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PHTH 517 > Elbow - itis and ligaments > Flashcards

Elbow - itis and ligaments Flashcards

1
Q

Lateral Epicondylitis

What structure is affected?

A

Common extensor muscles and their tendons @ origin of lateral humeral epicondyle

  • ECR Brevis
  • ECR Longus
  • Extensor digitorum
  • Extensor carpi ulnaris
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2
Q

Lateral Epicondylitis

What movement is limited with this pathology?

A

Wrist extenion and radial deviation

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3
Q

Lateral Epicondylitis

Where is pain located during specific movements?

A

Pain on the lateral side of the elbow during wrist extension and radial deviation

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4
Q

Lateral Epicondylitis

What is the prevalence of this dx?

A

Affects between 1-3% of the population

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5
Q

Lateral Epicondylitis

What population does this dx affect?

A

mostly ages 35-50 y.o
- rarely seen in less than 20 y.o

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6
Q

Lateral Epicondylitis

What is the MOI?

A

constant grasping (w/ wrist extension)
- sports that center on this movement are all at risk

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7
Q

Lateral Epicondylitis

If not an inflammatory condition, what kind of condition can this be?

A

A degenerative condition = tendinosis

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8
Q

Lateral Epicondylitis

Grade 1 stage of repetitive microtrauma

A

possible inflammatory injury - likely to resolve

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9
Q

Lateral Epicondylitis

Grade 2 stage of repetitive microtrauma

A

has to do with pathologic alterations
like tendinosis or angiofibroblastic degeneration

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10
Q

Lateral Epicondylitis

What is grade 2 mostly associated with?

A

sports-related tendon injuries and general overuse

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11
Q

Lateral Epicondylitis

In a grade 2, what is the response within the tendon?

A

fibroblastic and vascular response compared to an immune blood-cell response

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12
Q

Lateral Epicondylitis

Grade 3 stage of microtrauma

A

pathological changes and partial tears

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13
Q

Lateral Epicondylitis

Grade 4 stage of microtrauma

A

Macroscopic tears
- associated with other changes like fibrosis, matrix calcification and hard osseous

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14
Q

Lateral Epicondylitis

What are the subjective findings?

A

C/O of diffused achiness and morning stiffness
Localized tenderness over the lateral aspect of the elbow

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15
Q

Lateral Epicondylitis

What are the objective findings?

A
  • Tenderness usually over ECRB and ECRL
  • active motions = painless
  • wrist flexion + elbow extension = possible pain
  • PROM pain = wrist flexion + pronation + elbow extension
  • Resistance pain = wrist extension + radial deviation + elbow extension
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16
Q

Lateral Epicondylitis

Type 1 - Palpation

A

lesion of the muscle of origin of the ECRL

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17
Q

Lateral Epicondylitis

Type 2 - Palpation

A

Insertion tendinopathy of the ECRB
- most common site

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18
Q

Lateral Epicondylitis

Type 3 - Palpation

A

Pain @ radial head

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19
Q

Lateral Epicondylitis

Type 4 - Palpation

A

ECRB muscle belly strain

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20
Q

Lateral Epicondylitis

Type 5 - Palpation

A

Inflammation @ origin of extensor digitorum

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21
Q

Lateral Epicondylitis

What are the confirming/special test needed for a dx?

A

Cozen test
Mill test

Radiographs to help with ruling out other dx

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22
Q

Lateral Epicondylitis

What is the overall intervention goal?

A

Initial = decreasing activities that cause pain
- be able to progress accordingly

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23
Q

Lateral Epicondylitis

What is the improvement percentage within 1 year?

A

around 80% improve within that time spams

24
Q

Medial Epicondylitis

What structures are affected?

A

Tendinopathy @ the origin of flexor/pronator muscle

  • pronator teres
  • flexor carpi radialis
  • palmaris longus
  • flexor digitorum superficialis
  • flexor carpi ulnaris
  • medial collateral ligament
25
Q

Medial Epicondylitis

What is the MOI?

A

Overuse = strain on the small origin of common tendon
- makes a high load

26
Q

Medial Epicondylitis

How common is this pathology?

A

Only 1/3 as common as lateral

27
Q

Medial Epicondylitis

What is the biomechanical movement?

A

pronation
wrist flexion
elbow flexion

28
Q

Medial Epicondylitis

What are the subjective findings?

A

C/O of pain along medial elbow

Hx of reptitive grapsping or not use to the movement

increased pain w/ active wrist flexion and forearm pronation

29
Q

Medial Epicondylitis

What are the objective findings?

A

TTP around 5 mm distal and anterior to the mid-point of medial epicondyle

Pain on resisted wrist flexion (w/ elbow straight) and pronate

Pain @ extreme PROM wrist extension w/ forearm supination w/ elbow extension and ulnar deviation

30
Q

Medial Epicondylitis

What are the confimatory/special tests needed to dx?

A

sx = resisted forearm pronation and wrist flexion
- dx based on hx of medial epicondyle pain
- on exam = local tenderness and pain w/ iso wrist flexion, pronation or both

radiograph not helpful - rule out arthritis or loose bodies

31
Q

Medial Epicondylitis

What is the success rate of conservative intervention?

A

as high as 90%

32
Q

Medial Epicondylitis

What are the conservative methods for intervention?

A

Initial rest
modify activity
local modalities

32
Q

Medial Epicondylitis

What is not a recommended intervention?

A

Immobilization because it takes away structural stresses that is needed for grow new collagen to return to activity

33
Q

Medial Epicondylitis

What is needed once the acute phase has passed?

A

Need to get ROM back
Fix imbalances with flexibility and strength

34
Q

Medial Epicondylitis

What is needed to strength program?

A

Include concentric and eccentric exercises of the flexor pronator muscles

35
Q

MCL Tear

What is the purpose of the MCL?

A

Primary struture to resist valgus stress @ the elbow

36
Q

MCL Tear

What is the MOI?

A

chronic attenuation of valgus and ER forces

seent in serves or pitches or FOOSH

37
Q

MCL Tear

What can be affected with an MCL tear?

A

Ulnar nerve irritation
sx of ulnary neuritis (2nd to ligamentous inflammation)

38
Q

MCL Tear

What are the subjective findings?

A

C/O medial elbow pain @ ligament origin
or
Insertion site if acute avulsion is there

39
Q

MCL Tear

What are the objective findings?

A

Tenderness along course of MCL, ulnar nerve and (+) Tinel signs are common
Loss of terminal elbow extension
(+) valgus stress test

40
Q

MCL Tear

What are the confirmatory/special tests?

A

Valgus stress test

AP and lateral to rule out a fracture
MRI gold standard

41
Q

MCL Tear

What interventions are needed for early signs of MCL injury?

A

Rest and modify activity
Restrict for around 2 to 4 weeks
ROM exercises
PT modalities
NSAIDs

42
Q

MCL Tear

What interventions are initiated once the acute inflammatory stage is done?

A

stretch and strengthen the flexor carpi ulnaris, pronator teres and flexor digitorum superficialis

Pain free @ mid-ROM

43
Q

MCL Tear

What structures need empahsis on isometric ex to enhance their role as secondary stabilizers?

A

Forearm flexors
ulnar deviators
pronators

Also making sure shoulder and elbow muscles will help with reinjury

44
Q

MCL Tear

What is the overall prognosis?

A

surgical repair is only needed for throwing athletes or manual labor

valgus laxity has minimal functional impairments

45
Q

Little League Elbow

What is the most common population?

A

8-15 y/o

46
Q

Little League Elbow

What is the objective findings?

A

Medial elbow pain
Decreased throwing power or methods
Medial swelling
sometimes flexion contractures

47
Q

Little League Elbow

How are you able to dx?

A

Radiographs can assist with dx

Hx of pain when throwing or palpation

48
Q

Little League Elbow

General pain is indicated from?

A

Injury to medial epicondyle and UCL

Osteochondritis dissecans of capitellum

49
Q

Little League Elbow

What is the mechanism of injury during pitches?

A

During the cocking and acceleration phase
- there’s valgus stress happens at the medial elbow
- posterior shearing forces
- lateral elbow compression

50
Q

What is the misdiagonsis of median nerve entrapment?

A

rare @ the elbow and often misdiagnosed

51
Q

Pronator Syndrome

What is the subjective findings?

A

Sudden and unknown pain on the anterior aspect of elbow, radial side of the palm and palmar side of digits

Heaviness of the forearm

52
Q

Pronator Syndrome

What are the digits affected?

A

1st
2nd
3rd
half of 4th

53
Q

Pronator Syndrome

How is pain reproduced?

A

Pressure over the pronator teres - 4 cm distal to the cubital crease

54
Q

Pronator Syndrome

What resisted movement reproduces pain?

A

Pronation
Elbow flexion
Wrist flexion
supination
long finger flexor

55
Q

Pronator Syndrome

What is the treatment?

A

Usually repond well to activity modification
Rest, NSAIDs, Ice
Get flexibility and strength back at the wrist flexors and forearm pronators
Manual techniques to break up adhesions if need

PHTH 517 (16 decks)

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