Elbow

Question 1

Lateral Epicondylitis

Answer 1

• ECRB involved OVERUSE
• pain with gripping (you have stronger grip with wrist ext vs flexion)
  Tx: anti inflammatories, stretching wrist ext, eccentrics

Question 2

Lateral epicondylagia (tennis elbow)

Answer 2

Tx: USE MOBILIZATION WITH MOVEMENT!
Steroids best outcome in short term < 6 weeks, worsening outcomes > 6 weeks
PT with better outcomes long term > 6 weeks

Question 3

Medial Epicondylagia (Golfers elbow)

Answer 3

Flexor carpi radialis and pronator teres usually involved

1. Pain with palpation to medial epicondyle
2. Pain with resisted wrist flexion and pronation
3. can have ulnar nerve sx, and grip strength usually unaffected

Tx: Stretch wrist flexors and eccentrics

Question 4

AIN syndrome

Answer 4

Affects flexor digitorum profundus, flexor pollicus longus, pronator quadratus (branches after FDP and PQ)

AIN- PURELY MOTOR (no sensory loss) and largest branch of median nerve- DDx vs pronator teres syndrome (would have sensory loss)

Question 5

Pronator Teres Syndrome

Answer 5

Differential vs AIN and CTS

• will have SENSORY component, median nerve entrapped b/w 2 heads of pronator teres
• will also have distal median nerve muscle weakness (PL, FCR, FPB, FDS, OP, 1-2 lumbricals)
• vs CTS- it is a proximal or high median nerve entrapment so tinnels at the wrist and prolonged wrist flexion test will be unaffected

Tx: rest, activity modification, avoidance of aggravating factors- splinting in neutral wrist position at 90 degrees elbow flexion

Question 6

Ligament of Struthers syndrome

Answer 6

Differential from PT syndrome
- PT syndrome no PT weakness. LOS has PT weakness, with also distal median nerve weakness like PT syndrome and radicular symptoms with pain at the elbow

Question 7

Wartenbergs sign

Answer 7

unable to adduct 5th MCP- ask pt to put hand on table, passively abd fingers and ask pt to add

Question 8

PIN syndrome (supinator syndrome)

Answer 8

impingement/compression of radial nerve

• PURELY MOTOR, no sensory
• weakness along radial nerve distribution
• would see wrist ext/radial dev with wrist ext due to lack of innervation to ECU and ECB and overpowering of ECRL

Radial nerve branches into PIN after supinator

“BCDDIPPPS”

Question 9

RCL

Answer 9

Taught throghout flexion/ext and also SUPINATION

Question 10

Mills test

Answer 10

PASSIVE stretch of ext: finger and wrist flexion, elbow flexion and passively take arm into elbow ext and shoulder ext

Question 11

Cozens test

Answer 11

ACTIVE RESISTANCE: resisting ext and radial dev by positioning pt into wrist flexion and ulnar dev

Question 12

handshake test

Answer 12

perform handshake with elbow ext, repeat at 90 degrees of flexion. If less pain with elbow flexion, wont need sx. if same amount of symptoms in both flex/ext, need surgery.

Question 13

Posterolateral rotary instability

Answer 13

Affects RCL (LCL)- usually operative

Rehab- avoid shoulder abd, IR to decrease tension on RCL- put in a locked brace at 90 degrees elbow flexion and pronation 2-4 weeks

Question 14

Little leaguers elbow

Answer 14

apophysitis (injury and inflammation of tendon/ligament and its attachment to a growth plate. Can develop into avulsion fx at medial epicondyle)
- top predictor in kids is pitch count

Question 15

UCL rehab

Answer 15

forces in accel/decel phase > than fail rate in cadaveric studies. Flexor pronator group adds dynamic stability, but not enough bc of this. Need to develop trunk and shoulder

Question 16

Terrible Triad

Answer 16

Posterior disclocation of the elbow, fx of radial head, fx of conoid process of ulna

Question 17

Radial head fx

Answer 17

• moI: compression on pronated forearm, direct blow or hyperflexion injury

Mason Johnsonston Classification system 1-4

Question 18

Double crush syndrome

Answer 18

States that an asymptomatic site of nerve compression can predispose nerve compression/injury at a different site

Risk factors:

1. systemic
2. neurotoxic medication
3. age
4. lifestyle

Question 19

cubital tunnel syndrome

Answer 19

ulnar nerve irritation
- avoid wrist ext and supination

“Rest, immobilization, modalities:

Question 20

Osteochondritis dissecans

Answer 20

“bone, joint inflammation”. dissec- separate

• lateral compression injury to radial head and capitellum. common in young female gymnasts and male baseball players (UCL stress?)
• fatigue failure of subchondral bone –> bone resorption and separation of fragment that becomes avascular (bone chip?)

Question 21

Panners disease

Answer 21

apopphysitis of capitellum-dull lateral elbow pain- SELF limiting condition- may take 3 years- non-op with splinting

Question 22

RA

Answer 22

Total elbows shown to have good outcomes- TE really more like a salvage procedure

Question 23

Total elbow replacement

Answer 23

cant go back to swinging sports like tennis or golf- higher risk than hips/knees of complications and loosening/lifespan

Question 24

Cubital tunnel special tests

Answer 24

• elbow flexion test (best to rule in)
• wartenbergs sign (add of 5th MCP)
• ulnar compression test (best to rule out)
• Froments sign

Question 25

PIN treatment

Answer 25

• avoid supination and wrist ext

- splint in 90 degrees elbow flexion and neutral rotation