Elbow Complaints Flashcards
Elbow Stability
Extension limited by:
1) Fit of olecranon into olecranon fossa (humerus)
2) Anterior capsule
3) ____________
Flexion limited by:
1) Soft tissue approximation
2) Posterior capsule
3) ____________
- –Pronation limited by crossing of radius and ulna
- –Supination restricted by pronator muscle group
Valgus forces resisted by:
1) Anterior oblique part of MCL
A) Lax between 10 and 60 degrees of elbow flexion
(high incidence of medial sided injuries)
B) Tight beyond 90 degrees of flexion
Varus forces resisted by: 1) Weak LCL 2) Anconeus muscle 3) Extensor wad Carrying angle: male = \_\_\_-\_\_\_\_; female = \_\_\_-\_\_\_\_\_ “\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_” - cubitus varus
Biceps tendon
Triceps
5-10º
10-15º
Gunstock deformity
Location of Symptoms————Anterior
Traumatic injury?
1) Anterior capsule sprain
2) Distal biceps strain
3) Fracture and/or ____________
Non-traumatic/overuse?
1) Capsular sprain
2) Biceps __________
3) Pronator teres strain
dislocation
tendinitis
Location of Symptoms————————–Posterior
Traumatic?
1) ____________ fracture
2) Bursitis
3) Triceps strain
Non-traumatic?
1) _________ bursitis
2) Triceps tendinitis
3) Osteoarthritis/DJD
Olecranon
Olecranon
Location of Symptoms—————————Medial
Traumatic?
1) __________ ___________ ligament sprain
2) Ulnar nerve traction
3) Epicondyle avulsion
4) Flexor/pronator strain
Non-traumatic?
1) Minor ulnar collateral ligament sprain
2) Chronic ulnar nerve irritation
3) Medial ____________
Ulnar collateral
epicondylitis
Location of Symptoms——————-Lateral
Traumatic?
1) Radial head fracture
2) ___________ __________ ligament sprain
3) Osteochondritis dessicans (affecting capitellum)
Non-traumatic?
—Lateral ____________
Radial collateral
epicondylitis
Lateral Epicondylitis (Tennis Elbow)
1–Lateral elbow pain (usually with history of repetitive activity using wrist ________, radial deviation and supination)
2–Muscular origin (ECRB, ECRL, Supinator, Anconeus)
3–Painful resisted wrist extension (Cozen’s)
4–Painful passive wrist and finger flexion (Mill’s)
5–Chair test (extension of arm and pronation)
6–Calcification in radiographs (seen 25% of time)
7–Modify activities
extension
Nursemaid’s Elbow
1–Lateral elbow pain children (most common age of presentation: ___-____ y.o.)
2–Usually after swinging by their arms or sudden jerking by the arm (not considered obvious trauma)
3–Distraction or rotational force on the radial head → annular ligament entrapment
4–Altered position of _____ ______ (may be palpable)
5–Reduced with elbow flexion and rotation
2-4
radial head
Medial Epicondylitis (Golfer’s Elbow)
1–Medial elbow pain (flexor insertion), usually with history of repetitive activity using wrist _____ deviation, flexion and pronation (hammering, using screwdriver, golf, throwing, etc.)
2–May complain of ______ weakness
3–Muscular origin – tendinopathy of wrist flexor and pronator insertions
4–Painful resisted wrist flexion and/or _________
5–Painful passive wrist and finger ___________
6–Modify activities
ulnar
grip
pronation
extension
Little League Elbow
- -Medial OR lateral ELBOW pain in adolescent baseball pitcher
- -Repetitive VALGUS with pitching – ________ of medial elbow and ____________ of lateral
- -Micro-trauma of medial anterior oblique ligament and accelerated growth and fragmentation of medial epicondylar epiphysis
- -May have laxity with VALGUS stress, use x-ray to rule out epiphyseal involvement
- -Most radiographs show no signs but some may see widening of medial epicondylar apophysis
stretch
compression
Osteochondrosis- Panner’s Disease
—___________ elbow pain and stiffness secondary to osteochondrosis of the capitellum caused by avascular necrosis (throwing, gymnastics, etc.)
—Increased in young MALES
(affects dominant arm in most cases)
—Clicking or locking
—Palpate for crepitus on _________/________
—Rest and ergonomic modification
—Stretch and strengthen
Lateral
supination/pronation
Olecranon Bursitis
–Swelling just distal to point of posterior elbow
–Fall or hit to area of bursa, repeated stress
–Swelling/irritation of bursa
–Infection > tenderness & warmth
–DDx from tophi in _______and kidney failure
–Tx with removal of initiating stimuli, aspiration and potentially excision if no improvement
–Aspiration and antibiotics necessary
(if etiologically related with __________)
gout
infection
Fracture
1--Distal humerus fracture --1/3 of all elbow fractures in ADULTS --Resembles \_\_\_\_\_\_\_\_\_\_\_\_ 2--Condylar fracture 3--Epicondylar fracture 4--Supracondylar fracture ---Always considered in children with history of hyperextension after \_\_\_\_\_\_\_\_\_\_ or direct blow to antecubital fossa ---Account for 2/3 of elbow fx in CHILDREN (Transverse or oblique above condyles) 5---Intercondylar fracture ---T or Y-shaped between condyles -High energy mechanism -Check neurovascular status -Managed by open reduction with internal fixation
dislocations
F.O.O.S.H,
Fracture (cont.)
1—Olecranon fracture
Direct blow
Forceful __________contraction
May be isolated or occur with dislocation
6-8 weeks to heal
2—Coronoid process fracture
Usually associated with dislocation, avulsed by brachialis or impaction into trochlear fossa
Cast with early AROM (within 3 weeks)
3—-Radial head fracture
FOOSH
Pain with passive ___________&____________
Isolated posterior fat pad sign consistent with trauma is suggestive of occult fracture
4—Radial neck fracture
triceps
supination & pronation
Dislocation
1—_________(most common)
—Usually from a FOOSH
—If fractured, then may be associated
(attempts at relocation may cause neurovascular damage)
2—Anterior—Occurs with ___________ or leverage of trochlea over coronoid
- -Direct blow
- -MCL rupture, possible radial head/capitellar fracture
3—Important exam requirements
- -Rule out associated neurovascular injury
- –Rule out _________
- -Intra-articular fractures of the elbow are often occult (Boo)
Posterior
hyperextension
fracture
Locking & Crepitus
1–If young patient → Osteochondritis dessicans
2–If older patient → _____________/DJD
3–If occurs with supination and/or pronation → check the radiocapitellar joint
4–If occurs with extension → Consider osteophyte
5–If “popping” with __________:
1) Radial head (if lateral)
2) Ulnar nerve irritation (if medial)
Osteoarthritis
extension:
