X-Ray showing elbow effusion after fall

[CurlyhairedAssassin]

I fell onto my outstretched arms 8 days ago and had a swollen and painful elbow with restricted movement (couldn't touch shoulder or straighten it fully.). Had it x-rayed the next day at a walk-in type of place and my GP phone a couple of days later to say it didn't identify a fracture but it did show an effusion (fluid in the joint?) and thought it should be referred to a fracture clinic.

There has been a cock up with the referral and I still haven't hAd a follow up x Ray done, but my sick note ends today and as my arm feels a lot better I was going to go back to work tomorrow, not having had a second x Ray done. I have movement back, the swelling has gone down and only getting the tiniest twinge of pain now and again. Only other symptom is a slight twinge of my funny bone nerve occasionally and the odd feeling of pins and needles.

Do I really need a follow up x Ray? All this faffing trying to get an appointment is a nuisance so feel like telling the GP to just leave it now. I would have thought I would still be feeling pain if it was a small break? Or could a small break mean I could Be pain free after 8 days if it was very minor?

I think you do need the followup x ray - I had a small break in my elbow which went undetected (in the context of a very serious injury elsewhere in my arm), and I would have had a better outcome if I'd had physio to that elbow and known to keep pushing the movement

Well the referral went astray so has been done again. GP very much still wants me to have a follow up early so I supoose I'd better do it! Back to work today though, no heavy lifting for me till a fracture is ruled out.

If your elbow is feeling better then it will likely be nothing.

There are two types of elbow effusions, one on the front of your elbow and one at the back as seen on the X-ray. One indicates a fracture one is merely due to a bit of soft tissue damage or irritation. By the sound of things you have the latter. You could go for a repeat X-ray if your symptoms were the same or worsened.

Any effusion seen on an elbow X-ray should be checked out as they can indicate a fracture is present. These effusions are the subtle signs of fractures which may well be missed at a walk in centre with no medics present. I wouldn't return to work until i had it checked out to ensure no further damage was done. The reason you will have been called back is that they think there is an issue worth checking. Get it checked.

Incorrect Izzy an anterior effusion does not indicate a fracture only a posterior one does.

Yes, I have been googling and it does seem to be that anterior effusion doesn't necessarily indicate a fracture but a posterior one is definitely grounds for suspicion. GP didn't tell me what type it was. I didn't even know what an effusion was till I came off the phone and googled. Surely the GP would know the difference between the 2 types and only have referred me if there was a posterior Effusion showing? And how does the referral system work? Does the GP tell the fracture clinic just that there is an effusion or would she have to describe it as anterior and/or posterior? And if it was described as only anterior would they reject the referral?

Suppose it's needless pondering. My appointment for fracture clinic is next Tuesday. Apparently there weren't any appointments befor then.

My arm has been achey all the way down since I've been using it in work. Something isn't right. Unless this is what tissue damage feels like when it's healing. But it isn't bad enough NOT to use it if you see what I mean. Oh well, only a few more days to wait. Will let you know in case anyone's interested.

No a GP might not necessarily know the difference, it is up to whoever is reporting on the X-ray to diagnose or for Orthopaedics to have a look as they are the specialists.

I disagree bumwad yes an anterior effusion can be normal, however if it's raised in a sail sign then it is an issue and can indicate fracture.

I'm back! I was shown the original x Ray at fracture clinic today and she pointed at both very clear posterior and anterior sail signs. Said she suspected the area of the bone that she thought a fracture would be hiding but said there would be no point doing another x Ray just to confirm a little crack when In all probability there would be one, based on x Ray, the way I fell, and the history of pain and swelling and lack of movement etc. Plus, as my movement is more or less back to normal, that rules out a follow up x ray even more.

She gave me a leaflet on radial head fractures and some physio exercises to do because there is a danger of the elbow joint stiffening up . And a phone number to attend outpatient physio if the exercises don't help. She said the funny bone nerve feelig and the slight twinge of pain when doing things like lifting a pan while cooking would go away in time as everything healed but everything was pointing to it healing fabulously well.

I just have got to avoid lifting anything heavier than about 5lb with that arm for the next 6 weeks. And she said I was right to attend the clinic (I apologised for being there as I am more or less fine) because they do have to check that everything is healing as it should be and can only do that by seeing the patients in person.

So there you are. Thanks for your input.

Glad to hear you've been given some useful advice to follow. Take care xx

Just seen this glad you are sorted OP!

Izzy you are incorrect an anterior effusion is not indicative of a fracture! Only posterior. Can you back up what you are saying?

I did my radial head a few years ago. It gets better very quickly OP. Glad you're diagnosed now.

I never said that an anterior effusion was indicative of a fracture. I said that an anterior effusion in a sail sign is. Read my posts. I can back it up with an Honours degree . Can you?

See here

Seems my picture won't post

I never said that an anterior effusion was indicative of a fracture. I said that an anterior effusion in a sail sign is.

But you said this:

Any effusion seen on an elbow X-ray should be checked out as they can indicate a fracture is present. These effusions are the subtle signs of fractures

And this:

yes an anterior effusion can be normal, however if it's raised in a sail sign then it is an issue and can indicate fracture

Raised posterior fat pad or raised sail sign is the soft tissue indication of an occult fracture. The anterior one when diagnosing is disregarded. This is because an anterior fat pad is visible on a normal elbow however a posterior pushed out fat pad isn't.

I can back it up with an Honours degree . Can you?

I have been diagnosing patients for 10 years plus now.

Time for some CPD

Seriously?! You want to be that arsey about all this?

Yes I did initially state that any effusion should be checked out. At that point the OP hadn't stated which she had.

I think you may also require some CPD. An anterior effusion can be visible on a normal elbow film however an anterior effusion in a sail sign is indicative of an occult fracture. I'm not sure how much plainer I can make this without linking to a bunch of medical journals and anatomy textbooks.

I have 14 years experience. Does that mean I win?

No need to reply. I think we're probably both a bit old for this backwards and forwards verbal battling.