Elbow, Forearm, Hand Flashcards
What is functional ROM in the elbow?
30-130*
50 pronation
50 supination
Normal is 0-145
What part of the UCL of the elbow is most important for valgus stress?
anterior bundle
Distal Biceps Rupture
tenderness to palpation, ecchymosis
may not feel a defect
hook test is reliable, MRI confirmation
loss of 40% supination strength and 30% flexion
Distal Biceps Rupture Risk Factors and Incidence
rare, dominant elbow, men in their 40s
steroids, smoking, hypovascularity, intrinsic degeneration, mechanical impingement in the space available for the biceps tendon
Treating distal biceps rupture
non- op in low-demand patient; will lose sup, flex, grip
surgical treatment for young health patients who dont want to lose function
1 vs 2 incision technique
Tennis Elbow
overuse syndrome of muscular inflammation
possible tears, degen of common extensor tendon
gradual onset, dull aching pain, worse with activity, radiates to forearm, flex/ext reproduces pain, normal xray
Tennis elbow vs Golfer elbow
T- lateral epicondyle
G- medial epicondyle
Treatment of Tennis Elbow
rest, activity mod, PT, NSAIDs, corticosteroid injection, PRP
T elbow strap, long arm cast, self-limiting
surgery for recalcitrant cases (release of conjoint tendon)
MCL/UCL of elbow
overhead athletes, valgus stress
microtraumas from repetitive valgus stress
late cocking and early acceptance of throwing
valgus load increases with poor throwing mechanics
Treatment of MCL/UCL of elbow
Non-Op: 6 weeks rest, strengthening/change in mechanics, progressive throwing program
Operative: Tommy John
Valgus Extension Overload
Pain at deceleration phase of throwing
pitching mechanics
Examination shows loss of extension, osteophytes of the posteromedial
olecranon
Treatment is rest or surgery if nonresponsive
Osteochondritis Dissecans
separation of articular cartilage and subchondral bone of the capitellum
After age 10, kids have better outcome than adult
risks: repetitive overhead motion, gymnasts, throwers
Types 1- intact, stable 2- collapse 3- loose body
1 no surg, panners no surg
Olecranon bursitis
acute traumatic blow
tender, painful swelling over olecranon
acutetx: aspiration with compression
chronic/recurrent tx: excision of bursa
Dislocation of elbow
fall on outstretched hand, obvious deformity, posterior more often, must diff from supracondylar fracture
emergent reduction, temp stiffness common, some residual restriction happens
Fracture of head/neck of radius
fall on open hand extended elbow
pain on rotation or flexion, tenderness, local swelling
Lesser fractures sling and splint with early motion
Displaced = ORIF
Peds = lesser is <30* angulation, otherwise ORIF
Fracture of Olecranon
fall on tip of elbow
Non-displaced- immobilize
Displaced- ORIF required; tension band wiring, allows early ROM exercise
Carpal Tunnel
median nerve, wrist, most common UE neuropathy,
diabetes, pregnancy, repetitive motion, obesity
tingling in radial 3.5 digits
worse at night, drop things, cant open jars, thenar atrophy
tinels, phalens, med n compression test, 2 pt discrimination, semmes-weinstein, thumb opposition
EMG-NCV test
activity mod, splint, steroid, oral med
surgical ligament release for >3 mo
Dupuytren’s Contracture
1 or more Nodular thickening an contraction of palmar fascia (RING*),
N Euro genetic disposition, Men >50, epileptics, DM, Pulm, alcohol, smoking, vibrational repetitive trauma
difficulty grasping things, gloves, putting hand in pocket
splints meh, percutaneous aponeurotomy, collagenase injection, surgery to excise cords, release joint, skin closure
Trigger Finger
painful locking of digit due to thickened flexor tendon, 3-4 digit in adult, thumb in peds, idiopathic or RA/DM
pain, catching, painful nodule
rest, NSAIDs, injection
Surgical release of A1 pulley
DeQuervain’s Tenosynovitis
Swelling or stenosis of the tendon sheath surrounding the APL and EPB
Locking and pain within the radialaspect of the wrist
middle aged women and repetitive use of thumb
tender to palpation, finkelsteins
Thumb Spica, NSAIDs
corticosteroid injection
Surgical release
Flexor tendon injury
traumatic or RA
Jersey Finger, Ring
Test both PIP and DIP
Treatment is surgical repair within one week of injury
Extensor Tendon Injury
mallet finger, inability to fully straighten
tx: continuous splinting of DIP 6 weeks and PM 2 weeks more
consider surgery for non-compliant patients
•Galeazzi fracture
radial fracture with dislocation of the distal radioulnar joint
Monteggia fracture
ulnar fracture with dislocation of the proximal radiocapitellar joint
Distal Radius Fractures
Most common orthopaedic injury • Bimodal distribution • Predictor of subsequent fractures • Fall on outstretched arm • Treatment • Closed reduction and splinting, then casting • ORIF if more than 5 degrees dorsal angulation
Fractures of the Scaphoid
• Fall on outstretched hand. • High incidence AVN and nonunion. • Tenderness and swelling in “anatomic snuffbox”. • Initial x-rays often normal. • Whenever suspected - short-arm cast with thumb spica. • May take 3 to 6 months to heal. • Surgical treatment often preferred.
Boxer’s Fracture
• Direct impact to the metacarpal head • Volar angluation • 10-15 degrees angulation acceptable without reduction • All others reduce • Heals with loss of knuckle • Don’t accept malrotation • Up to 70 degrees acceptable in 5 th MC • Otherwise surgery
Fractures of the Phalanges
• Dorsal angulation due to intrinsics. • Stable - closed reduction and splinting. • Unstable - closed reduction with percutaneous pinning or ORIF. • Absolutely no angulation or malrotation acceptable.
Paronychia
• Infection of the nail fold • Adults: S. aureus • Children: mixed orophalangeal flora • Diabetics: mixed infection • Acute infection: warm soaks, oral antibiotics (Augmentin or clindamycin) • If abscess, perform incision and drainage with partial nail plate removal, antibiotics
Felon
• Infection and abscess of the fingertip pulp space • May occur from direct trauma or spread from paronychia • Untreated may lead to osteomyelitis of distal phalanx • Treatment: I&D of abscess and IV antibiotics
Pyogenic Flexor Tenosynovitis
• Infection of the synovial sheath around the flexor tendon of the hand • S. aureus and MRSA are most common • May develop into a “horseshoe abscess” • Present with pain and swelling • Kanavel Signs: • Tenderness at sheath • Flexed posture • Pain with passive extension • Fusiform swelling of digit
Herpetic Whitlow
• Viral infection of the finger caused by HSV-1 • Usually self-limiting, resolves within 7-10 days • Small vesicular rash that coalesces into a crust • Treatment is observation and/or acyclovir
Human Bite
• Direct inoculation from tooth in “fight bite” • S. viridans and S. aureus most common • Eikonella corrodens in up to 29% • May be associated with extensor tendon laceration • Treatment is I&D with IV antibiotics
Dog and Cat Bites
• Most infections are delayed presentation
(>7 days)
Dog bites
• Pasteurella (50% of infections)
Cat bites
• Pasteurella (75% of infections)
• Pasteurella multocida and Pasteurella septica
Treatment is non-operative • Copious irrigation of wound • Antibiotics: Augmentin is effective against Pasteurella • Rabies prophylaxis • Immobilization
Surgical treatment if abscess is present
PIP/DIP Dislocation
difficult to reduce, axial traction
