Elbow B Flashcards
Elbow:
Pain with activities suggests __________
Pain after activities suggests _________
With: Tendinopathy
After: Instability
What non-MSK conditions can refer pain to the elbow
Acute MI
Pancoast Syndrome
Esophageal Motor Disorders
Pt has random acute swelling at elbow with no MOI?
Septic Arthritis??
What are the 3 parts of the OSPRO-YF
Negative mood
Fear Avoidance
Negative Affect/Coping
What are the 2 questions on the PHQ-2
Over the past 2 weeks how often have you had little interest in doing things?
Over the past 2 weeks, how often have you felt depressed or hopeless
The elbow joint is inherently strong, but _____________
leaves little room for compensation
What kind of elbow fx is most common in kids
Supra-condylar fx
from fall on hyperext elbow or flexed elbow
Elbow dislocations are most commonly…
Posterior or posteriorlateral
due to FOOSH w/ axial force
What is nurse-maids elbow?
Where radial head comes out of annular ligament d/t distraction force
How will a UCL sprain typically present?
Acute pain w/ pop and sharp pain at medial elbow
OR
progressive pain w/ throwing
UCL sprains typically happen due to what phase of throwing
acceleration phase
next most common is deceleration phase
What are the 6 phases of throwing
Wind up
Early Cocking
Late cocking
Acceleration
Deceleration
Follow Through
What is this MRI showing
evidence of a complete UCL tear
What is the most common type of recurrent instability at the elbow
Postero-lateral rotary instability
A combo of axial compression + shoulder ER and valgus at elbow will cause what?
LCL Sprain
T or F: conservative management of LCL sprain/PLR instability often not effective for elbow
T
Pt w/ history of Lateral elbow pain, mechanical clicking
LCL sprain
Aggressive debridement of lateral elbow structures during tennis elbow surgery can cause what?
PLR instability/LCL sprain
Tendinopathy represents what?
Tissue response to fatigue
is a degenerative disorder
What is the most common cause of lateral elbow pain between the ages of 35-50
Lateral elbow tendinopathy
What muscles are involved in Lateral elbow tendinopathy
ECRB or EDC
Pt w/ lateral elbow pain
Point tenderness 1cm distal to lateral epicondyle
Pain w/ Passive wrist flexion, gripping, and resisted wrist ext and finger ext
Lateral elbow tendinopathy
__________ occurs in 50% of athletes competing in overhead sports
lateral elbow tendinopathy
What conditions can present similar to tennis elbow
Radial/PIN nerve entrapment
Instability/stress at radio-capitellar joint
Pt w/ dull aching at medial elbow
weak grip
ulnar nerve paresthesia
Medial elbow tendinopathy
Forceful work or overuse
Valgus stress of pronator teres, FCR, and FCU
Medial elbow tendinopathy
Which kind of bicep tendon rupture needs surgery immediately?
Distal
if they have a proximal bicep tendon rupture they might opt not to get surgery since there is still another head of the muscle
What can cause cubital tunnel syndrome?
A valgus traction
longstanding valgus deformity
Sustained flexion postures (cyclists)
What nerve passes through the cubital tunnel
Ulnar nerve
(note: 2nd most common nerve entrapment)
What is unique about Radial tunnel syndrome?
No sensory involvement
How will radial tunnel syndrome present (what muscles are weak)
what nerve is compressed
Compression of deep branch of radial N
Deep extensor muscles of forearm weak (extensor indicis, extensor pollicis longus)
What is pronator teres syndrome?
What nerve is compressed?
compression of MEDIAN nerve b/t heads of pronator teres muscle
How do you diagnose pronator teres syndrome
resisted pronation
A pt w/ anterior interosseus nerve syndrome cannot do what?
Make an OK sign (median nerve)
(weak grip)
The anterior interosseus nerve supplies what muscles
Flexor pollicis longus (OK Sign)
Pronator quad
Flexor Digitorum profundus of 2 and 3 (OK sign)
Pt reports difficulty buttoning shirts, forming fist, gripping
Anterior interosseus nerve syndrome
T or F: anterior interosseus nerve syndrome will have sensory involvement
F
TTP over olcecranon process
Pain w/ forced elbow extension
increased valgus laxity
Valgus extension overload syndrome
Common in gymnasts and baseball players
usually has a bone bruise
What is panners disease
Osteochrondrosis of humeral capitulum
Usually occurs 7-10 years old (peak at 9)
Repetitive valgus stress causing compression of radio-capitellar joint (limited blood supply)
T or F: Kids will not have panner disease, only adults
F, ONLY KIDS will have panner syndrome
What are the symptoms of panner disease
Fairly sudden onset of lateral elbow pain
dull aching pain, worsened by motion
absence of mechanical symptoms
What is the prognosis of panner disease
condition is self limiting
probability of remodeling of joint is high
long term disability is rare
What part of the body is affected by Osteochronditis Dissecans
Humeral capitulum
What is osteochonditis dissecans
subchondral head of bone begins to separate from humerus d/t repetitive valgus stress causing compression
or w/ repeat ext and forceful pronation
Osteochondritis dissecans commonly affects who
throwers/gymnasts b/t 12-17
What is this XRAY showing
Cresent shaped region on humeral capitulum -> osteochondritis dissecans
T or F: Osteochondritis dissecans will get better on its own
F, needs PT
Gradual onset of lateral elbow pain
Dull aching, worsened by motion
Pt experiences locking/catching
Mild/Moderate limitation of ext
Osteochondritis Dissecans
Pt tender at radio-capitellar jt
Joint effusion
crepitis
gradual onset of lateral elbow pain
locking/catching
Osteochondritis dissecans
What is little league elbow
Basket term covering a wide spectrum of pathologies
all related to growth plate stresses
Pt fell on tip of elbow
swelling
Pt missing last bit of elbow flexion
Olecranon bursitis
Pt w/ swelling at elbow, missing last bit of elbow flexion, redness, recent abrasion
Cellulitis
Pt was recently sick, has pain at elbow joint, swelling
Potential septic arthritis
Cyclists who hold sustained postures are at risk of
Cubital tunnel syndrome
What Is the elbow flexion test
For ulnar nerve problems
Hold wrist extension and elbow flexion for 3-5 minutes
Positive if ulnar Parasthesia
If you suspect radial tunnel syndrome, you should test _______ muscles
Extensor Indicis and Extensor Pollicis Longus
Radial tunnel syndrome happens where
Between the heads of the supinator muscle (arcade of Frohse)
what this?
Pronator teres syndrome
(median nerve)
What muscles will be effected by AIN syndrome?
Supplies FPL, Pronator Quadratus, and FDP of digits 2 and 3
(OK sign)
What can tenderness here mean?
Radial Tunnel syndrome (at supinator muscle)
remember: no sensory involvement!
