Elbow and Wrist

Question 1

sprains and dislocations of elbow
1. causes
2. sign and symptoms
3. possible injured structures

Answer 1

1. axial weight bearing from FOOSH, elbow ext, valgus pos in gymnasts, wrestlers, contact and combat sports, and weight bearing
2. bruising, swelling, pain, deformity, most dislocations result in ulna dropping posteriorly, pain with active and passive ext of elbow for dislocation, pain with res elbow flexion and sup and passive elbow ext and pronation when biceps brachii strained
3. with posterior motion, medial ulnar ligament complex (most likely ant band in post translation of ulna), joint capsule, biceps and brachialis tendons, forearm flexor tendons at med epicondyle, ulnar nerve
   (loss of sensation at hypothenar side); radial ligament complex, annular ligament, bone fracture; depending on MOI

Question 2

valgus extension overload syndrome
1. clinical presentation
2. causes and sport
3. mechanics and tissue changes

Answer 2

1. chronic posteromedial elbow pain into olecranon, sensation of locking, clicking, catching, or crepitus (grating or crunching produced by motion), may have larger carrying/cubital angle (more natural valgus)
2. high valgus stress and tensiile load assoc with rapid elbow ext in overhead sport
3. medial ulnar collateral lig complex gets distended by stress and increase length decreasing ability to limit valgus
4. cartilage and bone exp pinching where olecranon meets olecranon fossa during valgus and head of radius meets capitulum exp compression during elbow ext; osteophytes are bony outgrowths occur due to rebuilding of bone after stress, chondromalacia cartilage softens and weakens, osteochondritis dissecans when soft cartilage can’t protect bone underneath, bone weakens, blood supply decreases, slow healing and cartilage and bone break off into loose pieces

Question 3

lateral epicondylalgia
1. clinical presentation
2. mechanical causes specific to tennis
3. tissues damaged

Answer 3

1. tennis elbow, chronic later elbow pain and into ECRB tendon, tightness in post forearm, assoc with racquet sports, and aggravated by grip tasks since extensors stabilize wrist during finger flexion, pain during active and res wrist ext and rad dev and passive wrist flexion
2. ECC loading through backhand tennis stroke (F exerted by ball cause flexion, ext to hit ball), poor technique when maintaining grip after ball has left racquet cause overuse of ext, different racquet handle dimension and weight changes activation of extensors
3. ECRB tendinopathy, periosteal inflammation, sensitation of radial nerve stim greater pain

Question 4

impact related wrist injury
1. acute radial side pain
2. acute ulnar pain
3. chronic ulnar pain

Answer 4

1. usually bear more weight since radius larger, can fracture radius and scaphoid (easy to fracture since it has peanut shape with narrow neck)
2. impact weight bearing on ulnar side can damage to TFCC containing fibrocartilage on end of ulna, radioulnar ligaments, ulna, and tearing of mensical homologue (fatty tissue filling space between carpals, ulna, and TFCC), pain during passive wrist ext and ulnar dev
3. damage to TFCC due to friction from constant supination and pronation in racquet and stick sports, pain during those motions

Question 5

3 fracture tests for scaphoid

Answer 5

1. palpate antomic snuffbox (post base of mtcp 1)
2. palpate scapoid tubercle on palmar side just distal to radius
3. scaphoid compression test (axial load into thumb while stabilizing wrist)

Question 6

MUCL surgically replaced with

Answer 6

palmaris longus, similar size and strength, easy to harvest and little impact when removed

Question 7

2 immobilization approaches to elbow dislocation

Answer 7

1. Early mobilization would be recommended over PoP because it speeds up return of range of motion, function and return to work, reduces operative rates, re-dislocation rates and heterotopic ossification (excess bony growth) despite increased pain during the first six weeks of rehabilitation
2. Plaster of Paris is recommended to increase ligament and capsular healing

Question 8

counterforce braces in lateral epicondylalgia

Answer 8

physiotherapy interventions compared to counterforce braces may have better effects, especially over the long term but counterforce braces may have better effects on pain in people <45 years old over the short term