Common Elbow Pathology Flashcards
1
Q
Common orthopedic impairments of the elbow
A
- Soft tissue injuries: lateral epicondylagia/-itis, medial epicondylagia, medial valgus stress overload
- Fractures: supracondylar, radial head, olecranon
2
Q
Describe lateral epicondylalgia
A
- aka Tennis elbow
- common extensor tendinopathy/overuse syndrome: ECRB, ECRL, ED, and EDM
- often associated with cervical spine pathology of C5
- involves impairment of the motor system, dysfunction of the nociceptive system, and changes in collagen structure
3
Q
Symptoms of lateral epicondylalgia
A
- pain on palpation of the common extensor tendon especially over ECRB
- pain with resisted wrist extension
- pain on stretch of the wrist extensors
- grip strength with dynamometer painful and limited
4
Q
Management of lateral epicondylalgia
A
- decrease overuse
- cock up splint to stabilize wrist with finger flexor use
- counterforce bracing may be utilized to dissipate force on the common extensor tendon: creates a pseudo attachment site
- patient education: all movements in the pain free ROM
- soft tissue massage/mobilization (STM) to decrease muscle tone
5
Q
Describe medial epicondylalgia
A
- aka Golfers elbow
- overuse injury: pronator teres, FCR, FD, FCU
6
Q
Symptoms of medial epicondylalgia
A
- pain with screwdriver/hammer use, golfing, baseball
- palpation tenderness along medial epicondyle and common flexor tendon/muscles
- discomfort with combined wrist/elbow extension
- pain with resisted wrist flexion and forearm pronation
7
Q
Management of medial epicondylalgia
A
- decrease overuse
- modifications in use of flexors and pronators of the wrist & forearm
- patient education: all movements in the pain free ROM
- soft tissue massage/mobilizations (STM) to decrease muscle tone
8
Q
Describe medial valgus stress overload
A
- aka valgus extension overload (VEO)/Pitchers elbow
- repetitive stress at ulnar collateral ligament leads to micro trauma of collagen
- common in overhead athletes & pitchers
9
Q
Symptoms of medial valgus stress overload
A
- pain over medial elbow & posterior aspect of olecranon
- increased valgus of elbow
- pronator mass hypertrophy
- loss of extension ROM
10
Q
Management of medial valgus stress overload
A
- avoid valgus stress/limit sports participation
- pain free ROM at hand
- resistance exercise to hand, wrist, and forearm avoiding all activities that increase pain
- slow return to pain free activity: pitch counts and pitching coach
11
Q
Describe a supracondylar fracture
A
- transverse fracture of the distal humerus
- usually occurs in children
- Gartland classification
- treatment usually closed reduction in elbow flexion, possibly percutaneous pinning (external fixation)
- distal humerus displaced posteriorly: fall on extended outstretched arm
- distal humerus displaced anteriorly: direct trauma to the posterior elbow
12
Q
Management after immobilization of a supracondylar fracture
A
- gentle AROM
- passive stretching/PROM is contraindicated
- watch for neuromuscular compromise, compartment syndrome
13
Q
Complications of a supracondylar fracture
A
- Volkmann ischemic contracture: severe pain in forearm muscles, limited & painful finger movement, paresthesia (median nerve with loss of sensation), loss of radial pulse, and pallor & paralysis
14
Q
Describe a radial head fracture
A
- fall on outstretched arm
- 1/3 of all elbow fractures
- may result in change in elbow carrying angle
15
Q
Describe the four types of radial head fractures
A
- Type I: non-displaced, immobilization 1-4 weeks, gentle pain free ROM
- Type II: marginal fracture with displacement, ORIF, immobilization in hinged splint, ROM as allowed by surgeon, joint mobilizations (probation/supination)
- Type III: comminuted & displaced, excision of fracture, change in carrying angle, ROM as allowed by surgeon
- Type IV: radial head fracture + elbow dislocation, excision of fracture, change in carrying angle, ROM as allowed by surgeon, Type III & Type IV typically demonstrate extension lag
