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Summer FDTN Exam 4 > Elbow > Flashcards

Elbow Flashcards

1
Q

Per normal anatomy, the anterior humeral line should intersect what

A

The middle of the capitellum

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2
Q

Per normal anatomy, the middle of the capitellum should have a straight line going through

A

the proximal radial shaft

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3
Q

What is the MOI of lateral epicondylitis (tennis elbow)

A

Overuse inflammatory injury from repetitive wrist or wrist finger extension
Involves common extensor tendon

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4
Q

Lateral epicondylitis will show what on PE

A

Significant pain and 3/5 strength with resisted 3rd digit extension

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5
Q

What is tendonITIS vs tendonOSIS

A

itis: inflammation; fiber disruption and degeneration
osis: sporadic inflammation (process is stalled); mucoid degeneration; fiber disorganization (basically degeneration inside that doesn’t yield inflammation usually)

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6
Q

How do you treat tendonitis

A 
Steroid injection 
Activity modification 
NSAIDs 
Ice 
Stretching and strengthening 
Bracing considerations 
\+/- PT
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7
Q

How do you treat tendinosis

A 
Activity mod 
PT
Stretching and strengthening 
\+/- Bracing 
NO NSAIDs or steroid injections because this is more chronic
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8
Q

The fundamentals of treating tendonosis are

A

modify aggravating activity
correct biomechanical faults
Astym, Graston, Dry needling, and PRP injections to help degeneration
Stretching and Eccentric strengthening as therapy

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9
Q

What movements are associated with distal biceps tendon tear

A

Rapid eccentric contraction (catch something falling) and a pop

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10
Q

What deficit is felt with a distal biceps tendon tear

A

Flexion at elbow is diminished

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11
Q

How do you test biceps brachii

A

With patient’s arm extended and pronated, ask them to resist supination

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12
Q

How do you test brachialis

A

Put them in neutral (like they are holding a coke can) and ask them to resist as you apply pressure inferiorly

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13
Q

Who is more likely to get a distal biceps tendon tear

A

men >40 with pre-existing degenerative changes

rapid eccentric contraction of biceps at radial insertion

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14
Q

How do you treat distal biceps tendon tears, NON-surgically

A

Partial: brace and limit ROM x 4 weeks. Gradual progression of ROM and strengthening
Complete: only non-surg if older sedentary, and willing to accept strength loss

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15
Q

Who should have distal biceps tendon tears treated surgically

A

Complete tear in young, active individuals

Elective for partial tear in young active adults

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16
Q

What does medial epicondylitis affect

A

Common flexor muscle group
Common flexor tendon
Colateral ulnar ligament
Ulnar nerve

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17
Q

What is you ROM loss with medial epicondylitis

A

Reduced wrist flexion and arm flexion

BUT- you can’t make your Dx based on Sx, you ned more testing to r/o ulnar collateral ligament pathology, etc.

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18
Q

What are the parts of the ulnar collateral ligament

A

Anterior, intermediate, and posterior band

19
Q

What is the Valgus stress test

A

Perform at 0 and 30 degrees flexion

Move distal arm lateral while stabilizing the elbow. This mainly tests the anterior band of the UCL

20
Q

What is the Milking maneuver

A

Test for posterior band of UCL

Assess pain, medial joint laxity, and end feel

21
Q

Best test for testingUCL is

A

Moving Valgus test!

If they have pain throughout

22
Q

Best test for testingUCL is

A

Moving Valgus test!
If they have pain throughout the ROM= UCL insufficiency
“Shear” angle is where the most pain is felt; 120-80 degrees

23
Q

How do you treat medial epicondylitis/osis

A

Similar to Lateral!

If there is a UCL tear, need surgical consult bc it does not heal well on it’s own

24
Q

What is medial epicondyle apophysitis (little leaguers elbow)

A

When the growth plate in the medial epicondyle widens due to traction to the area

25
Q

How do you treat medial epicondyle apophysitis

A

Activity modify
PT
GRadual return to throwing (no throwing 6-8 weeks, then PT, then 1 month of gradual return)

26
Q

What is in the region of the posterior elbow

A

Olecranon bursa
triceps tendon
olecranon process

27
Q

MOS for olecranon bursitis is commonly

A

constant pressure to the area (like resting on an arm rest)

28
Q

How does non-infectious bursitis present

A

as a result of repeated trauma, fluid develops in the bursa causing obvious swelling

29
Q

Non-infectious bursitis on PE is remarkable for

A

Obvious swelling at the tip of the elbow
Absence of pain, erythema, warmth
Full painless ROM of elbow

30
Q

Infectious bursitis is a result of

A

Infection or other intense inflammatory process

31
Q

On PE, infectious bursitis will show

A

Obvious swelling at tip of elbow
marked warmth, erythema, and pain when palpating the bursa
Limitation of elbow flexion

32
Q

How do you treat olecranon bursitis

A

Small fluid and mild Sx: activity modify + NSAIDs
wear elbow pad
avoid hyperflexion against hard surfaces
Aspirate bursa if effusion is large or you are concerned for infection

33
Q

What is the procedure for olecranon bursa aspiration

A

inject lidocaine w/ 27g needle
aspirate w/ 18g 10ml syringe until bursa is flat
Send fluid for C&S if concerned for infx
NO steroids if you suspect infection!!!
If infection not present, may inject 40mg Kenalog (steroid)
Keep compression to prevent refilling

34
Q

What causes elbow dislocations

A

High energy injuries
MC joint dislocation in kids
MC posterior dislocation

35
Q

When suspecting an elbow dislocation, you must r/o

A

olecranon or radial head fractue!
Coronoid process fractures are very common in posterior dislocations
MUST do a neurovascular exam

36
Q

What structures provide stability to the elbow

A

Valgus: medial collateral ligament and radial head
Varus: lateral collateral ligament
Coronoid process
Sigmoid fossa

37
Q

What is Nursemaid’s elbow

A

Radial head dislocation! Can occur with parents lifting child by the arms
Essentially subluxation of radial head

38
Q

How can you correct radial head dislocation

A

They will come in pronated.

Place your hand posteriorly over the radial head. Quickly supinate and flex the elbow

39
Q

What are the types of radial head fractures

A

I: NOT displaced, fat pad sign. Repeat XR in 7-10 days b/c Fx may not be visible on XR
II: displaced
III: comminuted, >3 fragments. + damage to ligaments and joints

40
Q

What sign is associated with fracture on XR

A

fat pad sign surrounding the affected area

Indicated blood seeping out

41
Q

How do you treat a type I radial head Fx

A

Non-surgical: splint or sling for a few days, they implement early motion

42
Q

How do you treat type II radial head fracture

A

Minimal displacement: splint 1-2 wks, then ROM exercises

+/- open reduction internal fixation depending on size and function

43
Q

How do you treat type III radial head fracture

A

Surgery to remove broken bone fragments and repair soft tissue damage
Early movement to stretch and bend elbow and avoid stiffness

Summer FDTN Exam 4 (14 decks)

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