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Conditions (2nd year) > Conditions Of The Elbow & Forearm > Flashcards

Conditions Of The Elbow & Forearm Flashcards

0
Q

What are the actions of the Humeroulnar Joint?

A

Flexion & Extension

Women = 5* - 15* hyperextension

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1
Q

What type of joint is the Humeroulnar Joint?

A

Hinge Joint

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2
Q

What is the closed pack position of the Humeroulnar Joint?

A

Extension

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3
Q

Where do you find the Humeroradial Joint?

A

Between spherical capitulum & proximal radius

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4
Q

Closed packed Position of the Humeroradial Joint?

A

Elbow at 90* & forearm, supinated 5*

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5
Q

What is a carrying angle?

A

Angle between long axis of humerus & ulna when arm is in anatomical position
Males = 5-10*
Females = 10-15*

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6
Q

What are the functions of the elbow?

A

Mobility

Stability - modified hinge joint that encompasses 3 articulations

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7
Q

What are the 3 articulations of the Elbow?

A

Humeroulnar
Humeroradial
Proximal Radioulnar

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8
Q

What muscles contribute to FLEXION of the arm?

A 
Brachialis
Biceps Brachii
Brachioradialis 
FCU
FDS
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9
Q

What muscles contribute to elbow EXTENSION?

A

Triceps

Anconeous

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10
Q

What muscles contribute to PRONATION?

A

Pronator Quadratus

Pronator Teres

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11
Q

What muscles contribute to SUPINATION?

A

Supinator

Biceps Brachii

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12
Q

Contusions Etiology

A

Direct blows to arm/forearm

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13
Q

Contusions S&Sx

A

Ecchymosis
Myositis ossification
Tacklers exostosis

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14
Q

Contusions Management

A

PIER

Avoid aggressive strengthening/stretching

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15
Q

What is Tacklers Exostosis.

A

Anterolateral proximal humeral cortex after repeated injuries cause periosteal stripping & new bone formation

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16
Q

What is Myositis Ossification?

A

Separated from cortex, occurring in muscle belly

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17
Q

Olecranon Bursitis MOI

A

Fall on flexed elbow
Constantly leaning on elbow
Repetitive pressure & friction, flexion & extension
Infection

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18
Q

Acute & Chronic Bursitis MOI

A

Fall on flexed elbow

Constantly leaning on elbow

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19
Q

Acute & Chronic Bursitis S&Sx

A

Immediate, tender, swollen area of redness
If bursa ruptures, discrete, sharply demarcated goose egg is visible
Limited ROM at end of flexion

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20
Q

Acute & Chronic Bursitis Management

A 
PIER 
Compressive wrap
Chronic- cryotherapy, NSAIDs 
             - elbow cushions
             - bursa may be aspirated
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21
Q

Septic & Non-septic Bursitis MOI

A

Infection in absence of trauma
Septic bursitis maybe related to seeding from infection at a distant site
Non-septic (RA)

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22
Q

Septic & Non-septic Bursitis S&Sx

A

Infection: malaise, fever, pain, localized heat, restricted ROM, tenderness

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23
Q

Septic & Non-septic Bursitis Management

A

Refer to MD
Aspiration to culture
Sling

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24
Q

Collateral Ligament Sprain MOI

A

Rare
FOOSH
Repetitive tensile forces irritate & tear lig’t part of UCL
If UCL is damaged, ulnar nerve may have damage

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25
Q

Collateral Ligament Sprain S&Sx

A

Pain localized at medial aspect w/late cocking & early acceleration
Point tenderness at joint line
Increase pain & instability w/ valgus/varus/milking sign

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26
Q

Collateral Ligament Sprain Management

A

Standard care

Strengthening flexor-Pronator group

27
Q

Anterior Capsulitis MOI

A

Anterior joint pain cause by hyperextension, usually attributed to anterior capsulitis rather than chronic repetitive throwing

28
Q

Anterior Capsulitis S&Sx

A

Diffuse anterior elbow pain after traumatic episode
TOP (deep) particularly anteromedial side
-R/O strain to point tenderness & entrapment of median nerve

29
Q

Anterior Capsulitis Management

A

Standard care
Immobilization 3-5 days
Flexion contracture may result w/ repetitive injury

30
Q

Dislocations MOI

A

Adolescents most common traumatic injury to elbow are subluxations/dislocations of proximal radial head often associated w/immature annular ligament

31
Q

What is Nurse Maids elbow?

A

Dislocation of the radial head, accompanied by a decrease in pronation/supination w/o pain refer to ER

32
Q

Dislocations S&Sx

A
  • Snapping/cracking w/impact, severe pain, rapid swelling, loss of function & obvious deformity
  • Nerve palsie are also common
33
Q

Dislocations Management

A

Stabilize in position found
-R/O circulatory impairment, neuro impairment
-check vitals, treat for shock
refer to MD

34
Q

Flexor/Extensor Strains MOI

A

Repetitive tensile stress to muscle (elbow flexion/extension)

35
Q

Flexor/Extensor Strains S&Sx

A

Palpable pain over muscle mass

36
Q

Flexor/Extensor Strains Management

A

Standard acute management

Proper technique

37
Q

Rupture of Biceps Brachii MOI

A

97% of ruptures are proximal
Pre-existing degenerative changes in tendon make it vulnerable following sudden eccentric load
- men <30 w/ Hx of steroid use

38
Q

Rupture of Biceps Brachii S&Sx

A

Tenderness, swelling
Biceps tendon is not palpable b/c tendon retracts
Able to flex/supinate but weak

39
Q

Rupture of Biceps Brachii Management

A

May involve non-operative approach
- studies indicate significant loss
- May be sufficient for ADL but not sports
Surgical repair involves attachment of tendon

40
Q

Rupture of Triceps MOI

A

Direct blow to posterior aspect of elbow
Uncoordinated tricep contraction during fall
80% of ruptures involve Olecranon #

41
Q

Rupture of Triceps S&Sx

A

Pain, swelling over distal attachment on Olecranon process
Palpable defect in triceps
AROMA present, but weak/non-existent

42
Q

Rupture of Triceps Management

A 
Standard care w/immobilization
Refer to MD
Partial tears treated conservatively 
Surgical reattachment is necessary for total rupture 
Avulsion # requires extensive surgery
43
Q

Compartment Syndrome MOI

A

Secondary to elbow # or dislocations, crushing injury! forearm # or excessive muscular contraction
Hemorrhage/edema, increase pressure within the compartment
- excessive pressure on neuro vascular structures

44
Q

Compartment Syndrome S&Sx

A

Onset of symptoms is rapid

  • swelling, discolouration, absent/diminished pulse leading to sensory changes & paralysis
  • severe pain at rest, aggravated by PROM of muscles in compartment
45
Q

Compartment Syndrome Management

A
  • immobilization of forearm & wrist
  • ice & elevation
  • no external compression
  • immediate referral b/c fasciotomy may be needed to decompress the area
46
Q

Medial Epicondylitis (Golfers Elbow) MOI

A

Med/late tension compression forces places on elbow during acceleration phase of throwing
Medial humeral apophyseal growth plate of paediatric athlete
Valgus force produce a combined w/flexor muscle strain or UCL sprain & ulnar neuritis

47
Q

Medial Epicondylitis (Golfers Elbow) S&Sx

A

Swelling, ecchymosis TOP Humeroulnar jt./flexor/Pronator origin slightly distal & lateral to medial epicondyle
Pain w/RROM wrist flexion & pronation & by valgus stress at 20-30*
Ulnar nerve involvement
4th&5th digits

48
Q

Medial Epicondylitis (Golfers Elbow) Management

A

Standard care

Prevention w/proper mechanics & throwing

49
Q

What tendons are usually involved in Golfers Elbow?

A

Pronator Teres & FCU

50
Q

Lateral Epicondylitis MOI

A

Pain in lateral epicondyle is most common
Caused by eccentric loading of extensor muscles during deceleration of forearm extension
Caused by mechanical errors (leading w/elbow) poorly fitted equip & age (30-50) years

51
Q

Lateral Epicondylitis S&Sx

A

Pain anterior or just distal
Pain often subside & becomes more severe w/repetition
Tennis Elbow

52
Q

How do you test for Lateral Epicondylitis?

A

Coffee cup test

53
Q

Lateral Epicondylitis Management

A

Standard care
Counter force strap/tape
Find the cause treat the cause

54
Q

Cubital Tunnel Syndrome S&Sx

A

Shocking sensation along medial aspect of elbow (hitting funny bone)
(+) Tinel Sign
Pt. may develop hand weakness FCU & 5th digit (intrinsic muscle innervation)
Decrease grip&pinch strength

55
Q

Where does the Median Nerve travel through?

A

Passes through Cubital fossa, between 2 heads if Pronator Teres & FDS

56
Q

Pronator Syndrome S&Sx

A

Pain is felt in anterior proximal forearm & aggravated w/ pronation activities
Numbness anterior forearm of middle index fingers & thumb

57
Q

Radial Tunnel Syndrome S&Sx

A

Often mimic lateral epicondyle
Aching lateral elbow pain that radiates down posterior forearm
TOP Supinator muscle
Resisted supination is more painful than wrist extension
Wrist drop (ext weakness) seen in extreme cases but no sensory loss

58
Q

Radial Tunnel Syndrome Management

A

Refer to MD
Rx depends on Fx & NSAIDs can help in acute cases
Injury 2nd to direct blows, protect from further injury
Chronic nerve damage may require surgery to release pressure on nerve

59
Q

Epiphyseal & Avulsion # MOI

A

Growth plate in adolescents are sensitive to tension stress, repeated or sudden contraction of flexor-Pronator muscle group result in Avulsion # of medial epicondyle
“ Little League Elbow “ (forceful pronation)

60
Q

Epiphyseal & Avulsion # S&Sx

A

Initially individual complains of aching activity but no limitations in performance & no residual pain
Conditions progresses aching pain w/activity limitations & mild post-exercise pain, some TOP on epicondyle

61
Q

Epiphyseal & Avulsion # Management

A

Acute care w/activity modification
If performance limited due to pain & post exercise pain is present refer to MD
Conservative management rest & immobilization for >2 weeks
No throwing for 6-12 weeks
Surgery only if valgus instability is present or neural Sx

62
Q

Osteo-chondritis Desecans (OCD) MOI

A

Due to repetitive stress in skeletally immature elbow
Lat compressive forces exerted during throwing motion which can damage Radial head, capitulum or both
Leading cause of permanent elbow disabilities in adolescents
Causes fragmentation & softening of under lying subchondral bone
Leads to microfracture & eventual avascular necrosis

63
Q

Panner Disease

A

Associated w/OCD
Most common cause of chronic lateral elbow pain encompassing entire capitulum in athletes <10
Pain lat & ant elbow
Pain increase w/deep Palpation or pron/supination
Resolves w/rest
Elbow ext. limited by 20*

64
Q

Panner Disease S&Sx

A

Mirror little league elbow
Insidious onset of dull activity related & poorly localized pain
Eventually locking, decrease ROM & flex contraction are more than 15*
Swelling TOP over radiocapitellar joint
Decrease elbow extension

65
Q

Panner Disease Management

A

Refer to MD
Rest 16-18 mos.
no loose fragments resume activity
Fragment displacement may be warranted to reattach or excise small fragments

Conditions (2nd year) (6 decks)

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