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

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

- 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.

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

- 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.

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

Elbow/Forearm Pathologies Flashcards by jake Heeren

Olecranon Bursitis

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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Ostechondritis Dissecans

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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Advanced OCD

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

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OCD Etiology

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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OCD Pathomechanism

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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OCD Clinical Presentation

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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OCD Diagnosis

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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OCD Treatment

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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Panners Disease

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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Static Elbow Joint Stability

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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MCL/UCL Complex

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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LCL

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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Elbow Subluxation/Dislocation

Postero-lateral displacement from FOOSH is most common

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Elbow Sprains/dislocations

Posterior dislocation

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

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Postero-medial dislocation

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

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UCL Rupture and Throwing

Pitching MOI: Extreme Valgus

Late cocking phase
Early Acceleration phase

Dx of UCL Rupture

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

Nerves passageways

Ulnar nerve- travels through ulnar groove “funny bone”
Median nerve- Pierces the pronator teres
Radial nerve- Pierces the supinator

Neuropathy Grades 1-3

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

Cubital Tunnel Borders

Medial epicondyle, Olecranon fossa, two heads of FCU

Cubital Fossa Borders

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

Structures within cubital Fossa (Lateral to medial)

Biceps tendon
Brachial artery
Median nerve
Musculocutaneous nerve

Epicondylalgia- Medial

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

Lateral Epicondylalgia “ Tennis Elbow”

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

Pronator Teres Irritation

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

Pronator Syndrome

Median Nerve Entrapment - Median N passes b/n 2 heads of pronator teres. - Overuse may lead to hypertrophy/inflammation/scaring which can cause compression

Median Nerve Compression

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

Supinator Irritation

- Overuse of supinator may be compensation for a shoulder that does not ER enough.

Supinator Syndrome

Radial Nerve Entrapment - Pierces supintaor, may become compressed with overuse and hypertrophy of supinator - May have wrist drop - May look like lateral epicondylagia

Radial Nerve compression

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

Cubital Tunnel Syndrome/Ulnar N Entrapment/ Ulnar Neuritis

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

Ulnar Nerve Contusion

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

Median Nerve Contusion

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

Radial Nerve contusion

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

Volkmann's Ischemia

- 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