Elbow Flashcards
Carrying Angle
(4)
Normal carrying angle:
Male: 5-10
Female: 10-15
Excessive cubitus valgus: 30 degrees
Cubitis varus: -5 degrees
Gun stock deformity: > -5 degree
Ulnar Collateral Ligament Tear
Etiology & S/S
A tear in the UCL (Fan-shaped bundle of ligamentous fibers which differentiate into anterior, posterior, & tranverse (oblique) portions)
Etiology:
MOI: valgus stress (acute or chronic)
- Baseball pitcher
- FOOSH w/ elbow slightly flexed
- QB throwing a football - excessive ROT @ shoulder - cannot go any further so elbow gives
S/S
- Pain
- Localized tenderness
- Joint effusion
- Instability with valgus stress (Gr. 2-3)
- Limited ROM - swelling or pain guarding
- May have heard an audible pop
*All ligament injuries
Valgus Stress Test
0, 20-30 degrees
20-30 - limits stretch of joint capsule - really biasing the ligament
UCL Tear: Interventions
2 Types (7)
PT Management (conservative)
1. Activity modification
2. Correcting faulty technique
3. Decrease pain
4. Decrease swelling - ultrasound, ice, compression, elevation
5. Bracing (medial strapping of the elbow) - external contraints
6. Strengthening (focus on forearm flexors & pronators)
7. Restore ROM
Surgical Management
- Ligament Reconstruction: Gr.3 - complete tear
Tommy John Sx - replace ligament w/ tendon
- immobilized in 90 flexion & neutral sup/pro
- Tx: prevent elbow stiffness - working back into elbow ext
Dislocations
5 Types
Named based on the DISTAL segment
- Posterior (-lateral): FOOSH w/ elbow slightly bent
MOST common - Anterior: High energy trauma - MVA (driving w/ elbow bent on window > T-boned)
- Lateral: More often humerus is hit & goes MEDIAL & distal segment is LATER relative to the humerus
- Medial: Hit on Medial side of humerus & distal segment sit medially relative to humerus
- Divergent: driving force down (ulna & radius separate)
Posterior Dislocation
(4)
- Dislocation of the olecranon (ulna) posteriorly
- Often involves disruption of the UCL & RCL (have to disrupt these ligaments to have the ulna dislocate)
- Often involves a fracture of the coronoid process or radial head
- Major complications can occur including impairment of vascular supply to the forearm
*Check pulses distally
Nursemaid’s Elbow
Description & Epi & Etiology & S/S & Intervention
Subluxation of the radial head - disruption of annular ligament
Epi:
- Common among yound children (1-4 yo)
- (Annular lig has not developed fully - NOT as stable as it will be)
Etiology:
- Longitudinal traction with wrist in pronation
S/S:
- Child refuses to move arm
- Arm is commonly held in slight flexion
Interventions:
- Reduction of subluxed radial head
Hyperpronation (preferred method - more effective & better tolerated) OR supination/flexion maneuver
Compressive manipulation on radius w/ arm in supintation
Olecranon Bursitis
Description & Etiology & S/S & Intervention (2)
Inflammation of the olecrannon bursa
Etiology:
- Trauma
- Pressure
- Infection (in bursa sack)
S/S:
- Swelling
- Redness
INC risk of developing a bursitis (condition):
- RA
- Gout
Intervention:
PT management
- Activity modifications
- Ice
- Compression
- Education: do not do anything that bothers it & limit excessive pressure
Medical Management:
- NSAID
- Corticosteriod injection
- Aspiration
- Antibotic (if infected)
- Bursectomy (surgicle removal) if repeatable getting a bursitis
Lateral Epicondylosis
Description & EPI & Etiology
- Degenerative changes to the wrist extensor tendons inserting into the lateral epicondyle of the hummerus (common extensor origin)
- Commonly revolves the ECRB tendon
- “Tennis elbow””
Epi:
- Commonly > 35 years old
Etiology (RF):
- Repetitive use - most common RF
- Poor technique
- Heavy racquet
- Heavy ball
- Small grip
- Poor blow flow applied to the area = DEC capacity to recover = more prone for developing
LOAD > CAPACITY to recover
- stress is greater than the capacity of the tendon = degenerative changes
Lateral Epicondylosis:
S/S
(5)
- Aching Pain
Radiating from lateral epicondyle to proximal extensory mm mass
More commonly insidious onset - creeped up slowly - Tender on palpation at or near lateral epicondyle
- Pain w/ resisted wrist extension &/or gripping
- Pain w/ stretching of wrist extensions (flexion of wrist)
- Decreased wrist extension & grip strength
Baseline - hand dynameter grip strength - objective measure of improvement
Special Test: Cozen’s Test
Method 1
Resisted wrist extension
(+) = if it provokes pain
Special Test: Mill’s Test
Method 2
Passive wrist flexion (stretching of wrist extensors)
(+) = if it provokes pain
Special Test: Maudsley’s Test
Method 3
Resisted 3rd digit extension
(+) = if it provokes pain
Lateral Epicondylosis: DDx
(6)
- Cervical radiculopathy (C5-6) - can mimic tennis elbow
Differentiate: distraction/compresion, derm/myo/reflexes, ULTT (DEC ROM, reproduces symptoms), C/S ROM (lateral flex or rot) = more (+) may inform C/S as the source - Radial nerve entrapment
- Musculocutaneous nerve tunnel syndrome
- Supraspinatus referral
- Radial head fracture
- Radiohumeral synovitis
3-6 are less common
Lateral Epicondylosis: Interventions
(2 Types)
PT Management:
1. Activity modifications - job & sport w/ lots of repetitive tasks
2. Counterforce brace - disperses the force - INC surface area so not an INC force on a smaller area (helps to reduce pain on contraction)
3. Stretching
4. Strengthening (eccentric)
helps DEC S/S - old-school thought was it realigned collagen w/ eccentrics
Eccentric > concentrics
5. Mobilizations
6. Cross-friction massage
7. Pain modalities & modalities that reduce inflammation
Medical Management:
1. NSAIDS
2. Corticosteriod injection
