Elbow Flashcards
pain w/ gripping and wrist extension, lifting, shaking hands, screwdriver, tennis backhand
(extensor carpi radialis brevis)
lateral epicondylitis
“golfer’s” elbow, pain with pronation and wrist flexion, swing, baseball pitching, bowling, pull-through swim strokes
(flexors/pronators)
medial epicondylitis
RF for epicondylitis –
30-50 years
What causes epicondylitis?
Chronic, repetitive overuse triggered by an acute event
PE: pain on palpation of elbow, resisted ROM causes pain
XR: negative (rule out loose body or arthritis)
epicondylitis
How do you treat epicondylitis?
Activity modification
NSAIDS/anti-inflammatory creams
ice/heat
Elbow strap
Stretching + strengthening exercises
Refer to rehab
Consider steroid injection, PRP, shock wave therapy
Refer to specialist after failure of 6 months conservative treatment
Numbness and tingling of pinky + ring fingers, numbness at night, decreased grip strength, tenderness over medial elbow, muscle wasting
ulnar nerve entrapment
Ulnar nerve entrapment is more common in
Diabetes, ETOH use
“Cubital tunnel syndrome”, pressure on nerve as it passes through groove from direct blow or repetitive motion, trauma
ulnar nerve entrapment
+ Tinel’s sign, + Froment sign, + elbow flexion test
CXR: rule out other causes
EMG/NVC: reduction of 30% or more = substantial compression
ulnar nerve entrapment
how do you treat ulnar nerve entrapment?
Avoid bending, night splints, NSAIDs, change workstation, padding of elbow
Swelling, deformity, ecchymosis, pain, effusion, crepitus with flexion in humerus area
distal humerus fracture
a distal humerus fracture is — in adults
uncommon
Distal humerus fractures are associated with
trauma + high morbidity
ALWAYS check — in distal humerus fractures
Check neurovascular status → radial pulse, capillary refill, medial, radial, and ulnar nerves (ulnar MC issue)
XR: AP + lat views
Fat pad “sail” sign in kids (occult)
distal humerus fracture
How do you treat a distal humerus fracture?
Non-displaced = sling/splint
Displaced = surgery
Early ROM
Pain, deformity, swelling, inability to bend elbow
elbow dislocation
MC dislocation in children
elbow
an elbow dislocation occurs when –
someone falls on their outstretched hand
Elbow dislocation is often associated with –
radial head fracture
ALWAYS check with elbow dislocation –
Check neurovascular
Radial pulse/capillary refill
Sensation of median/ulnar nerves
Motor function of radial nerve
How do you treat elbow dislocaiton?
Reduction
Repeat neurovascular exam
Repeat XRs
Early ROM –
5-7 days post reduction
Block terminal extension w/ brace
NSAIDs to reduce ectopic bone formation
Swelling around ball of elbow, ecchymosis, abrasions, poor ROM
olecranon fracture
olecranon fracture occurs with
direct blow or fall on elbow in flexion
— nerve is most commonly affected with an olecranon fracture
ulnar - check neurovascular!
How do you treat an olecranon fracture?
Non-displaced = posterior splint in 45 degree flexion w/ follow up XR in 10 days
Displaced = surgery
Early ROM
Pain on outside of elbow + loss of flexion, extension, and rotation
+/- swelling
radial head fracture
associated w/ dislocation of elbow
radial head fracture
you will see what on a radial head fracture XR?
fat pad sign
Loss of 10-15 degrees of extension is common in
radial head fracture
How do you treat a radial head fracture?
Type 1 = splint/sling w/ early ROM
Type II + III = surgery
Gradual or sudden w/ tender “lumps” of scar tissue described as bits of “gravel”
– dramatic swelling, redness, warmth (chronic = not tender), extremely tender w/ acute or infection
olecranon bursitis
Inflammation of the bursa between skin + olecranon
→ trauma, inflammation, infection, or from occupation or chronic lung disease (leaning forward to breathe)
olecranon bursitis
Only need what if trauma occured in olecranon bursitis?
XR
Recurrence is common/uncommon in olecranon bursitis?
common
How do you treat olecranon burisitis?
Mild = leave alone or treat symptoms
Activity modification, NSAIDs, padding
Symptomatic
Aspiration (culture), compression, reassess in 2-7 days
Antibiotics (cover MRSA)
Surgery
>3 recurrences
