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UM - UQ > Elbow Pathology > Flashcards

Elbow Pathology Flashcards

1
Q

What are the concave/convex components of the HumeroUlnar Joint?

A

Concave: trochlear notch of the ulna
Convex: trochlea of humerus

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2
Q

Which joint has a carrying angle + norms?

A

The HU joint: 11-14 men, 13-16 women

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3
Q

What is the resting position of the HU joint?

A

70 degrees elbow flexion, 10 degrees of supination

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4
Q

What is the closed pack position of the HU joint?

A

full elbow extension and supination

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5
Q

What is the capsular pattern of the HU joint?

A

flexion, extension

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6
Q

What are the concave/convex partners of the HumeroRadial joint?

A

Concave: head of the radius
Convex: Capitulum of the humerus

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7
Q

What is the resting position of the HR joint?

A

full elbow extension and supination

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8
Q

What is the closed pack position of the HR joint

A

Elbow flexed to 90 deg and supinated to 5 deg

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9
Q

What are the concave/convex partners of the proximal radioulnar joint

A

Concave: ulna
Convex: head of the radius

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10
Q

What is the resting position of the proximal RU jont

A

70 deg flexion 35 deg supination

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11
Q

What is the closed pack position of the proximal RU joint

A

5 deg supination

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12
Q

What is the capsular pattern of the prox. RU joint

A

pronation and supination equally limited

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13
Q

What are the medial ligaments of the elbow?

A

Ulnar Collateral Ligament w/anterior, transverse, and posterior bundle

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14
Q

Which bundle of the UCL is the primary restraint against valgus stress?

A

Anterior bundle

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15
Q

What are the lateral ligaments of the elbow?

A

Annular ligament
Lateral Radial Collateral Ligament
Lateral Ulnar Collateral ligament

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16
Q

Which lateral ligament wraps around the radial head?

A

Annular ligament

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17
Q

Which lateral ligament is associated w/ECRB and supinator

A

Lateral Radial collateral ligament

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18
Q

What are the primary flexors of the elbow?

A

Biceps, bracialis, bracioradialis

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19
Q

What are the weak flexors of the elbow?

A

PT
FCR
FCU
ECRL

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20
Q

What are the extensors of the elbow?

A

Triceps and anconeus

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21
Q

Where is the common extensor/supinator insertion?

A

Lateral epicondyle

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22
Q

Where is the common flexor/pronator insertion?

A

Medial epicondyle

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23
Q

List some pathologies that can occur at the lateral elbow

A

Lateral epicondylitis
Posterior interosseous nerve syndrome
Radial Tunnel Syndrome
Osteochondritis dissecans
panners disease
Osteochondral degenerative changes
Lateral collateral ligament injury
Synovitis & bursitis
Capitellum fracture
Radial head fracture
Cervical origin (C6-7)

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24
Q

What is the mechanism of injury for Lateral Epicondylitis

A

Overuse/insidious onset from manual labor actiities (could be due to a repetitive microtrauma)

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25
Q

What would you hear in the history to make you think Lateral Epicondalgia

A

Pain over lateral epicondyle
Pain with gripping
Occasional night pain or neck and shoulder pain

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26
Q

What are the special tests for lateral epicondalgia

A

Cozens, Mills and Middle Digit Extension Test

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27
Q

What are the examination findings that would indicate lateral epicondalgia

A

Full PROM of the elbow, limited wrist flexion - especially with pronation and elbow extension
Pain with resisted extension & RD, weak and painful grip strength
Tenderness at lateral epicondyle

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28
Q

What PT Interventions should be used for lateral epicondalgia?

A

Education
PREs (for chronic tendonosis not tendonitis)
Prox. forearm strap
Addressing proximal mm strength
manual therapy

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29
Q

What condition should you be mindful of when examining for lateral epicondalgia?

A

Radial tunnel syndrome

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30
Q

What are the possible areas of compression for Radial Tunnel Syndrome?

A

1 - Fibrous bands connecting brachialis to brachioradialis
2 - Vascular leash of henry (BV at radial neck)
3 - Medial leading edge of teh ECRB
4 - Fibrous bands at proximal and distal edge of supinator

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31
Q

What is the clinical presentation of Radial Tunnel Syndrome

A
  • Diffuse aching in forearm
  • Aggravated by repetitive pronation & supination
  • Pain with resisted supination
  • No sensory/motor changes
  • tenderness over radial tunnel
  • worsened w/forearm strap
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32
Q

What are the special tests for Radial Tunnel Syndrome

A

Pain w/resisted middle finger extension

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33
Q

What Interventions should be used for Radial Tunnel Syndrome?

A
  • Conservative: immobilizations, NSAIDs, PT, and activitiy modification
  • Sx (wide success range 10-95%): to decompress radial nerve
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34
Q

What is the clinical presentation of Posterior Interosseus Nerve Syndrome

A
  • Lateral forearm/elbow pain
  • Weakness of finger extension
  • Thumb extension causes lateral epicondyle pain
  • No sensation loss
  • Motor symptoms (Impaced mm: EDM, ECU, ED, ECRb, EI, EPL, EPb, APL, Supinator - SPARED MM: Triceps, anconeus, brachiorad & ECRL)
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35
Q

What is capitellar osteochondritis dissecans (OCD)

A

Separation of a localized area of articular cartilage and subchondral bone

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36
Q

What are the signs and symptoms of capitellar osteochondritis dissecans

A
  • Difficulty extending elbow - often 5-23 degree flexion contracture
  • tenderness over lateral epicondyle
  • lateral/antereior elbow/forearm pain
  • Pain w/Weight bearing
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37
Q

What are the special tests for Osteochondritis Dissecans

A

Active compression test (Extended elbow w/pronation and supination)

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38
Q

Treatment of OCD

A

Depends on severity & compliance
- early: conservative 4-6 months
- Late/if needed: Sx (remove loose bodies, microfractures, OATs)

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39
Q

What is Panners disease

A

Focal osteonecrosis of the entire capitellum

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40
Q

A. OCD vs B. Panners
1. Age
2. History/onset
3. Locking and catching?
4. Duration of symptoms

A

1A. 10-21 yo vs B. 7-12 yo
2. Repetitive trauma overuse vs B. insidious
3A. locking and catching present vs B. not
4A. 5-6 mo, B. 2-24 mo

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41
Q

MOI for RCL sprain

A

Trauma, FOOSH, or axial compression w/ER and force

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42
Q

What does radiohumeral bursitis present similarly to?

A

Lateral epicondylitis

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43
Q

What are possible pathologies of the medial elbow?

A

Medial epicondylitis
Flexor/pronator strain
UCL sprain
Ulnar neuritis
Coronoid Fracture
CFCS

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44
Q

What two muscles are most affected with medial epicondyalgia

A

FCR and PT

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45
Q

MOI for medial epicondyalgia

A

Insidious onset or overuse (more common in golfers, tennis players, and overhead throwers)

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46
Q

Which decade of life is common onset for medial epicondyalgia

A

4th to 6th

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47
Q

What other condition should you be mindful of if you are thinking medial epicondyalgia?

A

UCL pathology in OH athletes or an ulnar nerve pathology

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48
Q

What population is a UCL sprain common in?

A

Baseball pitchers and gymnasts

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49
Q

What is MOI of UCL sprain?

A

Cummulative microtrauma from valgus + ER at HU jt or FOOSH

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50
Q

What portion of the UCL is affected most in a sprain?

A

anterior band of anterior oblique ligament

51
Q

What are the signs/symptoms of UCL sprain

A
  • point tenderness at insertion (1 inch distal to medial epi)
  • pain/laxity w/valgus testing
  • flexor muscle soreness
52
Q

What are the special tests for UCL sprain?

A

Valgus stress test
Milking maneuver
Moving valgus stress test

53
Q

Non-Sx MGT of UCL Sprain

A
  • period of rest to preserve ROM
  • Start w/ROM, PREs of wrist flexors + other surrounding
  • Also treat other neighbouring joints, including the trunk/hip
54
Q

What is little leaguer’s elbow?

A

Not a diagnosis itself, but is from valgus overload from repetitive throwing

55
Q

What are possible pathologies from little leaguers elbow?

A
  • medial apophysitis/avulsion fx
  • Panners or OCD
  • olecranon apophysitis
  • posteromedial impingement
56
Q

What is the best treatment for Little League elbow?

A

PREVENTION!!
- pitching < 8 mo in the year + adherence to pitching counts
- general LE and UE strength/conditioning
- other sports played too

57
Q

What is treatment for a small little league lesion?

A
  • rest
  • resistance training avoided until full ROM without pain (2-3 weeks)
  • no throwing for 6-12 weeks
  • total body conditioning
58
Q

What is Cubital Tunnel Syndrome

A

Ulnar Neuritis from compression of the medial head of triceps, anconeus, or between FCU

59
Q

What is the most commonly effected nerve in the elbow?

A

Ulnar nerve

60
Q

What are the signs and symptoms?

A
  • Early = sensory w/pain and paresthesia in medial elbow/forearm and ulnar distribution
  • late = atrophy of ulnar musculature (FCU + ulnar half FDP, hypothenar eminence, 3rd & 4th lumbricals)
  • clawing contracture of ring and little fingers
61
Q

What muscles are most affected with cubital tunnel syndrome

A

FCU, ulnar half FDP, hypothenar eminence, 3rd and 4th lumbricals

62
Q

What are the special tests for cubital tunnel syndrome

A
  • biships deformity
    • Tinels at elbow
  • Wartenberg’s sign (pinky in)
  • Froment sign (paper grip)
63
Q

How to manage cubital tunnel syndrome?

A
  • Avoid positions that provoke it
  • Elbow pad
  • Night splint 40-60 deg flexion
  • Nerve glides
  • possible sx decompression
64
Q

What are possible MOI for chronic exertional compartment syndrome

A
  • prolonged/repetitive gripping from muscle expansion during exertion while contained in an inelastic tissue envelope
  • motorcross, rowing, gymnastics, hockey, WC athletics, climbing
  • rarer in UE than LE
65
Q

True or false: Compartment syndrome = Chronic exertional compartment syndrome

A

FALSEEEE

66
Q

What are the signs/symptoms of CECS

A
  • pain in forearm brought on by activity and resolved in periods of rest
  • loss of grip strength
  • altered senstaion in the hands that does not follow any specific nerve root
  • bilateral
67
Q

Management of CECS

A
  • Non-operative: cessation of activities, PT, botox, taping
  • Operative = open fasciotomy
68
Q

What is Volkman’s Ischemia

A

Compartment syndrome of the elbow that causes permanent damage

69
Q

T or F: CECS is permanent damage

A

False

70
Q

What are the causes of volkmann’s ischemia

A
  • arterial injury from open laceration
  • arterial disruption secondary to severly displaced fractures or dislocations
71
Q

What does prolonged ischemia to forearm muscles cause (like in Volkmann’s Ischemia)

A
  • muscle necrosis and paralysis
  • mm tissue replaced w/fibrous tissue
  • severe deformities of hand and wrist
72
Q

Mild Volkmann’s Ischemia

A
  • 2-3 fingers contracted
  • no limited/loss of feeling
73
Q

Moderate Volkmann’s Ischemia

A
  • all fingers flexed
  • thumb stuck in palm
  • wrist bent
  • loss of some feeling in the hand
74
Q

Severe Volkmann’s Ischemia

A
  • all mm involved (finger flexors and extensors)
  • severely disabiling
75
Q

What are the S/S of Volkmann’s Ischemia

A
  • purple/pale discoloration of the hand
  • severe pain in forearm mm
  • paresthesia as dysfucntion progresses
  • pain on passive stretch
  • swelling
76
Q

What are the pathologies of anterior elbow pain

A
  • Median nerve entrapment
  • biceps strain
  • distal biceps tendinopathy/tear
77
Q

What are the common sites of median nerve entrapment

A
  • Ligament of struthers (supracondylar process to medial epicondyle)
  • Bicipital aponeurosis
  • PT heads
  • Fibrous arch of FDS
78
Q

What are S/S of pronator syndrome

A
  • pain in proximal anterior aspect of the forearm
  • tenderness to PT
  • weakness in median nerve distribution distal to PT
  • paresthesia/numbness in median nn distribution
  • lack of nocturnal symptoms
79
Q

What mm are involved in pronator syndrome

A

FCR, PL, FDS, FPL, lateral FDP, PQ, thenar eminence

80
Q

MGT of pronator syndrome

A
  • rest/activity modification
  • NSAIDS
  • ICE
  • restoration of flexibility/strength of wrist flexors/pronators
  • STM
  • splinting at 90 deg
81
Q

What is AIN syndrome

A

Motor loss but no sensory loss for FPL, lateral half FDP, and PQ from compression at PT head

82
Q

What are special test for AIN

A

Ok sign test

83
Q

What leads to a biceps muscle strain

A
  • strong elbow flexion force
  • hyperextension force
  • could lead to a rupture
84
Q

What is MOI for distabl biceps tendon rupture

A
  • eccentric load on lengthened biceps, common in middle-aged men
85
Q

What are the tests for a distal biceps tendon rupture

A
  • biceps squeeze
  • hook test
86
Q

When should Sx be completed for distal biceps tendon rupture

A

Soon after injury, but there is debate

87
Q

S/S of bicipital radial bursitis

A
  • visible/palpable enlargement
  • pain in antecubital fossa
  • tenderness to palpation at radial tub
  • painful resisted movements of elbow flexion and supination
88
Q

What are pathologies that cause posterior elbow pain

A
  • olecranon tip stress fracture
  • olecranon bursitis
  • posterior impingement
  • triceps tendonopathy
  • ulnar neuritis
89
Q

What is MOI of olecranon bursitis (Students elbow)

A
  • direct trauma
  • repetitive grazing
  • prolonged WB
90
Q

S/S students elbow

A
  • slight to extreme distention
  • decreased ROM or difficulty wearing a shirt
91
Q

MOI of posterior impingement

A

repetitive injury/overuse from forced extension (throwing, swimming, boxing) that causes impingement of olecranon process in the fossa

92
Q

What are the S/S of posterior impingement

A
  • Posterior elbow pain locking, catching or crepitis worsened w/elbow extension
  • limited full elbow extension
93
Q

Onset of triceps tendonitis

A

Sudden severe strain as arm is fully extended or sudden sapping of elbow w/flexion force

94
Q

Signs of triceps tendonitis

A
  • pain with resisted elbow extension
  • pain w/PROM of elbow flexion and shoulder flexion
95
Q

What is the elbow imaging criteria

A

age > 14 yo
Less than 24 hours
Inability to actively extend the elbow

96
Q

Adolescent Ossification Sequence at the elbow

A

C - Capitulum
R - Radial head
I - Internal (med.) epicondyle
T - trochlea
O - olecranon
E - external (lat.) epicondyle

97
Q

What is the sail sign

A
  • finding on a radiograph that suggests a fx of one or more bones on the elbow
98
Q

1/3 of all elbow fx are …

A

at the radial head

99
Q

MOI for radial head fx?

A
  • axial load on pronated forearm
  • direct blow to forearm
  • hyperflexion injury
100
Q

Radial head fx classification

A

I - non dispalced
II - large dispalced
III - comminuted
IV - Fx w/dislocation

101
Q

What is MOI of Nursemaid’s Elbow

A

distraction force on elbow causing radial head to dislocate out of annular lig, common 2-3 yo

102
Q

Sign of nursemaid’s elbow

A

Arm held at side + pronated

103
Q

What technique to fix nursemaid’s elboq

A

closed reduction and manipulation w/forearm forcefully supinated + downward pressure on radial head

104
Q

Capitellum Fx?

A

seen in young male w/blunt force trauma or elderly female w/low to mod force trauma

105
Q

Coronoid Fx

A

Uncommon in isolation - more w/RCL instability or terrible triad of the elbow

106
Q

Olecranon fx?

A

MOI: FOOSH or backwards fall
Common in elderly

107
Q

What is a greenstick fx?

A
  • incomplete fx of one or both forearms
108
Q

What is a nightstick fx?

A
  • ulnar fx in midportion of the bone
  • consider pt safety
109
Q

What is a Monteggia Fx

A
  • radial head injury + prox ulnar fx + disolcation of radial head
110
Q

MOI of monteggia fx

A

FOOSH w/ hyperextension/hyperpronation

111
Q

What is a galeazzi fx?

A

fx of distal third of the radius accompanied w/dislocation of distal RU jt

112
Q

What are common causes of elbow dislocation?

A
  • falls, sports, physical assault from valgus moment w/axial load and supination
113
Q

What is the 2nd most frequent dislocated major joint

A

Elbow

114
Q

How are elbow dislocations named?

A

Direction of the ulna/radius

115
Q

What injuries can occur from dislocations

A

Nerves!

116
Q

Posterior/posteriolateral dislocation of elbow presentation

A
  • sudden onset hx
  • deformity of elbow: shorter forearm, disrupted anatomical triangle, dlbow in 45 deg flexion
117
Q

What should you do if you see posterior/posteriolateral dislocation?

A

Immediate reduction + ortho consult for neurovascular assessment

118
Q

What is the terrible triad of the elbow?

A
  • posterior elbow dislocation
  • radial head fx
  • type I cornoid fx
119
Q

What is a perched dislocation?

A

subluxation of humerus onto coronoid process that can lead to medial instability

120
Q

RA at the elbow causes?

A
  • loss of elbow extension
  • local swelling and warmth
  • large cysts along olecranon/prox ulna
121
Q

OA at the elbow s/s?

A
  • loss of terminal extension
  • painful locking
  • ulnar neuropathy
122
Q

What causes myositis ossificans of the elbow?

A
  • contusino to brachialis from posterior dislocation or suprachondylar fx
  • too mch stretching post injury/immobilization
123
Q

S/S of myositis ossificans

A
  • pain w/elbow flexion and extension
  • palpable area on mm that is warm to touch
  • bony end feel
  • limited ROM

UM - UQ (5 decks)

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