Elbow 1 Flashcards
Condition?
- Overuse inflammatory injury involving common extensor tendon.
- Repetitive wrist extension or combined wrist and finger extension.
- “Tennis elbow”
- Point and click elbow
Lateral Epicondylitis
Condition?
- Significant pain
- 3/5 strength w/ resisted 3rd digit extension
Lateral Epicondylitis
Condition?
Inflammation
Fiber disruption / degeneration
Tendonitis
Condition?
Inflammatory process becomes “stalled”
Typically occurs b/w 6-8 weeks
Fiber disorganization and pronounced degeneration
Tendonosis
Tx for what?
- NSAIDs
- Activity modification
- Ice
- Therapeutic exercise
- stretching
- strengthening
- Supportive bracing
- Steroid injection
Lateral Epicondylitis - Tendonitis
Tx for what?
- Activity modification
- PT / OT
Therapeutic exercise- stretching
- strengthening
- Supportive breaching
Lateral epicondylitis - Tendonosis
What 2 treatments are NOT beneficial for long term management of Lateral Epiconylitis - Tendonosis
- NSAIDs
- Steroid Injection
Condition?
- “Golfers elbow”
- medial elbow pain
- weakness
- TTP of medial epicondyle
- Dec strength w/ wrist flexion
Medial Epicondylitis
Is it more likely to have central or peripheral nerve injury?
peripheral
Distal Biceps Tendon Rupture
- Men > ___ yrs w/ pre-existing what?
- Rapid eccentric contraction of biceps leads to distal tendon tear at what location?
- >40
- Pre-existing degenerative changes in biceps tendon
- Radial insertion
Non-surgical tx for partial tears of Distal Biceps Tendon Rupture (2)
- Bracing w/ ROM limitation x 4 weeks
- Gradual progression of ROM & strengthening
Non-surgical tx for complete tear of Distal Biceps Tendon Rupture is appropriate in what situation?
Older patients w/ sedentary lifestyle who are willing to accept strength loss
Surgical tx for Distal Biceps Tendon Rupture for what 2 scenarios
- Complete tendon rupture in young active individuals (quick surgical consult is imperative for best outcomes)
- Elective for partial tears in young active individuals
Which ligament is hurting if a pt c/o pain while throwing baseball?
Ulnar Collateral Ligament
What are the special tests to evaluate for Ulnar Collateral Ligament injury?
- Valgus Stress Test
- Moving Valgus Stress Test
- Milking Maneuver
Which special test for Ulnar Collateral Ligament?
- Assess for pain, medial joint laxity, and end feel
- Marginal to good sensitivity & specificity
Milking Maneuver
Valgus Stress Test
Perform at 0 and 30 degrees flexion
Forearm neutral rotation
Assess for pain, medial joint laxity, an end feel
Marginal sensitivity / specificity
Which special test for Ulnar Collateral Ligament?
- Perform at 0 and 30 degrees flexion
- Forearm neutral rotation
- Assess for pain, medial joint laxity, an end feel
- Marginal sensitivity / specificity
Valgus Stress Test
Which special test for Ulnar Collateral Ligament?
- Pain throughout ROM = UCL insufficiency
- Good sensitivity / specificity
- Shear angle 80° to 120°
Moving Valgus Stress Test
Ulnar Collateral Ligament Injury
- Obtain radiographs to r/o what?
- This is MC in people under what age? Why?
- Avulsion fracture
- <18 yrs, bc growth plate has not fully fused, so an avulsion is more common.
What is the gold standard imaging study of Ulnar Collateral Ligament Injury?
MR arthrogram of the elbow
- Golf ball hanging off elbow
Condition?
Olecranon Bursitis
Which condition?
- Result of repeated trauma (e.g. persistent leaning on elbows)
- Excess fluid develops within the bursa, causing it swell / enlarge
Non-inflammatory bursitis
PE findings of which condition?
- Obvious swelling at the tip of the elbow
- Absence of pain, redness or warmth, as there is usually a minimum of inflammation
- Full, painless range of motion of the elbow → may complain of tightness at end range of flexion
Non-inflammatory Bursitis
Which condition?
- Typically the result of infection
- Obvious swelling at the tip of the elbow
- Marked warmth, redness, and pain on palpation of the bursa.
- Elbow flexion will likely be limited at end range due to pain and tightness
Inflammatory Bursitis
Olecranon Bursitis
- If fluid accumulation is small and there is no concern for infection, how do you treat?
Symptomatically
- Ice
- Compression sleeve / elbow pad
- NSAIDs
- Activity modification
Olecranon Bursitis
- What is tx for bursa w/ large effusion or concern for infection?
Aspiration of bursa
Procedure - Olecranon Bursa Aspiration
- What gauge needle? / What anesthesia?
- Through skin wheal, insert a ___ G needle attached to a 10 mL syringe into bursa and aspiration contents until bursa is flat
- If concern about infection, what should you do/not do?
- If infection not probably, what might be helpful?
- 27 G / 1% Lidocaine
- 18 G
- Send fluid for C&S and DO NOT inject steroid
- 1mL of 40 mg/ml corticosteroid may be helpful
Elbow Dislocations
- Typically due to what mechanism of injury?
- MC joint dislocation in what age group?
- 98% are anterior or posterior?
- Must r/o what 2 fractures?
- What fx is MC seen in posterior dislocations?
- MOI: FOOSH
- Age group: children
- 98%: posterior
- 2 fxs: olecranon / radial head
- MC posterior: coronoid process fx
What exam is critical for Elbow Dislocations?
NV exam
Which ligament is being tested w/ Valgus?
- Ulnar collateral ligament
Which ligament is being tested w/ Varus?
Radial Collateral Ligament
The 4 structures responsible for Elbow Stability
- Ulnar collateral ligament
- Radial collateral ligament
- Coronoid process
- Trochlear (sigmoid) notch
