Etiology - most common cause is RA, then post traumatic
Primary OA is rare
Others - previous OCD, infection...
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What is the functional ROM of elbow?
Functional arc = 30 - 130 °. ROM is 100 °; 50/50 of P/S.
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How do you differentiate RA vs OA on XR?
RA has periarticular osteopenia, “panarticular”, absence of osteophytes
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What is a flail elbow? Causes?
A flail joint is one which the patient has no control of the joint in flexion / extension or both and whose forearm hands dependant 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 clinical features? What nerve to check? (in PE)
Elbow OA will present with loss of terminal extension
Pain only at end range of ROM
Clicking, locking
Check stability - due to ligament attenuation from synovitis
Check neurology -
ulnar nerve - cubital tunnel syndrome commonly seen, thought to be due to osteophytes pressing on nerves.
PIN - synovitis/ panus
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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) only eliminates pain due to terminal impingement
If pain at mid arch range, then pain cannot be eliminate pain with OK procedure ➔ consider interpositional arthroplasty ➔ will eventually need total elbow arthroplasty
If patient has pain on prono-supination or pain in radiocapitellar joint ➔ can consider radial head excision
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What is interposition arthroplasty?
Joint interposed with achilles tendon allograft/ ITB autograft
(+) No weight restriction like TEA. Good for younger patients
Good interim treatment for severe OA
Main complication = early elbow instability
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What are the Rheumatoid Pre-Operative considerations?