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Patho > Elbow/Forearm Pathologies > Flashcards

Elbow/Forearm Pathologies Flashcards

1
Q

Olecranon Bursitis

A

MOI: Direct contact, landing on elbow or friction

  • Golf ball size behind elbow, flex
  • Warm to touch, Flexion is limited by post tissues

Tx: Limit swelling, NSAIDS, drained

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2
Q

Ostechondritis Dissecans

A

Humerus capitellum osteochondritis dissecans occurs when capitellum has ossified - injury to subchondral bone- AVN

  • Children ages 12-15
  • 85% males, mostly little league pitchers
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3
Q

Advanced OCD

A

Upper end of radius, particularly head of radius is also involved

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4
Q

OCD Etiology

A

Unknown

  • Possible genetic link
  • Limited blood supply to humero-radial joint may somehow get blocked
  • Overuse of adolescent elbow plays major role in OCD
  • Excessive elbow valgus jams head of radius against capitellum during cocking phase and acceleration
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5
Q

OCD Pathomechanism

A
  • Portion of bone will eventually weaken, and even crack.
  • When damaged, the tiny blood supply going to the area is somehow blocked.
  • Small area undergoes AVN without blood supply.
  • The necrotic loose body becomes freely moving, hallmark OCD.
  • Hallmark loss of ROM, often times 20° of extension.
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6
Q

OCD Clinical Presentation

A

OCD occurs after growth in the capitellum has stopped, which is usually b/n ages of 12-15.

  • 20% of kids w/ elbow OCD remember hurting their elbow
  • 80% are insidious, dont remember specific MOI
  • Cant extend elbow all the way
  • Elbow and FA will atrophy in advanced cases
  • Audible crepitus
  • Advanced cases will lead to early onset of OA as an adult.
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7
Q

OCD Diagnosis

A

Repetitive injury, loss elbow extension ROM

  • x-ray may show changes in the capitellum
  • Normal shape of the bony knob may appear irregular, may even look flattened out
  • MRI/CT
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8
Q

OCD Treatment

A 
Conservative Treatment
- Rest
- Activity
- Modalities
- Stretching
- Gentle AROM/PROM, jt mobes
Surgeons dont want to do surgery on 12-15 yo
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9
Q

Panners Disease

A
  • Also affects capitellum in children, looks OCD but not the same.
  • Affects the epiphyseal plate of the capitellum
  • Generally occurs in children 5-10
  • Involves entire capitellum and usually heals completely when bone growth is gone.
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10
Q

Static Elbow Joint Stability

A

Olecranon in the Olecranon fossa: Gives stability 0-20°
- Radio-capitellum gives stability > 120° flexion
Static Stabilizers: Cartilage, ligaments, bony shape
Dynamic stabilizers- NMC

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11
Q

MCL/UCL Complex

A

Anterior Oblique Ligament- Most important for valgus instability, strongest of unit.
- FCU, Pronator teres, FDS go over it
Posterior Oblique Ligament
Transverse Ligament

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12
Q

LCL

A

Lat epicondlye tor adial head/annular lig

  • Protects us against varus forces
  • More common to get radial collateral than ulnar collateral
  • Radial head fx could disrupt annular lig
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13
Q

Elbow Subluxation/Dislocation

A
  • Postero-lateral displacement from FOOSH is most common
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14
Q

Elbow Sprains/dislocations

A

Posterior dislocation

  • Usually from fall onto flexed elbow
  • Olecranon pops back and hits into radial nerve
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15
Q

Postero-medial dislocation

A
  • Dynasplint
  • May never get endfeel back
  • 30° limited extension can still function, need at least 120° of flexion
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16
Q

UCL Rupture and Throwing

A

Pitching MOI: Extreme Valgus

  • Late cocking phase
  • Early Acceleration phase
17
Q

Dx of UCL Rupture

A 
Valgus stress @ 30° & 70°
Moving Valgus Stress
O'Briens Milking
Ulnar nerve testing
Radiograph
MRI
18
Q

Nerves passageways

A
  1. Ulnar nerve- travels through ulnar groove “funny bone”
  2. Median nerve- Pierces the pronator teres
  3. Radial nerve- Pierces the supinator
19
Q

Neuropathy Grades 1-3

A 
Neuropraxia Gr 1
Axontomesis Gr 2
Neurotomesis Gr 3
- Covered with myelin sheath
- Schwann cells
-Nodes
20
Q

Cubital Tunnel Borders

A

Medial epicondyle, Olecranon fossa, two heads of FCU

21
Q

Cubital Fossa Borders

A

Medial- Pronator Teres
Lateral- Brachioradialis
Superior- Imaginary line b/n 2 epicondyles

22
Q

Structures within cubital Fossa (Lateral to medial)

A

Biceps tendon
Brachial artery
Median nerve
Musculocutaneous nerve

23
Q

Epicondylalgia- Medial

A

Acute/chronic condition from overuse/poor technique with activities that use pronation/supination or wrist flex/ext
- Medial epiconylalgia (little leagers elbow/golfers elbow)- comes from bad gripping mechanics

24
Q

Lateral Epicondylalgia “ Tennis Elbow”

A

Tennis backhand- ECRB/ECRLstroke/musicians
S & S
- Lat epicondyle p!, supinator aches
MILLS test, Cozens test

25
Q

Pronator Teres Irritation

A

Repetitive over-pronation could be compensation for not enough shoulder IR ROM
- Median nerve may be involved and getting pinched on

26
Q

Pronator Syndrome

A

Median Nerve Entrapment

  • Median N passes b/n 2 heads of pronator teres.
  • Overuse may lead to hypertrophy/inflammation/scaring which can cause compression
27
Q

Median Nerve Compression

A

Sensory loss= palmar surface
Motor Loss= FDS, FDP, ulnar 2 fingers
Digits 1-3.5

28
Q

Supinator Irritation

A
  • Overuse of supinator may be compensation for a shoulder that does not ER enough.
29
Q

Supinator Syndrome

A

Radial Nerve Entrapment

  • Pierces supintaor, may become compressed with overuse and hypertrophy of supinator
  • May have wrist drop
  • May look like lateral epicondylagia
30
Q

Radial Nerve compression

A

Direct trauma to radial nerve above the elbow from sudden contraction of triceps or humeral fx’s.
- Below elbow would be form supinator syndrome
Radial Nerve- Dorsal central FA, webspace, dorsum of finger 2,3, half of 4

31
Q

Cubital Tunnel Syndrome/Ulnar N Entrapment/ Ulnar Neuritis

A

Irritation/inflammation of ulnar nerve within cubital tunnel
- Repetitive valgus stresses, overyse FCU
+ Tinels
Ulnar half of ring finger, all of pinky finger

32
Q

Ulnar Nerve Contusion

A

This injury will occur due to impact over medial aspect of elbow bruising the ulnar nerve

33
Q

Median Nerve Contusion

A

Impact over the pronator teres or impact over the volar aspect of the wrist
+ tinels at wrist

34
Q

Radial Nerve contusion

A

Direct trauma t the radial nerve above the elbow from sudden contraction of triceps or from humeral fx’s

35
Q

Volkmann’s Ischemia

A
  • Complication of a humeral fx
  • Brachial artery is injured
    S & S
  • Severe pain
  • Loss of wrist extension
    -Discoloration
  • Coldness
  • MEDICAL EMERGENCY
    FA will always be stuck in pronation

Patho (8 decks)

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