Elbow effusion: lift the fat pad

Question 1Where does elbow joint fluid collect in the posterior view?

1. aInside the triceps tendon
2. bIn the olecranon bursa
3. cUnder the skin of the forearm
4. dIn the posterior recess, lifting the fat pad out of the olecranon fossa

Question 2A child fell on an outstretched hand. Ultrasound shows a lifted posterior fat pad, but no fracture line is seen. What do you do?

1. aTreat it as a possible occult fracture: immobilise and follow the fracture pathway
2. bReassure, because no fracture line was seen
3. cDischarge without follow-up
4. dAspirate the elbow immediately

Question 3Which position helps the posterior view?

1. aThe elbow bent to about 90 degrees
2. bThe elbow fully straight and locked
3. cThe arm above the head
4. dThe forearm fully pronated and straight

Question 4What can be mistaken for an elbow effusion?

1. aThe ulnar nerve only
2. bAn olecranon bursitis or anisotropy of the triceps tendon
3. cThe brachial artery
4. dLung sliding

Question 5A febrile adult has a hot, swollen elbow with no injury and a posterior effusion. What next?

1. aIce and rest
2. bReassurance
3. cAspiration for possible septic arthritis
4. dAn X-ray only