Elbow Pathology Flashcards
Etiology - elbow dislocation
Usually from forced elbow hyperextension
Elbow dislocation - which direction is most common
98% are posterior dislocations
What is typically associated with an elbow dislocation
MCL injury (34% are torn) 25-50% have associated fractures
What are the associated fractures with an elbow dislocation
Usually radial head
Coranoid process can also be fractured (brachialis)
Type of elbow dislocation
Complete
Partial/Perched
Complete elbow dislocation
Anterior capsule is disrupted
Brachialis is torn or significantly stretched
Partial/perched elbow dislocation
Partial dislocation
Less capsular/ligamentous injury
Presentation with elbow dislocation
Pain/edema
Possible deformity
ROM limitations
Weakness
Elbow dislocation - stable dislocations are usually
splinted to prevent hyperextension of the elbow for the first few days
Elbow dislocation - unstable dislocation usually require
repair of the MCL
Elbow dislocation - recurrence
is rare but may be present if dislocation was unstable or occurred in childhood
What structures may be involved with an elbow dislocation
Coronoid Radial head Brachialis Ulnar or median n. MCL
Functional limitations someone with an elbow dislocation may complain of
Dec ROM
Inflammation
Maybe bruising if mm involved
Wont be able to lift things, carry objects, extension would be bad
Nursemaid’s elbow - describe what it is
Radial head subluxation - typically in children
Etiology of nursemaid’s elbow
traction force applied to forearm
Presentation of nursemaid’s elbow
Diffuse pain
Dec use of arm
MCL Sprain/Tear - etiology
Elbow dislocation
Forceful valgus stress
Repetitive trauma (throwing)
MCL Sprain/Tear - surgical repair
Graft from palmaris longus, extensor hallucis longus
Presentation of an MCL sprain/tear - Grade 1
A small number of fibers are torn
Some pain but full function
Presentation of an MCL sprain/tear - Grade 2
A significnat number of fibers are torn
Moderate loss of function
Presentation of an MCL sprain/tear - Grade 3
All fibers are ruptured resulting in elbow instability
Major loss of function
Can you live with an MCL tear/without an MCL?
Yes - Humeroulnar joitn has a lot of boney contact, plus there are not many times that we go into full extension with a calgus stress at the elbow
Might have reduced extension but as long as life/occupation allows, the person would be fine
What is the surgery called for MCL tear
Tommy Johns
Etiology - radial head fracture
Direct trauma
Usually a fall or dislocation
Presentation for radial head fracture - Type 1
Non displaced
What should be avoided with Type 1 Radial head fracture
Carrying
Pronation and supination in full range
Flexion and extension in extreme range
Presentation of radial head fracture - Type 2
Minimal displacement and/or angulation
Presentation of type 3 radial head fracture
Comminuted radial head
Presentation of type 4 radial head fracture
Radial head fracture with elbow dislocation
Radial head fracture secondary to elbow dislocation - what other structures may be involved
MCL
Coranoid process
Brachialis
Capsule
Rehab for type 1 radial head fracture
Little to no immobilization
ROM ASAP
Protocol and rehab for type 2 radial head fracture
ORIF
Immoblization for brief time
Pain and edema relief, ROM
Protocol and rehab for type 3 radial head fracture
ORIF - usually requires stabilization of elbow and excision of fragments
Immobilize
Pain and edema relief
Protocol and rehab for type 4 radial head fracture
Rehab depends on extent of injury
Etiology of lateral epicondylitis/epicondylagia
Caused by repetitive microtrauma to teh extensor mass - specifically ECRB
Could also be caused by change in regular activity or overuse
Presentation of lateral epicondylitis/epicondylagia
Pain with resisted wrist and finger ext
Tenderness with palpation of common extensor site
Wrist ext weakness, maybe decreased grip strength
Coffee cup sign
Diffuse medial region elbow pain - what will you check
Tendon of wrist flexors
Ulnar nerve and mm innervated by it
MCL
Etiology of medial epicondylitis/epicondylalgia
Tendonitis of the wrist flexors
Caused by microtrauma to wrist flexor insertion site
Faulty mechanics with gold swing
Repetitive and/or forceful throwing
Presentation of medial epicondylitis/epicondylalgia
pain with resisted wrist flexion and/or pronation
Weakness due to pain, dec grip
Etiology of olecranon bursitis
Trauma - direct blow to elbow
Prolonged sustained pressure on the elbows
Presentation of olecranon bursitis
Swelling and erythema over olecranon process
Exquisite tenderness directly over olecranon process
Swollen bursa
Functional limitation with medial epicondylitis/epicondylalgia
elbow and/or wrist flexion activities
Olecranon bursitis patient - cause is trauma - what else do you need to do
Check for fracture - refer for xray
Olecranon bursitis - not concerned about fracture - what do you do
Rest, avoid stress and pressure on bursa, make sure they keep motion but avoid repetitive motion
Arthroplasty - post decompression of the elbow - etiology
Presence of a post compartment osteophyte
Severe arthritis
Presentation of arthroplasty - post decompression of the elbow
ROM limitations
Pain
Biceps brachii rupture - etiology
Degeneration - long head prox attachment (most common)
Heavy lifting - typically distal attachment
Presentation of biceps brachii rupture -
Physical deformity
Initial pain and then progress to no pain
Strength limitations
If long head of biceps ruptures proximally - does the patient need surgery
No because the the shoulder mm can produce shoulder flexion and we can flex shoulder without long head
If long head of biceps ruptures distally - do they need surgery
No - but elbow flexion and supination will dec in power and force
Neuropathies =
Compression of nerve located within the area of the elbow or forearm
Symptoms of neuropathies
Parasthesias, weakness, pain
Can be acute or chronic
Compression of the median nerve- site
Elbow
Pronator teres
Ant. interossei region
Wrist - carpal tunnel
Median nerve compression - presentation
Paresthesia in thumb, 2nd and 3rd fingers
Weakness in forearm/hand mm innervated by median nerve
Radial nerve compression - sites
Elbow
Post interosseous region
Diff Dx - complain of lateral elbow pain
Radial head position
Nerve
Extensor mm for lat epi
Radial nerve compression - presentation
Paresthesia in radial nerve distribution
Possibel weakness in radial nerve innervated mm
Similar sx of lateral epcondylitis
Ulnar nerve compression - site
Cubital tunnel
Guyon’s tunnel
Ulnar nerve compression - presentation
Paresthesia in ulnar nerve distribution
Possible weakness in ulnar nerve innervated mm
