Elbow ddX

Question 1

Carry Angle

Answer 1

Normal men 5-10
Women 10-15
Valgus greater than 15
Varus less than 5 (gun stock deformity)

Question 2

Normal ROM/ End Feels

Answer 2

Flexion 140-150 tissue
Extension -10-15 bone
Supination/pronation 90 tissue

Question 3

ROM for ADLs

Answer 3

30-130 flexion 50 for supination and pronation

Question 4

Lateral epicondylitis tennis elbow

Answer 4

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

Question 5

Acute treatment

Answer 5

Ice, pain, inflammation, compression
Rest or splint 
ROM
Iontrophoresis/ phonophoresis
Laser
Injection

Question 6

Chronic

Answer 6

Education and activity adjustments
Ultrasound/ phonophoresis 
Friction massage
Stretching/ROM
Strengthening/eccentric exercise
Brace,taping
Ergonomic/biomechanics analysis and intervention

Question 7

Medial Epicondylitis golfers elbow

Answer 7

Wrist flexion and pronation
Pronator teres and flexor capris radialis
Ulnar nerve compression in ulnar groove
Precursor to medial tension overload syndrome

Question 8

Medial instability little league elbow

Answer 8

Excessive valgus 
Overhead throwing common mechanism
Medial elbow pain
Tenderness distal to medial epicondyle
Bracing 
Avulsion fx

Question 9

Medial tension overload syndrome

Answer 9

Tendinosis, instability, (go lateral)
Valgus stress
Ulnar nerve involvement

Question 10

Treatment medial instability

Answer 10

Surgery
Inflammation, pain
Strengthening
Protect injured tissue via taping bracing

Question 11

Osteochondrosis

Panner’s

Answer 11

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

Question 12

LCL

Answer 12

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

Question 13

Lateral ligament injury

Answer 13

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)

Question 14

Lat lig rehab

Answer 14

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

Question 15

Posterior elbow dislocation

Answer 15

Fx or unstable before 60 flexio. - surgical stabilization
Reduction and immobilization 90 with post splint for 4 days
Lack extension - wait 6 weeks
FOOSH

Question 16

PT for post dislocation

Answer 16

Soft tissue involve
ROM
Strength
Function 
Wait 8 was before return to light activity
Most common

Question 17

Radial head dislocation nurse maids elbow

Answer 17

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

Question 18

Myositis ossificans

Answer 18

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

Question 19

Nerve entrapment

Answer 19

Rule out cervical/ brachial plexus

Question 20

PIN

Answer 20

Motor and sensory -radial

Question 21

AIN

Answer 21

Motor, deep median

Question 22

Ulnar

Answer 22

Damaged with supracondylar and epicondyle fx
Behind medial epicondyle (trauma and direct injury
Friction syndrome in ulnar grove or inter muscular septum
Repetitive movement

Question 23

Ulnar cont

Answer 23

Involved with medial instability
Adductor Pollicis (froment sign)
Wartenburgs weak 5th finger add
Sensory changes later hand little finger

Question 24

Treat ulnar

Answer 24

Rest, ice, padding
Correct mech dysfxn
Reroute nerve

Question 25

Median nerve

Answer 25

Injured posterior dislocation
Callus formation distal humerus
Struthers lower third humerus(hand and wrist)
Presents as neurpraxia
Diagnosed with EMG, NCV

Question 26

Anterior interosseous

Answer 26

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

Question 27

Radial and PIN

Answer 27

Mid shaft humeral fx spiral groove
Direct trauma to brachioradialis, ECR
Motor nerve
Enters supinator (frohse)
ECRB and fibrous edge supinator
Radial tunnel syndrome

Question 28

PIN

Answer 28

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

Question 29

Bursitis

Answer 29

Trauma
Inflammatory disease-gout
Rep microtrauma
Infection/cellulitis
Warm to palpate
Inject padding 
Olecranon most common
Trauma, surgical remove fluid

Question 30

Triceps injury

Answer 30

Sudden snapping of elbow toward extension
Pain resisted ext
Post impingement
Synovial tissue/capsule pinched between olecranon fossa