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

* #1 elbow fx in adults

* MOI: FOOSH

* Xray:

* Often difficult to see

* + fat pad sign

* 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