Etiology - most common cause is RA, followed by post-traumatic arthritis
Primary OA is rare
Others - previous OCD, infection...
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What is the functional ROM of the elbow?
Functional arc: 30β130Β°. Total ROM = 100Β°; 50/50 of P/S.
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How do you differentiate RA vs OA on XR?
RA has periarticular osteopenia, βpanarticularβ, absence of osteophytes
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What is a flail elbow? Causes?
A flail joint is one in which the patient has no control of the joint in flexion/extension (or both), and the forearm and hand hang dependent wherever the upper arm is positioned.
Trauma - Distal humerus non union, severe trauma with bone loss, chronic fracture dislocations
Infection - Explanted TEA and infection
Nerve - Neurogenic causes
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What are the clinical features? Which nerves should you check? (in PE)
Elbow OA typically presents with loss of terminal extension.
Pain occurs mainly at the end range of motion.
Clicking or locking may be present.
Assess stability (ligament attenuation can occur with synovitis).
Perform a neurological assessment:
Ulnar nerve: cubital tunnel syndrome commonly seen, likely due to osteophyte compression.
PIN: synovitis/pannus.
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What is the classification for RA Elbow?
Larsen Grading
Stage 1 - soft tissue, normal XR
Stage 2 - periarticular erosions
Stage 3 - Marked joint space narrowing
Stage 4 - Advanced erosions penetrating subchondral bone plate
Stage 5 - Advanced joint damage + Subluxation
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How can you classify the management options?
Joint preserving - Open (column procedure), Arthroscopic (Debridement/ OK)
Joint sacrificing - Replacement/ fusion
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What is the column procedure?
Column procedure is a limited lateral approach that allows for joint arthrotomy, release of the capsule, and excision of osteophytes.
It allows for anterior and posterior capsular release and exposure adequate to remove osteophytes from the coronoid process and olecranon.
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What are the surgical principles of management of elbow arthritis?
OK procedure (open or arthroscopic debridement) relieves pain due to terminal impingement only.
If there is pain at mid arch, pain is unlikely to improve with an OK procedure β consider interpositional arthroplasty β may eventually require total elbow arthroplasty.
If there is pain on prono-supination or radiocapitellar pain β consider radial head excision.
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What is interposition arthroplasty?
Interposition using Achilles tendon allograft / ITB autograft.
(+) No weight restriction like TEA; useful for younger patients.
Good interim option for severe OA.
Main complication = early elbow instability.
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What are the Rheumatoid Pre-Operative considerations?