Elbow Pathology Flashcards by Alex Stein

Etiology - elbow dislocation

Usually from forced elbow hyperextension

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Elbow dislocation - which direction is most common

98% are posterior dislocations

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What is typically associated with an elbow dislocation

MCL injury (34% are torn)
25-50% have associated fractures

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What are the associated fractures with an elbow dislocation

Usually radial head

Coranoid process can also be fractured (brachialis)

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Type of elbow dislocation

Complete

Partial/Perched

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Complete elbow dislocation

Anterior capsule is disrupted

Brachialis is torn or significantly stretched

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Partial/perched elbow dislocation

Partial dislocation

Less capsular/ligamentous injury

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Presentation with elbow dislocation

Pain/edema
Possible deformity
ROM limitations
Weakness

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Elbow dislocation - stable dislocations are usually

splinted to prevent hyperextension of the elbow for the first few days

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Elbow dislocation - unstable dislocation usually require

repair of the MCL

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Elbow dislocation - recurrence

is rare but may be present if dislocation was unstable or occurred in childhood

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What structures may be involved with an elbow dislocation

Coronoid
Radial head
Brachialis
Ulnar or median n. 
MCL

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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

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Nursemaid’s elbow - describe what it is

Radial head subluxation - typically in children

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Etiology of nursemaid’s elbow

traction force applied to forearm

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Presentation of nursemaid’s elbow

Diffuse pain

Dec use of arm

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MCL Sprain/Tear - etiology

Elbow dislocation
Forceful valgus stress
Repetitive trauma (throwing)

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MCL Sprain/Tear - surgical repair

Graft from palmaris longus, extensor hallucis longus

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Presentation of an MCL sprain/tear - Grade 1

A small number of fibers are torn

Some pain but full function

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Presentation of an MCL sprain/tear - Grade 2

A significnat number of fibers are torn

Moderate loss of function

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Presentation of an MCL sprain/tear - Grade 3

All fibers are ruptured resulting in elbow instability

Major loss of function

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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

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What is the surgery called for MCL tear

Tommy Johns

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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