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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
Radial tunnel syndrome
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
25
Little League Elbow Signs and Sx's
-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.
26
Treatment for Little League Elbow
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
27
Recommended return to sport testing for Little League Elbow
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.
28
Clinical Presentation for Lateral Epicondylitis
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
29
What is benefit of moving valgus test vs standard valgus test for UCL tear?
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
30
Explain Phase 1 post of UCL reconstruction
: improve motion, diminish pain and inflammation, retard muscle atrophy, & prevent joint laxity and instability” describes the goal of which phase of rehabilitation?
31
Describe Phase 2 of UCL reconstruction
intermediate phase, is a time to enhance elbow and UE mobility, improve muscular strength and endurance, and to reestablish neuromuscular control.
32
Describe the anterior bundle of the elbow ulnar collateral ligament
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
Tenderness of osseous landmarks may indicate acute fracture, stress fracture, or tendinitis.
lateral olecranon tenderness may indicate a stress fracture, whereas proximal-medial olecranon tenderness may be related to impingement.
34
what can help identify osteochondral defects, joint incongruency, and injury to the annular ligament.
Elbow palpation of the radial head during an arc of passive supination and pronation
35
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
36
testing elbow flexion of approximately 70° allows the greatest intracapsular volume and may be an indication of effusion
37
Flexion of up to 20° may be secondary to an extension block resulting from postero- medial olecranon osteophytes.
38
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
39
Anterior Interosseus sybdrome
weakness of pronator quadratus mm, no sensory changes, unable to do OK sign
40
Pronator Teres syndrome
weakness of mm’s innervated by Median N, parasthesias to 2d and 3 rd digits and fatigue
41
triceps tendinitis
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
What mechanics help with returning to throwing after med condyle tendinitis?
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
Posteromedial osteophytes will be picked up using the extension overload test
44
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
45
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
46
What elbow angle is best to test the ligamentous stability of UCL?
20-40 degrees
47
48
What are the return the throwing phases?
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
What is usually injured in medial epicondylitis?
Flexor carpi radialis or pronator teres May have associated UCL injury Must clear UCL
50
Initial Rehab principles for medial epicondylitis
Eccentric, high rep, low load Wrist flex and ext at 30-45 degrees
51
Phase 2 medial epcondylitis rehab
Progress to Louis and throwing activities
52
Phase 3 medial epicondylitis
Throwing program Look at throwing mechanics
53
Flexor pronator = pronator teres
54
Little league elbow
Medial epicondyle avulsion or apophysisits 2/2 repetitive stress and inadequate rest -
55
How to diagnose little league elbow
X-ray to show widening of physeal plate Must compare to contralateral elbow
56
Treatment for little league elbow
Extended rest and ice until sx’s resolve Need to be cleared by X-ray to show bone Union
57
What is the general time for return to throwing after UCL reconstruction surgery?
4 months to begin  throwing program
58
panners disease
-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
Return t THROW program after UCL reconstruction via docking procedure
4 months for start of throwing, then progress to mound Return to play ~ 9-12 months competitive pitching at 12 months
60
pinch grip test
for entrapment of anterior interosseous nerve
61
tinel's sign
ulnar nerve compromise
62
cozen's sign, mills test
lateral epicondylagia
63
milking sign, moving valgus
MCL involvement
64
Chair sign
LCL involvement
65
medial epicondyle apophysitis
ages 9-12 most common, pain at medial elbow, decreased strength rest, conservative treatment
66
Volkmann's Contracture
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
Anterior UCL bundle
tight in extension
68
Posterior UCL bundle
tight in flexion
69
MCL recontrustion protocol
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
Heterotrophic Ossification elbow
-2/2 direct trauma - swelling, hyperemia, loss of motion - surgical excision
71
Dislocation of elbow
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
olecranon bursitis
protect with padding
73
ossification appearance sequence: CRITOE
C- capitellum R- radial head I- internal epicondyle T- trochlea 0- olecranon E- external epicondyle
74

SCS (17 decks)

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