Elbow wrist and hand Sporting injuries Flashcards
What is Little League Elbow?
Umbrella term for elbow injuries in young athletes caused by different forces: traction (medial), compression (lateral), and shear/traction (posterior)
Includes conditions like Medial Epicondylar Apophysitis
What is Medial Epicondylar Apophysitis?
Classic condition associated with Little League Elbow, characterized by medial elbow pain due to repetitive valgus force
Common in baseball pitchers aged nine to twelve
What are common causes of Little League Elbow?
Repetitive valgus force at elbow (pitching)
High incidence (20-40%) among young baseball pitchers
What demographic is most affected by Little League Elbow?
Baseball pitchers aged nine to twelve years old, also seen in football quarterbacks, gymnasts, and tennis players
20-40% incidence in young baseball pitchers
What are the differential diagnoses for Little League Elbow?
- Medial epicondyle avulsion fracture
- Flexor-pronator tendonitis
- Ulnar collateral ligament sprain/tear
- Ulnar nerve injury or neuritis
- Neoplasm
- Pain referred from neck or shoulder
Diagnosis typically made clinically
What are the symptoms of Medial Epicondylar Apophysitis?
- Insidious medial elbow pain
- Decreased velocity, distance, accuracy
- Increased TTP over medial epicondyle
- Localized swelling
- Stiffness and decreased elbow extension
- Locking and popping
Symptoms progress during late cocking and acceleration phases
What is the recommended treatment for Medial Epicondylar Apophysitis?
- Rest from pitching (4-6 weeks)
- Ice and NSAIDs as needed
- Stretch and range of motion exercises
- Return to competitive throwing (4-6 weeks)
Most can return to pitching in 8-12 weeks
What is the prognosis for athletes with Medial Epicondylar Apophysitis?
Most can return to pitching within 8 to 12 weeks, but long-term issues may arise if they continue pitching
Important to follow treatment recommendations
What causes a Medial Epicondylar Avulsion Fracture?
Valgus stress with flexor-pronator muscle contraction
Typically associated with acute medial elbow pain
What are the symptoms of a Medial Epicondylar Avulsion Fracture?
- Acute medial elbow pain
- Increased severe TTP over medial epicondyle
- Localized swelling and ecchymosis
- Inability to extend elbow
Symptoms occur during late cocking and early acceleration phases
What is the treatment protocol for a Medial Epicondylar Avulsion Fracture?
- Non-surgical: immobilization, range of motion starting at 2-3 weeks, begin throwing after fracture healing
- Surgical: for 2-5mm of fracture displacement, return to play in 12 weeks for position players and 4-6 months for pitchers
Treatment varies based on fracture displacement
What is Ulnar Collateral Ligament Insufficiency?
Uncommon in skeletally immature athletes, characterized by chronic medial elbow pain and decreased velocity and control
May present with ulnar nerve paresthesia and positive valgus stress test
What are the key symptoms of Ulnar Collateral Ligament Insufficiency?
- Medial elbow pain
- Decreased velocity and control
- Ulnar nerve paresthesia (occasional)
- Positive TTP over medial epicondyle
- Localized swelling
- Flexion contracture
Positive valgus stress test at 30 degrees elicits pain
What is Ulnar Collateral Ligament Insufficiency?
a condition where the UCL is weakened or damaged, causing instability in the elbow joint, often leading to pain and decreased ability to perform overhead throwing motions
Often associated with pitching injuries.
What are the non-surgical treatments for UCL insufficiency?
- Rest from pitching (2-3 months)
- Cryotherapy
- Elbow and shoulder range of motion exercises
- Rotator cuff and scapular stabilizer strengthening
- Interval throwing program when asymptomatic
These treatments focus on rehabilitation and recovery.
What surgical treatment is commonly associated with UCL insufficiency?
UCL reconstruction
Also known as Tommy John Surgery.
What percentage of athletes return to play at the same level or higher after UCL reconstruction?
74%
This statistic is observed at around eleven months post-surgery.
What is Little League Elbow?
A condition affecting young athletes, typically characterized by elbow pain due to overuse
Common in youth baseball players.
When should a referral be made for Little League Elbow?
If there is no improvement with rest after 6-8 weeks
Indicates a need for further evaluation.
What are the prevention strategies for Little League Elbow?
- No competitive throwing for more than 9 months per year
- Follow pitch guidelines
- Avoid high velocity and breaking pitches
- Correct technique
- Cardiovascular fitness and core strengthening
These strategies help reduce the risk of injury.
What is Panner Disease?
Idiopathic osteochondrosis of the capitellum in children
Typically found in children aged four to nine.
What are the common symptoms of Panner Disease?
- Insidious onset of vague lateral elbow pain
- Stiffness
Symptoms can gradually develop over time.
What is the preferred non-operative treatment for Panner Disease?
- Ice
- NSAIDs
- Immobilization
- Rest for 3-4 weeks
Most cases recover with conservative treatment.
What is Osteochondritis Dissecans (OCD)?
Lesions affecting the capitellum or radial head
Primarily affects adolescents aged 12 to 16.
What are the presentations of Osteochondritis Dissecans?
- Dull, vague lateral elbow pain
- Increased pain with activity
- Catching and locking sensations
- Tenderness to palpation, swelling, crepitus, extension loss
Symptoms often worsen with physical activity.
What is the arthroscopic staging system for Osteochondritis Dissecans?
- Stage Ia: intact articular cartilage; no stability loss
- Stage Ib: intact articular cartilage; unstable bone
- Stage II: cartilage fracture; bone collapse
- Stage III: loose cartilaginous fragments in joint
Staging helps guide treatment options.
What is the prognosis for non-operative treatment in OCD?
Somewhat unpredictable
Depends on the stage of the condition and patient factors.
What is Posteromedial Impingement?
Impingement of the medial aspect of the olecranon process against the olecranon fossa
Common in throwing athletes.
What is the mechanism of injury (MOI) for Posteromedial Impingement?
Shear stresses during the deceleration phase of throwing
Also referred to as ‘Valgus Extension Overload.’
What are the symptoms of Posteromedial Impingement?
- Posteromedial elbow pain
- Limitation of motion
- Loose body symptoms
Symptoms may vary in severity.
What is the main clinical test for confirming posteromedial impingement?
The posteromedial impingement test
The examiner forces the slightly flexed elbow into extension while applying a valgus force, reproducing pain along the posteromedial elbow.
List the preferred non-operative treatments for posteromedial impingement.
- Rest
- Activity modification
- Ice
- NSAIDs
Non-operative treatment is preferred for posteromedial impingement.
What surgical treatment is indicated for failed conservative management of posteromedial impingement?
Removal of osteophytes (arthroscopic vs. open)
Surgical treatment is considered when non-operative methods fail.
What is the most common type of elbow dislocation?
Posterior dislocations
Posterior dislocations are the most common type in elbow injuries.
What are the mechanisms of injury (MOI) for posterior elbow dislocations?
- FOOSH (fall on an outstretched hand)
- Traction
These mechanisms can lead to posterior elbow dislocations.
What is the emergent treatment for posterior elbow dislocations?
- Closed reduction attempt (on the field)
- Medication reduction under conscious sedation (if closed reduction fails)
Radiographs are also necessary for assessment.
What are the post-reduction treatment steps for posterior elbow dislocations?
- Cessation of sport (one to two weeks)
- Posterior splint (one to two weeks)
- Active range of motion therapeutic exercise (progressive)
This treatment aims to restore function after dislocation.
What criteria must be met for a player to return to play after a posterior elbow dislocation?
- No pain or swelling
- Normal elbow range of motion and strength
These criteria ensure the player is fit to resume activities.
What complications can arise from posterior elbow dislocations?
- Stiffness
- Instability
- Myositis Ossificans
- Neurovascular injury
These complications can affect recovery and function.
What is Nursemaid’s elbow?
Radial head pulled inferiorly from annular ligament
This condition is often due to a traction injury of the radius.
What is the emergent treatment for Nursemaid’s elbow?
- Closed reduction attempt (on the field)
- Medication reduction without sedation (if closed reduction fails)
Radiographs may also be necessary for assessment.
What are the post-reduction treatment steps for Nursemaid’s elbow?
- Allow patient to move arm normally (five minutes)
- No splinting needed
- Active range of motion therapeutic exercise (progressive, unstructured)
This approach facilitates recovery and normal function.
What criteria must be met for a patient to return to play after Nursemaid’s elbow?
- No pain or swelling
- Normal elbow range of motion and strength
These criteria ensure safety for resuming activities.
What are the rare complications associated with Nursemaid’s elbow?
- Instability
- Stiffness
While rare, these complications can occur post-treatment.
Describe the technique for posterior dislocation reduction.
- Traction-countertraction with the arm in extension
- With traction maintained, the elbow is gently flexed
- Pressure with the thumb is applied to the olecranon
This allows the coronoid to clear the trochlea.
How is Nursemaid’s elbow reduced?
- Supination, flexion (squeeze)
- Pronation, extension (squeeze to guide radial head back into place)
This technique is effective for restoring the radial head position.
What is the primary complaint associated with chronic wrist pain in gymnasts?
Dorsal-sided wrist pain
This condition is particularly prevalent among gymnasts.
What radiographic findings are associated with chronic wrist pain in gymnasts?
- Positive ulnar variance
- Ulnocarpal abutment
- Triangular fibrocartilage tears
- Radiocarpal joint degenerative changes
These findings are common in both elite and non-elite gymnasts.
What is the conservative treatment for chronic wrist pain?
Rest for four to six weeks, training modification, bracing (wrist cock-up or thumb spica splint)
Conservative treatment focuses on non-surgical methods to alleviate pain and promote healing.
What are the surgical treatment options for chronic wrist pain?
Arthroscopy, shortening osteotomy (distal ulna)
Surgical options are considered when conservative treatments fail to relieve symptoms.
What is the most common carpal fracture in children?
Scaphoid fracture
Despite being the most common, scaphoid fractures have a low overall prevalence.
What is the mechanism of injury (MOI) for a scaphoid fracture?
Usually a FOOSH injury (fall on outstretched hand)
This type of injury is a common cause of wrist fractures in children.
What percentage of scaphoid fractures are missed in radiographs?
12-36%
This indicates that scaphoid fractures can often go undetected on initial imaging.
Where can a scaphoid fracture occur?
Distal pole, waist, or proximal pole
The location of the fracture can affect treatment and prognosis.
What symptoms suggest a scaphoid fracture?
Pain over the volar surface of scaphoid, pain with radial deviation of wrist, pain with active wrist range of motion
These symptoms are critical for diagnosis.
What is the treatment for a minimally displaced scaphoid fracture?
Long arm thumb spica cast
Immobilization is key until healing is evident on radiographs.
What type of cast is used after two weeks for a scaphoid fracture?
Short arm thumb spica cast
This is typically used once initial swelling has decreased.
What are the characteristics of lunate/capitate dislocations?
Either dorsal or volar direction
Directionality can impact treatment and recovery.
What is the mechanism of injury (MOI) for lunate/capitate dislocations?
History of fall on hand or strain
Similar to scaphoid fractures, these injuries are often due to falls.
What are the presentations of lunate/capitate dislocations?
Generalized wrist pain, wrist pain at end range flexion/extension, decreased grip strength, pain with grasping objects
These signs help in identifying the dislocation.
What is Kienbock’s Disease?
Avascular necrosis of the lunate bone
This condition is often seen in adolescents and can lead to chronic pain.
What are the symptoms of Kienbock’s Disease?
Pain and stiffness, carpal tunnel syndrome-like symptoms
These symptoms may mimic other wrist conditions.
What is the modified Stahl’s classification for Kienbock’s Disease?
Stage I: normal appearing lunate with compression fracture, Stage II: sclerosis of the lunate, Stage III: collapse of the lunate, Stage IV: pancarpal arthrodesis
This classification helps in determining the severity and treatment options.
What is a Boxer’s fracture?
Fifth metacarpal neck fracture
Commonly associated with punching injuries.
What is the typical mechanism of injury (MOI) for a Boxer’s fracture?
Usually street scuffle or amateur boxing
This injury often occurs in combat sports or fights.
What is the presentation of a Boxer’s fracture?
Rotation/overlapping digits
This can be indicative of the fracture’s impact on finger alignment.
What is Jersey Finger?
FDP tendon avulsion from distal phalanx insertion
This injury typically affects the flexor tendon in the finger.
What is the mechanism of injury (MOI) for Jersey Finger?
Forced extension of a flexed distal interphalangeal (DIP) joint
This often occurs in contact sports.
What classification exists for Jersey Finger?
Type I: retraction to palm, Type II: retraction to PIP joint, Type III: retraction to A4 pulley
This classification helps in determining the severity of the injury.
What is the ‘Gold Standard’ treatment for Jersey Finger?
Surgical repair (seven to ten days)
Timely surgical intervention is crucial for optimal recovery.
What is the typical recovery time for return to play after Jersey Finger treatment?
Eight to twelve weeks
Recovery time can vary based on the severity of the injury and treatment.
What is Mallet Finger?
Terminal extensor disruption at its insertion on the distal phalanx
Involves inability to extend the distal interphalangeal joint (DIP) actively.
What is the mechanism of injury (MOI) for Mallet Finger?
Hyperflexion of extended DIP or hyperextension with axial load
This typically occurs during sports activities.
What is the presentation of Mallet Finger?
Inability to extend DIP actively
Radiographs are warranted to assess the injury.
What is the non-operative treatment for Mallet Finger?
Splinting for four to six weeks (24 hours), night splint/day taping, and flexion exercises
Flexion should never be allowed during the treatment.
When is surgical treatment indicated for Mallet Finger?
For large dorsal fragments (30-40% of the articular surface) or Salter-Harris III fractures
This is necessary if non-operative treatment fails.
What is Gamekeeper’s Thumb?
Disruption of UCL of thumb MP joint
The UCL is the ulnar collateral ligament.
What is the MOI for Gamekeeper’s Thumb?
Falling with a ski pole or a valgus force on an abducted thumb
This injury is common in sports involving gripping.
What are the key symptoms of Gamekeeper’s Thumb?
Pain and/or laxity of thumb ulnar side
Radiographs are needed to rule out fractures.
What is the non-operative treatment for Gamekeeper’s Thumb?
Short arm thumb spica splint for four weeks if there is no significant fracture
This is applicable for nondisplaced fractures around the MP joint.
When is surgical treatment necessary for Gamekeeper’s Thumb?
For displaced fractures around MP joint or if proper and accessory ligaments are disrupted
A Stener lesion may be present, indicated by a palpable mass.
What are digit fractures most common in?
Ball sports
Injuries occur when fingers get ‘jammed’ by a ball.
What are the presentations of digit fractures?
Pain at site, ecchymosis, restricted motion (intraarticular)
Radiographs are needed to rule out rotational deformity.
What is the non-operative treatment for digit fractures?
Aluminum finger splint (three to four weeks) and buddy tape (three to four weeks)
This treatment is not effective for fixing rotational deformities.
What is the surgical treatment for digit fractures?
K-wire (two to four weeks), immobilize (three to four weeks), buddy tape (two more weeks)
Surgery is indicated in 10-20% of cases.
What techniques are evaluated in the demonstration?
Scaphoid fractures, lunate/capitate dislocations, boxer’s fractures, jersey finger, mallet finger, gamekeeper’s thumb, digit fractures
The demonstration uses a pen at the volar plate of the fourth digit.
What is Ehlers Danlos Syndrome (EDS)?
Inherited disorder characterized by a decrease in the tensile strength and integrity of connective tissues
What types of tissues are primarily affected by Ehlers Danlos Syndrome?
Skin, joints, and blood vessel walls
What is the prevalence of Ehlers Danlos Syndrome?
1 in 10,000 to 15,000 people
Which type of Ehlers Danlos Syndrome is primarily dealt with in the content?
Type III (hypermobile type)
What is the Beighton Score used for?
Assessing joint laxity
What is the score for passive dorsiflexion of the left little finger beyond 90 degrees?
1
What is the score for passive dorsiflexion of the left little finger less than or equal to 90 degrees?
0
What is the score for passive dorsiflexion of the left thumb to the flexor aspect of the forearm?
1
What is the score for a right elbow that hyperextends beyond 10 degrees?
1
What indicates a left knee that extends less than or equal to 10 degrees?
0
What must be true for the forward flexion of the trunk with knees fully extended to score 1?
Palms and hands can rest flat on the floor
What is a recommended approach to treatment for Ehlers Danlos Syndrome?
Maintain a global approach, keep things ‘low and slow’, avoid cross-legged sitting
Why are typical treatment procedures not always effective for EDS patients?
If EDS is suspected, referral to human genetics is often necessary
True or False: It is more common to have a common presentation of an uncommon problem.
False
