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Ortho Test 4 > elbow patho > Flashcards

elbow patho Flashcards

1
Q

what two structures do you imagine will be implicated in a central/deep posterior elbow symtpoms?

A

HUJ or C7 root

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2
Q

what causes an elbow dislocation?

A

high energy trauma directly to elbow or FOOSH

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3
Q

which direction is most common in elbow dislocations and why?

A

posterior dislocation of the ulna due to shape of the articulations

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4
Q

describe a simple elbow dislocation

A

acute soft tissue injury named for the direction of displacement

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5
Q

describe the terrible triad

A

aka complex elbow dislocation - posterior dislocation, radial head fx, and coronoid fx

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6
Q

what neurovascular structures must we be concerned with in simple dislocations? complex?

A

simple: median and ulnar

complex - radial

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7
Q

what is heterotopic ossificans?

A

ectopic bone formation in paraarticular soft tissues

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8
Q

what causes HO?

A

56% following elbow fx/dislocations peaking around 2 months following incident

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9
Q

what increases your risk for HO (and thus causes physicians to treat pts prophylactically following an elbow trauma)

A
  1. excess bone development
  2. anky spine
  3. pagets
  4. hx of HO
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10
Q

what is the primary sxs of HO? secondary?

A

pain with progressive loss of ROM; hyperemia, swelling, warmth

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11
Q

comment on radiographs for HO

A

bone scan: increased uptake by wk 2

xray: may not show evidence until wk 5

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12
Q

although varus instability is less common than valgus instability, what three typical scenarios lead to varus instability?

A
  1. varus stress
  2. iatrogenic - tennis elbow surgery or multiple cortisone injections
  3. dislocations
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13
Q

Posterolateral Rotary Instability is related to varus instability… so what is it

A

persistent insufficiency of the LCL causing posterior dislocation without compromising the PRUJ

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14
Q

what is the MOI for posterolateral rotary instability?

A

humerus IR/valgus stress, compression, and supination

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15
Q

how does a patient with varus instability/posterolateral rotary instability present?

A
  • vague discomfort and clicking/popping/clunking
  • difficultly with elbow extension and supination
  • giving out during loading
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16
Q

how do you manage varus instability/posterolateral rotary instability?

A
  • protect and deload
  • hinged brace for 4-6 weeks
  • avoid abd/IR acts
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17
Q

what causes valgus instability? pt profile?

A

FOOSH or chronic valgus stress - overhead throwers

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18
Q

what structure is at greatest risk for valgus instability?

A

anterior UCL

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19
Q

how does a pt present with valgus instability?

A
  • medial elbow pain
  • may have been an instant pop, after a day of pitching/spiking, insidious
    • tendinosis may or may not be present
20
Q

what does radiography show for UCL insufficient pts with valgus instability?

A

gapping on the effected joint line

21
Q

what is valgus extension overload syndrome

A

the olecranon compresses the humerus causing medial impingement leading to medial elbow pain and thus arthroscopic debridement

22
Q

what can repetitive valgus stress lead to?

A
  1. chrondrolysis (cartilage damage)
  2. osteophytes
  3. loose bodies
  4. MCL tensioning
  5. lateral compression
23
Q

what are the sxs of valgus extension overload syndrome?

A
  • flexion contracture
  • painful active extension w crepitus
  • PROM painful: pronation, valgus, extension
  • TTP post med elbow
24
Q

how do you treat valgus extension overload syndrome?

A

RICE > address ROM and strengt > surgery

25
Q

what is lateral tendinosis?

A

tennis elbow - lesion at the common extensor origin at the lateral epicondyle - overuse of extensors particularly ECRB

26
Q

what is the pt profile for lateral tendinosis?

A

35-50yrs female with high physical work or computer work

27
Q

what clues you in to lateral tendinosis?

A
  • pain with gripping
  • pain with passive wrist flexion stretching
  • tenderness 1 cm distal to lateral epicondyle
28
Q

what are the primary muscles involved in golfers elbow

A

PT, FCR, and PL

29
Q

what provokes medial tendinosis?

A

wrist flexion resistive testing, TTP, and wrist extension stretching

30
Q

how do you treat medial or lateral tendinosis

A

self stretching and eccentric strengthening

injections, bracing, and modalities

31
Q

what mechanisms typically cause ulnar cubital tunnel syndrome

A

traction from throwing and long standing valgus deformity

32
Q

how does a patient present with cubital tunnel syndrome?

A
  • paresthesia esp waking from sleep
  • clumsiness or lost finger coordination
  • sublux during flexion/extension
33
Q

advanced cubital tunnel can show atrophy where?

A

interosseus and first web space; wartenberg sign (not shown)

34
Q

what is wartenberg sign

A

abducted 5th digit due to weak adductors

35
Q

which three tests can be performed to indicate cubital tunnel syndrome

A

tinnel’s, froment, and elbow flexion

36
Q

how do you manage cubital tunnel?

A

night splinting at 20-45 flexion and full supination for 4-6 weeks

avoid aggressive stretching early

kinetic chain mobiliity

37
Q

what is AIN syndrome

A

entrapment of the median nerve due to trauma, causes motor-only issues (ok sign)

38
Q

what is pronator teres syndrome

A

high median nerve compression caused by overuse pronation/supination

39
Q

how does pronator teres syndrome present?

A
  • anterior elbow pain
  • no specific MOI
  • anterior forearm/hand weakness
  • sensory complaints
  • pronator teres unaffected
40
Q

how do you treat pronator teres syndrome?

A

avoid aggs, rest, immobilization

gentle ROM for 2 weeks

41
Q

what does ligament struthers syndrome impact?

A

median nerve

42
Q

what is radial tunnel syndrome?

A
  • deep ache distal lateral epicondyle
  • pain with resisted supination
  • no motor or sensation loss
43
Q

what are the clinical features of PIN syndrome

A
  • finger drop
  • wrist ext with radial dev
  • sensation intact
  • pain increased with supination
44
Q

what does saturday night palsy affect?

A

radial nerve

45
Q

how does saturday night palsy present?

A

drop wrist with normal triceps with some pain at the superficial entrapment site

Ortho Test 4 (7 decks)

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