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EIM OCS Prep > Elbow and Post Op shoulder > Flashcards

Elbow and Post Op shoulder Flashcards

1
Q

Throwers elbow
Non-op early goals

A

Wrist and elbow ROM focus, particularly on regaining elbow extension

Elbow is predisposed to flexion contractures due to anterior capsule adhesions, joint capsule tightness, brachialis scarring

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2
Q

Humeroulnar Joint mobilization to improve elbow extension

A

Posterior glides

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3
Q

Non-op thrower elbow acute goals

A

Weeks 0-2

Improve ROM, reduce risk of elbow flexion contractures, reduce pain/inflammation, reduce atrophy

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4
Q

Non-op thrower elbow sub-acute goals

A

Week 2-4
Normalize motion, improve strength, power, endurance

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5
Q

Non-op thrower elbow intermediate phase

A

Week 4-6
Prep athlete for return to functional structures (swinging drills, light plyo, throwers 10)

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6
Q

Non-op thrower elbow return to activity stage

A

Week 6+
Throwing program, functional drills, ongoing strength and flexibility focus

Emphasis of eccentric elbow flexion (deceleration during throwing), concentric elbow extension (acceleration during throwing)

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7
Q

Non-op Epicondylitis treatment

A

Iontophoresis, cryotherapy, stretching, very light strengthening

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8
Q

Non-op epicondylosis treatment

A

Cross friction massage, stretching, eccentric strengthening with gradual load progression, warm modalities

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9
Q

Common secondary pathology of UCL insufficiency

A

Ulnar neuropathy

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10
Q

Valgus extension overload treatment focus

A

Eccentric elbow flexion strength to control rapid elbow extension

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11
Q

Non-op UCL injury treatment

A

Inflammation mgt with modalities
ROM in non painful arc of motion (10-100deg) with increase of 5-10deg per week- elbow flexion/extension encouraged for collagen formation and alignment
Isometrics of shoulder, elbow, wrist

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12
Q

Osteochondritis dissicans of elbow
Stage 1

A

Lateral elbow pain upon palpation or valgus stress but no evidence subchondral detachment or articular cartilage fracture

May be treated conservatively

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13
Q

Osteochondritis dissicans of elbow
Stage 2

A

Lesions show evidence of subchondral detachment or articular cartilage fracture

Warrants surgery but long term sx results seem unfavorable, suggesting prevention or early detection is best

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14
Q

Osteochondritis dissicans of elbow
Stage 3

A

Detached osteochondral fragments or loose bodies present

Warrants surgery but long term sx results seem unfavorable, suggesting prevention or early detection is best

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15
Q

Non-op osteochondritis dissicans treatment

A

Relative rest and immobilization until elbow symptoms have resolved

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16
Q

Ulnar nerve transposition treatments

A

Early immobilization with posterior splint at 90deg flexion to reduce tension on nerve from excessive extension
After week 2, Light ROM
After week 4, isotonic strengthening
Week 8 plyo and aggressive strengthening

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17
Q

Posterior olecranon osteophyte excision treatment

A

Regain elbow ROM, but elbow extension slightly more conservative sure to post op pain and synovial joint inflammation
Rehab focus is similar to valgus extension overload treatment with focus of eccentric elbow flexion and dynamic stabilization of medial elbow

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18
Q

Neurapraxia

A

Most benign form of peripheral nerve injury, usually a temporary palsy resulting from prolonged ischemia that induces conduction block

No loss of myelin or axons

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19
Q

Axonometsis

A

Peripheral nerve injury involving loss of axons and nerve fibers, sometimes due to crush injury or laceration

Wallerian Degeneration occurs, followed by Axonal Regeneration phase

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20
Q

Neurotmesis

A

Severe peripheral nerve injury involving loss of axons and connective tissue
Poor recovery potential

Wallerian Degeneration occurs, followed by Axonal Regeneration phase

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21
Q

Median nerve neuropathies

A

Pronator teres syndrome (uncommon)
Anterior interosseous syndrome (uncommon)
carpal tunnel syndrome (very common)

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22
Q

Pronator teres syndrome
Clinical features

A

Pain and tenderness over pronator teres, increased with activity
Sensory changes over thenar eminence, palmar digits 1-3, sometimes 4
Motor weakness thenar muscles, flexor policies longus, FDP i/ii, PQ, 1/2 FPB. Pronator teres may be spares

Sparing of FCR, PL, FDS

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23
Q

Pronator teres special testing

A

(+) pronator teres syndrome test
(+) tinels in forearm
(-) phalens test

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24
Q

Anterior interosseous syndrome
Clinical features

A

No sensory loss!! But aching present
Motor weakness FPL, FDP digits 1-2, pronator quadratus
Kiloh nevin sign: cannot perform dip flexion of digits 1-2 thus cannot make “OK” sign

25
Q

Kiloh nevin sign

A

Seen with anterior interosseous syndrome due to motor weakness FPL, FDP digits 1-2
Canot make “ok” sign

26
Q

Carpal tunnel syndrome
Prevalence

A

40-60 years old
Female > males

Can be associated with RA due to thickening of tendon sheath

27
Q

Carpal tunnel syndrome
Clinical features

A

Sensory deficits anterior palm digits 1-3, sometimes 4 but sparing thenar eminence. Sensory deficits dorsal and distal digits 1-3
Motor weakness of thenar muscles

28
Q

Carpal tunnel syndrome
Special testing

A

(+) tinels sign at wrist
(+) phalens and reverse phalens

Nerve conduction velocity testing is gold standard, BC phalen’s and tinel’s signs found to have higher sensitivity and specificity for tenosynovitis vs carpal tunnel

29
Q

Carpal tunnel syndrome
CPG

A

Hand shaking improves symptoms
Wrist-ratio index > 0.67 (rounder wrists)
Decreased sensation median sensory field 1 (thumb)
Age> 45
Symptom severity score > 1.9

90% post-test probability if 5/5 positive
70% post-test probability if 4/5 positive

Wrist ratio index has highest sensitivity (0.93)

30
Q

Ulnar nerve entrapment areas

A

Cubital tunnel syndrome
Guyons canal

31
Q

Tardy ulnar nerve palsy

A

Aka cubital tunnel syndrome
Second most common peripheral nerve compression injury

32
Q

Cubital tunnel syndrome
Clinical features

A

Sensory deficit of palmar AND dorsal digit 5, 1/2 digit 4
Motor weakness or atrophy of hand intrinsics (especially interossei)

33
Q

Cubital tunnel syndrome
Special testing

A

+ elbow flexion test
+ tinels @ cubital tunnel

34
Q

Differentiating factor for cubital tunnel syndrome vs guyons canal entrapment

A

Sensory deficits are dorsal and palmar for cubital tunnel syndrome
Dorsal digit 4-5 sensation spared with guyons canal entrapment

35
Q

Froment’s sign

A

Indicative of ulnar neuropathy
Inability to use adductor pollicis to grab piece of paper thus you see IP flexion

36
Q

Wartenburg’s sign

A

Indicative of ulnar neuropathy
Pinky drifts apart from all other fingers, remains abducted due to weakness of palmar intrinsic

37
Q

Upper arm radial nerve lesion
Clinical features

A

Sensory loss dorsum of hand, digits 1-2
Complete wrist drop
Weakness distal to tricep (if lesion is proximal to spiral groove, tricep also affected)

38
Q

Posterior interosseous syndrome

A

Radial nerve entrapment. May occur at arcade of frohse, between 2 heads of the supinator

39
Q

Posterior interosseous syndrome
Clinical features

A

No sensory deficits
Motor weakness of extensor digitorum longus, ECU (supinator, ECRB, ECRL intact so radial deviation can still occur),

40
Q

Wartenburg’s syndrome

A

Compression of superficial branch of radial nerve

41
Q

Ape hand

A

Indicative of (distal) median nerve lesion
Atrophy thenar eminence where thumb is permanently rotated and adducted

42
Q

Bishop’s sign

A

Indicative of ulnar nerve lesion
Patient is asked to make a fist. Digit 4-5 able to flex but digits 2-3 unable to flex at MTP or IP joints

Ulnar paradox: sign is worse if lesion is lower

43
Q

Axillary nerve injury

A

Can result from shoulder dislocation or fracture of the surgical neck of humorus

Clinical features:
Loss of sensation at axillary patch
Motor weakness teres minor and deltoid

44
Q

Erb’s palsy

A

C5 and c6 brachial plexus involvement involving upper trunk of because plexus
(More common than total brachial plexus involvement and klumpke involvement)

45
Q

Klumpke’s palsy

A

Brachial plexus disorder involving c7-t1 nerve roots
Affect hand function

46
Q

Erb’s palsy clinical features

A

Shoulder is extended, adducted, internally rotated
Shoulder may be posteriorly subluxed
Elbow may be involved

47
Q

Klumpke’s palsy

A

May have associated Horner’s syndrome
Intrinsic hand weakness, weakness of long finger flexors and extensors
Sensory deficit medial arm, forearm, hand

48
Q

Peripheral nerve injury treatments

A

Education!!
Pain control
Maintain rom/strength with consideration to antagonist relationships. Do not overstretch denervated muscle. LOW LOAD strengthening to avoid axonal fatigue
Sometimes bracing or splinting
E-stim questionable

49
Q

Ulnar collateral ligament tear

A

Medial elbow injury associated with repetitive overhead throwing. Repetitive valgus stress can lead to ligamentous injury
Paresthesias or associated cubital tunnel syndrome possible

50
Q

Posterior interosseous syndrome

A

Peripheral nerve entrapment of posterior interosseous nerve, branch of radial nerve. No sensory deficits but will note weakness of extensor muscles of thumb, wrist, and digits

51
Q

Wartenburg’s syndrome or handcuff palsy

A

Peripheral nerve entrapment of superficial radial nerve.
No motor deficits.
Sensory deficits of dorsal hand and wrist but fingertips spared

52
Q

Moving valgus stress test

A

More sensitive than standard valgus stress test for small, mildly symptomatic years of UCL
Good for athletes with small partial tears

53
Q

Fat pad sign

A

Radiographic finding indicative of intra-articular fracture

54
Q

RTC repair
Factors for good prognosis

A

Younger age
Traumatic tear
Smaller tear
Arthroscopic repair

55
Q

Labral repair
Factors for good prognosis or better outcomes

A

Non-throwing athlete
OH athlete with traumatic tear > overuse injury

56
Q

TSA rehab considerations for prognosis

A

Better with OA than RA or trauma

57
Q

Monteggia fracture

A

Proximal ulna fracture. Often has radial head involvement.
Results from FOOSH

58
Q

Galeazzi fracture

A

Fracture of distal 1/3 radius, along with dislocation or instability of distal radioulnar joint

EIM OCS Prep (11 decks)

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