Distal Biceps Ruptures Flashcards
Structures in the AC Fossa from medial to lateral
- median nerve
- brachial artery
- biceps tendon
- radial nerve
Most commonly injured nerve during repair is:
lateral antebrachial cutaneous nerve
next most common is superficial radial nerve
Benefit of distal biceps repair?
40% improvement of supination strength
30% improvement of flexion strength
management of partial biceps tear with chronic pain?
exploration, debridement, and reattachment
where does the distal biceps usually tear?
radial aspect of tendon
cortisone fro lateral epicondylitis?
don’t do it
can worsen your overall outcomes, increase rate of recurrence
where does ECRB insert
base of the 3rd MC
pathoanatomy of lateral epicondylitis
ECRB rubs against the capitellum
angiofibroblastic dysplasia
where does the LUCL insert
supinator crest of ulna
best grafts for LUCL reconstruction?
palmaris longus autograft
gracilis allograft
muscles that originate on the lateral epicondyle
- anconeus
- ecrb
- ecrl
- edc
- ecu
Facts about elbow OA
- preferential for radiocapitellar joint
- spares the ulnohumeral joint
Primary stabilizers of the elbow:
- anterior band of the MCL (anterior oblique fibers)
- LCL
- Coronoid
Secondary stabilizers of the elbow:
- radial head
- medial capsule
- anconeus
symptoms of elbow OA:
pain at end range of motion
- usually painless mid-flexion arc
- loss of terminal extension
- ulnar neuropathy in 50%
Who gets a total elbow arthroplasty
old patients
low demand
soft tissue interpositional elbow arthoplasty reserved for:
young patients
high demand
would otherwise be TEA candidates
Contraindicated in:
- rheumatoid
- osteonecrosis
what do you do for young guy with elbow OA who is a laborer
scope, osteophyte removal, capsular release
there is generally no role for PT with advanced OA and joint contracture
can you convert an elbow interpositional arthroplasty to a TEA?
yes
results are good
10/12 patients in one series had good results
waht degree of constraint should be used in a TEA?
semiconstrained
fully constrained prosthesis have high rates of loosening
who is at risk for elbow OCD lesions?
people who have repeitive upper extremity activties like throwers and gymnasts
waht is Panner’s diseae?
osteochondrosis of the capitellum
- children < 10 years
- benign course, self-limiting
- no surgery
- involves the entire capitellar ossific nucleus
earliest sign of elbow OCD?
lack of elbow extension
Management of stable type 1 capitellum OCD
- treat with cessation of activity +/-
immobilization - gradual return to activity over 12 weeks
Management of unstable type 1 or type 2 OCD capitellum?
driling/microfracture
Management of a large type 2 OCD incompletely displaced?
scope and fix it
Should you MRI a partial biceps tear?
yes
Where does the pec major insert relative to the LHBT
just lateral to it.
