Elbow Imaging and Surgeries

Question 1

What is the 1st image of choice for an elbow

Answer 1

Radiographs

Question 2

What are the sample standard elbow imaging views (listed)

Answer 2

AP
Lateral
Oblique

Question 3

What do you see in an AP View of the elbow

Answer 3

• HR and HU joint spaces
• Superimposition of olecranon behind the trochlea
• carrying angle

Question 4

What do you see in a Lateral View of the elbow

Answer 4

• olecranon and coranoid process
• Radial heads
• Tear drop shape (superimposed medial and lateral epicondyles)
• Sail sign if occult fx

Question 5

What is the sail sign

Answer 5

anterior fat pad sign represents an intra-articular fracture

Question 6

What do you see in an Oblique Internal Rotation View of the elbow

Answer 6

• best view of coranoid process
• olecranon is in fossa
• view the space between the trochlea and notch

Question 7

What do you see in an Oblique External Rotation View of the elbow

Answer 7

• radial head, neck, and tuberosity
• lateral epicondyle
• HR and HU joint spaces

Question 8

In which X-ray view is the forearm
a. supinated
b. pronated

Answer 8

a. oblique external rotation
b. oblique internal rotation

Question 9

What do you see in an AP Forearm radiograph

Answer 9

entire radius, ulna & wrist w/normal bowing and contour of the shafts shown

Question 10

What do you see in a lateral forearm radiograph

Answer 10

• superimposition of radius and ulna

Question 11

What is a CT scan beneficial for

Answer 11

• viewing a complex fracture to help with surgical planning

Question 12

What is an MRI good for

Answer 12

Viewing inflammation –> bright white is not good

Question 13

Supracondylar fx

Answer 13

• above the condyles
• 2nd most common in children

Question 14

Transcondylar fx

Answer 14

• across the condyles
• more common in the elderly

Question 15

Intercondylar fx

Answer 15

• splitting the condyles in a Y or T shape

Question 16

Condylar fx

Answer 16

• medial or lateral
• uncommon in adults, but can be seen in children

Question 17

Articular fx

Answer 17

• trochlea or capitulum but rare in all age groups

Question 18

Epicondylar fx

Answer 18

• uncommon in adults but can be from a direct blow
• typically as an avulsion fx in children

Question 19

What is Cubical Varus?

Answer 19

• a gunstock deformity best seen with the elbow extended
• correct w/ wedge osteotomy

Question 20

What are surgical options for a simple radial head fx

Answer 20

• ORIF
• fragment excision
• radial head replacement

Question 21

What are surgical options for a comminuted Fx

Answer 21

• Radial head resection
• radial head replacement

Question 22

What is a fx of the proximal third of the olecranon

Answer 22

Type I olecranon fx

Question 23

What is a fx of the middle third of the olecranon

Answer 23

Type II olecranon fx

Question 24

What is a fx of the distal third of the olecranon

Answer 24

Type III fx

Question 25

What is the most common type of olecranon fx

Answer 25

Type II

Question 26

What is done in a distal biceps tendon repair

Answer 26

Re-attach biceps tendon ASAP after an injury

Question 27

Protocol Post-Op distal biceps tendon repair

Answer 27

- 2 weeks: immobilized at 90 flexion - Gradual towards full extension 6-8 weeks - AROM at 6-8 weeks - 12 weeks: strengthening

Question 28

When would you do an ulnar nerve transposition surgery

Answer 28

When the nerve subluxes and is very copmressed

Question 29

Post-Op Protocol ulnar nerve transposition

Answer 29

- brief immobilization 1-2 weeks - full ROM 4 weeks - no heavy lifting/repetitive activities for 6 weeks

Question 30

Indications for UCL reconstruction sx

Answer 30

- Failure via non-operative treatment - significant dysfunction and persistent pain - desire to perform at a higher level - understanding of rehab program

Question 31

T or F: There is only one type of UCL reconstruction sx

Answer 31

False, there are multiple methods

Question 32

Post-Op Protocol for UCL Reconstruction

Answer 32

*VARIES - extension is more important than flexion - full flexion at 8 weeks

Question 33

How do you manage dislocations post relocation

Answer 33

- Brief immobilization w/progressive ROM to tolerance as early as 1-2 days post reduction - No restrictions on ROM - Strengthening at 6 weeks

Question 34

T or F: Total Elbow Arthroplasties are very uncommon

Answer 34

True

Question 35

What is the goal of a total elbow arthroplasty

Answer 35

Relieve pain and maintain functional ROM

Question 36

What is the expected outcome of a total elbow arthroplasty

Answer 36

- not full ROM - no heavy lifting - no throwing/impact activities