Elbow injury (Full Version)

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Alex Brenner PT MPT OCS -> Elbow injury (December 12, 2004 8:21:00 PM)

Hi all. 17 year old high school football player, left tackle, was running down field to make a block. As he pushed away the defender he felt a pop and immediate pain deep in his elbow. He had to come out of the game and was seen in ER where he was released with a diagnosis of "triceps strain". Radiographs of the elbow were read normal by ER physician. You are friends with the kid's Mom so she decides to bring him in to see you for a second opinion. He is hand carrying his radiographs.

What are the findings?
[IMG]http://img.photobucket.com/albums/v85/brennerak/Test2.jpg[/IMG]



fapt -> Re: Elbow injury (December 12, 2004 11:39:00 PM)

hmm
i am the first guy here...
lol
Under his hx and Radiography were estimated, I think there is no significance fracture line in this X-ray. But the second X-ray(the below ones) the elbow joint has shiny white, I suggest that may be his joint has some problems. We have to check his joint line tenderness, joint play and ROM.That's my opinions.

Cheers, Lin,MS,PT



SJBird55 -> Re: Elbow injury (December 13, 2004 2:34:00 AM)

I'm having a difficult time seeing the image clearly. I'm guessing radial head region just proximal to neck may have a small fracture of some sort?



Jon Newman -> Re: Elbow injury (December 13, 2004 2:55:00 AM)

Perhaps a fracture of the coronoid process.

jon



chiroortho -> Re: Elbow injury (December 13, 2004 5:53:00 AM)

impacted non-displaced rad head fx



UTDC -> Re: Elbow injury (December 13, 2004 7:50:00 AM)

Minimally displaced radial head fracture. There is no fat pad sign, however lateral view taken is somewhat unusual.


Jeff



Jon Newman -> Re: Elbow injury (December 13, 2004 4:05:00 PM)

Have you ever had one of those, oh yeah now that you say it, type situations? That radial head fracture couldn't have be more obvious had I suffered it myself, yet I couldn't see it my first look through.

jon



UTDC -> Re: Elbow injury (December 13, 2004 6:43:00 PM)

Jon,

Absolutely. Whenever I spend time with a radiologist, I invariably have "duh" moments. That was a good call on the coronoid process, it does look suspicious, although I believe that it is normal.

Jeff



Alex Brenner PT MPT OCS -> Re: Elbow injury (December 14, 2004 8:33:00 PM)

Seasons greetings to all. I will be taking the long flight home to Kentucky tomorrow (14 hours) and I am not sure when I will be able to get to a computer so here is the answer to the elbow case early.

Findings: There is a non displaced fracture of the radial head. All other structures are within normal limits.

[IMG]http://img.photobucket.com/albums/v85/brennerak/Elbow.jpg[/IMG]

Below is a normal elbow to compare the radial heads.

[IMG]http://img.photobucket.com/albums/v85/brennerak/NormalElbow2.jpg[/IMG]

This gentleman was splinted for a couple of weeks and by the 4th week was feeling much better and was able to return to practice.

Good job UTDC, Chiroortho and SJBird for correct answers. We should start keeping score.



fapt -> Re: Elbow injury (December 16, 2004 6:00:00 PM)

lol
How can you see that?
I can't
:'(



Alex Brenner PT MPT OCS -> Re: Elbow injury (January 6, 2005 2:39:00 AM)

Just a follow on with this elbow study. Does anyone know what "Sail Sign" is?



UTDC -> Re: Elbow injury (January 6, 2005 5:58:00 AM)

Hi Army,
Sail sign is the same as the fat pad sign I referred to earlier which can be a sensitive indicator of fracture.

Jeff



Alex Brenner PT MPT OCS -> Re: Elbow injury (January 7, 2005 3:00:00 AM)

Jeff brings up a good clinical point when examining elbow radiographs. The "sail sign" is an invaluable soft tissue finding in cases of intra-articular injury of the elbow. Fat is normally present within the joint capsule of the elbow, but outside the synovium. Typically "hidden" in the concavity of the olecranon and coronoid fossae, the fat is usually not visible on the lateral radiograph. However, injuries that produce intra-articular hemorrhage cause distension of the synovium and forces the fat out of the fossa, producing triangular radiolucent shadows anterior and posterior to the distal end of the humerus. When present in a patient with a history of acute trauma to the elbow, the fat pad sign indicates the presence of an intra-articular hemorrhage, which in turn is often associated with an intra-articular skeletal injury (usually the radial head in an adult). It is called the "sail sign" becuase the radiolucent lines form the shape of a boat's sail.

[IMG]http://img.photobucket.com/albums/v85/brennerak/Elbowsailsign.jpg[/IMG]



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