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What is the MOI of radial head / neck fractures
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What movements may still be normal with a radial head / neck fracture
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what is the management of a radial head / neck fracture
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What is the MOI of an olecranon fracture
Direct blow onto the olecranon
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What is the management of a fractured olecranon
- Refer to orthos - same day
- C&C
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What is the MOI of a supracondylar fracture
FOOSH
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Which age groups are most likely to suffer a supracondylar fracture
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What is the management of supracondylar fracture
- Above elbow back slab
- Refer orthos
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With supracondylar fractures, which nerve is most likely to be damaged
Medial nerve
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In which direction are dislocations most likely to present
Posterior
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What structures are at risk with dislocations
Neurovascular
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How is diagnosis of dislocation confirmed
Xray
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What drugs should be used during reduction of dislocations
- Sedatives
- Not entonox alone
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If the elbow has been relocated, what may not be present on X-ray and why
- Fat pads
- Complete rupture of the capsule
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What is a monteggia injury
- Ulna shaft fracture
- Dialocation of radial head
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Why is an angulated ulna fracture always associated with a radial head
- If the ulna is angulated it becomes shorter
- If the ulna attachment to the radius at the wrist is intact, the radial head HAS to be dislocated
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What is a galeazzi injury
- Fractured radius
- Dislocated distal ulna
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What is the MOI of an isolated ulna fracture
- Direct blow - night stick fracture
- Defence injury
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What does a pop-eye deformity indicate
Ruptured bicep
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In which groups are ruptured biceps most common
- Strength athletes
- Heavy manual workers
- Males > 35 years
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Where do people presenting with ruptured biceps complain of pain
- Front of elbow
- Proximal upper arm
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What may patients with ruptured biceps describe at the time of injury
A pop and then pain
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What is the treatment for ruptured biceps
- Ruptured head is treated with physio
- Ruptured distal attatchment needs surgical repair
- Refer orthos
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What are non trauma elbow problems caused by
- Repetitive movement
- DIY
- sport
- Manual work
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What the technical term for tennis elbow
Lateral epicondylitis
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What is lateral epicondylitis / tennis elbow caused by
- Over use of the extensor muscle of the forearm, where they attach to the lateral epicondyle
- Any activity with repetitive backwards movement of the wrist
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How do patients with lateral epicondylitis / tennis elbow present
- Tenderness over the lateral epicondyle
- Increased pain on passive wrist flexion with the elbow in extension
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What is the technical term for golfers elbow
Medial epicondylitis
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What is medial epicondylitis / golfers elbow caused by
- Over use of the flexor muscles of the forearm, where they attach to the medial epicondyle
- Any activity causing fingers to be curved, to type or grasp, whilst the wrist is curled palm wards
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How do patients with medial epicondylitis / golfers elbow present
Increased pain on passive wrist extension, with the elbow extended
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What is the management of medialepicondylitis / golfers elbow
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What is the treatment of lateral epicondylitis / tennis elbow
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What is the management of non displaced elbow fractures with elevated fat pads
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What is the management of displaced fracture or neurovascular deficit
Refer orthos
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What is the management of an elbow dislocation
Refer to ED for reduction
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What is olecranon bursitis caused by
- Repetitive friction or minimal trauma at tip of the elbow
- Causing an inflammatory response
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What are the differential diagnoses for olecranon bursitis
- Septic bursitis
- Gout
- Arthritis
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What is the management of olecranon bursitis
- NSAID
- C&C
- GP or ED follow up
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With olecranon bursitis, how are elbow movements
Usually ok
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How does infected olecranon bursitis present
- Possible wound over the olecranon
- Bursitis not settling with NSAIDS
- localised redness, pain and swelling
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When does infected olecranon bursitis need referring
- Systemically unwell
- Ascending lymphangitis
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What is the management of infected bursitis
- Flucloxacillin or erythromycin 500mg
- May need aspirating
- ED referral
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What are the differential diagnoses for warm swollen joints
- Septic arthritis
- Gout / pseudo gout
- Arthritis
- Insect bite /cellulitis
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What are the clinical features of cellulitis
- Increased pain on movement
- Gradual loss of movement and stiffness
- Joint swelling due to excess fluid caused by inflammation
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What are the clinical features of septic arthritis
- Joint is warm and swollen
- No history of trauma
- Sudden onset
- Pyrexia
- Systemically unwell
- Diffuse joint tenderness
- Reduced ROM
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Which age groups are most prone to septic arthritis
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What are the clinical features of gout
- Warm swollen joint
- No history of trauma
- Sudden onset
- Systemically well
- Diffuse joint tenderness
- Normal ROM
- possible diuretic therapy for high BP
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Which groups are most prone to gout
- Overweight
- Diuretic therapy
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What is the management of septic arthritis
Refer
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What is the management of arthritis and gout
- Rest
- Ice
- NSAIDS
- Review to ensure symptoms have resolved
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Which age group is most likely to present with a pulled elbow
- 2-4 years
- Can occur anywhere between 1 and 8 years
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What is a pulled elbow
Subluxation of the radial head through the fibres of the annular ligament
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What is the MOI of a pulled elbow
- Pulling the arm against resistance
- Ie falling whilst hand in hand with an adult
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How do pulled elbows present
- Arm limp and slightly pronated
- Or
- Partly flexed with the child holding the wrist to stop extension and supination which is painful
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With a pulled elbow, where is the child most tender
Radial head
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When may a child with a pulled elbow be manipulated without and X-ray
- Clear history
- Tenderness to the radial head
- No other bony tenderness
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When is an X-ray needed before attempting manipulation of a ? Pulled elbow
- Unclear history
- Bony tenderness other than the radial head
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How is a pulled elbow manipulated
- Thumb at the radial head, elbow flexed
- Supinate the forearm as far as possible and flex the elbow untill the hand touches the shoulder
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What is the management of a pulled elbow after manipulation
Observe for use of the arm - 15-20 mins
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With a pulled elbow, if after manipulation and observation, the arm is still not being used, what is the management
- Outside C&C 2-3 days
- ED clinic appointment for 2-3 days, to be cancelled if symptoms resolve
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Where does a supracondylar fracture occur
- Distal third of humerus
- Proximal to the articular surface
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Why does the olecranon become displaced when fractured
The triceps attach to the olecranon and may pull the fragment away from the rest of the bone
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Following a pulled elbow, what should parents be advised of
- May reoccur
- Avoid pulling on arms
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