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Musculoskeletal > Elbow Lecture > Flashcards

Elbow Lecture Flashcards

1
Q

History indicates insidious onset; Pt complains of weakness and pain. What should you do?

A

Screen the cervical spine

Include extremity joint assessment, reflexes, and/or myotome assessment).

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2
Q

If there is pain while leaning on the “point” of the elbow, what is indicated?

A

Olecranon bursitis

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3
Q

What elbow pathology is more likely in a younger Pt than older?

A

Radial head dislocation

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4
Q

Falling forward FOOSH has an increased risk of _____________ fracture than falling backward FOOSH which has an increased risk of a _________ fracture.

A

Forward FOOSH -> Radial head fx

Backward FOOSH -> Olecranon fx

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5
Q

With locking or catching in the elbow, what may be present?

A

Loose bodies

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6
Q

What two pathologies are a possibility if the elbow is unable to fully extend (elbow extension test)?

A

Synovitis
Fracture

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7
Q

What is elbow synovitis?

A

Inflammation of the synovial membrane surrounding the elbow

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8
Q

A “pop” with pain and swelling medially may mean a ___________.

A

MCL sprain

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9
Q

How are conditions at the elbow commonly described?

A

by their location

E.g lateral epicondalgia, radial tunnel syndrome…

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10
Q

Identify 3 medial impairments of the elbow:

A

Golfer’s elbow
Little Leaguer’s elbow
Cubital tunnel syndrome

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11
Q

Identify 2 anterior problems of the elbow:

A

Biceps tendonitis / -osis
Biceps bursitis / tumor

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12
Q

Identify 5 posterior problems of the elbow:

A

Olecranon bursitis
Olecranon fracture
Triceps tendonitis / osis
Cubital fossa pain
Left-arm / elbow pain

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13
Q

Identify 2 mechanisms that could lead to cubital fossa pain:

A

Tear of brachialis muscle at MT junction
Biceps brachii lesion

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14
Q

When left arm / elbow pain is precipitated by physical exertion and relieved by rest, what is a likely symptom?

A

Angina

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15
Q

When a fracture is suspected, what can be done during screening?

A

Use of a tuning fork + stethoscope

If sounds are diminished or absent from injured limb compared to uninjured = positive.

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16
Q

During an isolated muscle test of the biceps, the forearm should be in ________.

A

Supination

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17
Q

During an isolated muscle test of the brachialis, the forearm should be in ________.

A

Pronation

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18
Q

During an isolated muscle test of the brachioradialis, the forearm should be in ________.

A

Neutral

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19
Q

During an isolated muscle test of the common flexors, the forearm should be in ________.

A

Supination

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20
Q

_____ is the strongest wrist flexor.

A

Flexor carpi ulnaris

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21
Q

During an isolated muscle test of the common extensors, the forearm should be in ________.

A

Pronation

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22
Q

______ is the strongest wrist extensor.

A

Extensor carpi ulnaris

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23
Q

What nerves may be involved if the common flexors are impaired?

A

Ulnar (C8-T1)
Median (C6-7)

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24
Q

What nerve root may be involved if the common extensors are impaired?

A

C6-8 nerve root

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25
Q

If there is pain in the common extensors resisted test, what else is likely?

A

Possible lateral elbow pain / epicondylalgia

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26
Q

If there is pain with the common flexors resisted test, what else is likely?

A

Possible medial elbow pain / tendinopathy

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27
Q

When there is pain during resisted elbow flexion, what are 4 structures that could be lesioned?

A

Biceps brachii
Brachialis
Brachioradialis
Wrist extensors

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28
Q

When there is pain during resisted elbow extension, what are 2 structures that could be lesioned?

A

Triceps
Anconeus

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29
Q

When there is pain during resisted forearm supination, what are 4 structures that could be lesioned?

A

Biceps brachii
Wrist extensors
Radial nerve
Supinator

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30
Q

When there is pain during resisted forearm pronation, what are 4 structures that could be lesioned?

A

Wrist flexors
Median nerve
Pronator teres
Pronator quadratus

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31
Q

When there is pain during resisted wrist extension, what are 2 structures that could be lesioned?

A

Wrist extensors
Radial nerve

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32
Q

When there is pain during resisted wrist flexion, what could be lesioned?

A

Wrist flexors

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33
Q

Osteokinematics refers to ______.

A

ROM

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34
Q

Arthrokinematics refers to _______.

A

Joint play/mobilizations

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35
Q

Which tendon of the biceps is more likely to rupture?

A

The long head of the biceps tendon

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36
Q

What is the MOI for the distal biceps tendon to rupture?

A

With a large eccentric load, usually with fatigue

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37
Q

What event is the most common cause of trauma at the elbow joint?

A

FOOSH

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38
Q

Identify 3 things that may fracture due to a traumatic event in the elbow:

A

Olecranon
Capitellum
Radial head

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39
Q

Identify 2 neural issues that may be caused after a traumatic event:

A

Neuritis
Ulnar nerve subluxation

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40
Q

Overuse syndromes are most likely to primarily include the following (3):

A

Lateral epicondylopathy
Medial epicondylopathy
Triceps tendon enthesopathy

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41
Q

Traumatic pathologies are most likely to include the following
(4):

A

Partial or total tendon rupture
Ligament rupture
Fracture
Dislocation

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42
Q

Inflammatory disorders are most likely to include the following (2):

A

Bursitis
Intra-articular effusion

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43
Q

Entrapment neuropathies are most likely to include the following (2):

A

Cubital tunnel syndrome
Radial tunnel syndrome

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44
Q

A medial collateral ligament sprain is also known as what?

A

Ulnar collateral ligament sprain

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45
Q

The MOI for an elbow MCL sprain is VALGUS/VARUS force.

A

Valgus

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46
Q

In throwing athletes, what phase causes MCL sprain?

A

The wind-up phase

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47
Q

Two ways to diagnose an MCL sprain:

A

Valgus stress test is painful
Palpation over ligament is painful

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48
Q

How do you manage an MCL sprain?

A

Restrict ROM to 20-90 with gradual progression
Ice
anti-inflammatory modalities
Isometrics
(Rest)

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49
Q

What is the MOI for little leaguer’s elbow?

A

Forceful pitching

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50
Q

A stress fracture and partial avulsion of the medial epicondyle in children and adolescents is known as __________.

A

Little leaguer’s elbow

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51
Q

Two ways to diagnose little leaguer’s elbow:

A

Mobile epicondyle
Point tenderness

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52
Q

How do you manage little leaguer’s elbow?

A

Rest
Ice
Limit contraction of wrist flexors
Progressive ROM and strengthening
Limit pitch count

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53
Q

Miner’s elbow or Washwoman’s elbow refer to this condition:

A

Subcutaneous bursa over triceps tendon (olecranon bursitis)

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54
Q

What is the MOI for Miner’s elbow?

A

Repeated pressure on elbow

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55
Q

What is the MOI for Washwoman’s elbow?

A

Repeated elbow extension

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56
Q

What are 2 mechanisms of injury for olecranon bursitis?

A

Repeated pressure
Deposit of uric acid crystals (gout)

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57
Q

How is olecranon bursitis diagnosed?

A

Soft, fluid filled pouch, pain with pressure.

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58
Q

How do you manage olecranon bursitis?

A

Modalities, behavior modification, aspiration, compression.

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59
Q

Cubitus varus is also known as what?

A

Gunstock deformity

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60
Q

What is the cause of cubitus varus?

A

Malunion of medial supracondylar fracture. May have healed in an abnormal position

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61
Q

How is cubitus varus diagnosed?

A

Varus deformity

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62
Q

How do you manage cubitus varus?

A

Generally you don’t… but you can get an osteotomy (insert bone fragment to correct alignment).

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63
Q

A fragment in the joint space is termed what?

A

A loose body

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64
Q

A loose body can be _______, _________, ________, etc.

A

Bony, cartilaginous, soft tissue, etc

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65
Q

Identify 3 potential causes for loose bodies:

A

Osteochondritis dissecans
Acute trauma
OA

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66
Q

How do you diagnose a loose body (2)?

A

History of sudden locking
Fragments on radiograph

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67
Q

How do you manage loose bodies in a joint (2)?

A

High velocity low amplitude (HVLA)
Excision

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68
Q

When is an excision appropriate/likely to deal with loose bodies in a joint?

A

If manipulation and moving around to alleviate pain isn’t effective.

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69
Q

What two ligaments in the elbow are often injured together? Why?

A

The lateral collateral and annular ligaments due to the LCL being attached to the annular ligament.

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70
Q

What is the MOI for LCL and annular ligament sprain?

A

Excessive varus force

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71
Q

How do you diagnose a sprain of the LCL and annular ligament (2)?

A

Varus stress test
Tenderness

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72
Q

How do you manage a sprain of the LCL and annular ligament (3)?

A

Ice
Modalities
Friction massage (??)

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73
Q

Biceps tendinopathy at the distal attachment is LESS/MORE common than at the long head at the shoulder.

A

Less common

74
Q

What is the MOI for Biceps tendinopathy?

A

Strong or repetitive elbow flexion

75
Q

How do you diagnose biceps tendinopathy?

A

Resisted static contraction

76
Q

How do you manage biceps tendinitis?

A

Similar to any tendinitis - Modalities, ice, gradual strengthening

Friction massage (??)

77
Q

What is the MOI for distal biceps tendon rupture?

A

Forceful eccentric contraction

78
Q

How do you diagnose distal biceps tendon rupture?

A

Weak, painless flexion during resisted isometric

79
Q

How do you manage distal biceps tendon rupture?

A

Usually do nothing.
Surgical repair possible

80
Q

A brachialis tear is managed in the same way as what other structure?

A

Distal biceps

81
Q

Lateral epicondylitis is also known as _________.

A

Tennis elbow

82
Q

According to Cyriax, the origin of the __________ was the primary site of injury for lateral epicondylalgia, but the ECRL and ECU are also indicated.

A

ECRB

83
Q

___–___% of the population have lateral epicondylalgia?

A

1-3%

84
Q

People who have lateral epicondylalgia are typically ___-___ years old.

A

35-50

85
Q

What is the MOI for lateral epicondylalgia?

A

Overuse (micro) or a single forceful contraction (macro)

86
Q

How do you diagnose lateral epicondylalgia?

A

Resisted static contraction, tenderness

87
Q

How do you manage lateral epicondylalgia (7)?

A

Modalities, ice, stretching, modify activity, gradual strengthening, cuff/brace.

Friction massage (??)

88
Q

Medial epicondylalgia is also known as what?

A

Golfer’s elbow

89
Q

What is the MOI for medial epicondylalgia?

A

Overuse (micro) or a single forceful contraction (macro)

90
Q

How do you diagnose medial epicondylalgia?

A

Resisted static contraction, tenderness

91
Q

How do you manage medial epicondylalgia (7)?

A

Modalities, ice, stretching, modify activity, gradual strengthening, cuff/brace.

Friction massage (??)

92
Q

T/F Medial and lateral epicondylalgia must be diagnosed and managed in ways unique to their side.

A

False, they are the same.

93
Q

Histology shows that epicondylosis is often not inflammatory, but _________.

A

degenerative

94
Q

Describe Nirschl’s stages of repetitive microtrauma stages I-IV:

A

Stage I: Injury is inflammatory, no associated pathologies, likely to resolve.

Stage II: Associated with pathologic alterations (tendinosis, degeneration)

Stage III: Associated with pathologic changes and complete structural rupture.

Stage IV: Features of stage 2 and 4 as well as other changes

95
Q

Which stage of Nirschl’s stages of repetitive trauma is most associated with overuse / overload?

A

Stage II

96
Q

What two arteries does the brachial artery divide into at the elbow?

A

Radial and ulnar arteries

97
Q

What is Volkmann’s ischemic contracture? What does it follow?

A

A permanent shortening of the forearm muscles that gives rise to a clawlike deformity of the hand, fingers and wrist. It follows a disruption of blood flow (i.e. fracture).

98
Q

Describe the different grades of Volkmann’s ischemic contracture (mild-severe).

A

Mild: Flexion contracture of 2-3 fingers
Moderate: all fingers and thumb, some decreased sensation
Severe: Involves all muscles of the forearm and hand

99
Q

How do you manage Volkmann’s ischemic contracture?

A

Splinting in functional hand position

100
Q

What causes cubital tunnel syndrome?

A

Entrapment of the ulnar nerve in the cubital tunnel

101
Q

Identify 4 S/S of cubital tunnel syndrome:

A

Numbness and/or weakness in ring and little fingers
Tenderness
Decreased coordination of hand
Ulnar nerve distribution

102
Q

How do you manage cubital tunnel syndrome (2)?

A

Decrease pressure
Surgical release

103
Q

Radial nerve palsy is also known as what?

A

Saturday night palsy

104
Q

What are the causes of radial nerve palsy (4)?

A

Dislocation of the radial head
Entrapment in supinator
Repetitive twisting
Pressure

105
Q

What are the S/S of radial nerve palsy?

A

No active extension of fingers, wrist

106
Q

How do you manage radial nerve palsy (3)?

A

Relocation of radial head or release
Decrease pressure
Splinting

107
Q

Median nerve palsy is sometimes referred to as what?

A

Pronator teres syndrome

108
Q

What is the cause of median nerve palsy?

A

Entrapment in pronator teres

109
Q

What are the S/S of median nerve palsy (2)?

A

Forearm pain
Decreased pinch

110
Q

How is median nerve palsy managed (1)?

A

Soft tissue release (??)

111
Q

What three regions refer pain to the elbow? “What should I screen to rule out my differential diagnoses?”

A

Shoulder
Wrist
Neck

Above and below and the part of the spine related to the area.

112
Q

A supracondylar fracture occurs most often in this patient population:

A

Children

113
Q

What are the MOIs for posterior displacement and anterior displacement supracondylar fractures?

A

Posterior displacement: FOOSH (can injure anterior neurovascular tissues as well).

Anterior displacement: Fall onto flexed elbow

114
Q

What are the S/S of a supracondylar fracture?

A

Pain
swelling
S-shaped deformity
Fragments seen on radiograph

115
Q

Management for a non-displaced supracondylar fracture:

A

Immobilization - probably casted
Return to activity

116
Q

Management of a displaced supracondylar fracture:

A

Closed reduction or ORIF
Immobilization
Progressive ROM and strengthening

117
Q

Transcondylar fractures are more common in this patient population:

A

elderly, osteoporosis

118
Q

T/F the MOI and the management for a transcondylar and a supracondylar fracture are the same.

A

True

119
Q

What is an ORIF?

A

Open reduction and internal fixation - a type of surgery used to stabilize and heal a broken bone.

120
Q

What is required for a fracture to be considered complex?

A

The joint space must be disrupted

121
Q

Intracondylar fractures are ALWAYS considered _________ fractures.

A

Complex

122
Q

A vertical fracture between condyles is termed this:

A

Intracondylar fracture

123
Q

What is the MOI for an intracondylar fracture?

A

Excessive force through olecranon (fall onto point of elbow, splits condyles apart)

124
Q

What are the S/S for an intracondylar fracture (4)?

A

Short arm
Wide elbow
Mobile condyles
Fragments seen on radiograph (difficult to see non-displaced)

125
Q

How do you manage an intracondylar fracture (3)?

A

ORIF
Gentle ROM
Isometrics - progress to isotonics

126
Q

What movement is slow to return after an intracondylar fracture?

A

Extension

127
Q

If a fracture may impact a growth plate, it is considered a __________________ fracture.

A

Complex

128
Q

A Lateral condylar epiphysis fracture occurs in children under what age?

A

Under 16

129
Q

MOI for a lateral condylar epiphysis fracture

A

FOOSH with supination and varus stress

(Stretches LCL, avulses lateral epiphysis)

130
Q

S/S of lateral condylar epiphysis fracture (3)

A

Edema
Tenderness
Painful passive wrist extension

131
Q

Management for lateral condylar epiphysis fracture (non-displaced and displaced):

A

Non-displaced: Immobilize, ROM, strengthening.

Displaced: ORIF, immobilize, etc.

132
Q

Medial condylar epiphysis fracture is similar to ___________.

A

Little leaguer’s elbow

133
Q

MOI for a medial condylar epiphysis fracture

A

FOOSH with wrist hyperextension

134
Q

S/S for a medial condylar epiphysis fracture

A

Edema
Tenderness
Possible N/T in ulnar fingers

135
Q

With a medial condylar epiphysis fracture, what nerve may experience pressure?

A

Ulnar nerve

136
Q

The management of a medial condylar epiphysis fracture is the same as what?

A

Laterala condylar epiphysis fracture

137
Q

MOI for olecranon fracture:

A

Direct trauma

138
Q

S/S for an olecranon fracture (4):

A

Edema/effusion
Pain
Decreased ROM

If triceps torn (sometimes happens) - inability to extend elbow

139
Q

Management of an olecranon fracture (non-displaced and displaced):

A

Non-displaced: Immobilization, ROM, strengthening.

Displaced: ORIF, immobilization, etc.

140
Q

MOI for an avulsion fracture of the olecranon:

A

Pull of triceps (e.g. javelin throwers)

141
Q

S/S of an avulsion fracture of the olecranon:

A

Unable to extend elbow against gravity

142
Q

Managment of an avulsion fracture of the olecranon (2):

A

ORIF or fragment excision
reattachment of triceps

143
Q

A radial head fracture is an _________ fracture.

A

impaction

144
Q

MOI for a radial head fracture:

A

FOOSH

145
Q

S/S for a radial head fracture (3):

A

Painful pronation
Painful supination

Radiograph shows vertical split, lateral displacement or shattering

146
Q

Management of a radial head fracture (5):

A

Immobilization or ORIF then immobilization
ROM
Strengthening
Possible radial head excision
Possible radial head implant

147
Q

A simple dislocation is defined as what?

A

Only dislocation, no fracture.

148
Q

A complex dislocation is defined as what?

A

Dislocation with fracture

149
Q

The elbow is the ___ most commonly dislocated/subluxed joint in the body following the _________.

A

2nd; shoulder

150
Q

With an ulnar dislocation, the ulna dislocates ANTERIORLY/POSTERIORLY. What else will often dislocate with it?

A

Posteriorly; the radial head

151
Q

MOI for an ulnar dislocation:

A

FOOSH with elbow extended or hyperextended.

152
Q

S/S for an ulnar dislocation (4):

A

Deformity
Pain
Swelling
Complications

153
Q

Managment for an ulnar dislocation:

A

Closed reduction under anesthesia
Surgical repair of soft tissues
Immobilization, ROM, etc.

154
Q

MOI for a radial head dislocation:

A

Swinging child by arms or yanking

155
Q

S/S for a radial head dislocation (1):

A

Pain with supination

156
Q

Management of a radial head dislocation:

A

Relocation with distraction, supination, and flexion.

157
Q

What is the most common form of elbow instability?

A

Posterolateral rotary instability (PLRI)

158
Q

Describe a Monteggia’s fracture:

A

Fracture of proximal third of ulna with anterior dislocation of the radial head

159
Q

MOI for a Monteggia’s fracture:

A

Forced pronation

160
Q

S/S for a Monteggia’s fracture:

A

Anterior angulation and shortening of forearm.

Radial head palpable in antecubital fossa

161
Q

What is a possible complication after a Monteggia’s fracture?

A

Radial nerve injury

162
Q

Management for a Monteggia’s fracture:

A

Closed reduction or ORIF, immobilization, ROM, strengthening.

163
Q

What tissue damage is possible during an ulnar dislocation?

A

Tearing anterior capsule, brachialis
Overstretch of medial collateral, nerves, blood vessels.

164
Q

T/F Osteoarthritis can affect any/all of the elbow joints.

A

True

165
Q

Osteoarthritis of the elbow usually follows __________.

A

Trauma (unilateral)

166
Q

How do you diagnose elbow OA (2)?

A

Capsular pattern
Radiography

167
Q

Management of elbow OA:

A

ROM, isometrics, modalities, mobilization
May require arthroplasty

168
Q

Describe rheumatoid arthritis

A

Systemic inflammation of tendons and ligaments leading to decreased stability of joints. Often can occur bilaterally.

169
Q

Describe osteochondritis dessecans

A

Joint condition in which the bone and cartilage are inflamed and may lead to avascular necrosis.

170
Q

What structure is often involved with osteochondritis dessecans?

A

The capitulum of the humerus

171
Q

Osteochondritis dessecans often occurs in which 2 patient populations?

A

Adolescents and young adults

172
Q

Management of osteochondritis dessecans:

A

Manipulation PRN to restore normal mobility.

excision in extreme cases

173
Q

Night stick fracture tends to be _________ of the ulna. Monteggia is the ____________ of the ulna.

A

in the mid portion; proximal third.

174
Q

Septic arthritis is more often seen in the ________ and ________.

A

Shoulder and wrist

175
Q

What is the cause of septic arthritis?

A

A bacterial infection

176
Q

S/S of septic arthritis (4 acute and 3 chronic):

A

Acute - increased temp, swelling, stiffness, pain at rest.

Chronic - muscle wasting, osteoporosis, bony erosion.

177
Q

Management of septic arthritis:

A

Treat early on
Antibiotics, joint protection (e.g. splinting)

178
Q

Compare and contrast OA vs RA

A

No cure for either
Both cause joint pain, stiffness, and swelling.
Symptoms tend to be worse in the morning

OA is unilateral, RA often bilateral.
OA is bone, RA is soft tissue
OA caused by wear and tear, RA is autoimmune

179
Q

S/S of neuropathic arthritis

A

Progressive weakness and instability
Loss of pain and temp sensation
Can lead to flail elbow

180
Q

Treatment for neuropathic arthritis:

A

Splint in functional position

181
Q

List 4 indications for an arthroscopy:

A

Diagnostic
Excision of loose bodies
Debridement
Occasionally collateral ligament repair

Minimally invasive!

Musculoskeletal (10 decks)

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