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Clin Med II - Ortho > Elbow > Flashcards

Elbow Flashcards

1
Q

Articulations of elbow

A

Humeroradial
Ulnohemeral
Superior radioulnar

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2
Q

Humeroradial joint

A

Formed by radial head and capitellum of the humerus

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3
Q

Ulnohermeral joint

A

Ulnar notch and trochlea of the humerus

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4
Q

Ossesous anatomy provides stability in ___ and ___ of flexion

A

<20°

> 120°

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5
Q

Stable joint due to

A

Strong fibrous synovial capsule
Collateral ligaments
Muscular attachments

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6
Q

Lateral epicondylitis - in general

A

AKA - tennis elbow
An irritation, tendinosis and inflammation of the musculotendinous attachments of the long extensor muscles of the wrist and hand at the lateral epicondyle
The extensor carpi radialis brevis M. is most often involved
Most common cause of adult elbow pain

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7
Q

Lateral epicondylitis - RF

A

Smoking
Obesity
40-50yo
Repetitive movements for at least 2h daily
Forceful activity - managing physical loads over 20kg

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8
Q

Lateral epicondylitis - exam

A

Swelling over lateral elbow
Localized tenderness over the lateral epicondyle and proximal wrist extensor muscle mass
Pain with resisted wrist extension with the elbow in full extension
Pain with passive terminal wrist flexion with the elbow in full extension

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9
Q

Lateral epicondylitis - tx

A

Observation - s/s may last 6 months to 2 yrs
Activity modification / biomechanics
Counter force bracing - wear 6-10 cm distal to elbow joint
Splints to reduce wrist flexion / extension
PT / OT
NSAIDs - oral / topical
Steroid injection
Platelet-rich plasma injection

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10
Q

Lateral epicondylitis - management

A

Over 90% of cases can be managed non-operatively

X-ray to r/o bony abnormality or calcification

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11
Q

Lateral epicondylitis - when to refer to ortho

A

Severe pain or marked dysfunction > 6 months
Failure of conservative management, including PT/OT
Requested

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12
Q

Medial epicondylitis - in general

A

AKA - golfer’s elbow
Less common
An irritation, tendinosis and inflammation of the musculotendinous attachments of the long flexor muscles of the wrist and hand at the medial epicondyle

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13
Q

Medial epicondylitis - exam

A

Localized tenderness over the medial epicondyle and proximal wrist flexor muscle mass - not the MCL
Pain with resisted wrist flexion with the elbow in full extension
Pain with passive terminal wrist extension with the elbow in full extension

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14
Q

Olecranon bursitis - etiology

A

Direct injury or trauma
Prolonged pressure
Overuse or strenuous activity
Crystal-induced arthropathy - longstanding or tophaceous gout
Inflammatory arthritis such as RA or spondyloarthritis
Infection (septic bursitis) - this can occur due to transcutaneous transit of bacteria from penetrating injury or microtrauma (most commonly) or hematogenous seeding (less commonly)
Hemorrhage

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15
Q

Olecranon bursitis - exam

A

Obvious swelling and inflammation
Possibly warmth and erythema
Pain (or not)
Look closely for overt abrasion or puncture wound

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16
Q

Olecranon bursitis - imaging

A

Not necessary unless you suspect a foreign body

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17
Q

Olecranon bursitis - aspiration and analysis

A 
Palpable fluid
R/o infection
Dx microcrystalline d/o
examine the fluid and note color, thickness and sediment
Gram stain
Anaerobic / aerobic culture
Cell count
Crystal ID
Fungal and mycobacterium in immunosuppressed pts, gardeners and fishermen
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18
Q

Olecranon bursitis - tx

A

If high suspicion of infection, begin abx

- >80% are S. aureus and other G+ organisms, but Gram stain is (+) only ub 50-66% of cases

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19
Q

Olecranon bursitis - tx (mild)

A

Clindamycin
Doxycycline
Bactrim

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20
Q

Olecranon bursitis - tx (severe)

A

Hospitalization

IV vancomycin + Zosyn or Ancef

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21
Q

Olecranon bursitis - indications for sx

A 
Inability to adequately aspirate
Recurrent bursitis
Presence of foreign body
Adjacent skin/soft tissue infection
Ill pt
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22
Q

Distal Biceps Tendon

A

Attaches to the radial tubercle just distal to radial head

Major function is to supinate the forearm and also a secondary elbow flexor

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23
Q

Distal Biceps Tendon Rupture - MOI

A

Usually forceful lifting

24
Q

Distal Biceps Tendon Rupture - presentation

A

Sudden pain in AC fossa
May have felt a pop
Swelling and ecchymosis in the AC fossa

25
Q

Distal Biceps Tendon Rupture - exam

A

Tenderness over the radial tubercle, deep in the AC fossa
Pain / weakness with resisting flexion and supination of the forearm
May have Popeye sig, but less reliable than a proximal tear
Squeeze test
Hook test

26
Q

Squeeze test

A

Firm squeeze of biceps muscle belly causes forearm supination

27
Q

Hook test

A

The pt flexes the affected elbow to 90° with the forearm fully supinated
The examiner then attempts to “hook” the distal biceps tendon with their index finger and pull it forward

28
Q

Distal Biceps Tendon Rupture - imaging

A

MRI of elbow

29
Q

Distal Biceps Tendon Rupture - tx

A

Referral to ortho ASAP

Most require sx unless low demand pt

30
Q

Elbow dislocation - in general

A

Classified according to the direction of the distal bone
Posterior dislocations are the most common type (80-90%)
Predominantly 10-20yo
Both collateral ligaments are disrupted

31
Q

Elbow dislocation - MOI

A

Axial force applied to the extended elbow

32
Q

Elbow dislocation - presentation

A

Shortened extremity

Elbow in slight flexion

33
Q

Elbow dislocation - imaging

A

Obtain pre- and post-reduction radiographs

34
Q

Elbow dislocation - exam

A

Always check NV status before and after reduction

Watch for compartment syndrome

35
Q

Elbow dislocation - tx

A

Elbow should be splinted in flexion and pronation after reduction
Early immobilization is important to prevent muscle contractures
Refer to ortho to r/o more complex injuries

36
Q

Cubital tunnel syndrome - definition

A

An ulnar neuropathy caused by compression at the cubital tunnel along the medial elbow

37
Q

Cubital tunnel syndrome - MOI

A

Swelling from trauma or PG
Osteophytes about the elbow
Arthritis
Repeated microtrauma or pressure

38
Q

Cubital tunnel syndrome - Presentation

A

Numbness and tingling in the fourth and fifth digits
Medial elbow pain
Medial forearm pain
Nocturnal numbness and paresthesia
Worsening with elbow and/or repeated wrist flexion

39
Q

Cubital tunnel syndrome - exam

A

May have weakness of the innervated muscles (interossei, adductor pollicis, the hypothenar eminence, and flexor carpi ulnaris.
Look for muscle wasting / atrophy.
May have a positive Tinel’s sign at the elbow
Elbow flexion test
Fell the medial elbow during flexion and extension for subluxing nerve
Sensation testing

40
Q

Tinel’s sign at the elbow

A

Tapping over the tunnel causes / increases s/s

41
Q

Elbow flexion test

A

Hyperflexion at elbow and put pressure on cubital tunnel

42
Q

NCS

A

Externally applied stimuli and analysis for the consequent neurophysiologic responses of individual peripheral nerves

43
Q

NSC are used to

A

Dx focal and generalized d/o of peripheral nerves
Aid in the differentiation of primary nerve and muscle d/o
Classify peripheral nerve conduction abnormalities due to
- axonal degeneration
- demyelination
- conduction block
Tracks progression regarding clinical course and efficacy of tx

44
Q

NCS - goals in Cubital tunnel syndrome

A

Localized the lesion to the ulnar N at the elbow
Determine the character and severity of the injury
Aid in prognosis
Examine for the presence or absence of alternative dx

45
Q

Cubital tunnel syndrome - tx (non-operative)

A

PT/OT
Protective pad
Night splint
Nerve glide exercises

46
Q

Cubital tunnel syndrome - tx (sx)

A

Convincing clinical weakness, sensory loss
NCS evidence of moderate to severe degree
Moderate to severe progressive s/s for 6m despite conservative measures

47
Q

Olecranon fx - MOI

A

Bimodal - high energy injuries in young
Low energy fall in the elderly
A direct blow or as an avulsion injury with a forceful triceps contraction

48
Q

Olecranon fx - presentation

A

Pain
Swelling
Ecchymosis
Pain with elbow extension

49
Q

Olecranon fx - exam

A

May feel palpable defect

Inability to extend elbow - loss of extensor mechanism

50
Q

Olecranon fx - imaging

A

X-ray (best viewed on lateral)

CT by ortho if sx is planned

51
Q

Olecranon fx - tx

A

Immobilization if the fx is non-displaced and the extensor mechanism is still intact
ORIF

52
Q

Radial head fx - MOI

A

Most commonly from longitudinal loading from a fall on an outstretched arm

53
Q

Radial head fx - imaging

A

If fx not apparent, look for fat pad or sail sign on radiograph

54
Q

Radial head fx - the Mason classification

A

Type I - non-displaced
Type II - single, large displaced fragment
Type III - comminuted
Type IV - fx associated with an elbow dislocation

55
Q

Radial head fx - tx

A

Type I - non-sx with early motion
Type II, with near normal motion: <2mm displacement, no other injuries, non-sx
Type II, with any associated injuries or mechanical block - ORIF
Type III - fragement excision or radial head prosthesis
Type IV - follows above guidelines

56
Q

Nightstick fx - in general

A

An isolated ulna shaft fx

Usually from contact, not a fall

57
Q

Nightstick fx - tx

A 
Non-operative casting if
- <50% displacement
- <10% angulation
- no radial head dislocation
- located within the distal 2/3 of ulna
Refer

Clin Med II - Ortho (13 decks)

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