Elbow Pathologies Flashcards
Lateral Epicondalgia: MOI
Overuse/degeneration of ECRB tendon (wrist & elbow extension)
Lateral Epicondalgia: population/risks
35-55yr, highly repetitive UE routines (e.g., construction workers).
Lateral Epicondalgia: presentation
TTP: distal to lateral epicondyle.
Pain: sharp, stabbing.
Aggs: gripping, wrist ext, RD, finger ext.
AROM limited d/t pain, PROM usually WNL.
Impaired grip strength.
Weak shoulder ER = compensation with ECRB.
Lateral Epicondalgia: risk factors for degenerative
35-55yo
Symptoms >3mo
>1 episode
Lateral Epicondalgia: diagnostic test
ultrasound
Lateral Epicondalgia: surgery indications
If pain/disability remains after 6-12mo
Medial Epicondalgia: MOI
Repetitive microtrauma.
Involves:
Pronator Teres
FCR
Palmaris Longus
Medial Epicondalgia: presentation
TTP: medial epicondyle.
Aggs: stretching pronator mass (elbow & wrist ext, forearm supination).
Strength: may be compensating for weak shoulder IR.
Medial Epicondalgia: interventions
same as Lateral, but now focusing on forearm flexors instead of ext.
Distal Biceps Rupture: MOI
Overuse or traumatic (e.g., catching very heavy load).
GH elevation, elbow ext, forearm sup.
Violent pull of forearm into ext while biceps is contracting.
Distal Biceps Rupture: population
middle-age M > F
Distal Biceps Rupture: presentation
Popping, visual defect.
TTP antecubital fossa.
ROM/Strength: weak flexion/supination; may be WNL bc brachialis takes over elbow flexion.
Distal Biceps Rupture: surgical approaches & risks associated
Single-Incision Anterior Approach - lower risk of HO.
Double-Incision Posterior Approach - lower risk of neuropraxia.
Humerus Fx: population
12-19yo (M)
>80yo (F)
Humerus Fx: MOI
High-energy injuries (FOOSH from a ladder or MVC).
Humerus Fx: surgery indications
comminuted and/or fx within the joint.
Humerus Fx: surgical approaches
ORIF: best outcomes.
Total Elbow Arthroplasty: only if really bad, cant be stabilized with ORIF, elderly. No lifting >10lb restriction for LIFE.
Humerus Fx: non-operative treatment
Cast: no more than 2wks.
Hinged Brace: after cast comes off, allows F/E but protects lateral stability until healed.
Olecranon Fx: MOI
fall on elbow
Olecranon Fx: treatment
ORIF if displaced (most olecranon fx are displaced)
Radial Head Fx: MOI
FOOSH
Radial Head Fx: treatment for non-displaced
no surgery. AROM & 1wk in sling. If still fucked after 3 wks, refer to therapy.
Radial Head Fx: treatment for displaced
ORIF
Radial Head Fx: treatment for comminuted
radial head surgically removed
Capitellum/Trochlea Fx: MOI
FOOSH
Important considerations with elbow fractures
Avoid prolonged immobilization: elbow gets stiff FAST.
Avoid aggressive ROM too early: risk of HO.
Dislocations: population
5-20yo athletes
Dislocations: MOI
FOOSH
What is the most common type of dislocation (direction)?
Posterior
Dislocation: tx
Closed reduction
Sling & AAROM (1wk)
Compression sleeve for swelling
Return to sport 3mo
Cubital Tunnel Syndrome: what nerve?
Ulnar
Cubital Tunnel Syndrome: presentation
Sharp, ache at medial elbow.
Aggs: flexion.
Paresthesia: pinky & ring finger.
Strength: ↓ grip & lateral pinch.
If prolonged: thenar wasting, clawing, ABD of the pinky finger.
Cubital Tunnel Syndrome: indications for non-op
No atrophy
Mild EMG findings
Cubital Tunnel Syndrome: most common surgical procedure
Anterior Transposition
Cubital Tunnel Syndrome: rehab
Avoid terminal flex.
Stretch pronator mass.
Pronator Syndrome: compression sites
Ligament of Struthers
Bicipital Aponeurosis
Pronator Teres
Pronator Syndrome: populations
F 4x > M
Age 50+
Pronator Syndrome: subjective
Pain: prox forearm.
Aggs: forearm rotation, elbow motion.
Paresthesia: thenar eminence, thumb, index, middle, radial half of ring finger.
Pronator Syndrome: rehab
STM to biceps, pronator teres, FDS.
Nerve glides/flossing.
Limit gripping & repetitive turning.
If highly irritable - Posterior Elbow Gutter Orthosis for 2wks.
Radial Tunnel Syndrome: compression site
PIN
Radial Tunnel Syndrome: subjective
Pain: burning, achy at extensor mass & distal forearm.
Weak: supination, wrist/digit ext.
Radial Tunnel Syndrome: rehab
Stretch supinator & ECRB (pain-free range).
STM, nerve glides.
Off-shelf braces can make it WORSE - go with a custom orthosis.
Olecranon Bursitis: MOI
trauma, infection, excessive rubbing/friction
Olecranon Bursitis: presentation
Inflamed bulge where bursa is
Agg - flexion (pushes on bursa)
Olecranon Bursitis: rehab
ice, US, regain ROM/strength.
UCL Injury: MOI
Valgus stress on medial elbow (lateral blow to elbow).
May be combined with dislocation.
Most tears on humeral side of UCL.
UCL Injury: risk factors
Pitching velocity & volume.
Throwing mechanics
Breaking Ball toss
Humeral Retrotorsion
UCL Injury: presentation
Change in pitch stamina/strength.
Pain during cocking phase.
Ulnar N paresthesia.
UCL Injury: indications for surgery
Complete tear = surgery required.
Incomplete tear = surgery if conservative fails after 3mo.
UCL Injury: surgical options
Tommy John Surgery: splinted for 1 wk post-op, very specific protocol to follow.
Other: ASMI (modified Tommy John), Docking, and DANE-TJ.
UCL Injury: conservative treatments
Throwers 10 Program, strength, ROM, address biomechanics.
Platelet-rich plasma.
Return to pitch 12-14wks.
How does pitching cause humeral retrotorsion?
Throwing arm: excess shoulder ER & restricted IR = increased retrotorsion.
ER concentric during cocking phase, then ER eccentric during throw.
Throwing stress on the elbow = ___x BW
5
Proper pitch mechanics
Lead with hips
Hand on top position
Closed-shoulder position
Stride foot toward home plate
Elbow flex on ball release
Plant foot before trunk rotation.
What type of pitch is a higher risk for UCL injury?
Sidearm pitch = more valgus stress than overhand pitch.
Medial Epicondyle Apophysis: definition
UCL injury in age 12-13 - “Little League Elbow.”
Epiphyseal plate separates from medial epicondyle.
Same MOI/risks as UCL.
Capsular Tightness causes
Prolonged immobilization post-injury
Myositis Ossificans
Same as HO, but in muscle.
Causes: aggressive stretching post-injury.
Myositis Ossificans treatment
Self-resolving process.
Immob 3-7 days, RICE.
Surgery if lesion matures despite conservative tx.
