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Home » Features » Ortho Dx


ORTHODX: RIGHT ELBOW PAIN

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FIGURE 2. LATERAL X-RAY OF THE RIGHT ELBOW.




FIGURE 1. ANTEROPOSTERIOR X-RAY OF THE RIGHT ELBOW.



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FIGURE 2. LATERAL X-RAY OF THE RIGHT ELBOW.




FIGURE 1. ANTEROPOSTERIOR X-RAY OF THE RIGHT ELBOW.



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FIGURE 2. LATERAL X-RAY OF THE RIGHT ELBOW.



 * CASE STUDY:

 * EXPLANATION:

A 32-year-old man presents with right elbow pain after a fall 2 days ago. He
slipped on ice and fell with an outstretched hand on his right side. He reports
having difficulty moving the elbow since the injury. On physical examination,
the patient is able to move the elbow to -20 degrees of extension and 90 degrees
of flexion. He has pain to palpation over the radiocapitellar joint.
Anteroposterior and lateral radiographs of the right elbow are shown in figures
1 and 2, respectively.

Radial head fractures are the most common type of fracture of the elbow.1,2 The
mechanism of injury is typically a fall on an outstretched hand where the radial
head is compressed into the capitellum.1,2 Injury severity can range from a...

Submit your diagnosis to see full explanation.

Radial head fractures are the most common type of fracture of the elbow.1,2 The
mechanism of injury is typically a fall on an outstretched hand where the radial
head is compressed into the capitellum.1,2 Injury severity can range from a
simple nondisplaced radial head fracture to a completely displaced, comminuted
fracture with associated dislocation or collateral ligament injury.2

Minimally displaced fractures with less than 2 mm of displacement can be treated
nonoperatively with excellent results.2 Early motion of the elbow should be
initiated as soon as pain tolerates.1 The elbow can become permanently stiff
with prolonged immobilization so early motion is crucial.1 A sling can be used
for the first 1 to 2 weeks to allow for elbow rest but the patient should remove
the sling for gentle range of motion 2 to 3 times a day.2 Patients should be
instructed to avoid any lifting with the injured arm as any valgus stress placed
on the elbow could cause fracture displacement.2

Follow-up radiographs are generally performed at 1, 3, and 6 weeks after injury
to be certain the fracture does not displace.2 Full range of motion of the elbow
without pain is expected at 6 weeks.2 Patients may resume lifting with the
injured arm when full painless range of motion is achieved and radiographs show
full healing.2

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in
the southern New Hampshire region and is editor in chief of the Journal of
Orthopaedics for Physician Assistants.

REFERENCES

1. Tejwani NC, Mehta H. Fractures of the radial head and neck: current concepts
in management. J Am Acad Orthop Surg. 2007;15(7):380-387.
doi:10.5435/00124635-200707000-00003

2. Rosenblatt Y, Athwal GS, Faber KJ. Current recommendations for the treatment
of radial head fractures. Orthop Clin North Am. 2008;39(2):173-185.
doi:10.1016/j.ocl.2007.12.008

QUESTION

What is the next best treatment option?
 * MRI of the elbow
 * Resume elbow range of motion as pain tolerates
 * Sling at all times for 3 weeks
 * Long arm cast

1/1
Submit
Please mark all the Question(s) to submit your Quiz.


TOPICS:

Bone and Joint Case Studies Ortho Dx Orthopedics


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