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MSK > Elbow/Forearm Common Presentations > Flashcards

Elbow/Forearm Common Presentations Flashcards

1
Q

What is heterotopic ossification?

A
  • Mature lamellar bone integration in non-osseous tissues

- Asymptomatic -> painful -> progression to ankylosis (loss of motion at joint)

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2
Q

Common MOI of Radial head fracture and dislocations?

A

FOOSH

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3
Q

Because radial head fractures can be isolated to radial head, proximal forearm, or combined complex, what should we check for?

A
  • Check for concomitant injury at the wrist & upper arm

- Check for concomitant neurovascular compromise

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4
Q

T/F Patient commonly presents to PT following a reduction of their radial head fractures/dislocations

A

True, might experience - Closed reduction & immobilization vs. ORIF/ replacement/ resection

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5
Q

Symptomology of radial head fracture/dislocation:

A
  1. Local pain
  2. Comminution: More than 2 segments
    - Check pulse/sensation
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6
Q

Physical examination of radial head fracture/dislocation:

A
  1. Local swelling & tenderness

2. Limited/ painful ROM (active & passive), painful/ weak resistance testing (if administered)

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7
Q

With a radial head fracture/dislocation monitor for what type of complications?

A
  • neurovascular compromise
  • healing failure
  • incision infection
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8
Q

T/F Early mobilization for radial head fracture/dislocation okay in tolerable ranges

A

True

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9
Q

What type of interventions for radial head fracture/dislocation? How progress?

A

Isometrics (initiate around 3 weeks) -> resistive training (5-6 weeks)

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10
Q

What is a monteggia fracture?

A

Dislocation of the proximal radius (anterior, posterior, or lateral) & ulna fracture

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11
Q

Common MOI of monteggia fracture?

A

Arm positioned in hyperextension or hyperpronation with direct trauma or FOOSH

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12
Q

What concomitant neurovascular structures should be checked with a monteggia fracture?

A
  1. posterior branch of radial nerve
  2. anterior interosseous nerve
  3. ulnar nerve
    - Light touch sensation, pin prick sensation, and eventually motor
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13
Q

T/F Patient with monteggia fracture commonly present following ORIF (open reduction internal fixation).

A

True

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14
Q

Symptomology of monteggia fracture:

A

Local Pain

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15
Q

Physical examination of monteggia fracture:

A
  1. Local swelling & tenderness
  2. Limited/ painful ROM (active & passive)
  3. Painful/ weak resistance testing (if administered)
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16
Q

Typical intervention management of monteggia fracture:

A
  • Arom initiated ~ 4 weeks post-op

- extension > 90 degrees usually held until ~4-6 weeks post-op

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17
Q

Common MOI of olecranon fractures:

A

trauma involving triceps contraction with flexion moment on elbow (fall on elbow, FOOSH) = avulsion

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18
Q

Symptomology of olecranon fracture:

A
  • Local elbow pain

- Pain provoked with UE use during daily activities

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19
Q

Physical examination of olecranon fracture:

A
  1. Local swelling, tenderness, palpable gap at olecranon

2. Absent/ significant limitations with elbow extension (AROM, resistance)

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20
Q

Non-displaced management of olecranon fracture:

A
  • Immobilized
  • Maintain triceps function
  • Early (tolerable) ROM (pronation/ supination after 2-3 days, flexion/ extension at ~ 2 weeks with limitations on flexion x ~2 months)
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21
Q

ORIF/excision & repair management of olecranon fracture:

A
  • Pending surgeon restrictions, though early ROM
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22
Q

What is nursemaid’s elbow?

A

Dislocation of proximal radial head (slips through annular ligament)

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23
Q

Incidence of nursemaid’s elbow in children? Sex?

A

Incidence: 3% children < 8 y/o

Boys > Girls

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24
Q

Common MOI of nursemaid’s elbow:

A
  • Traumatic injury

- traction on the pronated/ extended forearm

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25
Q

Symptomology of nursemaid’s elbow:

A

Pain in forearm, wrist, and/or elbow

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26
Q

Physical examination of nursemaid’s elbow:

A

Painful, flaccid arm in pronated position

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27
Q

What is panner’s disease?

A
  • Growth plate injury
  • Osteochondritis
  • osteonecrosis (bone dies) of epiphysis
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28
Q

MOI of panner’s disease:

A
  • direct trauma

- vascular changes

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29
Q

Common age of panner’s disease? Sex?

A
  • 5-16

- Males (90%)

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30
Q

Symptomology of panner’s disease:

A

Lateral elbow pain

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31
Q

Physical examination of panner’s disease:

A
  1. Local swelling & tenderness
  2. Limited/ painful ROM (active & passive)
  3. possibly hard end-feel with fragmentation
  4. Painful/ weak resistance testing (if administered)
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32
Q

Management of panner’s disease:

A
  1. Activity modification, possibly splinting

2. ROM/ resistive progression based on pt tolerance

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33
Q

What is Osteochondritis Dessecans Capetellum?

A
  • Microtrauma over time (Pathomechanics poorly understood)
  • Focal arterial injury f/b necrosis
  • Possibly compression of humeroradial joint
  • Commonly insidious onset
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34
Q

Symptomatology of Osteochondritis Dessecans Capetellum:

A
  • diffuse lateral elbow pain/ “stiffness”

- Locking/ clicking/ popping/ catching

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35
Q

Physical examination of Osteochondritis Dessecans Capetellum:

A
  • Tenderness humeroradial joint
  • Diminished Extension ROM
  • Painful pronation/ supination
  • Pain with resistance testing
  • Imaging: flattening of capitellum, loose bodies
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36
Q

MOI of elbow instability:

A
  • acute trauma (FOOSH with/out rotary force)

- microtrauma (overhead throwers/ repetitive throwing)

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37
Q

Important history when diagnosing elbow instability:

A
  • Prior elbow dislocation

- Repetitive throwing with stress during mid-flexion of elbow

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38
Q

Symptomology of elbow instability:

A
  • Clicking/ popping/ clunk/ locking/ catching in extension AROM (supinated forearm)
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39
Q

Physical examination of elbow instability:

A

+ Moving Valgus Stress Test

+ Varus and/or Valgus Stress Test

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40
Q

Common MOI of MCL sprain:

A

Attenuation of valgus/ ER force (Tennis/ overhead throwing/ FOOSH)

41
Q

Physical examination of MCL sprain:

A
  • C/o medial elbow pain
  • Tenderness MCL, local swelling
    • Valgus stress testing: Painful/ excessive motion with testing
    • Moving Valgus Stress Test
  • Painful / limited elbow ROM
42
Q

Common MOI of LCL sprain:

A
  • Axial compression, ER, valgus force on elbow
43
Q

Physical examination of MCL sprain:

A
  • C/o lateral elbow pain
  • Painful/ limited elbow AROM/ PROM
  • Local swelling
  • Tenderness LCL
    • Varus stress testing: Painful/ excessive motion with testing
44
Q

Hx of what can lead to olecranon bursitis?

A

Hx prolonged w/b through UEs or trauma/ fall onto elbow

45
Q

Physical examination of olecranon bursitis:

A
  • painful posterior elbow
  • Observable focal swelling
  • Pain with AROM elbow, passive flexion painful
46
Q

T/F With patient with olecranon bursitis, important to monitor for signs of infection (septic bursitis).

A

True

47
Q

Hx of what can be the cause of distal biceps tendinopathy?

A

Hx repetitive elbow hyper extension or repetitive flexion with stressful pronation/ supination

48
Q

Physical examination of distal biceps tendinopathy:

A
  • c/o pain anterior distal upper arm
  • Tenderness to palpation
  • A/PROM: pain end-range shoulder/ elbow extension
    PROM – extension (flexion not so much)
    AROM – flexion puts stress on biceps tendon
  • Resistive Testing: painful flexion and supination
49
Q

Distal biceps tendinosis can progress to what?

A

Distal Biceps Tendon Rupture at the Musculotendinous junction or radial tuberosity

50
Q

Incidence of Distal Biceps Tendon Rupture:
Sex?
Age?

A
  • Most likely male

- Increased risk 5th decade

51
Q

MOI of Distal Biceps Tendon Rupture:

A
  • acute onset
  • significant extension moment with elbow flexed 90 deg
  • strong biceps contraction
52
Q

Physical examination of Distal Biceps Tendon Rupture:

A
  1. Weakness/ pain with active/ resisted elbow flexion &/or forearm supination
    - Pain with PROM & AROM of elbow ext
  2. Ecchymosis (bruising) distal biceps insertion
  3. Palpable defect/ tenderness
    • Biceps Squeeze Test
53
Q

Hx of what can lead to triceps tendinopathy?

A

Hx repetitive elbow extension (microtrauma)

54
Q

Physical examination of triceps tendinopathy:

A
  1. Posterior elbow pain
  2. A/PROM: painful flexion at end-range
    - PROM extension probably not so painful
  3. Resistive testing: painful extension
  4. Tender locally
55
Q

T/F Triceps rupture is rare, but can be caused by sudden strong triceps contraction with elbow flexion motion (FOOSH)

A

True

56
Q

What is lateral epicondylopathy?

A
  • Tendinopathy of the common wrist extensor tendon
  • Most common ECRB, ECRL, ECU, EDC origin
    AKA:
    1. “Tennis Elbow”
    2. Lateral Epicondyalgia (pain)
    3. Lateral Epicondylitis (acute)
57
Q

T/F Lateral epicondylopathy is 7x more likely than medial epicondylopathy.

A

True

58
Q

Most common age group for lateral epicondylopathy?

A

35-50

59
Q

Patient interview for lateral epicondylopathy:

A
  1. Lateral elbow pain
  2. MOI: Microtrauma, repetitive grasping/ throwing
  3. Aggravation with gripping/ carrying/ grasping
60
Q

Physical examination for lateral epicondylopathy:

A
  1. Tenderness bulk of extensor muscle bellies, common extensor tendon
  2. Painful tensile loading of extensor units (wrist flexion/ fist, elbow extension)
  3. Resistive testing painful wrist/ finger extension (especially 3rd digit), radial deviation
    • Cozen’s Test
    • Resisted Tennis Elbow Test
    • Passive Tennis Elbow Test
61
Q

What is medial epicondylopathy?

A
  • Tendinopathy common flexor tendon of wrist

AKA “Golfer’s Elbow”

62
Q

Patient interview for medial epicondylopathy:

A

MOI: Microtrauma (f/b infiltration of fibrotic tissues)

63
Q

Physical examination for medial epicondylopathy:

A
  1. Tenderness common wrist flexor tendon, FCR, pronator teres (radial head), PL, FCU, FDS
  2. Painful A/PROM wrist extension/ supination
  3. Resistive testing: painful wrist flexion & pronation
64
Q

What is cubital tunnel syndrome?

A

Entrapment of the ulnar nerve as it runs between:

  1. Medial epicondyle and the olecranon (capsule and medial band of the MCL)
  2. Cubital retinaculum or between the two heads of FCU
65
Q

Hx of what can lead to cubital tunnel syndrome?

A
  • swelling
  • arthritic changes
  • trauma
  • job requiring prolonged elbow flexion
  • elbow varus or valgus deformity
  • overhead throwing athletes
66
Q

Cubital tunnel syndrome can cause weakness in what muscles?

A
  1. FCU
  2. ulnar half of the FDP
  3. adductor pollicis hypothenar muscles (only thumb muscle)
  4. interossei
  5. 3rd and 4th lumbricals
67
Q

Cubital tunnel syndrome can cause pain/paresthesia in what areas?

A
  1. medial elbow and forearm

2. 5th digit and medial half of 4th digit

68
Q

Pain/paraesthesia caused by cubital tunnel syndrome will worsen with what motion at the elbow?

A

Worsens with elbow flexion (space for nerve decreases by 55%)

69
Q

Physical examination of cubital tunnel syndrome:

A
    • tinel’s sign at the elbow
    • Pressure provocation test
    • Elbow Flexion Test
      4; “claw-hand posture”: MP joints are hyperextended and the IP joints are flexed
70
Q

Hx of what can lead to ulnar nerve entrapment as it passes through guyon’s canal?

A
  1. ulnar artery aneurysm or thrombosis
  2. carpal ganglia
  3. hamate fracture
  4. blunt trauma
  5. long distance cyclist
  6. use of pneumatic jack hammers
  7. use of crutches
71
Q

Entrapment of ulnar nerve in guyon’s canal can cause weakness in what muscles?

A
  1. hypothenar muscles
  2. adductor pollicis
  3. interossei
  4. medial 2 lumbricals (more distal – won’t effect FDP, FCU)
72
Q

Entrapment of ulnar nerve in guyon’s canal can cause sensory changes to what areas?

A

5th and medial ½ of the 4th digit

73
Q

What is pronator teres syndrome? Hx of what can lead to it? Age? Sex?

A
  • Median Nerve compression at lacertus fibrosus, pronator teres or FDS
  • Pain in proximal anterior forearm
  • Hx repetitive exertion grasping work
  • 5th decade; women 4x> men
74
Q

pronator teres syndrome can cause weakness in what muscles?

A
  • abductor pollicis brevis
  • Oppens pollicis
  • flexor pollicis brevis
  • flexor pollicis longus
  • FDP of 2nd and 3rd digits
  • pronator quadratus
  • FCR
75
Q

pronator teres syndrome can cause loss of sensation in what areas?

A

lateral 3.5 digits and palm

76
Q

Symptoms of pronator teres syndrome are reproduced with resisted:

A
  • Pronation with forearm neutral and gradual ext of elbow (PT)
  • Elbow flexion at 120-130 deg elbow flex and max supination (LF)
  • PIPJ of 2nd digit (FDS)
77
Q

Physical examination of pronator teres syndrome:

A
  1. Tinel’s: Pronator Teres <50%

2. Provocation with direct compression at pronator teres

78
Q

What is ANTERIOR INTEROSSEOUS NERVE SYNDROME?

A

Compression deep head of the pronator teres, FDS, accessory head of the FPL, palmaris profundus origin, accessory lacertus fibrosus

79
Q

Common clinical presentation for ANTERIOR INTEROSSEOUS NERVE SYNDROME:

A
  • pain in proximal anterior forearm
  • Motor = Weakness/ atrophy flexor pollicis longus, FDP of 2nd and 3rd digits, and pronator quadratus
  • OK sign: Hyperextension of DIPJ 2nd finger (FDP) and use of lateral portion of the 1st IPJ with pinch grip (opponens)
  • Direct compression: negative
80
Q

ANTERIOR INTEROSSEOUS NERVE SYNDROME causes what sensation impairments?

A

NONE, motor nerve only

81
Q

Hx of what can cause Carpal Tunnel Syndrome (CTS)?

A
  • Provocation with wrist movements
  • Symptoms increase at night (side lying position with elbow flexed and wrist flexed)
  • Repeated shaking of hands improves hand paresthesia/ anesthesia
82
Q

Carpal Tunnel Syndrome (CTS) affects sensation where?

A

Lateral 3.5 digits

83
Q

Carpal Tunnel Syndrome (CTS) affects which muscles?

A
  1. abductor pollicis brevis
  2. Oppens pollicis
    3, flexor pollicis brevis
  3. lumbricals (lateral 2)
    LOAF (Lumbricles Op, Abductor pb, Fpb)
84
Q

Physical examination of Carpal Tunnel Syndrome (CTS) :

A

+ Tinel’s at the carpal tunnel
+ Phalen’s Test
+ Median Nerve Compression Test
Provocation with direct compression at carpal tunnel

85
Q

What is ape hand deformity?

A
  • Paralysis of the thenar muscles secondary to median nerve injury causes the EPL to drift the thumb medially and posteriorly
  • Inability to perform opposition
  • Recurrent branch of median nerve injury
86
Q

What is bishop’s hand deformity?

A
  • Ulnar nerve injury (opening hand - extensors lacking)

- median nerve (close hand - flexor lacking)

87
Q

What is claw hand deformity?

A
  • Ulnar and median nerve or inferior roots of brachial plexus injured
  • Intrinsic weakness
  • Long extensors hyperextend the MCPJs
  • Long Flexors flex PIPJ and DIPJ
  • Curvature of palm lost
88
Q

What is saturday night palsy?

A
  • Wrist drop

- Radial nerve compression in radial groove

89
Q

What portion of brachial plexus affected in Erb’s palsy?

A
  • Superior portions of the brachial plexus affected

- Area of convergence of C5 & C6

90
Q

Loss of what muscles in Erb’s Palsy?

A
  1. shoulder lateral rotators & abductors
  2. elbow flexors
  3. hand extensors
91
Q

Loss of sensation where in Erb’s Palsy?

A

Sensory loss lateral forearm

92
Q

T/F Erb’s Palsy commonly associated with birthing (delivery) injury.

A

True, brachial plexus stretched due to traction

93
Q

Why is Erb’s Palsy also called “waiter’s tip deformity”?

A
  • Shoulder internally rotated & adducted
  • Elbow extended
  • Wrist flexed
94
Q

What portion of brachial plexus affected in Klumpke’s Palsy?

A
  • Inferior portions of the brachial plexus affected (intrinsic muscles mostly affected)
  • Area of convergence of C8 & T1
95
Q

Loss of what muscles in Klumpke’s Palsy?

A
  • Loss of intrinsic hand musculature

- Loss of ulnar flexors of the wrist & fingers

96
Q

Loss of what senses in Klumpke’s Palsy?

A

Sensory loss medial forearm & hand

97
Q

What is another name for Klumpke’s Palsy?

A

Claw hand deformity

98
Q

T/F Klumpke’s Palsy is associated with hyperabduction of shoulder (e.g. delivery injury).

A

True

MSK (18 decks)

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