Essentials of Orthopedic Surgery, third edition / 09-The Elbow

384 M.A. Haque

tologist. The differential diagnosis includes septic arthritis, gout or other crystalline arthropathy, or osteoarthritis. Aspiration for cell count with differential, Gram stain, and crystal examination of the joint fluid are very helpful. X-ray changes are variable, ranging from periarticular osteopenia in early disease to subchondral erosions, destructive-appearing joint collapse, and ultimately bony ankylosis as the disease progresses.

Treatment of the rheumatoid elbow varies with the stage of presentation. Early in the course, antiinflammatory and antirheumatoid medication, analgesics, and activity modification may be sufficient. Initial goals are to decrease pain and inflammation, maintain motion, and avoid further destructive changes. Later, efforts to relieve pain and improve function may rely on surgical treatment such as arthroscopic or open synovectomy with or without radial head resection. In end-stage disease, a total elbow replacement may be the only option.

Summary and Conclusions

The elbow is the critical link between the mobile positioning shoulder joint and the precisely coordinated wrist–hand complex. Conditions that interfere with the elbow’s normal motion can significantly compromise a patient’s ability to feed, dress, and clean himself or herself. In the athlete, compromise in function precludes the ability to participate. Fortunately, most conditions affecting the elbow do not result in significant limitations. Most elbow problems can be readily diagnosed with a thorough history, physical examination, and basic radiographic examination. An algorithmic approach to treatment facilitates resolution of most problems of the elbow.

Suggested Readings

Morrey BF, ed. The Elbow and Its Disorders, 3rd ed. Philadelphia: Saunders, 2000.

Norris TR, ed. Orthopaedic Knowledge Update: Shoulder and Elbow, 2nd ed. Rosemont, IL: American Academy of Orthopaedic Surgeons, 2002.

Questions

Note: Answers are provided at the end of the book before the index.

9-1. Which of the following is NOT a common finding in cubital tunnel syndrome?

a.Finger abduction weakness

b.Numbness over the small finger

c.Thenar atrophy

d.Positive Froment’s sign

e.Tinel’s sign posterior to the medial epicondyle

9. The Elbow

385

9-2. Treatment options for lateral epicondylitis include which of the following choices?

a.Corticosteroid injection

b.Arthroscopic debridement

c.Counterforce bracing

d.Physical therapy

e.All the above

9-3. Which of the following muscles is innervated by the musculocutaneous nerve?

a.Brachioradialis

b.Extensor carpi ulnaris

c.Flexor carpi radialis

d.Brachialis

e.Triceps

9-4. The pathologic tissue in tennis elbow is called:

a.Dermatofibroma protuberans

b.Angiofibroblastic hyperplasia

c.Pyogenic granuloma

d.Osteochondritis dissecans

e.None of the above

9-5. Treatment for a displaced, unstable, intraarticular fracture of the distal humerus would most likely involve which of the following?

a.Closed reduction and casting

b.Open reduction and pin fixation

c.Hinged splinting without any fixation

d.Open reduction and rigid internal fixation

e.External fixation

9-6. The function of the brachioradialis muscle is:

a.Pronation

b.Supination

c.Elbow flexion

d.Elbow extension

e.Wrist extension

9-7. Sites of compression of the ulnar nerve at the elbow do not include:

a.Arcade of Frohse

b.Medial intermuscular septum

c.The ligament of Osborne

d.The exit from the flexor carpi ulnaris

e.None of the above

9-8. The anterior interosseous nerve innervates all of the following except:

a.The pronator quadratus

b.The index flexor digitorum profundus

c.The middle finger flexor digitorum profundus

d.The flexor pollicis longus

e.None of the above

386 M.A. Haque

9-9. Indications for elbow arthroscopy include all the following except:

a.Release of contracture

b.Debridement for lateral epicondylitis

c.Release of the median nerve at the pronator teres

d.Removal of loose bodies in the elbow joint

e.Synovectomy

9-10. Magnetic resonance imaging of the elbow can be helpful for all the following conditions except:

a.Infection

b.Synovitis

c.Tumors

d.Osteochondritis dissecans

e.None of the above