elbow patho Flashcards
what two structures do you imagine will be implicated in a central/deep posterior elbow symtpoms?
HUJ or C7 root
what causes an elbow dislocation?
high energy trauma directly to elbow or FOOSH
which direction is most common in elbow dislocations and why?
posterior dislocation of the ulna due to shape of the articulations
describe a simple elbow dislocation
acute soft tissue injury named for the direction of displacement
describe the terrible triad
aka complex elbow dislocation - posterior dislocation, radial head fx, and coronoid fx
what neurovascular structures must we be concerned with in simple dislocations? complex?
simple: median and ulnar
complex - radial
what is heterotopic ossificans?
ectopic bone formation in paraarticular soft tissues
what causes HO?
56% following elbow fx/dislocations peaking around 2 months following incident
what increases your risk for HO (and thus causes physicians to treat pts prophylactically following an elbow trauma)
- excess bone development
- anky spine
- pagets
- hx of HO
what is the primary sxs of HO? secondary?
pain with progressive loss of ROM; hyperemia, swelling, warmth
comment on radiographs for HO
bone scan: increased uptake by wk 2
xray: may not show evidence until wk 5
although varus instability is less common than valgus instability, what three typical scenarios lead to varus instability?
- varus stress
- iatrogenic - tennis elbow surgery or multiple cortisone injections
- dislocations
Posterolateral Rotary Instability is related to varus instability… so what is it
persistent insufficiency of the LCL causing posterior dislocation without compromising the PRUJ
what is the MOI for posterolateral rotary instability?
humerus IR/valgus stress, compression, and supination
how does a patient with varus instability/posterolateral rotary instability present?
- vague discomfort and clicking/popping/clunking
- difficultly with elbow extension and supination
- giving out during loading
how do you manage varus instability/posterolateral rotary instability?
- protect and deload
- hinged brace for 4-6 weeks
- avoid abd/IR acts
what causes valgus instability? pt profile?
FOOSH or chronic valgus stress - overhead throwers
what structure is at greatest risk for valgus instability?
anterior UCL
how does a pt present with valgus instability?
- medial elbow pain
- may have been an instant pop, after a day of pitching/spiking, insidious
- tendinosis may or may not be present
what does radiography show for UCL insufficient pts with valgus instability?
gapping on the effected joint line
what is valgus extension overload syndrome
the olecranon compresses the humerus causing medial impingement leading to medial elbow pain and thus arthroscopic debridement
what can repetitive valgus stress lead to?
- chrondrolysis (cartilage damage)
- osteophytes
- loose bodies
- MCL tensioning
- lateral compression
what are the sxs of valgus extension overload syndrome?
- flexion contracture
- painful active extension w crepitus
- PROM painful: pronation, valgus, extension
- TTP post med elbow
how do you treat valgus extension overload syndrome?
RICE > address ROM and strengt > surgery
what is lateral tendinosis?
tennis elbow - lesion at the common extensor origin at the lateral epicondyle - overuse of extensors particularly ECRB
what is the pt profile for lateral tendinosis?
35-50yrs female with high physical work or computer work
what clues you in to lateral tendinosis?
- pain with gripping
- pain with passive wrist flexion stretching
- tenderness 1 cm distal to lateral epicondyle
what are the primary muscles involved in golfers elbow
PT, FCR, and PL
what provokes medial tendinosis?
wrist flexion resistive testing, TTP, and wrist extension stretching
how do you treat medial or lateral tendinosis
self stretching and eccentric strengthening
injections, bracing, and modalities
what mechanisms typically cause ulnar cubital tunnel syndrome
traction from throwing and long standing valgus deformity
how does a patient present with cubital tunnel syndrome?
- paresthesia esp waking from sleep
- clumsiness or lost finger coordination
- sublux during flexion/extension
advanced cubital tunnel can show atrophy where?
interosseus and first web space; wartenberg sign (not shown)
what is wartenberg sign
abducted 5th digit due to weak adductors
which three tests can be performed to indicate cubital tunnel syndrome
tinnel’s, froment, and elbow flexion
how do you manage cubital tunnel?
night splinting at 20-45 flexion and full supination for 4-6 weeks
avoid aggressive stretching early
kinetic chain mobiliity
what is AIN syndrome
entrapment of the median nerve due to trauma, causes motor-only issues (ok sign)
what is pronator teres syndrome
high median nerve compression caused by overuse pronation/supination
how does pronator teres syndrome present?
- anterior elbow pain
- no specific MOI
- anterior forearm/hand weakness
- sensory complaints
- pronator teres unaffected
how do you treat pronator teres syndrome?
avoid aggs, rest, immobilization
gentle ROM for 2 weeks
what does ligament struthers syndrome impact?
median nerve
what is radial tunnel syndrome?
- deep ache distal lateral epicondyle
- pain with resisted supination
- no motor or sensation loss
what are the clinical features of PIN syndrome
- finger drop
- wrist ext with radial dev
- sensation intact
- pain increased with supination
what does saturday night palsy affect?
radial nerve
how does saturday night palsy present?
drop wrist with normal triceps with some pain at the superficial entrapment site
