Olecranon fracture

1. How does an olecranon fracture usually occur?
2. What is a possible complication of olecranon fx?
3. How is an olecranon fx treated?

Answers:
1. Direct blow to elbow, fall on elbow with elbow flexed, or fall on outstretched arm.
2. Ulnar nerve involvement.
3. Nondisplaced fractures are immobilized. Displaced fractures are treated surgically.

Radial head fracture

1. What sort of elbow injury often is associated with radial head fractures?
2. How does a radial head fx usually occur?
3. How many types of radial head fx's are there? How are they treated?

Answers:
1. Elbow dislocation.
2. Fall on outstretched arm.
3. Type I (nondisplaced) is treated with short immobilization (3-5days) and early ROM. Type II (min displaced) is fixed surgically if there is greater than 2mm displacement or 30% radial head involvement. Type III (comminuted) is treated surgically.

Humeral fractures

1. What sort of nerve injury is associated with humeral shaft fracture?
2. How are humeral shaft fractures treated?
3. How are distal humerus fractures classified?
4. What are complications of a distal humerus fracture?
5. How is a distal humerus fracture treated?

Answers:
1. Radial nerve injury, 95% of which recover in 6 mo.
2. Splint for 2 wks.
3. Displaced or nondisplaced.
4. Neurovascular injury, nonunion, malunion, elbow contracture, poor ROM.
5. Displaced fractures require open reduction. Nondisplaced fractures can be splinted.

Osteochondrosis dissecans of the elbow

1. What is another name for OD of the elbow?
2. What is seen clinically?
3. What is seen on imaging?
4. What is the treatment?

Answers:
1. Panner's disease.
2. Tenderness and swelling in lateral elbow, limited extension on ROM, usually in young boys.
3. Plain films show sclerosis and patchy areas of lucency with fragmentation.
4. Immobilization, then gradual ROM.

Radial/Ulnar collateral ligament sprain

1. How does radial vs. ulnar collateral ligament sprain occur?
2. What is seen clinically in UCL sprain? How is it tested?
3. What is seen clinically in RCL sprain? How is it tested?
4. What imaging is used for UCL/RCL sprain?
5. How are collateral ligament sprains treated?

Answers:
1. UCL sprain occurs via valgus stress across elbow during a throw. RCL sprain occurs via traumatic elbow dislocation.
2. Medial elbow pain after a throw, pop or click, pain with valgus stress test (medial elbow tenderness, increased with valgus stress).
3. Recurrent locking or clicking of the elbow with extension and supination, pain with varus stress test (medial elbow tenderness, increased with varus stress). The lateral pivot-shift test is also used to assess the RCL for posterolateral instability.
4. Plain films, varus (RCL) and valgus (UCL) stress radiographs will show 2mm joint space.
5. Rest ice, NSAIDs, strengthening and stretching rehab, return to play criteria. Surgery if needed.

Distal biceps/triceps tendonitis

1. What is the mechanism of distal biceps/triceps tendonitis?
2. What is seen clinically in distal biceps tendonitis?
3. What is seen clinically in triceps tendonitis?
4. What is the treatment of biceps/triceps tendonitis?

Answers:
1. Repetitive overuse.
2. Insidious onset of pain in antecubital fossa, usually after eccentric overload. If avulsion, may be audible snap with obvious deformity, swelling, and ecchymosis.
3. Posterior elbow pain with tenderness over triceps insertion, pain with resisted elbow extension.
4. Rest, ice, NSAIDs, PT with modalities, possible surgical reattachment for avulsion.

Elbow dislocation

1. What is the mechanism of elbow dislocation?
2. What is seen clinically with elbow dislocation?
3. What are other injuries associated with elbow dislocation?
4. What is the treatment for elbow dislocation?
5. What are possible adverse outcomes?

Answers:
1. Fall on outstretched hand. Posterior dislocation is more likely.
2. Inability to bend elbow, pain in shoulder/wrist. On PE, do careful neurovasc eval.
3. Fracture of radial head, median nerve injury, brachial artery injury.
4. Reduction, splint for 10 days, then ROM and NSAIDs.
5. Loss of ROM (esp extension), ectopic bone formation, neurovasc injury, arthritis.

Olecranon bursitis

1. What are other names for olecranon bursitis?
2. What is the mechanism and pathology of olecranon bursitis?
3. What is seen clinically with olecranon bursitis?
4. What is the treatment of olecranon bursitis?

Answers:
1. Draftsman's elbow, Student's elbow, Miner's elbow.
2. Repetitive trauma or inflammatory disorder, resulting in inflammation of the bursa between the olecranon and skin.
3. Swelling, pain, decreased ROM. If hot, there may be infection.
4. Aspiration and culture, rest, NSAIDs, elbow padding.

Lateral Epicondylitis

1. What are some factors that cause lateral epicondylitis (LE)?
2. What is the pathology behind LE?
3. What are the clinical history of LE?
4. What is Cozen's test?
5. Why might X-rays be obtained?
6. What is the treatment for LE?

Answers:
1. Any repetitive sport (e.g. tennis) especially when poor techniques are used with a racket sport (inproper backhand, weak string tension, inappropriate grip size), overuse and poor mechanics.
2. Microtearing of the extensor carpi radialis brevis.
3. Patients c/o tenderness just distal to the LE at the ECR origin, pain and weakness of grip.
4. Cozen's test is when the examiner stabilizes the elbow with a thumb over the LE and there is pain with a fist, forearm pronation, radial deviation, and wrist extension against resistance. There may also be pain with passive extension of elbow with forced wrist flexion.
5. Obtain X-rays if there is suspicion of arthritis or loose body fragments.
6. Conservative treatment includes rest, ice, NSAIDs for 10-14 days. If no improvement, may do PT, splinting, steroid injection, and correction of improper techniques. Surgical treatment of ECRB debridement can be considered.

Medial epicondylitis

1. What are other names for medial epicondylitis?
2. What is the mechanism of medial epicondylitis?
3. What is the difference between medial epicondylitis and little leaguer's elbow?
4. What is seen clinically in medial epicondylitis?
5. What is the treatment of medial epicondylitis?

Answers:
1. Golfer's elbow or little leaguers elbow.
2. Repetitive valgus stress such as in throwing or a back and downward swing such is in golfing.
3. Medial epicondylitis involves inflammation of the common flexor tendon, which may cause hypertrophy of the medial epicondyle. Little leaguer's elbow involves hypertrophy of the medial epicondyle, leading to microtearing and fragmentation of the medial epicondylar apophysis.
4. Tenderness at medial epicondyle that can be reproduced with wrist flexion and pronation.
5. Conservative treatment includes rest, ice, NSAIDs, immobilization, and correction of throwing mechanics. Surgical pinning can be used for unstable elbow.

Elbow anatomy

1. What are the three ligaments of the elbow?
2. What muscles originate at the medial epicondyle?
3. What muscles originate at the lateral epicondyle?
4. What is the normal amount of elbow valgus?

Answers:
1. Medial (ulnar) collateral ligament (key stabilizer of elbow), lateral (radial) collateral ligament, annular ligament.
2. Medial epicondyle: FCR, FCU, FDS, FDP, palmaris longus, pronator teres.
3. Lateral epicondyle: ECRL, ECRB, ECU, EDS, supinator, anconeus.
4. 5 deg in males, 10-15 deg in females, >20 deg is abnormal.