Elbow Flashcards
When are the Radius and ulna farthest from each other?
During supination
Which bone of the forearm extends more distally?
The Radius. Creates ulnar variance or the tendency for the hand to deviate towards the ulnar side
RA causes a diffuse thickening of what structures?
Synovium
What two things can develop with RA?
Flexion contracture
Ligamentous laxity causing instability
When is a total elbow replacement most commonly performed?
For severe RA
How is OA usually treated?
Arthroscopically
Why are total elbow replacements not typically done?
Hard to mimic the multidirectional movement at the the elbow
What is OA seen with?
an end result of trauma, sports injuries or in heavy laborers
What are osteophytes?
Bone spurs/growths
What happens to the joint space with OA?
Narrows
What can happen to elbow extension with OA and why?
You will loose terminal extension due to flexion contractures
What are two treatments of severe OA?
Arthroscopic capsular release
Arthroscopic removal of osteophytes and/or loose bodies
Which muscle is usually the biggest culprit in Lateral Epicondylitis?
ECRB
In what patients is Lateral Epicondylitis most common in?
THose >35 yrs who participate in racquet sports or occupations such as carpentry, painting etc.
What are some common signs/symptoms of Lateral Epicondylitis?
pain with grip especially elbow extended, no loss of ROM
What is done surgically if there is no success with a conservative program for lateral epicondylitis?
Surgical release of the common extensor tendon
What is another name for lateral epicondylitis?
Tennis elbow
What is the prescription for Medial Epicondylitis?
same as that for lateral epicondylitis
What is triceps tendonitis usually secondary to?
Sudden stress with elbow extended fully
When will someone experience pain with triceps tendonitis?
pain at insertion to olecranon with resisted elbow extension and passive elbow flexion
How would you describe an olecranon Bursitis?
Very boggy, hot, swollen, posterior elbow
How can you get an olecranon bursitis?
Trauma, gout, or often from prolonged pressure on the olecranon.
What is the Rx for Olecranon bursitis?
rest, NSAIDS, may require cortisone injection
What ligament is compromised with a valgus stress?
MCL
What ligament is stressed with a Varus stress?
LCL
Where does the biceps tendon usually rupture?
At the musculotendinous or tendoperiosteal juncture
What is a conservative treatment for a Biceps tendon rupture?
Treated with a Velpeau bandage in 90 degree flexion for 3-6 weeks
What is a surgical treatment for a biceps tendon?
Repaired with sutures
In adolescent sport injuries, what is the cause of medial joint injuries?
Traction or tensile force injuries of/at flexor forearm group
In adolescent sport injuries, what is the cause of Lateral joint injuries?
compression forces on the lateral joint
What is traction apophysitis also known as?
Little leaguers elbow, due to excessive throwing
What happens with traction apophysitis?
inflammation with/without micro tears of the wrist flexors at their insertion
What are some signs of traction apophysitis?
tenderness at medial elbow, 15 degree loss of extension ROM
What are some treatments from traction apophysitis?
REST!!!!! strengthening as symptoms subside
What is an avulsion fracture of the medial epicondyle usually secondary to?
more forceful valgus stress from a fall or violent muscle contraction
When do you use conservative treatment vs. surgery with an avulsion fx of the medial epicondyle?
1 cm ORIF with K wire
What is osteochondritis Dessicans?
Piece of the Capitillum comes off the ulna
What is osteochondritis Dessicans often secondary to?
trauma or avascularity
What is the treatment for osteochondritis Dessicans?
Arthroscopy if there is a loose body
What on an X-ray can be a sign of trauma?
Whiteness - sign of effusion
What is a distal humerus fx usually 2ndary to?
FOOSH, especially in younger pts
Whats the difference between an intra-articular and extra-articular distal humerus fx?
extra-articular fx’s heal better due to blood supply
How can extra-articular distal humerus fx’s be treated?
Closed reduction
What is an extension supracondylar fx?
distal fragment of the humerus travels posteriorly
What is a flexion supracondylar fracture?
distal fragment of the humerus travels anterior
How do they repair an intercondylar Fx?
with tension band wiring
what type of fx accounts for about 50% of fxs at the elbow?
radial head fxs
Wht will a radial head fx do to the radio-ulnar length?
can shorten radius (normally longer)
can cause sxs at wrist
What direction are 80% of the Adult elbow dislocations?
posterior
How do radial head fxs usually occur?
FOOSH
What is a Monteggia Fracture?
Fx of proximal 1/2-1/3 of ulna with radial head dislocation
What is a Galleazi Fracture?
Fx of mid to distal RADIAL shaft with subluxation of distal RU joint
What is cubital Tunnel syndrome?
Ulnar nerve compression within ulnar nerve tunnel at bedial elbow
What is anterior interosseous syndrome?
Median Nerve compression under the pronator teres
What is posterior interroseous syndrome?
RADIAL nerve compression under the supinator and arcade of Frohse
What is myositis ossificans?
Ossified inflammatory tissue within muscles, commonly occurs after a brachialis injury where bleeding occurs
What should you avoid with Myositis ossificans?
No vigorous stretching, no US, no massage
What is Volkmann’s Ischemic contracture?
following injury to brachial artery leading to ischemia of muscle and nerves in forearm
What is Volkmann’s Ischemic contracture associated with?
Supracondylar fracture, which are more common in younger patients
What happens if treatment is not gotten w/in 4-6 hours?
irreversible damage
What are signs and symptoms of Volkmann’s ischemic contracture?
severe pain in forearm muscle groups limited and very painful finger motion purple hand color with prominent hand veins initial paresthesiae, eventual sensory loss loss of radial pulse pallor eventual paralysis if not treated
