Ch.38 Upper Extremity Arm Flashcards
Which tendon is MC involved in lateral epicondylosis?
Extensor carpi radialis brevis
What disorder can mimic lateral epicondylosis?
PIN syndrome
What exercise regimen should be used for tx of lateral epicondylosis?
Eccentric stengthening of wrist extensors
What are the MC involved tendons in medial epicondylosis?
Pronator teres and flexor carpi radialis
What can be seen on X-ray in Lateral/Medial epicondylosis?
punctuate calcifications at tendon origin
Exercises used for treatment of tendonopathy.
Eccentric stengthening
History of distal biceps tendonitis
Pain in antecubital fossa with repetive elbow bending & follow through phase of throwing
History of distal biceps tendon rupture
Male 30-50, dominant limb, heavy lifting with elbow at 90 deg flexion
History of triceps tendonitis
Aching and burning at distal triceps aggravated by throwing, using a hammer, wt lifting
How can tricep tendon rupture occur?
FOOSH injury, steroid use
Hx of snapping triceps tendon
snapping sensation over medial epicondyle with eblow flexion & extension
Hx of aseptic olecranon bursitis
direct blow or repetitive trauma to olecranon process develops small liquid pouch
Hx of septic olectranon bursitis
localized or systemic injection l/t infected joint
Tx of aseptic olecranon bursitis
Aspiration of bursa followed by compresive dressing and elbow pad
Tx of septic olecranon bursitis
Aspiration of bursa for CS and gram stain, followed by compresive dressing and Abx
Cause of ulnar collateral ligament strain
valgus stress to the elbow
What phases of throwing put stress on the UCL?
late cocking and acceleration phase of overhead throwing
PE of UCL strain
5 deg elbow flexion contracture, UCL tenderness and pain w/ or w/o laxity during UCL instability testing
Tx of UCL strain
no throwing for 3-6 wks, ROM, medial forearm muscle strengthening, interval throwing program once pain free ROM
Definition of valgus extension overload (VEO) disorder
impingement of posteromedial olecran against medial wall of olecranon fossa from valgus elbow stres w/ overhead throwing
PE of valgus extension overload (VEO) disorder
Pain over posterior medial tip of olecranon and pasive hyperextension w/ valgus load of elbow
What phase of throwing aggravates valgus extension overload (VEO) disorder
acceleration and follow through
Rehab of valgus extension overload (VEO) disorder
Scapula/core kinetics, medial forearm muscle strengthening
What disorders are referred to as Little Leaguer’s elbow?
Medial epicondolitis, traction apophytiis, stress fx, throught medial epicondylar epiphyses and avulsion fx of medial epicondyle
What is Panner’s disease?
osteochondrosis of capitellum that occurs in ages 7-10
PE of Panner’s disease
Dull, aching lateral elbow pain aggravated by throwing, elbow effusion, ROM not restricted
Tx of Panner’s disease
Stop throwing, posterior long arm splint for pain control
Hx of osteochondritis desicans of capitellum
throwing athletes 9-15yo, lateral elbow pain, 15 deg flexion contracture focal lesions to capitellum w/ loose body formation
Tx of osteochondritis desicans of capitellum
stop throwing for 6 wks, posterior long arm splint for pain control, surgery for loose bodies
MCC of elbow dislocation
FOOSh injury
MC direction of elbow dislocation
posterior lateral
Injuries associated w/ elbow dislocation
collateral ligament, flexor/pronator forearm muscle, brachial artery, median/ulnar/radial nerve disruptions
Hx of FCU tendonitis
volar wrist pain w/ wrist flexion & ulnar deviation (racquet sports, golf)
What can be associated with FCU tedonitis?
Pisotriquetral compression sydnrome as pisiform bone embedded in FCU tendon
Tx of FCU tendonitis
wrist hand orthoses in 25 deg flexion or surgery to resect pisiform bone w/or w/o Z-plasty lengthening of FCU tendon
Hx of FCR tendonitis
Lateral wrist pain w/ wrist flexion, radial deviation and grip
Tx of FCR tendonitis
wrist hand orthoses in 25 deg flexion
Tendons involved in de Quervain’s syndrome
Abductor pollicis longus & extensor pollics brevis over radial styloid
Tx of de Quervain’s syndrome
rest, thumb spica splint, first dorsal compartment steroid injection
What is Intersection syndrome?
Friction b/w abductor pollicis longus & extensor pollicis brevis tedongs 4-6 cm proximal to Lister’s tubercle
Who is Intersection syndrome seen in?
Oarsmen, racquet sports, wt lifters
PE of Intersection syndrome
Dorsoradial distal forearm pain aggravated by wrist extension
Tx of Intersection syndrome
neutral wrist-hand orthosis, steroid injection to point at maximal tenderness, rarely surgery
Hx of extensor carpi ulnaris tendonitis
dorsoulnar wristpain w/ reptitive wrist extension & ulnar deviation in nondominant hand of tennis two-handed backhand
Hx of ECU subluxation
pop after forceful volar wrist flexion & ulnar deviation w/ pain
Tx of ECU tendonitis
neutral wrist-hand orthosis
What should be assessed for if pt w/ ECU tendonitis does not get better with conservative therapy?
Triangular fibrocartilage complex injury
Tx of ECU tendon subluxation
Acute: cast of wrist in pronated and dorsiflexion for 6 wk or surgery Chronic: sugrical reconstruction
