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Ulnar neuritis (Cubital tunnel syndrome) Paediatric • Osteoarthritic/ rheumatoid narrowing of the Supracondylar fractures ulnar grooveand constrictionof the ulnar • most common # of childhood. nerve. Presentation = pain, swelling and inability to move Presentation = sensory symptoms inthe distribution the elbow. Most are due tohyperextension at the of the ulnar nerve(little andhalfof ring finger), elbow. clumsiness of the hand and weakness of the 4 small Grading = using the Gartlandclassification, using hand muscles. lateral X-rays to describe the severity of Test = nerve conduction studies can confirm site. displacement. Management = surgical decompression • Type 1= non-displaced • 2 = displaced but there is an intact Elbow dislocations posterior cortex By Gregor ramage and Dr • Commonly posterior, resulting from a Fall on Shaheer Aslam Joiya • 3 = unstable posterior displacement. not fullyoutstretched hand. Management Presentation = posterior ulnar displacement on • Assess neurovascular status – including humerus, swollen elbow fixed in flexion. Elbow radial pulse, cap refil, radial, median and Management = closed reduction, post-reduction ulnar nerves Lateral epicondylitis (Tennis elbow) image is requiredtoexclude fracture. Presentation = clear history of repetitive strain. Pain is • Type 1 = above elbow back slab and sling Immobilization for 10 days. felt at the lateral condyleand exacerbated when • 2 = may require reduction along with back slabandsling tendon is stretched. (wrist/ finger flexion with hand • 3 = surgical fixation using k wires. pronation) Management = most cases resolve with restriction of Complications = a cubitus varus deformity can activities, most recoverwithin1year. Physiotherapy is occur as a result of malunion. the most effective non-surgical treatment using Subluxation of the radial head (pulled elbow) eccentric loading. Corticosteroidinjections helpshort term but are disruptive in the long term. • 1-4 yr. old who has been lifted by the arm. Presentation = arm is held slighted flexed and Medial epicondylitis (Golfers’ elbow) twisted inwards. Presentation = clear history of repetitive strain, pain Management = reduction via hyperpronating or Fracture of the radial head supinating while flexing the elbow .Imaging is not • Caused by a FOOSH felt at the medial condyle. Pain is exacerbated by pronation and forearm flexion. needed however advice caution as can reoccur. Presentation = elbow is swollen and tender of the Management = same as tennis elbow radial head, pain on supination and pronation. Examination ofneurovascular status in children Management = un displaced = collar and cuff Olecranon bursitis (students elbow) • Median nerve (via anterior interosseous) = followed by mobilization. can you make anOK sign If displaced = internal fixation . = Traumatic bursitis after sustainedpressure onelbow Presentation = pain and swelling behind the olecranon. • Radial nerve(via posterior interosseous) = Complications = associated with ‘terrible triad’ of Management = if overlying cellulitis consider can you put yourthumbs up radial head #, elbow dislocation and coronoid antibiotics. • Ulnar nerve = can you cross your fingers process #