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S3- Musculoskeletal > Elbow and Forearm Common Clinical Presentations > Flashcards

Elbow and Forearm Common Clinical Presentations Flashcards

1
Q

INTRO

A

INTRO

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2
Q

What are the general health conditions that will be talked about in regards to the elbow and forearm?

A
  • Fracture and Other Bony Abnormality
  • Pediatric Elbow Conditions
  • Elbow Instability and Collateral Ligament Sprain
  • Olecranon Bursitis
  • Tendinopathies and Epicondylopathies
  • Distal UE Nerve Entrapments and UE Nerve Palsies
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3
Q

FRACTURES/BONY ABNORMALITIES

A

FRACTURES/BONY ABNORMALITIES

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4
Q

What are some fractures/other bony abnormalities?

A
  • Heterotopic Ossification
  • Radial Head Fracture
  • Monteggia Fracture
  • Panner’s Disease
  • Olecranon Fracture
  • Nurse Maid’s Elbow
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5
Q

What is heterotropic ossification?

A

When we get bone formation in areas where there shouldn’t be. Bone integration into soft tissue.

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6
Q

Heterotropic ossification can be both ___________ or painful. It can also progress to ________.

A
  • asymptomatic

- ankylosis

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7
Q

Radial Head Fractures and Dislocations:

  • Common MOI: ________
  • Isolated to radial head, proximal forearm, or combined plexus.
  • Check for concomitant injury at the _______ and __________.
  • Also check for concomitant __________ compromise.
A
  • FOOSH
  • wrist and upper arm
  • neurovascular
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8
Q

What is the symptom of radial head fractures and dislocations?

A

local pain

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9
Q

Radial head fractures are divided into __ types and can have comminution, what is this?

A
  • 3

- More than 2 segments with a fracture.

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10
Q

How do radial head fractures and dislocations present during a physical examination?

A
  • local swelling and tenderness
  • limited/painful ROM (active and passive)
  • painful/weak resistance testing (if administered)
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11
Q
  • Management of radial head fractures and dislocations involves monitoring for complications such as __________ compromise, healing failure, incision ________, etc.
  • Early ___________ can be done in tolerable ranges.
  • Progression from __________ (initiate ~3 weeks) to __________ training (5-6 weeks).
A
  • neurovascular, infection
  • mobilization
  • isometrics to resistive training
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12
Q

Monteggia Fracture:

  • Dislocation of the proximal _______ (anterior, posterior, or lateral) and _____ fracture.
  • Common MOI: Arm positioned in ____________ or ____________ with direct trauma or FOOSH.
  • Check for concomitant __________ compromise; posterior branch of ______ nerve, ________ _________ nerve, ______ nerve (commonly present following _____).
A
  • proximal radius and ulna fracture
  • hyperextension or hyperpronation
  • neurovascular compromise; radial, anterior interosseous, ulnar (commonly present following ORIF)
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13
Q

What is the symptom of Monteggia Fracture?

A

local pain

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14
Q

How do Monteggia Fractures present during physical examination?

A
  • local swelling and tenderness
  • limited/painful ROM (active and passive)
  • painful/weak resistance testing (if administered)
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15
Q
  • Management of Monteggia Fractures involves monitoring for complications such as __________ compromise, healing failure, incision ________, etc.
  • AROM initiated ~__ weeks post-op; extension >90 degrees usually held until ~__-__ weeks post-op.
A
  • neurovascular, infection

- 4 weeks, 4-6 weeks

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16
Q

Olecranon Fractures:

-Common MOI: trauma involving _______ contraction with flexion moment on elbow (fall on elbow, FOOSH) = __________.

A
  • triceps

- avulsion

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17
Q

What are the symptoms of an Olecranon Fracture?

A
  • local elbow pain

- pain provoked with UE use during daily activities

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18
Q

How will an Olecranon Fracture present during physical examination?

A
  • local swelling, tenderness, palpable gap at olecranon

- absent/significant limitations with elbow extension (AROM, resistance)

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19
Q

-Management of Olecranon Fractures if it is non-displaced involves ____________ while maintaining _______ function. Early (tolerable) ROM (pronation/supination after __-__ days, flexion/extension at ~__ weeks with limitations on flexion for ~__ months.

A
  • immobilization
  • tricep
  • (2-3 days, 2 weeks, 2 months)
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20
Q

If an Olecranon Fracture is treated via ORIF it is important to go through the surgeon __________, though early ____ is used.

A
  • restrictions

- ROM

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21
Q

PEDATRIC ELBOW AND FOREARM CONDITIONS

A

PEDATRIC ELBOW AND FOREARM CONDITIONS

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22
Q

Nurse Maid’s Elbow:

  • Dislocation of proximal _____ ____ (slips through _______ ligament).
  • Incidence rate is __% in children <8 y/o and is more common in _____.
  • Common MOI: ________ injury, traction on the pronated/extended forearm.
  • Pain in forearm, wrist, and/or elbow.
A
  • radial head (annular ligament)
  • 3%, boys
  • traumatic
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23
Q

How will Nurse Maid’s Elbow present during a physical examination?

A

Painful, flaccid arm in pronated position

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24
Q

Panner’s Disease (growth plate disorder):

  • Osteochondritis; osteonecrosis of epiphysis
  • Related to direct _________ or ________ changes
  • Common age range __-__ years
  • _____ more commonly affected (90%)
A
  • trauma or vascular changes
  • 5-16 years
  • males (90%)
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25
Q

What is a symptom of Panner’s Disease?

A

lateral elbow pain

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26
Q

How will Panner’s Disease present during a physical examination?

A
  • local swelling and tenederness
  • limited/painful ROM (active and passive); possibly hard end-feel with fragmentation
  • painful/weak resistance testing (if administered)
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27
Q
  • Management of Panner’s Disease involves _____ modification and possibly ________.
  • ____/________ progression based on pt tolerance.
A
  • activity, splinting

- ROM/resistive

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28
Q

Osteochondritis Dessecans Capetellum:

  • Pathomechanics are poorly understood but thought to be due to either a focal _______ injury f/b necrosis or possibly compression of ___________ joint.
  • Commonly ___________ onset.
  • C/o diffuse lateral elbow pain/”stiffness”
  • locking/clicking/popping/catching
  • Tenderness at _____________ joint.
  • Diminished ________ ROM.
  • Painful _________/__________.
  • Painful _________ testing.
  • Imaging: _______ of capitellum, _____ bodies
A
  • arterial, humeroradial
  • insidious
  • humeroradial
  • extension
  • pronation/supination
  • resistive
  • flattening, loose
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29
Q

ELBOW INSTABILITY

A

ELBOW INSTABILITY

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30
Q

What are some common MOIs for elbow instability?

A
  • Acute trauma (FOOSH with/out rotary force)

- Microtrauma (overhead throwers/repetitive throwers)

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31
Q

What are some history risk factors that increase the likelihood of elbow instability?

A
  • prior elbow dislocation

- repetitive throwing with stress during mid-flexion of elbow

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32
Q

Will patients with elbow instability present with clicking/popping/clunk/locking/catching?

A

Yes, through extension AROM

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33
Q

What positive tests indicate elbow instability?

A

+ Moving Valgus Stress Test

+ Varus and/or Valgus Stress Test

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34
Q

MCL Sprain common MOI?

A
  • attenuation of valgus/ER force

- tennis/overhead throwing/FOOSH

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35
Q

What is the symptom of MCL sprain?

A

medial elbow pain

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36
Q

How will a patient with a MCL sprain present during a physical examination?

A
  • tenderness MCL, local swelling
    • valgus stress testing (painful/excessive motion with testing)
    • Moving Valgus Stress Test
  • Painful/limited elbow ROM
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37
Q

LCL Sprain common MOI?

A

-axial compression, ER, valgus force on elbow

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38
Q

What is the symptom of LCL sprain?

A

lateral elbow pain

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39
Q

How will a patient with a LCL sprain present during a physical examination?

A
  • painful/limited elbow AROM/PROM
  • local swelling
  • tenderness LCL
    • Varus stress testing (painful/excessive motion with testing)
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40
Q

OLECRANON BURSITIS

A

OLECRANON BURSITIS

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41
Q

Olecranon bursitis is swelling/inflammation to the _________ bursa.

42
Q

What are things that can cause olecranon bursitis?

A
  • prolonged w/b through UEs

- trauma/fall onto elbow

43
Q

What is the symptom of olecranon bursitis?

A

painful posterior elbow

44
Q

How will a patient with olecranon bursitis present during physical examination?

A
  • observable focal swelling

- pain with AROM elbow, passive flexion painful

45
Q

With olecranon bursitis, we should MONITOR FOR SIGNS OF ___________.

A

INFECTION (septic bursitis)

46
Q

TENDONOSES OF THE ELBOW AND FOREARM

A

TENDONOSES OF THE ELBOW AND FOREARM

47
Q

Distal Biceps Tendinopathy is likely a result of elbow hyper __________ or repetitive _______ with stressful pronation/supination.

A
  • extension

- flexion

48
Q

What is the symptom for Distal Biceps Tendinopathy?

A

pain anterior to distal upper arm

49
Q

How will a patient with Distal Biceps Tendinopathy present during a physical examination?

A
  • tenderness to palpation
  • AROM/PROM pain at end range shoulder/elbow extension
  • Resistive testing painful flexion and supination
50
Q

A Distal Biceps Tendon Rupture can be a progression from _________ and is most likely in ______ in the ____ decade.

A
  • tendinosis
  • males
  • 5th
51
Q

What are some common MOI for Distal Biceps Tendon Ruptures?

A
  • significant extension moment with elbow flexed 90 degrees

- strong biceps contraction

52
Q

How will a patient with Distal Biceps Tendon Rupture present during a physical examination?

A
  • Weakness/pain with active/resisted elbow flexion or forearm supination
  • Ecchymosis distal biceps insertion
  • Palpable defect/tenderness
    • Biceps Squeeze Test
53
Q

Triceps Tendinopathy involves repetitive elbow ___________.

54
Q

What is the symptom for Triceps Tendinopathy?

A

posterior elbow pain

55
Q

How will a patient with Triceps Tendinopathy present during a physical examination?

A
  • AROM/PROM painful flexion at end range
  • Resistive testing painful extension
  • Tender locally
56
Q
  • A Triceps Rupture is a possible progression from tendinopathy but is _____.
  • What is a common MOI for a Triceps Tendon Rupture?
A
  • rare

- sudden strong triceps contraction with elbow flexion motion (FOOSH)

57
Q

Lateral Epicondylopathy is a tendinopathy of what? Most common origin where?

A
  • common wrist extensor tendon

- most common ECRB, ECRL, ECU, EDC origin

58
Q

Difference between -itis, -opathy, -algia?

A
  • itis = inflammation (acute)
  • osis = chronic
  • algia = pain at
59
Q

-Lateral Epicondylopathy is __x more likely than medial epicondylopathy. Its prevalence is __-__% and is most common at __-__ y/o.

A
  • 7x
  • 1-3%
  • 35-50 years
60
Q

What are symptoms of Lateral Epicondylopathy?

A
  • lateral elbow pain

- aggravation with gripping

61
Q

What are some common MOI of Lateral Epicondylopathy?

A

repetitive grasping/throwing

62
Q

How will a patient with Lateral Epicondylopathy present during a physical examination?

A
  • tenderness bulk of extensor muscle bellies, common extensor tendon
  • painful tensile loading of extensor units (wrist flexion,elbow extension)
  • painful resistive testing (wrist/finger extension (esp 3rd digit)) and radial deviation
    • Cozen’s Test
    • Resisted Tennis Elbow Test
    • Passive Tennis Elbow Test
63
Q

Medial Epicondylopathy is a tendinopathy of what?

What is it also called?

A
  • common flexor tendon

- Golfer’s elbow

64
Q

What is a common MOI of Medial Epicondylopathy?

A

-microtrauma (f/b infiltration of fibrotic tissues)

65
Q

How will a patient with Medial Epicondylopathy present during a physical examination?

A
  • tenderness at common wrist flexor tendon, FCR, pronator teres, PL, FCU, FDS
  • painful A/PROM wrist extension/supination
  • painful resistive testing with wrist flexion/pronation
66
Q

UE NERVE ENTRAPMENTS

A

UE NERVE ENTRAPMENTS

67
Q

Cubital Tunnel Syndrome is an entrapment of the ________ nerve as it runs between what?

A
  • ulnar nerve

- between the medial epicondyle and the olecranon, cubital retinaculum or between the two heads of FCU

68
Q

What will patients commonly report with Cubital Tunnel Syndrome?

A
  • swelling
  • arthritic changes
  • trauma
  • job requiring prolonged elbow flexion
  • elbow varus/valgus abnormality
  • overhead athletes
69
Q

What muscles may be weakened with Cubital Tunnel Syndrome?

A

FCU, ulnar half of FDP, adductor pollicis hypothenar muscles, interossei, 3rd and 4th lumbricals

70
Q

How will sensation present with Cubital Tunnel Syndrome?

A

pain/parasthesia in medial elbow and forearm into medial hand/digits

71
Q

What tests may be positive if a patient has Cubital Tunnel Syndrome?

A
    • Tinel’s sign
    • Pressure provocation test
    • Elbow flexion test
72
Q

Patients with Cubital Tunnel Syndrome may present with a ___-_____ posture.

A

claw-hand (MP joints hyperextended and the IP joints flexed)

73
Q

Guyon’s Canal entrapment is an entrapment of the ______ nerve as it runs between what?

A
  • ulnar

- between pisiform and hook of hamate

74
Q

What will patients commonly report with Guyon’s Canal Entrapment?

A
  • ulnar artery aneurysm or thrombosis
  • carpal ganglia
  • hamate fracture
  • blunt trauma
  • pneumatic jack hammer use
  • use of crutches
75
Q

What muscles may be weakened with Guyon’s Canal Entrapment?

A

hypothenar muscles, adductor pollicis, interossei, medial 2 lumbricals

76
Q

How will sensation present with Guyon’s Canal Entrapment?

A

Sensory chagnes to only the 5th and medial 1/2 of the 4th digit

77
Q

Pronator Teres Syndrome is an entrapment of the ________ nerve where?

A
  • median

- lacertus fibrosus, pronator teres, or FDS

78
Q

What is the symptom for Pronator Teres Syndrome?

A

pain in proximal anterior forearm

79
Q

Pronator Teres Syndrome is __x more likely in ______, and more common in the ___ decade.

A
  • 4x more likely in women

- 5th decade

80
Q

What muscles may be weakened with Pronator Teres Syndrome?

A

abductor pollicis brevis, opponens pollicis, flexor pollicis brevis/longus, FDP of 2nd and 3rd digits, pronator quadratus, FCR

81
Q

How will sensation present in Pronator Teres Syndrome?

A

lateral 3.5 digits and palm

82
Q

How can we reproduce symptoms of Pronator Teres Syndrome?

A
  • pronation with forearm neutral and gradual ext of elbow (PT)
  • elbow flexion at 120-130 degrees elbow flexion and max supination
  • PIPJ of 2nd digit (FDS)
  • direct commpression at pronator teres
83
Q

Anterior Interosseous Nerve Syndrome is a compression of the deep head of the pronator teres, FDS, accessory head of the FPL, palmaris profundus origin, accessory lacertus fibrosus. It will only present with ______ impairments, not _______ impairments.

A
  • motor

- sensory

84
Q

What is the symptom of Anterior Interosseous Nerve Syndrome?

A

pain in proximal forearm

85
Q

What muscles may be weakened with Anterior Interosseous Nerve Syndrome?

A

flexor pollicis longus, FDP of 2nd and 3rd digits, and pronator quadratus

86
Q

What is the OK sign of Anterior Interosseous Nerve Syndrome?

A

When making an OK sign, we will see a hyperextension of the DIPJ 2nd finger and use of lateral portion of the 1st IPJ with a pinch grip

87
Q

Carpal Tunnel Syndrome is a compression of the _______ nerve and with this we will see provocation with wrist movements and symptoms increase at ________.

A
  • median

- night

88
Q

In Carpal Tunnel Syndrome, _________ hands improves hand paresthesia/anesthesia.

A

shaking (TayTay sign)

89
Q

What muscles may be weakened with Carpal Tunnel Syndrome?

A

abductor pollicis brevis, opponens pollicis, flexor pollicis brevis, lumbricals (lateral 2)
-LOAF muscles

90
Q

How will sensation present in Carpal Tunnel Syndrome?

A

lateral 3.5 digits

91
Q

What tests may be positive when looking at Carpal Tunnel Syndrome?

A
    • Tinel’s at the carpal tunnel
    • Phalens Test
    • Median Nerve Compression Test
92
Q

What are some hand deformities that can be seen?

A
  • Ape Hand Deformity
  • Bishop’s Hand Deformity
  • Claw Hand Deformity
  • Saturday Night Palsy
93
Q
  • What is ape hand deformity?

- What do they have the inability to perform?

A
  • Paralysis of the thenar muscles secondary to median nerve injury causes the EPL to drift the thumb medially and posteriorly.
  • Opposition
94
Q

What is Bishop’s Hand Deformity?

A

Ulnar Nerve Injury (vs. Median Nerve*)

  • If we see when trying to open the hand, extensors are lacking and ulnar nerve is involved.
  • If seen when trying to close the hand, flexors are lacking and median nerve involved.
95
Q

What is a Claw Hand Deformity?

A
  • Ulnar and median nerve or inferior roots of brachial plexus injured.
  • Intrinsic weakness
  • Long extensors hyperextend the MCPJs, long flexors flex the PIPJ and DIPJ
  • Curvature of palm lost
96
Q

What is Saturday Night Palsy?

A
  • Wrist drop

- Radial nerve compression in radial groove.

97
Q

Erb’s Palsy is commonly a birthing injury involving the superior portions of the _________ _________. This involves an area of convergence of C5 and C6 and we see loss of shoulder ERs and abductors, elbow flexors, and hand extensors. With this we see a sensory loss where?

A
  • brachial plexus

- lateral forearm

98
Q

What is a classic sign of Erb’s Palsy?

A

Waiter’s Tip Deformity

  • shoulder IR and adducted
  • elbow extended
  • wrist flexed
99
Q

Klumpke’s Palsy is associated with hyperabduction of the shoulder and involves the inferior portions of the ________ _______. This involves an area of convergence of C8 and T1 and we see loss of intrinsic hand musculature and ulnar flexors of the wrist/hand. With theis we see a sensory loss where?

A
  • brachial plexus

- medial forearm and hand

100
Q

What is a sign of Klumpke’s Palsy?

A

Claw Hand Deformity

S3- Musculoskeletal (27 decks)

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