Elbow ddX Flashcards
Carry Angle
Normal men 5-10
Women 10-15
Valgus greater than 15
Varus less than 5 (gun stock deformity)
Normal ROM/ End Feels
Flexion 140-150 tissue
Extension -10-15 bone
Supination/pronation 90 tissue
ROM for ADLs
30-130 flexion 50 for supination and pronation
Lateral epicondylitis tennis elbow
ECRB
Tender above condyle
Caused by fatigue and micro trauma
Pain- full wrist flexion with ulnar deviation, full pronation and elbow extension
Resisted wrist extension with elbow extended
Ddx
C5, radial nerve trap, radial head and annular lig sprain
Acute treatment
Ice, pain, inflammation, compression Rest or splint ROM Iontrophoresis/ phonophoresis Laser Injection
Chronic
Education and activity adjustments Ultrasound/ phonophoresis Friction massage Stretching/ROM Strengthening/eccentric exercise Brace,taping Ergonomic/biomechanics analysis and intervention
Medial Epicondylitis golfers elbow
Wrist flexion and pronation
Pronator teres and flexor capris radialis
Ulnar nerve compression in ulnar groove
Precursor to medial tension overload syndrome
Medial instability little league elbow
Excessive valgus Overhead throwing common mechanism Medial elbow pain Tenderness distal to medial epicondyle Bracing Avulsion fx
Medial tension overload syndrome
Tendinosis, instability, (go lateral)
Valgus stress
Ulnar nerve involvement
Treatment medial instability
Surgery
Inflammation, pain
Strengthening
Protect injured tissue via taping bracing
Osteochondrosis
Panner’s
Intrarticular dysfxn/limitation
Young male 13-14 without locking and elbow pain
Osteonecrosis in subchondral bone ends causing erosion through articulated cartilage
Fragment of capitulum
Like leg valve perthes of hip
LCL
Ulnar portion runs obliquely Attach to annular lig With medial instability Stress radial and ulnar collateral lig Posterior displacement during supination Radial lig primary restrain to varus force MOI- elbow dislocation, varus elbow stress, iatrogenic (fx) Lose carrying angle
Lateral ligament injury
Congenital Chronic attenuation from postural Extreme WB on UE Develop posterolaterL rotary instability Steroid injection can cause this Ulna supinate away from trouchlea Mainly with compression and supination Normal exam Apprehension is positive test(push-up arms supinate)
Lat lig rehab
No evidence of particular program Good motor control strong muscles help Avoid Abduction with IR Brace 4-6 weeks NonWB Inhibit painful motion Surgery primary repair
Posterior elbow dislocation
Fx or unstable before 60 flexio. - surgical stabilization
Reduction and immobilization 90 with post splint for 4 days
Lack extension - wait 6 weeks
FOOSH
PT for post dislocation
Soft tissue involve ROM Strength Function Wait 8 was before return to light activity Most common
Radial head dislocation nurse maids elbow
FOOSH, MVA, direct blow, pull on arm Posterior most common Divergent-radius separate from Ulna Neuro vascular complications, alignment stability Work pronation supination Distract elbow in extension
Myositis ossificans
Result of fx, dislocation, direct blow (SCI and stroke) Ectopic bone growth Palpable Brachialis common site Increase ant elbow pain, hard mass ant Avoid active flexion No heat! No resistance exercise Develop in cast over 3-6 wk Spont. Repair Resistive motion make worse Blood pooling
Nerve entrapment
Rule out cervical/ brachial plexus
PIN
Motor and sensory -radial
AIN
Motor, deep median
Ulnar
Damaged with supracondylar and epicondyle fx
Behind medial epicondyle (trauma and direct injury
Friction syndrome in ulnar grove or inter muscular septum
Repetitive movement
Ulnar cont
Involved with medial instability
Adductor Pollicis (froment sign)
Wartenburgs weak 5th finger add
Sensory changes later hand little finger
Treat ulnar
Rest, ice, padding
Correct mech dysfxn
Reroute nerve
Median nerve
Injured posterior dislocation Callus formation distal humerus Struthers lower third humerus(hand and wrist) Presents as neurpraxia Diagnosed with EMG, NCV
Anterior interosseous
Branch median
Between 2 heads of pronator teres, fx or callus
Ganglia- scar tissue build up
Pure motor no pain
Flexor pollicis longus, FDP, pronator quadratus
Surgical release
Radial and PIN
Mid shaft humeral fx spiral groove Direct trauma to brachioradialis, ECR Motor nerve Enters supinator (frohse) ECRB and fibrous edge supinator Radial tunnel syndrome
PIN
Mimic lateral lat epicondylitis No std treat Pain PROM Weak with resisted wrist and finger ext Tender over radial Slight sensation with PIN Muscle atrophy Motor weakness
Bursitis
Trauma Inflammatory disease-gout Rep microtrauma Infection/cellulitis Warm to palpate Inject padding Olecranon most common Trauma, surgical remove fluid
Triceps injury
Sudden snapping of elbow toward extension
Pain resisted ext
Post impingement
Synovial tissue/capsule pinched between olecranon fossa
