Elbow Forearm Surgeries - Dr. Davies Flashcards
Patient Management Model - APTA (8 items)
- Examination
- Evaluation
- Diagnosis
- Prognosis
- Interventions
- (Re-evaluation)
- Outcomes
- Long term outcomes, i.e. 2 years)
Exam Techniques are predicated on (4)
- Clusters of s/s
- Critical pathways
- Clinical Practice Guidelines
- Clinical Decision making
Lateral epicondylitis is
Acute inflammation of the tendon with inflammatory cells
lateral epicondylitis is
(I think maybe it was supposed to say epicondylosis)
non-inflammatory necrotic tissue
Angiofibroblastic hyperplasia
scar tissue
Lateral epicondylalgia
pain at the lateral epicondyle
slang for lateral epicondylitis/osus
Tennis elbow
Slang for Medial epicondylitis/osus (2 names)
Golfer’s Elbow
Little Leaguer’s Elbow
What is the most common pathology we will see in the elbow?
Lateral Epicondylitis
What is the success rate for PT with Lateral epicondylitis?
90-95% success
Rehab for lateral epicondylitis (3 bullets)
- PT
- Eccentric Exercises (for angiogenesis, collagen synthesis, realignment)
- Counterforce braces
What is the most common thing surgeons do for the elbow?
Scopes
Why must we understand anatomy for radiographs?
because imaging studies are all predicated on anatomy
if you see something that looks like an opening in a child’s x-ray, what could it be and what should we do?
It could be many things, including an avulsion fracture or just the epiphysial line.
Look in a book that shows when each growth plate closes (we don’t have to know on hand)
OCD
Osteocondritis Dissicans
what is Osteocondritis Dissicans
I think Dr. Davies said sort of like a bone bruise.
From AAOS:
Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen.
The most common joints affected by osteochondritis dissecans are the knee, ankle and elbow, although it can also occur in other joints. The condition typically affects just one joint, however, some children can develop OCD in several joints.
In many cases of OCD in children, the affected bone and cartilage heal on their own, especially if a child is still growing. In grown children and young adults, OCD can have more severe effects. The OCD lesions have a greater chance of separating from the surrounding bone and cartilage, and can even detach and float around inside the joint. In these cases, surgery may be necessary.
http://orthoinfo.aaos.org/topic.cfm?topic=A00610
What are the top three most common elbow surgeries from most common to least common?
- Scopes
- Surgical Debridement: 5-10%
- UCL
what is the percentage of elbow surgeries that is surgical debreidment?
Surgical Debridement: 5-10%
why can a minor cut be a problem?
infection
- itis
acute inflammation
chronic
(don’t understand this card second time around)
- osus
chronic degenrated tissue
- algia
painful
Which muscles does lateral epicondylitis/osus/algia often involve and which is almost always the culprit?
ECRB (main culprit - almost always involved)
ECRL (usually involved)
ECRB = extensor carpi radialis brevis
ECRL = extensor carpi radialis longus
mechanism of injury: epicondylitis/osis /algia
over and over leads to itis
microtearing
osus
Rehab for lateral epicondylitis/osis/algia
Eccentric exercisis (angiogenesis, collagen synthesis, realignment)
counterforce braces
What is a counterforce brace?
It is a band around a body part close to a joint that changes the “attachment” and changes the pull of the muscle direction.
It distributes force over a larger area
What besides PT, Eccentric exercises, & Counterforce bracing can PTs do for lateral epicondyle pathology?
stretching (hand flex & extension)
TERT if pt has fibrotic tissue-necrotic tissue and needs to be stretched
When should PT do TERT on epicondyle pathology?
TERT if pt has fibrotic tissue-necrotic tissue and needs to be stretched
What does TERT stand for?
Total End Range Time
Modalities for Lateral Epicondylitis/osus /algia
Graston
A-stim
From internet: Astym® (A-stim) treatment sets the standard for soft tissue therapy. It regenerates healthy soft tissues (muscles, tendons, etc.), and removes unwanted scar tissue that may be causing pain or movement restrictions. Astym® treatment has helped countless patients by restoring movement, getting rid of pain, and giving back their lives. Here are some of their stories. http://astym.com/Main
What does Graston do and not do?
does not realign collagen. It loosens it. The active resistive exercises is what realigns
What is the Tyler Twist good for?
lateral epicondylitis
What is the Tyler Twist
From Theraband Website
TheraBand FlexBar® Tyler Twist for Tennis Elbow
This eccentric exercise for the wrist extensors was shown to be effective for tennis elbow pain
Instructions:
A. Grasp FlexBar® exerciser in front of you with the injured side and extend your wrist.
B. Grasp the upper end of the bar with your other hand facing away from you
C. Twist the bar with the top hand as you stabilize with the bottom hand
D. Hold both wrists steady as you extend both elbows in front of you. The wrist on your injured side should be extended and the other wrist flexed.
E. Slowly release the bar with your injured side while maintaining tension with the uninjured side.
Repeat 10-15 times up to 3 times a day. Begin with the red FlexBar and progress to the next color when you can easily perform 3 sets of 15. Use ice or Biofreeze for any soreness.
Reference: http://www.thera-bandacademy.com/tba-exercise/FlexBar-Tyler-Twist-for-Tennis-Elbow
What do you do if PT fails in lateral epicondylitis?
corticosteroid injection.
Dry needling may also help to stimulate healing
What do you do if PT and injections don’t work on lateral epicondylitis
Debride the area (remove Angiofibroblastic hyperplasia)
Angiofibroblastic hyperplasia = scar tissue
What two ways can a lateral epicondyle debridement be performed?
Open
Endoscopic
Endoscopy
same as arthroscopy with a scope, but not inside the joint like arthroscopy is
Who often suffers from medial epicondilitis/osus/algia?
Kids playing overhead sports
When is there lots of traction forces on the medial epicondyle?
during overhead throwing
what are the forces doing at the medial and lateral epicondyles during overhead throwing?
medial: distractive forces
lateral: compression forces