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SCS > Elbow > Flashcards

Elbow Flashcards

1
Q

Medial epicondylitis

A

-associated with older aged people (older than HS) and with pain of wrist flexor mm group which is distal to the epicondyle

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1
Q

ELBOW POSTERIOR IMPINGMENT TEST

A

Pain and tenderness at the elbow
Joint stiffness
Locking and catching of the elbow
Abnormal popping or crackling sound
Joint effusion (abnormal fluid build-up)
Decreased range of motion
Swelling and bruising of the elbow
Inability or difficulty to extend or straighten the elbow

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2
Q

Elbow extension Test

A

To rule out fracture (sensitivity 97.3%)
If patient can’t fully extend elbow after injury-need X-ray

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3
Q

Best xray view for elbow trauma

A

Lateral view

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4
Q

What is most common fracture of elbow

A

radial head fracture

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5
Q

What are 3 classic types of forearm fractures

A

Nightstick- fracture of midshaft of ulna
Monteggia- fratture of ulna with dislocation of radial head
Galaezzi- fracture of distal radius with dislocation of ulna from wrist

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6
Q

what is a greenstick fracture

A

incomplete fracture due to
flexibility of young bones
-One side of the bone breaks from a distraction force
and the other side bends but stays intact
-occurs most often in forearm

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7
Q

Nursemaids elbow

A

child’s radial head slips out of annulus

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8
Q

What is responsible for restricting passive supination?

A

palmar radioulnar ligament

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9
Q

What is MOST responsible for the increased volume of UCL reconstructions

A

OVERUSE,

including year-round play, early sports specialization, and concurrent participation on multiple teams.

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10
Q

which part of the UCL is the most important soft tissue stabilizer to valgus load?

A

,anterior bundle of UCL
-UCL is the primary restraint to valgus stress of the elbow. It has a broad insertion on the ulna at a bony ridge called the sublime tubercle.
oblique bundle originates and inserts on the ulna and is therefore clinically and mechanically insignificant.

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11
Q

Factors associated with failure of nonoperative treatment in lateral epicondylitis.

A

-workers compensation PRIMARY
-prior injection,
- presence of radial tunnel syndrome, -previous orthopedic surgery,
-duration of symptoms > 12 months.

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12
Q

which elbow mm are used ECCENTRICALLUY during acceleration and deceleration in overhead sports?

A

flexors and supinators - need bracing or tape to stabilize and to resist elbow extension and pronation

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13
Q

which mm are the main stabilizers for the UCL/medial elbow joint?

A

FCU- flexor carpi ulnas
FCR- flexor carpi radialis
PT- pronator teres
flexor digitorum superficialis (FDS

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14
Q

What is the cozen test?

A

Cozen test: lateral epicondylosis: resistsed wrist ext test

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15
Q

What is the classical definition of double crush syndrome?

A

condition of neurological dysfxn 2/2 compression at multiple sites along a single peripheral nerve

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16
Q

How do you interpret DASH scores>

A

higher score= worse disability

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17
Q

How are supra and epicondylar fractures casted or splinted?

A

at - 30 dgrs of ext

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18
Q

At 4 weeks post op UCL reconstruction, what can you strengthen?

A

-elbow flexors and extensors
-supinators and pronators
-shoulder internal rotators
CANNOT STRENGTHEN EXTERNAL ROTATORS YET! bc of stress on medial elbow

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19
Q

ELBOW POSTERIOR IMPINGMENT TEST

A

Palpate olecranon fossa and extend elbow fully- looking for pain - can be post lateral, post medial or central posterior

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20
Q

posterior elbow impingement causes:

A

-Synovitis or inflammation of the synovium, a membrane that lines the joints
-Bursitis or inflammation of the bursae, fluid-filled sacs that cushion the joints
-Bone spurs or abnormal bony projections along the ends of bones
-Inflammation of the joints
-Rupture of cartilage or other soft tissues
-Stiffening of the ligaments, muscles, and tendons

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21
Q

Test for UCL tear

A

Moving Valgus Test :
SN 100,
Best in Prone per Mike Reinhold or in supine
If on Right arm
Start in EF, palpate UCL with R thumb
stabilize thumb patient’s thumb with left hand by pulling back
use thumb to extend elbow

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22
Q

Anterior bundle of UCL attaches

A

medial epicondyle to ulna

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23
Q

Dynamic Stabilizers of the medial elbow:

A

Pronator teres
Flexor carpi radialis
Palmer’s Longus
Flexor carpi ulnaris
Flexor Digitor Superficialis
P

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24
Q

Radial tunnel
syndrome

A

Occurs between brachioradialis
and brachialis as it drives
below the proximal
supinator (Arcade of
Frohse).
Pain in the upper extensor forearm,
dysesthesias in a superficial radial nerve
distribution, weakening of the fingers, thumb,
or wrist

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25
Q

Little League Elbow Signs and Sx’s

A

-medial elbow pain especially with pitching, decreased
velocity, and early arm fatigue. If an avulsion fracture is present, they may have heard or felt a pop during a
single pitch. They also may present with a widening of the apophysis on radiographs.
Young athletes with Little League elbow
will present with flexion contracture, (+) Moving valgus stress
test/Milking maneuver, elbow and forearm weakness.
Radiographic images should be obtained to rule out avulsion
fracture.

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26
Q

Treatment for Little League Elbow

A

rest from pitching or aggravating sport for 4-6 weeks. Then PT:
-variation of Thrower’s Ten after 6 weeks rest
- core and leg strengthening.
-Range of motion exercises should
emphasize return of extension with addition of low load, prolonged holds if necessary
-Forearm and elbow strengthening should also be included

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27
Q

Recommended return to sport testing for Little League Elbow

A

Closed Kinetic Upper Extremity Stability Test
Upper Quarter Y-balance Scale,
Seated Shot Put Test,
Posterior Shoulder Endurance Test,
Prone Plyoball Drop Test,
Ball Taps on Wall Test.

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28
Q

Clinical Presentation for Lateral Epicondylitis

A

Maximum point tenderness over lateral epicondyle, occasionally in focal,
distal location 1-2cm from the lateral epicondyle itself. Absence of radicular symptoms is vital as part of the differential diagnosis

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29
Q

What is benefit of moving valgus test vs standard valgus test for UCL tear?

A

The moving valgus stress test can be a good test for high-level athletes with small partial tears of the UCL because: MOVING valgus is more SENSITIVE than a standard valgus test

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30
Q

Explain Phase 1 post of UCL reconstruction

A

: improve motion, diminish pain and inflammation, retard muscle atrophy, & prevent joint laxity and instability” describes the goal of which phase of rehabilitation?

31
Q

Describe Phase 2 of UCL reconstruction

A

intermediate phase, is a time to enhance elbow and UE mobility, improve muscular strength and endurance, and to reestablish neuromuscular control.

32
Q

Describe the anterior bundle of the elbow ulnar collateral ligament

A

the primary restraint to valgus force of the elbow from 30° to 120° of flexion and is subjected to near-failure tensile stresses during the acceleration phase of the throwing motion.

33
Q

Tenderness of osseous landmarks
may indicate acute fracture, stress fracture, or tendinitis.

A

lateral olecranon tenderness may indicate a
stress fracture, whereas proximal-medial
olecranon tenderness may be related to
impingement.

34
Q

what can help identify
osteochondral defects, joint incongruency,
and injury to the annular ligament.

A

Elbow palpation of the radial
head during an arc of passive supination
and pronation

35
Q

Tenderness over the insertions of
the various tendons around the elbow
can indicate microtrauma or inflamma-
tion. The origin of the flexor pronator
mass lies just anterior to the medial
epicondyle when the elbow is at 90° of
flexion

A
36
Q

testing elbow
flexion of approximately 70° allows the
greatest intracapsular volume and may
be an indication of effusion

A
37
Q

Flexion of
up to 20° may be secondary to an extension block resulting from postero-
medial olecranon osteophytes.

A
38
Q

Medial epicondylitis is associated with older aged people (older than HS) and with pain of wrist flexor mm group which is distal to the epicondyle

A
39
Q

Anterior Interosseus sybdrome

A

weakness of pronator quadratus mm, no sensory changes, unable to do OK sign

40
Q

Pronator Teres syndrome

A

weakness of mm’s innervated by Median N, parasthesias to 2d and 3 rd digits and fatigue

41
Q

triceps tendinitis

A

This problem often occurs at the acceleration and deceleration phases, which require triceps and pronator to be working concentrically to extend the elbow extension and pronate.
so need to train triceps and pronator concentrically

42
Q

What mechanics help with returning to throwing after med condyle tendinitis?

A

Increasing the arc of deceleration from the throwing arm assists in dissipating forces.
Increasing the throwing arm movement across the body assists in dissipating forces.
Increasing forward flexion of the trunk allows forces to be absorbed by the larger musculature of the trunk and legs.

43
Q

Posteromedial osteophytes will be picked up using the extension overload test

A
44
Q

The trochlea is an intra-articular structure that would result in a positive fat-pad sign ( radiographic finding indicative of intra-articular fracture), and require immobilization

A
45
Q

Tenderness of osseous landmarks
may indicate fracture, stress fracture or tendinitis. Palpation of the radial head during
supination and pronation can identify osteochondral defects, joint incongruency, or injury
to the annular ligament

A
46
Q

What elbow angle is best to test the ligamentous stability of UCL?

A

20-40 degrees

47
Q
A
48
Q

What are the return the throwing phases?

A
  1. Long toss
  2. Throwing from mound- gradually increase # throws, intensity and types of pitches - 50%-75%-90% - 100% over 4-6 weeks
    Breaking balls initiated once pitcher can throw 40-50 pitches at 89%
49
Q

What is usually injured in medial epicondylitis?

A

Flexor carpi radialis or pronator teres
May have associated UCL injury
Must clear UCL

50
Q

Initial Rehab principles for medial epicondylitis

A

Eccentric, high rep, low load
Wrist flex and ext at 30-45 degrees

51
Q

Phase 2 medial epcondylitis rehab

A

Progress to Louis and throwing activities

52
Q

Phase 3 medial epicondylitis

A

Throwing program
Look at throwing mechanics

53
Q

Flexor pronator = pronator teres

A
54
Q

Little league elbow

A

Medial epicondyle avulsion or apophysisits
2/2 repetitive stress and inadequate rest
-

55
Q

How to diagnose little league elbow

A

X-ray to show widening of physeal plate
Must compare to contralateral elbow

56
Q

Treatment for little league elbow

A

Extended rest and ice until sx’s resolve
Need to be cleared by X-ray to show bone Union

57
Q

What is the general time for return to throwing after UCL reconstruction surgery?

A

4 months to begin  throwing program

58
Q

panners disease

A

-osteochondrosis of capitellum of elbow
-children < 10 yrs or 7-12
-hx of pain with flags stretch (pitching)
-pain and stiffness not relieved by rest

59
Q

Return t THROW program after UCL reconstruction via docking procedure

A

4 months for start of throwing, then progress to mound
Return to play ~ 9-12 months
competitive pitching at 12 months

60
Q

pinch grip test

A

for entrapment of anterior interosseous nerve

61
Q

tinel’s sign

A

ulnar nerve compromise

62
Q

cozen’s sign, mills test

A

lateral epicondylagia

63
Q

milking sign, moving valgus

A

MCL involvement

64
Q

Chair sign

A

LCL involvement

65
Q

medial epicondyle apophysitis

A

ages 9-12 most common,
pain at medial elbow,
decreased strength
rest, conservative treatment

66
Q

Volkmann’s Contracture

A

ischemic contracture from brachial artery injury
-major complication of elbow injury
-pain in forearm that increases with passive finger extension
-cessation of brachial and radial pulses
-referral to MD

67
Q

Anterior UCL bundle

A

tight in extension

68
Q

Posterior UCL bundle

A

tight in flexion

69
Q

MCL recontrustion protocol

A

ROM progressing to 30-105 until 4 weeks

Splint: 50-60 1 week
45-90 weeks 1-3
30-105 at week 4
ROM 14-115 weeks 4-6
plyos at 12 weeks
interval throwing 4 months
interval batting 5 months
throwing off mound 9 months
pitch competitively 1 year

70
Q

Heterotrophic Ossification elbow

A

-2/2 direct trauma
- swelling, hyperemia, loss of motion
- surgical excision

71
Q

Dislocation of elbow

A

90% posterior
hemorrhage, swelling, severe pain
imaging: AP, Lateral, and oblique view
RX:splint 5-7 days in hinged brace 30-90, increasing 10-15 dgrs per week, PROM avoided, full flexion 6-12 weeks, full ext 3-5 months

72
Q

olecranon bursitis

A

protect with padding

73
Q

ossification appearance sequence: CRITOE

A

C- capitellum
R- radial head
I- internal epicondyle
T- trochlea
0- olecranon
E- external epicondyle

74
Q
A

SCS (17 decks)

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