elbow Flashcards
what would an anterior glide at the humeroradial joint improve?
flexion
what would a posterior glide at the humeroradial joint improve?
extension
what would an anterior glide at the proximal radioulnar joint improve?
supination
what would a posterior glide at the proximal radioulnar joint improve?
pronation
what are the tests for lateral epicondylagalgia?
-cozens
-mills
-third finger test
-palpatoin
what are the tests for cubital tunnel syndrome/which nerve is affected?
ulnar n
-elbow flexion test
-shoulder IR test
-froments sign
-wartenburg sign
-tinnels sign
what is the floor of the cubital tunnel
UCL
As part of your differential diagnosis consideration, if a patient complains of elbow locking, which of the following diagnoses is most likely?
loose body in the joint/OCD
what is the history of cubital tunnel syndrome
-repeptive activities
-trauma: hyperext, dislocation, UCL lax
-chronic compression
what is non-surgical intervention for cubital tunnel syndrome
-control pain and edema
-night orthosis
-elbow pads
what is the most frequently injured nerve in humerus fractures?
radial
what is the history of a high radial nerve injury
-fracture of humerus
-strenous exercise
-extended crutch ambulation
what are special tests for radial tunnel syndrome
-third finger sign
-reproduction of symptoms with direct pressure over nerve
what is pronator syndrome
compression of the median nerve between humeral and ulnar heads of pronator teres
where are the compression sites for anterior interosseous synrome
between muscle bellies of two heads of pronator teres
what is lateral epicongylitis/algia
tennis elbow
-most common elbow issue
-inflammation of common extensor tendon
-extensor carpi radialis brevis
35-60 typical age
-younger high volume training athletes
-can be a result of cervical radiculopathyu at C5-6
what is the lateral elbow pain differential dx
- cervical radiculopathy
- TOS
- radial tunnel syndrome
- radial head injury/OA
are injections beneficial for lateral elbow pain?
worse in the long run
-surgery only if conservative tx has failed
what is medial epicondyltis/algia
golfers/pitchers elbow
-forceful rep contractions of: prontator teres, FCR, FCU
-be sure to evaluate for laxity or ulnar n sypmtoms
what should you assume if a 10-14 year old is having medial elbow pain?
assume apophysitis
NO HSR OR ECCENTRICS
what is osteochondritis dessicans?
unknown etiology
-associated with gymnastics and throwing
-trauma and vascular insufficiency
-aged 15-20
-males>females
symptoms:
-joint effusion, limited ROM
-pain w activity, locking
-constant pain, ADL impairments
what is snapping elbow
-lateral elbow pain with palpable/audible snapping that occurs during flex/ext over radial head
-subsequent to trauma/hyperext injury
-repetivie stress
-pain may limit function
what is the differential dx of snapping elbow
-posteriolateral rotary instability
will have radial head translation/instability
sense of instaiblity with WB
-lateral epi
-OCD with loose body
what is the mechanism of an elbow dislocation
FOOSH
which direction elbow dislocation is most common
posterior
ulna no longer articulates w humerus
what are some associated fractures w an elbow dislocation
radial head
coronoid
epicondyles
what is a posterior elbow dislocation due to
hyperext
what is an anterior elbow dislocation due to
rare
-fracture of olecranon and tearing of joint capsule and ligaments
what is a lateral elbow dislocation due to
superior lateral displacement of radius
what is a medial elbow dislocation due to
rare
direct trauma
what is the tx of an elbow dislocation with no fracture present
-gentle closed reduction (axial traction, unlock coronid in ext, reduce and flex)
-check stability
-check radiographs
-splint/brace for 2 weeks
explain the protection phase of an elbow dislocation
typically immob at 90 for 7-10 days
-progresively begin to regain ROM at around 14 days post injury
-younger immobilize for longer
-early mobilize quicker to prevent stiffness
which kind of fracture is seen in 10% of elbow dislocations?
coronoid
-contributes to ant stability and brachialis insertion
talk about biceps tendon rupture
almost exclusively in males
-domniant elbow
-happens w sudden contractino of biceps against significant load with the elbow in 90 degrees of flexion
-need to see orthopedist ASAP as outcomes are better if they get surgery in first 24-48 hours
talk about late cocking
acceleration
-primary valgus force at elbow occurs during late cocking through acceleration
what is valgus extension overload syndrome
-secondary to medial instability
-impingement of medial olecranon on trochlea and olcecranon fossa
-may lead to osteophyte formation, loose bodies, chondromalacia
what are valgus extension overload syndrome S&S?
-pain in full ext, accentuated by valgus stress
-possible flexion contracture
what is a lateral compression injury
radiocapitellar overload syndrome
-secondary to medial instability
-abutment of radial head against capitulum
-may lead to osteophyte formation, loose bodies, chondromalacia, OCD
which kind of elbow instability is rare
varus
describe screening for elbow fx
elbow trauma plus 1 of the following
1. unable to fully extend the elbow
2. specific bony tenderness over:
-radial head
-medial epicondyle
-lateral epicondyle
-olecranon process
3. bruising/prescent of ecchymosis around elbow
what are the FOOSH possible fracture sites at the elbow
forces through radius:
-radial head on capitulum
-radial head fracture
forces through ulna:
-ulna on humerus
-fracture of either coronoid or olecranon
