Elbow Flashcards
Elbow instability injury that does not require x-rays
Nursemaid’s elbow
Ulnar collateral ligament tear physical exam test
Apply valgus stress to test for pain
Ulnar collateral ligament treatment
Surgical (90% success rate) if athlete
Best imaging methods for ulnar collateral ligament tears
- MRI arthrography with gadolinium contrast
- Ultrasound
How to differentiate ulnar collateral ligament tear from medial epicondylitis
Demographics
- UCL = younger, pitcher
- ME = older, golfer
(can use MRI w/contrast to confirm)
How to differentiate septic from non-septic olecranon bursitis on physical exam
Mass will be painful, erythematous, and warm if septic
(can aspirate and send fluid for culture if unsure)
Ligament involved in nursemaid’s elbow
Annular ligament
Ulnar collateral ligament tear symptoms
- “pop”
- progressive medial elbow pain (with throwing)
- Paresthesia along ulnar nerve
Compare and contrast lateral and medial epicondylitis
Both are more degenerative, over time changes.
Ages 40+
NSAIDs won’t help either.
Lateral = tennis elbow
- extensor carpi radialis brevis
Medial = golfer’s elbow
- flexor carpi radialis and pronator teres
Vascular exam for elbow dislocations
Modified Allen’s test
Three potential causes of olecranon bursitis
- Trauma
- Prolonged irritation
- Infection
Elbow dislocation treatment
- Reduction as soon as possible
- Begin ROM 5-7 days post-injury (will become very stiff otherwise)
Most common joint dislocated in children
Elbow
Two methods to manually reduce nursemaid’s elbows
- Supination + flexion
- Hyperpronation
The sail/fat pad sign indicates this
Blood pooling in posterior elbow, likely due to fracture
Two fractures that may co-present with elbow dislocation
- Radial head/ coronoid
- Medial epicondyle
Are elbow dislocations more often anterior or posterior?
90% are posterior
Physical exam test used in lateral epicondylitis that isolates the extensor carpi radialis brevis muscle
Maudsley’s test
(tenderness to palpation over epicondyle is better though)
Treatment for epicondylitis
- PT good for long term relief
- Activity modification (rest)
(NSAIDs don’t help)
Best physical exam tests for both medial and lateral epicondylitis
Palpate over epicondyles for tenderness
In an elbow dislocation patient you suspect neurovascular involvement. How would you test for disruption of the median and ulnar nerves?
Median
- Index finger to thumb strength
- Volar digits 1 + 2 sensation
Ulnar
- Resisted abduction of fingers
- Digits 4 + 5 sensation
Most common age for nursemaid’s elbow
Under 5
