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Physical Exam Course > Elbow > Flashcards

Elbow Flashcards

1
Q

Special Tests: lateral epicondylosis (2)

A
  1. Cozen test
  2. Resisted supination
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2
Q

Special Tests: Medial epicondylosis

A
  1. Resisted wrist flexion
  2. Resisted pronation
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3
Q

Special Tests: Radial Tunnel Syndrome

A
  1. Resisted middle finger extension
  2. Resisted supination
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4
Q

Special Tests: PIN Syndrome

A
  1. Radial deviation w/ wrist extension
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5
Q

Special Tests: UCL Injury

A
  1. Valgus stress test
  2. Moving valgus stress test (MORE SENSITIVE): Pain is worst from 120-70 degrees of elbow flexion
  3. Milking maneuver
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6
Q

Special Tests: OCD

A
  1. Active Radiocapitellar compression test: Active pronation/supination + Full elbow extension
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7
Q

Special Tests: Ulnar Neuropathy

A
  1. Elbow Flexion Test: 90 degree flexion + Supination + Wrist extension= Reproduction of pain in <60 sec
  2. Tinel’s
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8
Q

Special Tests: AIN

A
  1. Positive Pinch Grip Test: ok sign
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9
Q

Inspection: Carrying angles

A

Men: 5-10 degrees

Women: 10-25 degrees

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10
Q

ROM: Loss of smooth elbow motion in athletes

A

Osteonecrosis/Osteochondritis dessicans

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11
Q

Referred Pain: Elbow

A

Cervical Radic: C5

Rotator cuff pathology

Key element: Movement has no effect on pain

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12
Q

Referred pain: Hand

A

C6/C7

85% of cervical radiculopathies involve C6 and C7

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13
Q

Special Tests: Radial/Lateral Collateral ligament

A
  1. Varus stress test
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14
Q

Special Tests: Posterolateral instability (injury to ulnar part of RCL)

A
  1. Lateral pivot shift test: apprehension or impending dislocation w/ arm extended overhead + supination + valgus and axial force (usually under anesthesia)
  2. Posterolateral apprehension test
  3. Posterolateral rotary drawer test
  4. Chair test/stand up test
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15
Q

Most common tendon in lateral epicondylosis

A

ECRB

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16
Q

Percentage of pt’s w/ medial epicondylosis w/ ulnar nerve symptoms

A

50%

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17
Q

Compression of radial nerve near elbow

A

Radial tunnel syndrome

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18
Q
  • Tenderness 4-5 cm distal to lateral epicondyle
  • Pain reproduced w/ middle finger extension + Resisted supination
  • No weakness
A

Radial Tunnel Syndrome

19
Q

Pure motor branch of radial nerve

A

PIN

20
Q

PIN syndrome common site of compression

A

Arcade of Frohse: proximal tendinous orgin of supinator muscle

21
Q

Fracture of proximal ⅓ of ulna w/ dislocation on radial head

A

Monteggia Fracture

22
Q

Fracture associated w/ PIN syndrome

A

Monteggia fracture: proximal ⅓ of ulna w/ dislocation on radial head

23
Q

PIN Innervation

A
  • EDM
  • ECU
  • EDC
  • ECRB
  • EI
  • EPB
  • EPL
  • APL
  • Supinator
24
Q
  • Radial Deviation w/ wrist extension
  • Pain over lateral epicondyle
  • Wakness of thumb/finger extension at MCP
A

PIN Syndrome

25
Q

Positive XR for UCL injury

A

>2mm seperation in valgus stress

26
Q

Imaging of choice for UCL injury

A

MRI

27
Q

Little leaguers elbow

A
  • Repetitive microtrauma to medial epicondyle
  • Medial epicondyle apophysitis/fragmentation
28
Q
  • Pain w/ valgus stress test + no instability
  • Tenderness over medial epicondyle
  • Adolescent pitcher
A

Little Leaguers elbow

29
Q

Little Leaguer’s Elbow: Surgical indication

A

Avulsion >3-4 mm

30
Q

Ostochondrosis/AVN of capitellum

A

Panner’s Disease

31
Q
  • Tenderness and swelling of lateral aspect of elbow
  • Limited elbow extension (lack 20-30 degrees from full extension)
  • Young boy <10 yo
A

Panner’s Disease

32
Q

Elbow Pain: Adolescent overhead athlete w/o instability

A

Little Leaguers Elbow

33
Q

Elbow Pain: Young boy lacking 20-30 full extension

A

Panner’s Disease

34
Q

Osteochondritis dissicans

A

Fragmentation on bone/cartilage in capitellum

  • Older children vs Panner’s disease (10-16 yo vs 5-10 yo)
  • 2/2 throwing
35
Q

Subluxation of radial head

A

Nursemaids elbow

36
Q

Most common orthopedic injury in kids <2 yo (Girls > Boys)

A

Nursmaids elbow

37
Q

Reduction on nursemaids elbow

A

Supination + Elbow Flexion

Hyper pronation + Elbow at 90 (More successful)

38
Q

Elbow Impingement: Cause

A

Valgus extension overload:

  • Pinching of soft tissues/cartilage between olecranon tip and posterior fossa w/ repetitive forced elbow extension
    • May see olecranon spur on imaging
    • May see UCL laxity
39
Q
  • Pain/stiffness over posterior elbow worse w/ elbow extension
  • +/- Effusion
  • +/- ROM deficits
  • Pain over olecranon w/ palpation
  • Pain w/ active and passive elbow extension
  • Throwing athlete, racquet athlete, boxer
A

Elbow impingement

40
Q

Wartenberg sign

A

Ulnar Neuropathy

  • Inability to adduct little finger
41
Q

Froment’s Sign

A

Ulnar Neuropathy

  • Effects innervation to adductor pollicis and interossei muscles, which provide adduction of the thumb and extension of the interphalangeal joint.
  • The flexor pollicis longus (innervated by the median nerve), will substitute for the adductor pollicis (innervated by the ulnar nerve) and cause the thumb to go into hyperflexion.
42
Q

Pure motor branch of AIN

A

AIN

43
Q

AIN: Muscle innervation

A
  • FPL
  • FDP
  • Pronator quadratus
44
Q

AIN: Sites of compression

A
  • Pronator Teres Deep Head (MOST COMMON)
  • Thrombosed radial artery
  • Thrombosed ulnar artery
  • Gantzer’s muscle (Accessory head to FPL)
  • Fascial band at origin of FDS

Physical Exam Course (7 decks)

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