulnar nerve distribution, any wasting of hypothenars/interossei, Froments +ve
Investigations: NCS (slowed conduction in ulnar)
Pathophysiology
Narrowing of ulnar groove,
constricting nerve causing pain
and parasthesia
Management
Conservative: RICE, physio
Medical: analgesia
Surgery: decompression, medial epicondylectomy
Radial head subluxation
(pulled elbow)
Clinical presentation
Flexed and inwardly rotated arm
Diagnosis
History: play
Examination: flexed, inward rotation
Pathophysiology
Lifted by arm during play
Radial head slips out of annular ligament
Management
Conservative: reduction
Epidemiology
Young children (1-4y)
Lateral epicondylitis
(Tennis elbow)
Clinical presentation
Pain on lateral epicondyle
Diagnosis
History: repetitive strain, trauma
Examination: pain lat epicondyle. worse on finger flex in pronation (stretches extensor tendon)
Pathophysiology
Activity related (work, sport) or minor trauma
Inflammation where extensor tendon
arises from lateral epi of humerus
Management
Conservative: rest, avoid exacerbators, physio therapy,
bracing, splinting
Medical: analgesia (NSAIDs, CS injections)
Surgical: tendon release/decompression
Epidemiology
Common middle aged (35-50y)
Medial epicodylitis
(Golfer's elbow)
Clinical presentation
Medial epicondyle pain
Diagnosis
History: repetitive strain, minor trauma
Examination: medial epicondyle pain, worse on flexion and pronation of the forearm
Pathophysiology
Activity related (work, sport) or minor trauma
Inflammation of forearm flexor tendon
May have ulnar neuropathy (runs behind medial epi)
Management
Per tennis elbow
Epidemiology
Middle aged (35-50y)
Less common than tennis elbow