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
MOI: FOOSH
Xray:
Often difficult to see
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