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Musculoskeletal I > Elbow > Flashcards

Elbow Flashcards

1
Q

Besides elbow impairments specifically, what else needs to be considered in an examination and evaluation of the elbow? (3 things)

A
  • Upper quarter comprehensive exam (c-spine, clearing other joints)
  • Comorbidity consideration
  • Medical history
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2
Q

What are 6 relevant scales used to assess the elbow?

A
  • VAS
  • DASH
  • PSFS
  • UEFS
  • American Shoulder and Elbow Surgeons Elbow Form
  • Boston Questionnaire (carpal tunnel)
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3
Q

What are 7 general considerations when treating the elbow?

A
  • Posture of the head and neck
  • Muscle tone
  • Quality, color, and temperature of skin
  • Carrying angle - elbow (10 - 13 degrees)
  • Swelling
  • Resting position of elbow
  • Ability to use limb
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4
Q

What should be cleared when treating the elbow?

A
  • Shoulder
  • Wrist
  • C-spine
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5
Q

What are the accessory motions of the elbow and forearm?

A
  • Distration and radial and ulnar gapping of the humeroulnar joint
  • Distraction and radial and volar glides of the humeroradial joint
  • Dorsal and volar glides of the proximal and distal radioulnar joints
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6
Q

What are 4 performance based functional measures of the elbow?

A
  • Pushing (push-off test)
  • Pulling
  • Curling
  • Grip strength
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7
Q

What are 4 non-muscular tests for the elbow?

A
  • Ligament stability
  • Soft tissue mobility
  • Neurologic status
  • Functional status
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8
Q

What are 7 common pathologies of the elbow?

A
  • Lateral epicondylitis/algia
  • Medial “
  • Olecranon bursitis
  • Dislocation/ instability
  • Radial head subluxation
  • Volkman’s contracture
  • Nerve entrapment syndromes
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9
Q

What is the etiology of lateral epicondylitis?

A
  • Degeneration
  • Micro/macro tearing of common extensor tendon insertion
  • Often due to repetitive forceful wrist extension and gripping
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10
Q

What muscles are especially effected by lateral epicondylitis?

A
  • ECRB

- EDC III

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11
Q

What is the 3 part vicious cycle of lateral epicondylitis?

A
  • Inflammation
  • Tissue weakness
  • Tearing
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12
Q

What 4 other diganoses must lateral epicondylitis be discriminated from?

A
  • Radiohumeral DJD
  • Radial nerve entrapment
  • Ligamentous injury
  • Proximal pathology
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13
Q

Past what age does lateral epicondylitis become more common?

A

35.

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14
Q

Where is the elbow usually tender in lateral epicondylitis?

A
  • Over lateral humeral epicondyle
  • Extensor tendon
  • Muscle belly
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15
Q

In what phase is edema sometimes present in lateral and medial epicondylitis?

A
  • Acute phase
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16
Q

In what phase are tight fascial bands noted in lateral and medial epicondylitis?

A
  • Chronic phase
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17
Q

What active movements provoke pain, and what passive movements provoke pain in lateral epicondylitis?

A
  • Active wrist extension (+ with radial deviation)

- Passive wrist flexion (+ with ulnar deviation, elbow extension, pronation)

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18
Q

What do 7 % of plain films show in lateral epicondylitis?

A
  • Calcification.
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19
Q

What is the etiology of medial epicondylitis?

A
  • Micro/macro tearing of common flexor tendon insertion

- Repetitive active forceful wrist flexion.

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20
Q

What is another name for lateral epicondylitis?

A
  • Tennis elbow
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21
Q

What is another name for medial epicondylitis?

A
  • Golfer’s elbow
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22
Q

What active and passive motions provoke pain in medial epicondylitis?

A
  • Active wrist flexion and pronation

- Passive wrist extension (+ with supination)

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23
Q

What is the treatment for lateral and medial epicondylitis in the acute phase? Refer to medication, patient education, and 2 interventions.

A
  • Topical NSAIDS
  • Local injection of steroids
  • Pt Ed: Refrain from aggravating activities
  • Stretching
  • Splints and/or Straps
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24
Q

What treatment should be performed for lateral/ medial epicondylitis in the subacute phase? State manual therapy, exercises, and modalities.

A
  • Deep friction massage
  • Mill’s manipulation and radial head mobilizations
  • Exercise progressed from iso to concentric to eccentric
  • Acupuncture, laser, and ultrasound
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25
Q

What type of contraction promotes the realignment of collagen?

A

Eccentric.

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26
Q

Do corticosteroid injections or PT have better long term effects?

A

PT.

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27
Q

Corticosteroids have better effects than PT after 6 weeks, but what was the problem after that?

A

Higher recurrence/ regression of cases.

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28
Q

Is PT or wait and see a better method for lateral epicondylitis after a year?

A

No difference.

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29
Q

Did wait and see, steroid injections, or PT treatments result in lower additional treatments of lateral epicondylitis?

A

PT.

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30
Q

In what amount of patients with lateral epicondylitis are C-spine impairments prevalent?

A

57 - 90 %.

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31
Q

What are 4 common causes of elbow bursitis?

A
  • Fall on elbow/ trauma
  • Excessive friction
  • Infection
  • Systemic disease (RA, Gout)
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32
Q

How are ROM and strength affected by olacranon bursitis?

A
  • Decreased extension ROM and strength
33
Q

What will palpation of olecranon bursitis reveal?

A
  • Swelling confined to elbow
  • Pain
  • Increased temperature
34
Q

What is conservative treatment of olecranon bursitis?

A
  • Symptom reduction treatment
  • Warm soaks
  • Splinting
  • Protection
35
Q

What are 2 more aggressive treatments of olecranon bursitis?

A
  • Aspiration

- Aspiration with a steroid injection

36
Q

What are risks of aspiration of elbow in olecranon bursitis?

A
  • Skin atrophy
  • Septic bursitis
  • Chronic pain on pressure
37
Q

What are 2 common risks of elbow dislocation?

A
  • Nerve compromise

- Vascular compromise

38
Q

What 2 things can sometimes complicate elbow dislocations?

A
  • Fracture

- Ligament disruptions

39
Q

What individuals are prone medial elbow instability? Why?

A
  • Throwing athletes

- Stretching/ rupture of ulnar collateral ligament

40
Q

What often leads to lateral elbow instability?

A
  • Trauma to radial collateral ligament
41
Q

What are 2 clinical signs of an elbow dislocation or instability?

A
  • Feeling of “giving way”

- Pain on activities that stress the ligaments

42
Q

What is conservative treatment for an elbow dislocation or instability?

A
  • Dynamic stability from FCU
  • Stabilize proximal to the elbow
  • Practice proper form
43
Q

What is stressed during rehab following a surgical reconstruction of the elbow or its associated tissues?

A

Early protected motion.

44
Q

What is conservative treatment for medial elbow instability for non-throwing athletes?

A
  • Don’t overstress healing tissue
  • Establish flexibility
  • Muscle balance
  • Neuromuscular control
45
Q

What is medial epicondyle apophysitis?

A
  • Traction apophysitis at medial epicondyle
  • Result of valgus stresses in immature elbow
  • Inflammation along medial apophsysis.
46
Q

What is a valgus extension overload?

A
  • Olecranon on fossa with combined valgus

- Swelling, medial and posterior pain

47
Q

Which medial elbow pain is found in a skeletally immature individual?

A

Medial epicondyle apophysitis.

48
Q

What is a common mechanism of injury for an olecranon fracture?

A
  • FOOSH w/ elbow flexed

- Triceps contracts

49
Q

What nerve is vulnerable in an olecranon fracture?

A

Ulnar.q

50
Q

What is a common mechanism of injury for a fracture of the radial head?

A
  • FOOSH with supination
51
Q

What is the common 3 step process of treatment for olecranon or radial head fractures?

A 
- Short immobilzation with early motion
To address resultant biceps shortening:
- Contract-relax stretches and arm swings
To address extension loss:
- Joint mobilization
- Joint distraction
52
Q

What is the etiology of a radial head subluxation?

A
  • Longitudinal force at pronated forearm

- Radial head pulled from annular ligament

53
Q

What are clinical signs of a radial head subluxation?

A
  • Localized pain
  • Reluctancy to move forearm, and elbow held in pronation
  • Palpate a sulcus between humerus and radial head
54
Q

What is the 3 step treatment process for a radial head subluxation?

A
  • Reduction at ER
  • Guarded motion
  • PT to control inflammatin, symptoms, and improve impairmentos
55
Q

What is another name for a radial head subluxation?

A

Nurse-maid’s elbow.

56
Q

What is a Volkmann’s Ischemic Contracture?

A
  • Deformity of hand fingers and wrist caused by trauma induced ischemia
57
Q

What type of trauma typically causes the ischemia associated with Volkmann’s ischemic contracture?

A
  • Crush injury to forearm

- Elbow fracture in children

58
Q

What does the swelling from trauma associated with Volkmann’s ischemic contracture cause?

A
  • “Compartment Syndrome”
  • Pressure reduces blood inflow and prevents outflow
  • Tissue death
  • Tissue fibrotic and shortened
59
Q

What are 2 treatments for Volkmann’s contracture?

A
  • Fasciotomy

- Followed up by rehab to regain strength and ROM

60
Q

What structures impinge on the ulnar nerve to cause cubital tunnel syndrome?

A
  • Medial epicondyle
  • Olecranon
  • MCL
  • Ligament of Struthers
61
Q

What position causes further compression of the ulnar nerve and blood supply in the cubital tunnel?

A
  • Flexion
62
Q

What are signs and symptoms of Cubital tunnel syndrome?

A
  • Parathesias/ pain of the medial forearm and ulnar hand

- Provoked by flexion

63
Q

What 4 common positions can cause flexion impingement of the ulnar nerve in the CT?

A
  • Sleeping
  • Combing hair
  • Driving
  • Telephone
64
Q

What are 3 signs of chronic cubital tunnel syndrome?

A
  • Weak key turning
  • Grip/ pinch weakness
  • Dropping objects
65
Q

What are 4 areas of concern in suspected cubital tunnel syndrome during the exam?

A
  • Upper limb tension tests
  • Muscle bulk atrophy
  • Digits 4 - 5
  • Sensory testing
66
Q

What 3 other pathologies may be confused with cubital tunnel?

A
  • C8 - T1 nerve root impingement
  • Thoracic Outlet Syndrome
  • Guyon’s Canal
67
Q

What are 6 conservative treatments for cubital tunnel?

A
  • Avoiding elbow flexion activities
  • Night splints with 40 - 60 degrees flexion
  • TENs and physical agents to reduce inflammation
  • Nerve gliding
  • Stretching of extrinsic flexors and ulnar innervated intrinsics
68
Q

What is the surgical treatment for cubital tunnel?

A
  • transposition of the nerve anteriorly.
69
Q

What nerve becomes entrapped in radial tunnel syndrome?

A

Posterior interosseus nerve.

70
Q

What 4 structures impinge on the posterior interosseus nerve and its associated vasculature in radial tunnel syndrome?

A
  • Leash of henry
  • ECRB tendon
  • Arcade of Frohse
  • Supinator origins
71
Q

What repetitive actions cause radial tunnel syndrome?

A
  • Pronation/ supination

- Wrist flexion/ extension

72
Q

What are 3 symptoms of radial tunnel syndrome?

A
  • Pain in common extensors mid belly
  • Can appear similar to tennis elbow
  • Decreased strength
73
Q

How can pain from radial tunnel be differentiated from pain due to tennis elbow?

A
  • It is 3 - 4 centimeters below the extensor wad.
74
Q

What are 5 conservative treatments for radial tunnel syndrome?

A
  • Avoid aggravating activities (keep forearm in neutral)
  • Cock-up splint at wrist for 3 - 6 motnhs
  • Physical agents and TENS to control inflammation
  • Nerve gliding
  • Stretching of extrinsic extensors. flexors, and supinators
75
Q

What is the surgical intervention for radial tunnel syndrome?

A
  • Transposition of nerve anteriorly
76
Q

What are 2 tests for lateral epicondylitis?

A
  • Cozen’s test

- Lateral epicondylitis test

77
Q

What are 4 tests for elbow stability?

A
  • Moving valgus stress test
  • Posterior lateral rotary instability
  • Varus stress test
  • Valgus stress test
78
Q

What are 3 tests for nerve entrapment at the elbow?

A
  • Elbow flexion test
  • Pressure provocation
  • Tinel’s sign

Musculoskeletal I (8 decks)

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