Elbow Complex Flashcards
Describe the 3 joints and ligaments involved (Ulnohumeral, radiohumeral and Radioulnar (proximal))
- Ulnouhmeral
- Articulation between the coronoid process and trochlea of the humerus
- Ulnar collateral ligament: provides medial support
- Radial Collateral ligament that provides lateral support - Radiohumeral: Radial head and capitulum
Ulnar collateral ligament: provides medial support
- Radial Collateral ligament that provides lateral support - Proximal Radioulnar jnt: Annular ligament
Describe Carry Angle and what is the norm?
Normal carry angle is with slight Valgus 5-10degrees in males
10-15 in females
> 15degrees of valgus is Excessive Cubitus Valgus
Cubitus varus -5degrees
>-5degrees is Gun stock deformity
Describe Ligament sprain Grades (1-3)
G1: Minimal swelling and pain - NO ligament laxity
G2: Moderate swellling, ECCHYMOSIS (discoloration from bleeding underneath), and pain. Increased Ligament laxity, but wit firm end feel
G3: Significant swelling, Ecchymosis, and pain> Gross Laxity. no present end feel
Describe the Ulnar (Medial) collateral ligament
- fan shaped bundle of fibers which differentiate into anterior, posterior and transverse (oblique) portions
- RESTRAINS VALGUS
Whats is the Etiology of UCL tear and S+S
MOI: Excessive Valgus stress (acute - sudden tear FOOSH with slightly flexed elbbow)
Chronic - repeated excess stress - Baseball
S+S
- pain
- localized tenderness
- joint effusion
- Instability in valgus stress (G2 or G3)
- Limited ROM (due to swelling or pain guard)
- May have heard audible pop
PT Intervention for UCL ligament tear
- Activity modification (things that stress the ligament need to be avoided)
- correcting faulty technique - if pitcher is not getting enough rotation through shoulder and stresses UCL
- Decrease swelling and pain
- Bracing (medial strapping of the elbow) - provides external constraint
-Strengthening (focus on forearm flexors and pronators) - Restore ROM
What is the Surgical management for UCL tear
Grade 3 : Ligament reconstruction
- Tommy John Surgery
- Hamstring graft - attach were UCL was
- Immobilize pt in 90 degrees of flexion (elbow will get stiff - work on ROM)
What are the 5 different types of elbow dislocation
- Posterior (most common) (FOOSH with elbow bent)
- Anterior (High energy trauma)
- Lateral (Humerus shifts medially and radius and ulna shift laterally)
- Medial (Radius and ulna sire medial to humerus)
- Divergent (ulna and radius apart)
Describe Posterior dislocation
- Dislocation of the olecranon (ulna) posteriorly
- Often involves disruption of the UCL and RCL
- often invovles fracture of the coronoid process and radial head
- can have major concern such as imapirment of vascular supply to the forearm
What is Nursemaids elbow?
Subluxtion of the radial head
- common in young children 1-4yrs
MOI: longitudinal traction with the wrist in pronation - Arm pulled up
Often - care giver can yank the arm up to prevent child from going towards danger or when walking down stairs if stairs too tall and child holding parents hand when goign down will add traction
S+S of Nursemaid elbow
- child refuses to move their arm and holds it close to their body
- by the side in slight flexion
What is the intervention
Reduction of the subluxed radial head
* Hyper-pronation (preferred and more tolerated) or supination/flexion maneuver
* Compressive manipulation on radius with arm in supination
Describe olecranon Bursitis
- inflammation of the olecranon bursa
Etioloogy - Trauma
- Infection
- Pressure (leaning excessivley on elbow)
S+S
- swelling
- rednessWh
What is the intervention for Olecranon Bursitis
- Activity modification - Do not put pressure on that elbow
Ice
Compression
Medical Management
- NSAID
- Corticosteroid injection
- Aspiration (drain excess fluid)
- Antibiotic
- Bursectomy - surgical removal if they repeatedly get it
Describe Lateral Epicondylosis
- Degenerative changes to the wrist extensors tendons inserting into the lateral epicondyle of the humerus (common extensor origin)
- main mm involved ECRB
- Tennis elbow
>35yr old
What is the MOI for Lateral Epicondylosis
- repetitive use
- poor technqiue
- Heavy Racket
- Small Grip
- Heavy Ball
What are the S+S of Tennis Elbow (LE)
- Aching Pain
- radiating from lateral epicondyle to proximal forearm extensor mm mass
- insidious onset - TOP near LE (1-2cm below were tendon is)
- Pain on resisted wrist ext and/or gripping
- pain in stretching the wrist extensors
5.Decreased wrist extension and grip strength
What are the special tests for LE (lateral epicondyalgia)
1.Cozens (restricted wrist extension)
2. Maudsleys (esisted D3 extension)
3. Mills (passive wrist flexion)
What are the differential diagnosis for LE
- Cervical radiculopathy C5-C6 (c5-C7) mimic tennis elbow (differentiate by dermatome, myotome, reflexes, compression, distraction, ULTT)
- Radial N entrapment
- Musculocutaneous nerve tunnel syndrome
*supraspinatus referral
*Radial head fracture - Radiohumeral synovitis
What is the Intervention for LE
PT management
- activity modification
- counterforce brace - increases SA to transmiit force
- stretching
- strengthening * eccentric
- MObs
- Cross-friction Massage
- Pain modalities (pulse U/s, Ice, compression)
Describe medial Epicondylosis
- Degenerative changes to the wrist flexor tendons into the medial epicondyle
- commonly incolves PRONATOR TERES and Flexor carpi radialus tendon
>35years
What is the Etiology ME
Repetitive use of wrist flexors
- Load >capacity to heal for tendon = degenerative
Special Tests for Medial Epicondylosis
Medial Epicondylitis Test __> Reverse Mills (passive wrist extension)
Resisted wrist flexion (KAASH’s test)
Resisted pronation (pronator teres commonly invovled)
Intervention Same as LE
What are the 3 Median N injuries (C6-C8,T1)
- Humerus supracondylar Process (HSP) syndrome = Site of entrapment = Under the ligament of Struthers (ligament above the supracondylar process - which the median nerve travels under)
- Pronator syndrome = Site pf entrapment = Between two heads of the pronator teres mm
- Anterior interossues Syndrome = site of entrapment = between two heads of the pronator teres mm
- may occur with forearm #
- Pinch deformity - inability to pinch bw D1 and D2 (motor N innervates flexor pollicis longus, lateral half of flexor digitorum profundus + pronator quadratus)
