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PTMMD > Elbow Fractures and Compressive Neuropathies > Flashcards

Elbow Fractures and Compressive Neuropathies Flashcards

1
Q

What are radial head fractures and dislocations typically caused by?

A

Traumatic injuries, usually from a FOOSH injury.

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2
Q

What is the mechanism of injury for radial head fractures?

A

Force of impact transmitted up the hand through the wrist and forearm to the radial head.

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3
Q

What are the potential complications of untreated radial head fractures?

A

Stiffness, deformity, posttraumatic arthritis, nerve damage, or other serious complications.

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4
Q

Where can radial head fractures and dislocations be isolated to?

A

Isolated to the radial head (and neck), lateral elbow (and proximal forearm), or part of a combined complex fracture pattern.

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5
Q

What type of trauma rarely causes radial head injury?

A

Blunt or penetrating trauma.

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6
Q

What should be assessed if there is wrist pain, grinding, or swelling?

A

The presence of damage to the distal radioulnar joint.

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7
Q

What does the presence of bleeding from small puncture wounds indicate?

A

The possibility of open injury.

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8
Q

What neurovascular symptoms should be identified in radial head fractures?

A

Numbness, tingling, or loss of sensation.

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9
Q

What does severe pain in a radial head fracture patient indicate?

A

The possibility of compartment syndrome.

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10
Q

What are common clinical presentations of patients with radial head fractures?

A

Localized swelling, tenderness, and decreased motion.

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11
Q

What should a clinician palpate during the examination of radial head fractures?

A

The elbow, especially the radial head, and the wrist for stability of the distal radioulnar joint.

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12
Q

Which nerves are at risk during elbow fractures and dislocations?

A

All three major nerves of the forearm.

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13
Q

What role does the radial head play in elbow stability?

A

It is a secondary stabilizer for valgus forces and a restraint against longitudinal forces.

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14
Q

What increases the importance of the radial head as a stabilizer?

A

A compromise of the UCL (medial collateral ligament).

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15
Q

What correlates directly with a successful outcome in radial head fractures?

A

The accuracy of anatomic reduction, restoration of mechanical stability that allows early motion, and consideration of soft tissue

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16
Q

What is a Monteggia fracture-dislocation?

A

A combination of a dislocation of the proximal end of the radius and a fracture of the ulna

It may involve a fracture of the radial head or neck instead of a dislocation.

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17
Q

What types of injuries typically lead to a Monteggia fracture-dislocation?

A

Direct blow to the forearm or FOOSH injury with the arm positioned in hyperextension or hyperpronation

FOOSH stands for ‘fall on outstretched hand.’

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18
Q

What are potential complications of a Monteggia fracture-dislocation?

A
  • Damage to the posterior branch of the radial nerve
  • Damage to the anterior interosseous nerve (AIN)
  • Damage to the ulnar nerve
  • Nonunion
  • Poor active range of motion (AROM)

These complications can lead to serious problems and poor functional outcomes.

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19
Q

What is the best treatment for a Monteggia fracture-dislocation?

A

Open reduction and internal fixation (ORIF) of the ulnar diaphyseal fracture

This surgical intervention is crucial for proper healing.

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20
Q

How long should the elbow be immobilized after surgery for a Monteggia fracture-dislocation?

A

About 4 weeks in 90-120 degrees of elbow flexion

This immobilization helps stabilize the joint during the healing process.

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21
Q

Monteggia Fracture-dislocation

When should active range of motion (AROM) exercises for elbow flexion and forearm supination be initiated postoperatively?

A

After 4 weeks post-surgery

AROM exercises are important for recovery and regaining function.

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22
Q

When can AROM into extension beyond 90 degrees begin after a Monteggia fracture-dislocation surgery?

A

4-6 weeks postoperatively

Gradually increasing range of motion is crucial for rehabilitation.

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23
Q

What is a common cause of olecranon fractures?

A

High-energy or low-energy injuries such as falls onto the elbow or FOOSH injuries

Produces passive elbow flexion combined with a sudden powerful contraction of the tricep muscle, resulting in an avulsion fracture of the olecranon.

FOOSH stands for ‘Falling On Outstretched Hand,’ which can lead to specific types of elbow injuries.

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24
Q

What classic signs indicate an avulsion fracture of the olecranon?

A
  • Loss of active elbow extension
  • Palpable gap
  • Pain and swelling at the fracture site
  • Large hematoma developing into diffuse ecchymosis

Ecchymosis refers to the discoloration of the skin resulting from bleeding underneath.

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25
Q

What is the initial focus of intervention for nondisplaced or minimally displaced olecranon fractures?

A

Restoration of articular surfaces and maintenance of triceps function while allowing early range of motion (ROM)

Early ROM is crucial for recovery in order to prevent stiffness and loss of function.

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26
Q

In what position is the elbow immobilized for olecranon fractures?
What is used to immobilize this fracture?

A

In a posterior splint or a bow immobilizer with the elbow flexed at 90 degrees

This position helps to stabilize the joint while allowing some movement.

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27
Q

When should pronation and supination begin after an olecranon fracture?

A

These are started at 2-3 days

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28
Q

When should active flexion and extension exercises begin after an olecranon fracture?

A

At 2 weeks post-injury

This timing is crucial to promote healing while preventing stiffness.

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29
Q

What types of exercises should be avoided for up to 2 months after an olecranon fracture?
What exercises should be avoided for uo to 3 monthes after an olecranon fracture?

A

2 months: Active Full-flexion exercises

3 months: Resistance exercise

Avoiding these exercises helps prevent stress on the healing bone.

30
Q

How long should protected immobilization continue after an olecranon fracture?

A

Until there is evidence of union, approximately 6 weeks

Union refers to the process of healing where the fractured bone ends grow together.

31
Q

What surgical interventions are required for other types of olecranon fractures?

A
  • Open Reduction and Internal Fixation (ORIF)
  • Excision of bone fragments
  • Repair of the extensor mechanism

ORIF is a surgical procedure to realign bones and secure them with plates and screws.

32
Q

What remains the same in rehabilitation following surgical procedures for olecranon fractures?

A

The emphasis on regaining early motion

Early motion is key to a successful recovery, regardless of the surgical extent.

33
Q

Why is the Coronoid important?

A

The coronoid serves as an important attachment site for muscles and ligaments that is essential for elbow stability

34
Q

What is the MOI for a Coronoid Fracture?

A

Commonly seen with High-energy injuries

35
Q

What are the classifications for Coronoid Fractures?

A

Type 1: Tip Avulsion; generally stable and can be treated as simple dislocations with early motion

Type 2: Involves less than 50% of the height of the coronoid. Many of these are unstable and require ORIF

Type 3: Involves more than 50% of the height of the coronoid and frequently are accompanied by an instability of the elbow. ORIF or a hinged external fixator may be requied to maintain reduction.

36
Q

What is an Essex-Lopresti fracture?

A

A fracture of the radial head with proximal radius migration and disruption of the distal radioulnar joint and interosseous membrane.

37
Q

What type of injury typically causes an Essex-Lopresti fracture?

A

FOOSH injury (Fall On Outstretched Hand).

38
Q

When is gentle AROM for forearm rotation typically initiated after surgery for an Essex-Lopresti fracture?

A

About 6 weeks after surgery.

39
Q

What type of cast is used for immobilization in an Essex-Lopresti fracture?

A

Muenster cast.

40
Q

What is ulnar nerve entrapment also known as?

A

Cubital Tunnel Syndrome

Ulnar nerve entrapment is commonly referred to as Cubital Tunnel Syndrome due to the anatomical location of the nerve.

41
Q

What is the second most common compression neuropathy in the upper limb?

A

Ulnar nerve entrapment

The most common compression neuropathy is Carpal Tunnel Syndrome (CTS).

42
Q

What factors may initiate inflammation and edema in ulnar nerve entrapment?

A

Repetitive motion, prolonged elbow flexion, medial elbow instability

These factors can inhibit the normal gliding of the ulnar nerve.

43
Q

What additional injury occurs during elbow flexion related to ulnar nerve entrapment?

A

Traction forces producing compressive force on the nerve

This can exacerbate the severity of nerve injury.

44
Q

What anatomical structure has been reported as a cause of cubital tunnel syndrome?

A

Anconeus

The anconeus muscle has been found to contribute to cubital tunnel syndrome in various anatomical studies.

45
Q

What are common clinical findings for ulnar nerve entrapment?

A
  • Activity-related pain or paresthesias in fourth and fifth digits,
  • Pain worsening at night,
  • Decreased sensation in the ulnar distribution,
  • Progressive inability to separate fingers,
  • Loss of grip power,
  • Atrophy of intrinsic muscles,
  • Clawing contracture

Each of these findings can indicate the presence of ulnar nerve entrapment.

46
Q

What are late signs of ulnar nerve entrapment?

A

Atrophy or weakness of ulnar innervated intrinsic muscles

And/or

Clawing contracture of the ring and little fingers

This indicates a more severe and chronic condition.

47
Q

What is the positive test indicating ulnar nerve entrapment that involves flexion?

A

Elbow flexion and pressure-provocative test

This test assesses for symptoms during elbow flexion.

48
Q

Fill in the blank: A positive _______ sign and Froment sign may indicate ulnar nerve entrapment.

A

Wartenberg

These signs help in the clinical diagnosis of ulnar nerve entrapment.

49
Q

What is median nerve entrapment at the elbow often misdiagnosed as?

A

Carpal Tunnel Syndrome (CTS)

Median nerve entrapment can be confused with CTS due to similar symptoms.

50
Q

Where is the most proximal site for median nerve compression?

A

Distal arm (Humerus) by the ligament of Struthers

The ligament of Struthers is a fibrous band that can compress the median nerve.

51
Q

Name one site of potential median nerve entrapment in the antecubital area.

A

Under the lacertus fibrosus

Aka the bicipital aponeurosis. A fascial band extending from the bicep tendon to the forearm fascia

52
Q

What is the second site of potential median nerve entrapment after crossing the elbow?

A

At the level of the pronator teres muscle

The pronator teres muscle can exert pressure on the median nerve.

53
Q

Identify the third potential site of median nerve entrapment.

A

Under the Flexor Digitorum Superficialis (FDS)

The FDS muscle can compress the median nerve as it travels through the forearm.

54
Q

What is the term used to describe median nerve compression at any of the 3 sites in the antecubital area?

A

Pronator Syndrome (PS)

Pronator syndrome involves median nerve compression at any of the specified sites.

55
Q

What is the typical onset of pain in Pronator Syndrome?

A

Insidious onset

Pain is usually felt on the anterior aspect of the elbow, radial side of the palm, and the palmar side of the first, second, third, and half of the fourth digits.

56
Q

What symptom is commonly associated with Pronator Syndrome?

A

Heaviness of the forearm

This symptom is often reported by patients.

57
Q

True or False: In Pronator Syndrome, there is a Tinels sign at the wrist.

A

False

Unlike Carpal Tunnel Syndrome (CTS), there is no Tinels sign at the wrist.

58
Q

What type of symptoms are not present in Pronator Syndrome?

A

Nocturnal symptoms

Patients do not typically experience symptoms at night.

59
Q

How can pain in Pronator Syndrome be reproduced?

A

By applying pressure over the pronator teres and resisting certain movements

Pain can be reproduced with pressure applied over the pronator teres 4 cm distal to the cubital crease, resisted supination, and resistance of the long finger flexors.

60
Q

What is the main diagnostic tool for confirming Pronator Syndrome?

A

Electromyography

This tool is used to confirm the diagnosis.

61
Q

What initial treatments are effective for Pronator Syndrome?

A

Activity modification, rest, NSAIDs, ice, and restoring proper flexibility and strength

These treatments help alleviate symptoms and promote recovery.

62
Q

What rehabilitation approach may benefit patients with medial elbow tendinosis related to Pronator Syndrome?

A

Gentle massage along the fibers

This may aid in breaking adhesion.

63
Q

What might be necessary in recalcitrant cases of Pronator Syndrome?

A

Surgical relief

Surgery may be needed if conservative treatments fail.

64
Q

What is the most commonly injured peripheral nerve?

A

Radial nerve

The radial nerve is particularly vulnerable due to its anatomical course.

65
Q

What is the anatomical reason for the radial nerve’s susceptibility to injury?

A

Spiral course across the back of the midshaft of the humerus and fixed position in the distal arm

This anatomical positioning makes it prone to injuries, especially with humeral fractures.

66
Q

Name the four commonly cited radial nerve entrapments.

A
  • High radial nerve palsy
  • Posterior interosseous nerve syndrome (PINS)
  • Radial tunnel syndrome (RTS)
  • Superficial radial nerve palsy

These entrapments occur at different locations along the radial nerve.

67
Q

What types of involvements are associated with high radial nerve palsy?

A

Motor and sensory involvements

This condition affects both motor function and sensory perception.

68
Q

What is primarily affected in posterior interosseous nerve syndrome (PINS)?

A

Motor function

PINS results in weakness of muscles innervated by the posterior interosseous nerve.

69
Q

What symptoms are associated with radial tunnel syndrome (RTS)?

A

Pain, cramping, and tenderness in the proximal posterior forearm without muscle weakness

RTS symptoms help differentiate it from other entrapments.

70
Q

What type of disturbances occur with superficial radial nerve palsy?

A

Sensory disturbances

This condition affects the sensory function of the superficial radial nerve.

71
Q

Fill in the blank: The radial nerve is most frequently injured in association with _______.

A

fractures of the humerus

The anatomical course of the radial nerve makes it vulnerable during such injuries.

PTMMD (33 decks)

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