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SCS Prep > Elbow > Flashcards

Elbow Flashcards

1
Q

Brachialis

A

C5-C6, musculoskeletal

C7-C8, radial

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2
Q

Radial

A

C7-C8

brachiorad, triceps, supinator, anconeus

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3
Q

PT

A

C6-C7

median

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4
Q

Varus/Valgus

A

LCL/MCL

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5
Q

Pinch Grip Test

A

entrapment of ant IO nerve

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6
Q

Tinel’s Sign

A

ulnar nerve compromise

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7
Q

Lateral Epicondylagia (tests)

A

Cozen’s Sign (resisted wrist ext), Mill’s Test (passive ext stretch, wrist/elbow)

Maudsley’s - resisted middle finger ext

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8
Q

MCL involvement (tests)

A

Milking sign, moving valgus

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9
Q

LCL involvement (tests)

A

Chair sign

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10
Q

Pitch Type/Age

A 
fastball (8-10)
change up (10)
curveball, knuckleball (14)
slide, forkball, splitter (16-18)
screwball (17-18)
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11
Q

Pitch Count/Rest Days

A

21-35 (1)
36-50 (2)
51-65 (3)
66 (4)

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12
Q

Little League Elbow

A

possibilities: med epi frag/avul, delayed or accel apop growth of med epi, forms osteochondritis/rosis

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13
Q

Panner’s Disease (CET)

A

AVN of capitellum
C - not associated w/ trauma, common 7-12 yo
E - stiffness, pain at let elbow
T - rest

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14
Q

OCD (CET)

A

art cart separates from subchondral bone
C - repetitive trauma
E - pain at lat elbow, pop, swell, lock
T - conservative unless loose bodies (surgery)

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15
Q

Lat Epi (CET)

A

C - tennis elbow, excessive gripping (ECRB sometimes indicated)
E - Cozen and Mill, dec grip strength
T - conservative

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16
Q

Med Epi (CET)

A

C - golfer’s elbow, too much elbow flex on trailing arm w/ follow through, repeated use or chronic strain (FCR, PT, FCU indicated)
E - pain medially, swelling, passive wrist ext (pain)
T - conservative

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17
Q

Med Epi Apop (CET)

A

C - repetitive stress w/ throwing, 9-12 yo most common
E - pain at med elbow, dec strength
T - rest, conservative

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18
Q

Volkmann’s Contracture (CET)

A

C - ischemic contracture from brachial artery injury, major complication of elbow injury
E - pain in forearm that increased with passive finger ext, cessation of brachial/radial pulses
T - referral to MD

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19
Q

PT Syndrome (CET)

A

C - entrapment of median nerve due to edema and hypertrophy
E - neuropathy, sensory, and motor deficits
T - anti-inflammatories, rest, possible surgery

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20
Q

MCL bundles

A

ant (tight ext, loose flex)

post (tight flex, loose ext)

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21
Q

MCL injury (CET)

A

C - repetitive valgus stresses, valgus loads during throwing
E - pain medially, dec strength, milking sign, moving valgus
T - docking technique - surgery focus on ant bundle

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22
Q

MCL Reconstruction

A

Wk 1-4

  • ROM 40-90 wk 1-3, 30-105 wk 4
  • splint 50-60 wk 1

Wk 4-6
- ROM 15-115, pain free iso, scap stab

Wk 12-16
- begin plyo, light forearm/wrist strengthening

Mo 4-9

  • interval throwing 4 mo, batting 5 mo
  • throwing off mound 9 mo
  • pitch competitively 1 yr
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23
Q

Flexor Contracture (loss of ext) (CET)

A

C - most often result of valgus ext overload syndrome, osteophytes may develop and prevent ext
E - restricted ROM, pain at end range
T - LLLD, stretching, jt mobs, dynamic splinting at night

24
Q

Heterotrophic Ossification (CET)

A

C - direct trauma, surgical intervention
E - swelling, hyperemia, loss of motion
T - surgical excision

25
Q

Dislocation of Elbow (CEIT)

A

C - FOOSH, severe trust in flexed position, 90% post
E - hemorrhage, swelling, severe pain,
I - A/P, lat, oblique
T - elbow splint 5-7 days in hinged elbow brace 30-90; inc 10-15 per week, PROM avoided

full flex 6-12 weeks, full ext 3-5 mo

26
Q

OCD Capitellum (CET)

A

C - osteochondral injury, loose bodies
E - MRI best
T - non-op, arthroscopic

27
Q

Olecranon Bursitis (CET)

A

C - superficial nature makes it more susceptible to chronic injury or direct blows
E - pain, swelling, pt tender
T - protect with padding

28
Q

Monteggia Fx

A

dislocation of prox RU jt w/ forearm fx

29
Q

Nightstick Fx

A

at midpoint of ulna

30
Q

Galenzzi Fx

A

dislocation of ulnar head w/ fx of distal radius

31
Q

Nursemaid’s Elbow

A

dislocation of radius common from when child pulled up by hand

32
Q

CRITOE

A 
capitellum
radial head
internal/med epi
trochlea
olecranon
external/lat epi
33
Q

Tendinitis

A

Lat Epi

  • ECRB (wrist ext uln dev), EDC, ECRL (wrist ext rad dev), ECU
  • shear stress

Med Epi

  • PT (pro elbow flex), FCR (wrist flex rad dev)
  • tension overload

Bi/Tri - shear stress and tendon overload

34
Q

Pitching and Tendinitis

A 
Lat epi/LCL - decal/follow through
Med epi/PT - late arm cocking/early accel
UCL/ulnar nerve lesion - cocking
Tri tendinitis/avulsion - accel/decel
Radial/median nerve lesion - accel/decel
35
Q

Affected vs Healthy Arm

A

limited active wrist flex/ext, passive pro

36
Q

Biceps

A

secondary flexor, greatest torque 80-100 flex

active during elbow flex except when pro

37
Q

Brachialis

A

primary flexor, 100 flex

unaffected by forearm/sh position

38
Q

Triceps

A

primary ext, 90 flex

LH affected by shoulder

39
Q

Tennis

A

Serve

  • ticeps, PT(accel/decal), ECC of biceps/sup
  • taping/mvmt retrain - proper control of elbow ext/pro

Groundstroke

  • high ECRB, ERCL, EC
  • backstroke (ECRB and biceps)
  • avoid wrist flex on impact

short backswing = greater impact

40
Q

Stages of Tendon Healing

A

Inflam (1-7 days) - rest, protect, control inflame
Prolif (1-2 weeks) - controlled stretching/ROM
Maturation (1-2 mo) - controlled stretching and strengthening (avoid disuse/atrophy)
Fibrosis - repeated inflame episodes leading to scarring of tendon

41
Q

Lat Epi Non-Op

A

acute - steroid injection if unresponsive to modalities
subacute - ecc
chronic - plyo

42
Q

Lat Epi Post-Op

A

day 3 - gentle painfree ROM
day 17 - 80% ROM, light activity only
day 18-21 - submax isos, antigravity wrist no pain
wk 3-6 - RTC, elbow scap stab, aerobic, light stretch
wk 8-12 - UE plyo, CKC added
RTP 4 mo

conservative fails, pain 6-12 mo after onset; 3+ failed injections

43
Q

Med Epi Non-Op

A

RTP 8-10 weeks
similar to lat epi - focus on flex/pro
throwers at wk 6

Post-Op RTP 3-4 mo

44
Q

Bi Ten Non-Op

A

RTP 8-10 weeks
splint elbow 90 flex and neutral forearm, 3 weeks
PREs 8 weeks

45
Q

Bi Ten Post-Op

A

splint elbow 90 flex, sup forearm 6 weeks

Wk 3 - passive elbow flex/sup, active elbow ext 30 deg, A/PROM pro/sup
Wk 4- passive wrist and shoulder
Wk 6 - DC splint
Wk 7 - AAROM/PROM elbow flex; PRE
Wk 10-12 - ECC, throwing
3 mo - plyo
6 mo - contact sports
46
Q

Tri Ten Non-Op

A

splint elbow 45

PREs 8 weeks

47
Q

Tri Ten Post-Op

A

splint elbow 45, 3 weeks
wk 3 - ROM (AROM inc 20-30 deg/week)
wk 6 - PRE
3 mo - RTP

48
Q

Joint Integrity Tests

A

Valgus Stress - UCL ant
Milking - UCL complex
Moving Valgus - UCL complex (best Sn, Sp; max pain 90 deg)
Varus - LCL, annular
O’Driscoll - P/L rot instability, LCL ulnar, rot sublux/dislocation of UH jt

49
Q

UCL Info

A

provocation or valgus stress

FCR, FCU, and PT deficits

50
Q

UCL Non-Op

A

4-6 weeks, normal; start plyo, throwing/throwers wk 6

interval throwing wk 12
RTP 14-16 wks

51
Q

UCL Post-Op

A

Phase I - Wk 1-3
- post splint 1-2 weeks, hinge brace 30-100 (15-115 wk 3), submax sh isos, wrist flex/ext (wk 2)

Phase II - Wk 4-8
- 10-120 (inc 5-10 per week), isotonics (no ER)
wk 6 - 0-130, add ER

Phase III Wk 9-13

  • plyo, ECC elbow flex/ext
  • PNF, RTC, scap stab, sh arom isotonics
  • throwers ten

Phase IV Wk 14-26

  • interval warm up throwing program
  • fastball at 75% before breaking pitches
  • RTP 22-28 wks

pitch from mound 9 mo, competitively 1 yr

52
Q

Radial Tunnel Syndrome

A

Entrapment - radiocapitaller jt, tender ECRB origin, supinator (fibrous distally)
- distal tri, mid/post hum (spiral groove), sup head of supinator, ECRB/L and brachiorad

surgery after 12 wks pain - sig tender with resisted middle finger ext, along course of supinator
Post-op - grip wk 4, PRE 6, plyo 8, sports 10

53
Q

Cubital Tunnel Syndrome

A

cocking phase
Entrapment - FCU, FDC, retroepicondylar groove

Non-Op

  • volar splint, elbow 30-40 deg flex 6- 8 wks; avoid repetitive elbow flex/ext, full elbow flex
  • PRE wk 6

Post-Op

  • post splint 60 flex, neutral forearm
  • isos 3 weeks; AROM wk 3, PRE 7th, throwers 9th, RTP 12
54
Q

Stages of Fx Healing

A 
Inflammation (1-7 days) - fx frag moving freely
Soft Callus (3 wks) - angulation at fx site can still occur
Hard Callus (3-4 mo) - frag united firmly by new bone
Remodeling (after) - fx united solidly
55
Q

Splinting

A

Inflam - support tissues, prevent overstretch
Prolif - gentle stretch/inc ROM, prevent loss of align
Mat - provide support chronic jt lax/lig injury, traction to correct contracture

Static - I
Serial Static - IPM
Static Progressive - late I, PM
Dynamic - late I, P, early M

56
Q

Throwing

A

Wind up to Stride - low load = uncommon for injuries
- elbow flex (ISO to ECC), wrist/finger ext (ISO to CON)

Cocking to Accel - pelvis vs trunk rot
early - valgus stresses begin (flex/pro mass; pro resist valgus, tri ISO elbow flex)
late - max valgus (olecranon impinges vs groove/fossa = loose bodies)

Decel to Follow through
- ECC loads to decal arm
SH complex GH vs scap
elbow complex - PT, bi, sup, brach
-  ECC (brach, biceps, sup, wrist ext)
CON (PT, wrist flex)

SCS Prep (16 decks)

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