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OCS Prep > elbow > Flashcards

elbow Flashcards

1
Q

Elbows vascular supply

A

brachial artery
radial artery
ulnar artery
middle and radial collateral arteries
superior and inferior ulnar arteries

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2
Q

Anterior elbow symptoms possible causes

A
  • anterior capsular sprain
  • distal biceps tendon rupture or tendinopathy
  • elbow dislocation
  • pronator syndrome (throwers)
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3
Q

Medial elbow symptoms

A
  • medial elbow tendinopathy
  • ulnar collateral ligament sprain
  • ulnar nerve injury
  • flexor- pronator muscle injury
  • little league elbow
  • valgus extension overload
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4
Q

postermedial elbow symptoms

A
  • olecranon tip stress fracture
  • posterior impingement (throwers)
  • trochlea chondroalcia
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5
Q

posterior elbow symptoms

A
  • olecranon bursitis
  • olecranon process stress fracture
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6
Q

lateral elbow symptoms

A
  • capitulum fracture
  • lateral elbow tendinopathy
  • radial collateral ligament complex sprain
  • osteochondral degenerative changes
  • osteochondritis dissecans (Panners disease)
  • posterior interosseous nerve syndrome
  • radial head fracture
  • radial tunnel syndrome
  • synovitis
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7
Q

forearm symptoms

A
  • radius or ulna stress fracture
  • radial tunnel syndrome
  • cubital tunnel syndrome
  • brachialis tendinopathy
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8
Q

other non elbow causes of pain

A
  • C6/C7 radiculopathy (radiates to lateral elbow)
  • shoulder pathology
  • TOS
  • Brachial plexus
  • primary nerve
  • peripheral nerve entrapment
  • DM
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9
Q

What range do the majority of ADL’s happen in

A

50 degrees of pronation-supination
30-130 elbow flexion

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10
Q

Elbow flexion Test

A

CUBITAL TUNNEL SYNDROME
- elbow is maximally flexed and held from 60-3 minutes
- (+) is paresthesias in ulnar distribution

+LR 1.0 - 45.99
-LR .99 - .54

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11
Q

Pressure provocation test

A

CUBITAL TUNNEL SYNDROME
- full flexion and apply pressure to ulnar nerve for 30 seconds.
- (+) fourth and fifth tingling/numbness

+LR 45
-LR- .11

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12
Q

Tinel Sign

A

CUBITAL TUNNEL SYNDROME
- taps lightly at ulnar nerve at medial epiondyle
(+) tingling/numbness to 4/5 digit

+LR 1.3 - 53.99
-LR .72 - .46

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13
Q

scratch collapse

A

CUBITAL TUNNEL SYNDROME
- patient seated, arms adducted, elbows flexed to 90, hands outstretched. asked to perform simultaneous resisted bilateral shoulder external rotation. PT pushes in internal rotation, then PT scratches skin over nerve.
- (+) if patient has momentary loss of ER in affected side

+LR 68.99
-LR .31

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14
Q

Cubital tunnel special tests

A
  • elbow flexion test
  • pressure provocation
  • tinel sign
  • scratch collapse
  • crossed finger
  • shoulder internal rotation
  • chair sign
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15
Q

Posterolateral Rotary Instability tests

A
  • chair sign
  • push up sign
  • table-top relocation
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16
Q

UCL testing

A
  • valgus stress
  • milking maneuver (anterior portion)
  • moving valgus stress test
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17
Q

MET testing

A
  • passive medial elbow tendinopathy
  • ## active wrist flexion against resistance
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18
Q

LET testing

A
  • Cozen
  • maudsley
  • mill
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19
Q

distal biceps tendon rupture

A
  • biceps squeeze
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20
Q

3 etiologies of tendonopathy

A
  • vascular
  • mechanical- repetitive loading of tendon
  • neural modulation- neurally mediated mast cell degranulation and release of substance P
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21
Q

Possible cause of tendonopathy

A

too much or too little stimulation to tissue

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22
Q

Ideal Isometric prescription for tendonopaty

A

24 reps of 10 seconds
or
6 reps of 40 seconds

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23
Q

LET primarily occurs in who?

A

jobs requiring repetitive grasping, forceful or heavy manual tasks, non-neutral wrist postures

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24
Q

Primary symptom of LET

A

pain

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25
Q

Three common tests for LET

A

Cozen
Mill
Maudsley

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26
Q

Other DD for LET

A
  • radiocapitellar chondromalacia
  • posterolateral elbow instability
  • plical irritation
  • intra-articular loose bodies
  • malignancy
  • cervical radiculopathy (6 or 7)
  • radial tunnel syndrome
  • compression of posterior interosseous nerve at arcade of Frohse (supinator syndrome)
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27
Q

Standard care for LET

A

Non operative management with NSAID’s, cross friction massage, electrical and thermal modalities, TE and bracing and race.

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28
Q

Possible joint mobilizations for elbow

A
  • HU distraction: pain
  • HU lateral glide: LET
  • HR anterior glide: elbow flex
  • HR posterior glide: elbow ext
  • PRUJ glide: anteromedial supination, posteriorlateral pronation.
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29
Q

eccentrics for LET prescription

A

3x15 taking 4 seconds to complete with 30 second rest

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30
Q

Injections for LET

A
  • provide high success rates within first 6-8 weeks but result in high pain recurrence rates and protracted recovery in long term
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31
Q

surgical intervention for LET

A

lateral epicondylar release

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32
Q

Lateral epicondylar release protocol first 7 days

A

Immediate goals: decrease pain and inflammation, improve ROM, minimize atrophy

pain-free AROM of shoulder, wrist (flex only), and fingers. AAROM into wrist ext with elbow flexed to 90, PROM into elbow flex/ext and pro/sup

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33
Q

Lateral epicondylar release protocol 2 weeks on

A
  • AAROM/PROM progressed to AROM with goal of 80% ROM by 3 weeks
  • sub max isometrics for grip, can add weight as patient can perform 30 reps pain free ( all exercises being performed at 90 degrees flexion)
  • joint mobilizations introduced at week 3
  • full recovery at 8-12 weeks
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34
Q

MET

A

golfers elbow
involves FCR, pronator teres with occational involvement of PL, FCU, FDS
- overuse injury

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35
Q

Presentation of MET

A
  • medial elbow pain over flexor-pronator origin
  • symptoms worsen with resisted wrist flexion, resisted pronation, passive wrist extension combined with passive forearm supination and elbow extension
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36
Q

DD for MET

A
  • UCL injury or insufficiency
  • medial elbow intra-articular pathology
  • ulnar nerve entrapment or neuritis
  • shoulder injury
  • cervical spine nerve root impingement
  • TOS
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37
Q

Bicipital tendinopathy

A
  • occurs at radial tuberosity and is due to repetitive hyperextension of elbow with the forearm pronated or repetitive flexion combined with stressful pro/sup in athletic individuals over 35
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38
Q

complaints with bicipital tendinopathy

A
  • elbow/forearm pain over radial tuberosity
  • can be reproduced with resisted elbow flexion and forearm supination
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39
Q

4 phases of distal biceps tendinopathy in athlete

A

1: rest
2: stretching for scapular muscles, rotator cuff, and posterior GHJ capsule
3: eccentric strengthening of the elbow flexors and forearm supinators
4: progressive return to a throwing program

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40
Q

Avulsions of biceps tendon at elbow

A
  • occurs exclusively in males
  • most common being rupture of dominant elbow of muscular male in 50’s
  • based on patient history (sudden pop) and PE alone (ecchymosis in distal arm and proximal forearm, flattening of distal contour of arm created by proximal forearm soon after injury
  • MMT reveals weakness in flexion but mostly forearm supination depending on patient’s strength
  • Hook test- 100% sn, sp.
  • biceps squeeze- 96% sn
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41
Q

Biceps crease interval

A

distance between elbows antecubital crease and cusp of distal descent of biceps muscle (the point in which the distal curve of the biceps begins to turn most sharply toward the antecubital fossa

> 6cm has 92% SN, 100% SP

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42
Q

Distal BT repair early recovery

A

0-6 weeks
- focus on pain, protection of repair
- splint/brace immobilize elbow at 90 degrees flexion and in full supination worn at all times
- brace is unlocked for PROM from 30-full flexion (extension is progressed 10 degrees per week
- no active elbow flex or forearm supination
- cardiovascular exercises for LE early on
- next phase progression when no pain or swelling persists

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43
Q

Distal BT repair intermediate recovery

A

6-12 weeks
- iso triceps @ 6 weeks
- concentric triceps @ 8 weeks
- streengthening of shoulder girdle, wrrist flexors and extensors.

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44
Q

Distal BT repair late recovery

A

12-16 weeks
- bicep isometrics
- light bicep concentric at week 16

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45
Q

Distal BT repair final stage

A

16+ weeks
- biceps strengthening advanced to side curls

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46
Q

Distal triceps tear

A
  • occurs in less than 1%
  • happens when deceleration force occurs during elbow extension or with an uncoordinated contraction of triceps while eccentrically resisting elbow flexion force
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47
Q

common findings of distal triceps repair

A

inability to extend arm overhead against gravity and loss of overall elbow extension strength

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48
Q

Non op approach for partial triceps tear

A
  • immobilization for 3 weeks followed by gradual progression of ROM and strength
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49
Q

Distal triceps repair Immediately post op

A
  • patient is in cast of 45 flexion, no weightbearing
    -wrist extension/flexion with light dumbbell. shoulder pendulum
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50
Q

Distal triceps repair 2-6 weeks

A
  • elbow ROM brace locked 0-90
  • avoid PROM flexion past 90 and any elbow ext
  • AAROM elbow ext is allowed with shoulder at 90 abd
  • active supination/pronation, elbow flexion, light iso elbow flexion
  • initial elbow extensor strength
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51
Q

Distal triceps repair 6-12 weeks

A

ROM is increased until full ROM

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52
Q

Distal triceps repair 12+

A

return to work/sports

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53
Q

aseptic olecranon bursitis

A
  • injury from direct trauma or sustained pressure/vibration over bursa
  • sling to reduce symptoms
  • aspiration to analyze fluid to rule out infection or gout only when diagnosis is uncertain
  • ice, compression, bandaging, NSAIDs
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54
Q

Septic olecranon bursitis

A
  • redness, heat, tenderness
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55
Q

Chronic olecranon bursitis

A
  • prolonged or repetitive injury to bursa or secondary to comorbidities such as DM, gout, pseudo-gout
  • if no comorbidities, tis easy to treat through education about not irritating bursa
  • corticosteroid injections may be warranted to manage recalcitrant chronic bursitis once diagnosis of infection has been excluded.
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56
Q

DD of olecranon bursitis

A
  • acute fracture
  • RA
  • gout
  • synovial cysts
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57
Q

comorbidities leading to peripheral nerve trunk injury

A
  • DM
  • hypothyroidism
  • hereditary neuropathy
  • immune deficiency syndromes
  • RA
  • alcoholism
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58
Q

nerve injury recovery

A
  • 2mm-3mm per day in proximal segments
  • 1mm- 2 mm per day in distal segments
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59
Q

Neuropraxia Sunderland gr I

A

focal, but transient, segmental demyelination without wallerian degeneration

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60
Q

Axonotmesis Sunderland gr II

A

axon is damaged with intact endoneurium. Wallerian degeneration occurs

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61
Q

Axonotmesis Sunderland gr III

A

axon and endoneurium are damaged with intact perineurium. regenerating axons may not innervate to original end organs

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62
Q

Axonotmesis Sunderland gr IV

A

axon, endoneurium and perineurium damaged with intact epineurium

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63
Q

Neurotmesis Sunderland gr V

A

complete nerve transection. surgical intervention is usually required

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64
Q

double crush syndrome

A

serial compromise of axonal transport within the same nerve fiber, causing a subclinical lesion at the distal site to become symptomatic

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65
Q

splinting for injury to median nerve

A

to enhance thumb opposition while also providing some assistance to finer flexion

66
Q

splinting for injury to ulnar nerve

A

to prevent clawing of the hand by blocking MCP hyperextension

67
Q

splinting for radial nerve injury

A

to provide wrist stability while also providing some assistance to MCP extension

68
Q

cubital tunnel syndrome nerve and DD

A

ulnar

cervical radiculopathy
TOS

69
Q

cubital tunnel syndrome diagnosis

A

found in throwers, due to the extreme valgus stress placed upon the elbow

people with sustained flexed elbow positions

70
Q

pronator syndrome nerve and DD

A

Median

cubital tunnel syndrome
cervical radiculopathy
TOS
AIN syndrome

71
Q

pronator syndrome diagnosis

A

differentiated from carpal tunnel syndrome by using tinel test at the wrist or the provocation of symptoms throw prolonged wrist flexion- neither of which should produce symptoms from pronator syndrome

72
Q

AIN syndrome nerve and DD

A

median

cervical radiculopathy
brachial neuritis
rupture of flexor pollicis longus
pasonage-turner syndrome

73
Q

AIN syndrome diagnosis

A

to help rule out brachial neuritis and parsonage-turner syndrome, you should determine whether the patient has any history of transient shoulder pain, viral infection, or recent immunization

74
Q

PIN syndrome nerve and DD

A

radial

RTS

75
Q

RTS nerve and DD

A

radial

LET
PIN syndrome

76
Q

RTS diagnosis

A

only nerve compression syndrome in which signs and symptoms are note based on its distribution

  • main clinical feature is localized tenderness over radial tunnel
  • resisted supination of the forearm with the elbow fully extended should also reproduce pain
  • pain can become more severe when increased traction is applied to the nerve by extending the elbow, pronating forearm, and flexing wrist
77
Q

exercises for median nerve

A

thumb opposition
precision grip
strength in involved fingers

78
Q

exercises for ulnar nerve

A

key pinch
power grip
coordination

79
Q

exercises for radial nerve

A

MCP extension
thumb abduction
wrist extension

80
Q

cubital tunnel syndrome treatment

A

activity modification with protection over cubital tunnel with elbow pad placed on medial-posterior aspect
-limiting repetitive extreme elbow flexion
- night splinting at 40-60 degrees of elbow flexion
-exercises must not reproduce distal symptoms

81
Q

pronator syndrome treatment

A
  • gentle massage along the fibers to aid in breaking adhesions
82
Q

AIN syndrome treatment

A
  • period of rest and observation
  • splinting elbow near 90 of flexion
83
Q

PIN syndrome treatment

A
  • cock up splint combined with soft tissue techniques (active release techniques in conjunction with neural gliding
  • regular gentle stretching of the wrist extensor muscles with elbow in full flexion is initiated after spontaneous recovery
84
Q

radial tunnel syndrome treatment

A
  • education to avoid provocative positioning of the arm into forceful extension and supination of the wrist and forearm with splinting used
85
Q

when is surgery indicated for nerve pathologies

A

3-4 months of conservative care with muscle atrophy, persistent sensory changes, or persistent symptoms

86
Q

5 items for classifying elbow instabilty

A
  • timing (acute, subacute, chronic)
  • articulation involved ( HU or PRUJ)
  • direction of displacement ( varus, valgus, anterior, or posterolateral rotatory)
  • severity (subluxation or dislocation)
  • presence or absence of associated fractures.
87
Q

pt hx for elbow instability

A
  • recurrent painful clicking, snapping, clunking, or locking or elbow that occurs in the extension portion of arc of motion with forearm in supination
88
Q

ulnar collateral ligament test

A

elbow is placed in 20-30 degrees of flexion and forearm supinated and valgus stress applied

positive when no firm endfeel or greater than 10 mm opening noted, or pain felt

SN 66%
SP 60%

89
Q

radial collateral ligament test

A

patient sitting or standing, therapist places elbow in slight flexion between 5-30 and applies varus force

positive if the patient experiences pain or excessive laxity noted

90
Q

valgus instability tests

A

valgus stress test
milking maneuver
moving valgus stress test
modified milking maneuver

91
Q

varus instability clinical findings

A
  • posterolateral- vague elbow discomfort or clicking or clunking that is worse with supination of forearm
  • posteromedial- history of repetitive trauma and reports of clicking and popping with elbow flexion and extension
92
Q

valgus instability clinical findings

A
  • medial elbow pain and history of either trauma or overuse
  • associated tendinopathy or another source of local inflammation
  • more unstable when the forearm is in pronation than when the forearm is in supination
93
Q

the most common type of elbow instability

A

posterolateral rotatory instability

94
Q

posterlateral rotatory instability DD

A

varus posteromedial rotary instability
cervical pain referral
LET
RTS
valgus instability

95
Q

posterolateral rotatory instability symptoms

A
  • lateral elbow pain
  • clicking
  • recurrent subluxation when load is applied while elbow is in flexion and supination
96
Q

lateral pivot-shift test

A

patient in supine, elevate arm over head with shoulder placed in full external rotation and forearm supination. a valgus, supinating, and axial force is applies as the elbow is slowly flexed
- a skin dimple can be seen proximal to radial head
- with increased flexion the dimple disappears as the radial head reduces

con- may have apprehension

in anesthetized patient, 100% SN

97
Q

chronic cases of PLRI

A

do not have adequate tissue to repair and often require an open ligamentous reconstruction using autograft or allograft

98
Q

post op protocol for PLRI

A
  • immobilization device set to 45-90 elbow flexion with neutral or slight pronation with extension block for 8 weeks ( 60 at wk 2, 45 at wk 4, 30 at wk 6).
  • week 2 can begin forearm pronation exercises with extension and active supination beyond 90 elbow flexion is allowed
  • normal ROM is expected by 8 weeks and strength is initiated
  • return to sport when strength is 85%-90% equal
99
Q

posterior elbow impingement

A

common injury in throwers due to high amount of valgus torque and rapid extension occurs during pitching

can lead to compromise of integrity of UCL, producing a radiocapitellar overload syndrome and valgus extension overload

100
Q

6 phases of throwing

A

wind up
early cocking
late cocking
acceleration
deceleration
follow through

101
Q

acceleration phase of throwing

A

generates the most valgus force at the elbow

102
Q

deceleration phase of throwing

A

the dissipation of the forces creates pathological forces in the posterior elbow , generating a reactive bone formation on the olecranon’s posteromedial tip.

  • can lead to osteophyte development or the occurrence of loose bodies that may result in impingement.
103
Q

most SN test for posterior impingement

A

moving valgus stress test

104
Q

DD for posterior elbow impingment

A

LET
cubital tunnel syndrome
elbow instability
radiocapitellar synovial plica

105
Q

what percentage of 7-18 YO baseball players experience elbow and shoulder pain?

A

30-40%

106
Q

little league elbow

A
  • avulsion of the humeral medial apophysis in adolescents
  • irritation of the origin of the flexor-pronator mass
  • MET
  • UCL injury due to fragmentation and avulsion of medial epicondyle
107
Q

factors leading to little league elbows

A
  • overuse, exacerbated by high pitch counts, poor technique and pitch type
108
Q

clinical findings of little league elbow

A
  • patient reports a sudden increase in volume or intensity of training
  • steady increase in discomfort during throwing motion
  • subsequent aching
  • decreased throwing velocity and problems with accuracy due to diminished grip strength

medial epicondyle that is TTP and which may be enlarged, ROM exam reveals acute motion loss and pain with extremes of motion

109
Q

management of acute little league syndrome

A
  • rest and eliminating the offending activity for 2-3 weeks
110
Q

Osteochondritis dissecans of the capitulum

A
  • related to excessive repetitive valgus compression across the elbow joint in presence of immature articular cartilage
111
Q

Stage 1 OCD

A
  • hyperemic bone, edematous periarticular soft tissues are also found
112
Q

Stage 2 OCD

A

epiphysis deforms, sometimes with fragmentation

113
Q

Stage 3 OCD

A

necrotic bone is replaced by granulation tissue

114
Q

best imaging for OCD

A

radiographs AP view with elbow in 45 degrees of flexion- very insensitive

MRI or CT often needed

115
Q

OCD treatment

A
  • smaller lesions without cyst like features heal with nonoperative treatment
  • unstable lesions require osteochondral autologous transplantation surgery
  • nonop approach lasts between 3-4 months and focuses on pain control, non abusive activity with biceps/triceps
116
Q

Heterotropic ossification

A
  • ectopic ossification of myositis ossificans
  • bone formation at an atypical site
  • can happen in any place at elbow but typically posterior, deep to triceps extending from either epicondyle to olecranon or anterior at brachialis
  • direct elbow trauma or surgery is most common cause, can result from neural trauma, burns, or genetic disorders
117
Q

most common characteristics for HO

A
  • limited active and passive elbow flexion/extension
  • weak and painful elbow flexion/extension
118
Q

2 approaches to managing HO

A
  • preventative strategies to avert or lessen the extent of the condition
  • interventions to tackle the symptoms and address functional limitations (active and passive ROM, continuous passive motion, dynamic splinting and static splinting.)
  • low dose radiation and NSAIDs
119
Q

elbow dislocation

A
  • 2nd most common dislocated joint of UE, 1/4 are associated with elbow fracture
120
Q

simple dislocation

A
  • soft tissue injuries and more common
121
Q

complex dislocation

A
  • involve ligament injuries and associated fractures of articular surfaces.
122
Q

different types of acute elbow dislocations

A
  • classified as posterior (most common), anterior, divergent
123
Q

divergent dislocations

A
  • displacement of the radius and ulna from each other and both are dislocated from ulna
124
Q

radial head dislocation

A

most common associated with high force injury

125
Q

Monteggia lesions

A
  • rare, combination of injuries involving dislocation of the proximal end of the radius and fracture of the ulna
  • Bado classification
126
Q

Bado Classification type 1

A
  • anterior dislocation of the radial head accompanied by a fracture of the proximal or middle third of ulna ( most common in children/young adults.
127
Q

Bado classification type 2

A
  • posterior dislocation of the radial head accompanied by a fracture of the proximal or middle third of ulna (most common in adults)
128
Q

Bado classification type 3

A
  • lateral dislocation of the radial head with fracture to ulnar metaphysis
129
Q

Bado classification type 4

A
  • dislocation of the radial head in any direction accompanied by a fracture of the proximal or middle third of ulna/radius
130
Q

management of monteggia lesions

A
  • children - closed reduction
  • adults- surgery is required, open reduction of the radial head and internal fixation of ulna, internal fixation of ulna, or internal fixation of the ulna with excision of the radial head
131
Q

Nursemaid elbow

A
  • partial displacement of annular ligament
  • hold will often have protuberant radial head and will protectively old their arm in extended and pronated fashion
132
Q

olecranon fracture

A
  • common especially in elderly, usually caused by a fall backward onto elbow.
133
Q

olecranon fracture

A
  • common especially in elderly, usually caused by a fall backward onto elbow.
134
Q

how to classify olecranon fracture

A
  • anatomical location (metaphyseal (most common), physeal, epiphyseal)
  • fracture pattern (longitudinal, transverse, oblique)
  • displacement (undisplaced/minimally displaced but stable OR displaced and unstable (85%))
  • associated injuries of the elbow complex (radial head dislocation, radial neck fracture, lateral condyle fracture, supracondylar fracture)
135
Q

coronoid fracture

A
  • untypically isolated, most commonly part of a terrible triad (coronoid and olecranon fractures, head of radius dislocated posterolaterally)
136
Q

types of coronoid fractures

A

type 1- tip of coronoid
type 2- more than tip but less than 50% of coronoid
type 3- involving greater than 50% of the coronoid

type B= dislocation

137
Q

coronoid fracture presentation

A

history of hyperextension or twisting, hyperflexion with a sense of dislocation followed by spontaneous reduction
- no ROM if elbow is deformed
- light touch and 2 point discrimination and pulses

138
Q

treatment of coronoid fractures

A

type 1- early motion
type 2 - ORIF
type 3 - ORIF or hinged fixator

139
Q

medial epicondyle fracture

A
  • involved avulsion injury of attachment of forearms common flexors.
  • common in adolescents and older children
  • associated with elbow dislocation
  • operative when valgus instability or ulnar nerve entrapment is suspected, when fracture is displaced into elbow joint, or displaced greater than 5 mm
140
Q

Medial epicondylar ORIF what not to do for 4-6 weeks

A
  • elbow joint mobilizations
  • wrist flexor or pronator strengthening exercises
  • wrist flexor or pronator stretching
  • valgus stress to medial elbow
  • lifting greater than 5 pounds
141
Q

Lateral epicondyle fracture

A
  • mostly in children, rare in adults
  • classified by Jakob classification
  • main complication is nonunion
142
Q

Jakob stage 1

A
  • fracture line goes through the capitellar ossification center, minimal displacement (<2 mm)

treatment
- cast immobilization in 90 flexion with the forearm pronated for 3-4 weeks

143
Q

Jakob stage 2

A
  • fracture line runs medial to the capitellar ossification center
  • 2-4 mm displacement but intact articular surface

treatment
- immobilization or treated with closed reduction percutaneous pinning if there is questionable stability

144
Q

Jakob stage 3

A
  • fracture is completely displaced and rotated, leading to disruption of articular surface

treatment
- closed reduction percutaneous pinning or ORIF

145
Q

compartment syndrome

A
  • causes can be limb placement during surgery, use of tight dressings and plaster casts, bleeding, incresed capillary permeability, trauma, burns, intensive use of muscles, infection
146
Q

acute compartment syndrome of forearm

A
  • has 4 compartments, most common location of ACS
  • both anterior compartments are at highest risk for developing ACS following trauma (deep is affected more)
147
Q

findings for compartment syndrom

A
  • palpation of a swollen and tense compartment with overlying skin that is often pink or red
  • severe pain that may seem out of proportion to the injury and which is exacerbated by passive stretching of the muscles of the involved compartment
  • sensory deficits or paresthesia occurs within 30 min to 2 hours of the initial development of ACS
  • muscle weakness within 2-4 hours
  • possible absence of radial and ulnar pulses at the wrist
148
Q

normal pressure of compartments

A
  • should be between 0-8 mmHg
  • capillary blood flow becomes compromised when tissue pressure increases to within 25 mmHg to 30 mmHg of mean arterial pressure
149
Q

chronic exertional compartment syndrome

A
  • more common in female gymnasts and climbers
  • symptoms occur with exercise but completely resolve between periods of exercise.
  • definitive treatment is fasciotomy
150
Q

complex regional pain syndrome

A
  • intense burning pain, stiffness, swelling, discoloration that most often affects the hand but can affect hands, arm, and feet
  • amplified pain responses, alterations in perspiration, vasomotor anomalies, trophic changes
  • can be triggered by autonomic nervous system and immune system or genetic markers or psychological influences
151
Q

type 1 CRPS

A
  • occurs in absence of nerve trauma, following minor injury such as a strain or sprain or several other causes such as fracture, surgery, stroke, spinal cord injury
152
Q

type 2 CPRS

A
  • nerve trauma
153
Q

warm CPRS

A
  • inflammatory characteristics
154
Q

cold CPRS

A
  • autonomic features
155
Q

stages of CPRS

A
  • acute inflammation, dystrophy, atrophy
156
Q

DD of CPRS

A
  • RA, septic arthritis, gout, cellulitis, vasculitis, peripheral neuropathy, peripheral nerve entrapment, Raynauds, PVD
157
Q

OA of elbow

A
  • chronic MSK pain is the main symptoms
  • stiffness, reduction in ROM, weakness, instability, decrease in quality of life
  • capsular pattern with passive flexion most limited and pro/sup usually unaffected
158
Q

total elbow arthoplasty

A
  • most common indication is inflammatory arthropathies such as RA
  • posttraumatic OA, acute distal humerus fractures, distal humerus non-nions, reconstruction after tumor resection
159
Q

posttraumatic elbow stiffness definition

A

loss of more than 30 extension and less than 120 flexion

160
Q

first line of treatment for post traumatic elbow stiffness

A
  • static progressive stretching 3 times for 30 min per day in each direction
  • lack of response, bony block, flexion contracture greater than 30 or elbow flexion less than 130 requires surgery.
161
Q

when are re-ruptures most common in distal biceps repairs?

A

3-7 weeks but only 1-2% of patients

OCS Prep (11 decks)

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