Orthopedics: Elbow to Phalanges

PA Study Sesh

This week on PA Study Sesh, we will be finishing the upper extremity.
* Supracondylar fx
* MOI: FOOSH with hyperextended elbow
* Kids 5-10
* X-Ray:
* Normal: anterior humeral line must intersect capitulum (lateral view)
* May still be in alignment with fx
* Fat Pad sign=refer
* Anterior to humerus = sometimes normal
* Posterior to humerus = always abnormal
* Darkness=blood
* Anterior interosseous nerve @ risk (branch of median n)
* “ok” sign (A-ok)
* if not=immediate surgery
* Brachial artery @ risk
* Can lead to Volkmann Ischemic Contracture
* Contracture of wrist 2/2 ischemia
* Radial Head fx
* #1 elbow fx in adults
* MOI: FOOSH
* Xray:
* Often difficult to see
* + fat pad sign
* Unable to fully extend elbow
* Elbow Dislocation
* Rare
* Posterior most common (olecranon goes backwards)
* Often associated with medial condyle fx
* R/o brachial a, median, ulnar, radial n injury
* Tx: emergent reduction, splint/sling
* Nursemaid’s elbow
* Dislocation of radial head, stretched annular ligament
* Annular= ring shaped, radius=circle
* MOI: sudden pull of a pronated arm
* Grabbing from street
* Playing airplane
* Kids 1-4
* Presentation:
* Arm fully extended or slightly flexed and pronated
* REFUSES to use
* Pain increases with supination. Mild tenderness
* Usually no swelling
* Reduction:
* hyperpronation with pressure over radial head
* supination and flexion with pressure over radial head
* Lollipop test
* Imaging after 2 failed reduction of child continues to refuse to use arm.
* Olecranon fx
* Ulnar n at risk
* Olecranon bursitis
* Repetitive trauma or rhematologic conditions
* “goose egg” swelling
* +/- decreased ROM and tenderness
* Erythema and warmth may suggest infection
* Tx:
* Ice
* NSAIDS
* Avoid pressure
* Pads/sleeves
* Lateral epicondylitis
* “tennis elbow”
* extensor/supination muscle group
* local pain and swelling
* pain with wrist extension against resistance (elbow fully extended)
* Medial epicondylitis
* “golfer’s elbow”
* flexors & pronators (golf & flexor both have f)
* pain with wrist flexion against resistance (elbow fully extended0
* Tx: for epicondylitis (both)
* Acute: sling, wrist brace, Ice, NSAIDS
* Preventative: forearm strap
* Recurrent: steroid injections, surgical debridement
* Nightstick fx:
* Ulnar shaft fx
* Defensive injury
* Tx: Cast or ORIF
* Monteggia fx
* Proximal ulnar shaft with radial head dislocation
* May have radial n injury (wrist drop)
* Galeazzi fx
* mid distal radial shaft f x with dislocation of DRUJ
* both Galeazzi & Monteggia are unstable (any joint dislocation)
* TAKE HOME; evaluate elbow and wrist with forearm injury
* Cubital tunnel
* Ulnar nerve compression
* RF/SM tingling/numbness
* Increases with elbow flexion
* Decreased grip strength
* Tinel’s sign:
* Tap groove between olecranon process and medial epicondyle