One evening while playing in the yard, a father picked up ...



Musculoskeletal Case: elbow injury

One evening while playing in the yard, a father picked up his four-year-old daughter by her hand and started swinging her around in a circle. At first the girl giggled, but all of a sudden, she cried out in pain. When her father put her down, he noticed that she was holding her elbow. Her arm was partially flexed and pronated, and she was unable to supinate her hand without considerable pain, so her parents took her to the emergency room. When the physician palpated her elbow, she found that the joint was tender, especially on the lateral side, but all of the bony landmarks were in their normal locations, leading the physician to suspect that the head of the radius had slipped out of the annular ligament. Radiographs proved inconclusive. Fairly certain of the diagnosis, however, the physician attempted to reposition the head of the radius by supinating the forearm fully and then flexing the elbow. She felt a small pop on the lateral side of the cubital fossa as the head of the radius slipped back into position and within a few moments the girl's elbow was as good as new.

Questions:

1. What is the annular ligament and where is it located?

2. What are the bony landmarks that are readily palpable at the elbow?

3. This sort of elbow dislocation (pulled elbow, or subluxation of the head of the radius) is common in pre-school aged children, whose radial heads are somewhat small relative to the size of the annular ligament. What other types of elbow dislocations are common and how do they present?

4. List three additional common injuries to the elbow:

5. Why might the radiographs have been unhelpful in this situation?

6. What nervous structure is particularly vulnerable in elbow injuries and where is it located?

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