Elbow and Arm Flashcards
what is the treatment for a low grade distal biceps tendon tear/ partial tear?
rest and activity modification
what is pronator syndrome?
median nerve entrapment at the elbow
how is pronator syndrome differentiated from carpal tunnel syndrome?
decreased sensation over the thenar eminence in the palmar cutaneous branch of the median nerve
a pronator compression test reproduces pain/tingling in the radial fingers. what is the lesion?
pronator syndrome - median nerve entrapment at the elbow
a patient experiences volar arm pain and radial digit pain with resisted flexion of the PIP joint of the middle finger. what does this cause compression of? what is the condition?
compression of the FDS heads ; pronator syndrome
a patient with history of FOOSH has a flake sign on XR of the elbow. what is this and what does it signify?
small bony avulsion fragment from the olecranon - pathognomonic for triceps rupture
for non surgical management of low grade partial tear of the distal triceps tendon, how should the elbow be immobilized?
30 degrees flexion
what is the pathophysiology of valgus extension overload?
repetitive forceful shearing of the olecranon within its fossa causing chrondromalacia and olecranon osteophyte formation
physical therapy for valgus extension overload will focus on what?
eccentric strengthening of the wrist flexors
what is the management for the majority of olecranon stress fractures?
non surgical
corticosteroids may increase the risk of what when used to treat olecranon bursitis?
septic bursitis or skin/fat atrophy
t/f MRI necessarily correlates with symptoms in medial epicondylitis
false
physical therapy for how long is successful in treating 90% of cases of medial epicondylitis?
6-12 weeks
what is the roof of the cubital tunnel?
arcuate ligament
describe 4 areas of impingement of the median nerve at the elbow? (pronator syndrome)
ligament of struthers, lacertus fibrosus, pronator teres ulnar and humeral heads, flexor digitorum muscle
what nerve runs in the arcade of froshe in the posterior elbow?
radial nerve
which nerve passes beneath the arcade of struthers at the medial posterior elbow?
ulnar nerve
resisted pronation of the elbow tests function of what nerve?
median nerve
what nerve innervates the brachialis and biceps brachii?
musculocutaneous nerve
which nerve gives rise to the lateral cutaneous nerve of the forearm?
musculocutaneous nerve
the brachialis muscle inserts on what bone?
ulna
the coracobrachialis is innervated by what nerve?
musculocutaneous nerve
the brachialis is innervated by what two nerves?
radial nerve and musculocutaneous nerve
what two tendons form the conjoined tendon at the coracoid process?
coracobrachialis and short head of the biceps brachii
what are the four borders of the quadralateral / quadrangular space?
teres minor, teres major, long head and lateral head of the triceps
the posterior cutaneous nerve of the forearm arises from what nerve?
radial nerve
the posterior cutaneous nerve of the arm arises from what nerve?
radial nerve
which nerve lies between the biceps and brachialis muscles?
musculocutaneous nerve
which artery runs with the median nerve through the anteromedial arm?
brachial artery
a humerus fracture increases risk of injury to what nerve?
radial nerve
the radial nerve exits the deep space of the arm between what two muscles?
brachialis and brachioradialis
name the three muscles innervated by the musculocutaneous nerve?
coracobrachialis, brachialis, and biceps brachii
the ulnar nerve runs under the arcade of struthers onto which head of the triceps?
medial head
what branch of the radial artery can compress the radial nerve?
leash of Henry
which artery runs with the radial nerve in the spiral groove?
deep artery
the ulnar nerve can be compressed by the fascia of which muscle as a variant of cubital tunnel syndrome?
flexor carpi ulnaris fascia
what is panner’s disease?
osteochondrosis of capitellum
describe the difference in how a partial or proximal tear of the elbow UCL is managed compared to a distal tear
partial / proximal = better non operative outcomes, can treat non operatively
distal - more likely will need surgical repair
what is Little Leaguer’s elbow?
medial epicondyle stress lesions including edema, fragmentation, separation, or avulsion of the medial epicondyle apophysis
radiograph of the elbow in a 13 yo M throwing athlete shows medial epicondyle apophyseal widening, fragmentation, avulsion. what is the condition?
Little Leaguer’s elbow
for a patient with Little Leaguer’s elbow, how long should throwing be avoided for non operative treatment?
3 months
for non operative treatment of Little Leaguer’s elbow, how long should immobilization last at the start of treatment?
1-3 weeks
where (anatomic location) is the ulnar nerve most often compresses, resulting in cubital tunnel syndrome?
flexor carpi ulnaris aponeurosis
a patient with cubital tunnel syndrome should avoid which type of muscle strengthening exercise?
triceps
how effective is non operative treatment for cubital tunnel syndrome including activity modification, nighttime extension splinting, elbow pads?
50% effective
what nerve entrapment can mimic lateral epicondylopathy?
PIN
after 6-12 weeks of non operative treatment for lateral epicondylitis, what is the treatment success rate?
90%
describe the radiocapitallear joint compression test
elbow in extension, axial load applied, pronation and supination will resproduce lateral elbow pain
how is a stable (intact articular cartilage) osteochondritis dessicans lesion of the capitellum lesion treated?
non operative : physical therapy, activity restriction, gradual return to activities in 3-6 months
what is another term for “radial tunnel syndrome?”
PIN nerve compression
what is the most common anatomic site for radial tunnel / PIN nerve compression syndrome?
arcade of Frohse
a patient has lateral elbow pain, aggravated by supination and TTP 4cm distal to the lateral epicondyle. what is the most likely condition?
PIN nerve compression
what motions of the elbow and wrist should be avoided for treatment of PIN nerve compression syndrome?
elbow extension, pronation, and wrist flexion
what is the success rate of non surgical management of PIN nerve compression?
80% over 4-8 week recovery
what is a Monteggia fracture?
proximal ulnar fracture with radial head dislocation
a patient has lateral elbow pain and feelings of instability when axial loading the elbow and supinating, such as getting out of a chair. what is the most likely diagnosis?
posterolateral rotary instability (PLRI)
what condition is characterized by FOOSH injury with axial loading / forearm supination resulting in posterolateral dislocation or subluxation and injury to the lateral ligament complex of the elbow?
PLRI
a patient experiences lateral elbow joint pain, recurrent effusion, locking, catching, and loss of extension of the elbow. there is lucency seen in the capitellum. what is the cause?
OCD
what is the typical time for return to sport after a complete distal biceps tendon rupture?
4-6 months
how would you differentiate pronator syndrome from carpal tunnel syndrome from a sensation exam?
in pronator syndrome, there is decreased sensation over the thenar eminence in the distribution of the palmar cutaneous branch of the median nerve
a patient has paresthesias in the lateral three digits with resisted flexion of the middle finger PIP joint. what is the most likely diagnosis?
pronator syndrome
for a partial tear of the distal triceps tendon, in what degrees of elbow flexion should a patient be immobilized for 3-4 weeks?
30 degrees
which condition is characterized by pain in the medial aspect of the olecranon, exacerbated by UCL laxity, occurring in throwing athletes, resulting in chondromalacia and osteophyte formation?
valgus extension overload
how long does it typically take to return to sport in an adolescent with olecranon stress fracture?
3-6 months
what is the most common pathogen responsible for septic bursitis?
staph aureus
what two repetitive motions of the wrist lead to medial epicondylitis?
pronation and wrist flexion
what two associated conditions should be evaluated for in a patient with medial epicondylitis?
ulnar neuropathy and valgus instability
t/f MRI and ultrasound do not necessarily correlate with symptoms of medial epicondylitis
true
what band of the elbow UCL is the strongest and most important stabilizer of the of the medial elbow?
anterior band
the moving valgus stress test and milking maneuver are provacative tests for which condition?
medial elbow UCL injury
t/f proximal tears have better prognosis than distal UCL tears when treated non operatively
true
for how long should medial epicondyle stress fractures be immobilized for initial management?
1-3 weeks
what is the most common site of cubital tunnel syndrome?
FCU aponeurosis
what nerve innervates the adductor pollicis and is assessed with the Froment test (pinch)?
deep branch of the ulnar nerve
what is the Wartenberg sign regarding ulnar neuropathy?
involuntary abduction of the fifth finger an inability to adduct the fifth finger
what is the number one differential diagnosis to consider for lateral epicondylopathy?
PIN entrapment
t/f MRI and ultrasound do not necessarily correlate with symptoms of lateral epicondylitis
true
XR of an adolescent gymnastics athlete elbow reveals radiolucency of the capitellum, flattening of the articular cartilage, and sclerotic rim. what is the diagnosis?
OCD of the capitellum
a patient has TTP over the supinator arch, approximately 4cm distal to the lateral epicondyle. what is the most likely diagnosis?
radial tunnel syndrome/ PIN compression
for which nerve compressive neuropathy of the elbow should prolonged elbow extension, forearm pronation and wrist flexion be avoided?
PIN entrapment
what is the success rate of non operative management for PIN entrapment/ radial tunnel syndrome?
80% effective
what is the typical return to sports for time for non operative treatment of proximal PIN nerve entrapment?
4-8 weeks
what type of wrist splint should be used temporarily for non operative treatment of PIN nerve entrapment?
dorsiflexion wrist splint
what is the name for proximal ulnar fracture with radial head dislocation?
Monteggia fracture
intraarticular swelling of the elbow joint from fracture or dislocation will most like result in what radiographic sign?
sail sign
t/f non displaced radial head/neck fractures are considered stable
true
what condition of the elbow is a disruption of the lateral ligamentous complex leading to instability of the radiocapitellar and ulnohumeral joint
posterolateral rotatory instability
a patient has a feeling of instability with axial loading of the elbow and forearm supintation, such as a catch or pop with elbow extension. what is the condition?
PLRI
explain how to conduct the apprehension / pivot shift test for diagnosis of PLRI
valgus stress on the elbow during flexion to extension of the elbow - will notice visible shifting of the elbow
how should you immobilize the elbow for a stable PLRI injury?
2 weeks in pronation at 90 degrees
