Elbow Flashcards
Per normal anatomy, the anterior humeral line should intersect what
The middle of the capitellum
Per normal anatomy, the middle of the capitellum should have a straight line going through
the proximal radial shaft
What is the MOI of lateral epicondylitis (tennis elbow)
Overuse inflammatory injury from repetitive wrist or wrist finger extension
Involves common extensor tendon
Lateral epicondylitis will show what on PE
Significant pain and 3/5 strength with resisted 3rd digit extension
What is tendonITIS vs tendonOSIS
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)
How do you treat tendonitis
Steroid injection Activity modification NSAIDs Ice Stretching and strengthening Bracing considerations \+/- PT
How do you treat tendinosis
Activity mod PT Stretching and strengthening \+/- Bracing NO NSAIDs or steroid injections because this is more chronic
The fundamentals of treating tendonosis are
modify aggravating activity
correct biomechanical faults
Astym, Graston, Dry needling, and PRP injections to help degeneration
Stretching and Eccentric strengthening as therapy
What movements are associated with distal biceps tendon tear
Rapid eccentric contraction (catch something falling) and a pop
What deficit is felt with a distal biceps tendon tear
Flexion at elbow is diminished
How do you test biceps brachii
With patient’s arm extended and pronated, ask them to resist supination
How do you test brachialis
Put them in neutral (like they are holding a coke can) and ask them to resist as you apply pressure inferiorly
Who is more likely to get a distal biceps tendon tear
men >40 with pre-existing degenerative changes
rapid eccentric contraction of biceps at radial insertion
How do you treat distal biceps tendon tears, NON-surgically
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
Who should have distal biceps tendon tears treated surgically
Complete tear in young, active individuals
Elective for partial tear in young active adults
What does medial epicondylitis affect
Common flexor muscle group
Common flexor tendon
Colateral ulnar ligament
Ulnar nerve
What is you ROM loss with medial epicondylitis
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.
What are the parts of the ulnar collateral ligament
Anterior, intermediate, and posterior band
What is the Valgus stress test
Perform at 0 and 30 degrees flexion
Move distal arm lateral while stabilizing the elbow. This mainly tests the anterior band of the UCL
What is the Milking maneuver
Test for posterior band of UCL
Assess pain, medial joint laxity, and end feel
Best test for testingUCL is
Moving Valgus test!
If they have pain throughout
Best test for testingUCL is
Moving Valgus test!
If they have pain throughout the ROM= UCL insufficiency
“Shear” angle is where the most pain is felt; 120-80 degrees
How do you treat medial epicondylitis/osis
Similar to Lateral!
If there is a UCL tear, need surgical consult bc it does not heal well on it’s own
What is medial epicondyle apophysitis (little leaguers elbow)
When the growth plate in the medial epicondyle widens due to traction to the area
How do you treat medial epicondyle apophysitis
Activity modify
PT
GRadual return to throwing (no throwing 6-8 weeks, then PT, then 1 month of gradual return)
What is in the region of the posterior elbow
Olecranon bursa
triceps tendon
olecranon process
MOS for olecranon bursitis is commonly
constant pressure to the area (like resting on an arm rest)
How does non-infectious bursitis present
as a result of repeated trauma, fluid develops in the bursa causing obvious swelling
Non-infectious bursitis on PE is remarkable for
Obvious swelling at the tip of the elbow
Absence of pain, erythema, warmth
Full painless ROM of elbow
Infectious bursitis is a result of
Infection or other intense inflammatory process
On PE, infectious bursitis will show
Obvious swelling at tip of elbow
marked warmth, erythema, and pain when palpating the bursa
Limitation of elbow flexion
How do you treat olecranon bursitis
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
What is the procedure for olecranon bursa aspiration
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
What causes elbow dislocations
High energy injuries
MC joint dislocation in kids
MC posterior dislocation
When suspecting an elbow dislocation, you must r/o
olecranon or radial head fractue!
Coronoid process fractures are very common in posterior dislocations
MUST do a neurovascular exam
What structures provide stability to the elbow
Valgus: medial collateral ligament and radial head
Varus: lateral collateral ligament
Coronoid process
Sigmoid fossa
What is Nursemaid’s elbow
Radial head dislocation! Can occur with parents lifting child by the arms
Essentially subluxation of radial head
How can you correct radial head dislocation
They will come in pronated.
Place your hand posteriorly over the radial head. Quickly supinate and flex the elbow
What are the types of radial head fractures
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
What sign is associated with fracture on XR
fat pad sign surrounding the affected area
Indicated blood seeping out
How do you treat a type I radial head Fx
Non-surgical: splint or sling for a few days, they implement early motion
How do you treat type II radial head fracture
Minimal displacement: splint 1-2 wks, then ROM exercises
+/- open reduction internal fixation depending on size and function
How do you treat type III radial head fracture
Surgery to remove broken bone fragments and repair soft tissue damage
Early movement to stretch and bend elbow and avoid stiffness
