Elbow/ wrist/ hand Flashcards
Components of UCL and ROM with most stress at each band
Anterior band: the strongest, Todd from full extension to 60° of flexion
Posterior band taught from 60 to 100° of flexion
Transverse band a.k.a. Cooper’s ligament variably present
The Trochlea and it’s effect on the carrying angle
Carrying angle males and females
Trochlea extends more distantly then lateral consuls
Female = 13° to 60° male = 11° to 14°
RCL components and range of motion that most stress each component
Annular ligament: stabilizes PRUJ
Radio portion: taut through flexion and extension
Ulnar portion taught through both flexion and extension provide stability to humeral owner joint
Accessory portion: assists RCL and stabilizing the annular ligament against Varus stress, variably present
Radial head’s influence on stability for valgus stress
With UCL insufficiency Radial head plays a strong role as a stabilizer to valgus stress
Terrible Triad of the elbow
Posterior elbow dislocation with Radial head fracture in a coronoid fracture
Nerve injury and elbow dislocation
Ulnar and median nerve injuries more common with simple dislocations
Radial nerve injury more common with complex dislocations involving the radial head
Goals of nonoperative management of a simple dislocation
First: achieve stable joint immediate functional mobility is recommended
Secon:d if joint is unstable immobilization for less than 14 days
Five considerations for elbow dislocation
One – timing Two – articulations involved Three – direction of displacement Four – degree of displacement Five – presence or absence of fractures
Three core principles of operative management elbow fracture
One – restoration of integrity of humeralulnar joint
Two – restoration of Radial head position
Three – repair of collateral ligaments
Post surgical plan of care for terrible Triad injury
Immobilization – at 90° for 0 to 10 days
Active range of motion- begin between three and 15 days postoperatively
Strengthening – begin at eight weeks/when radiograph indicates fx healed
Radial head fracture three Common mechanisms of injury
Ask your road on a pronated forearm, direct blow to the elbow, hyper flexion injury
Indications for a total elbow arthroplasty
Advanced age, low physical demand, chronic instability, advanced rheumatoid arthritis, posttraumatic osteoarthritis, ankylosis of the elbow, stiffness, functional range of motion last, and pain
Heterotropic ossificans in three conditions that contribute to its formation
The appearance of ectopic bone in the para particular soft tissues
Osteogenic precursor cells, inducing agents, and a permissive environment
Indications for operative management of elbow stiffness
Failure of nonoperative management, chronic contracture present for up to 12 months, and lack of functional range of motion
Three mechanisms of injury for RCL
Elbow dislocation, varus elbow stress or iatrogenic cause
Presentation of our RCL or PLRI injury
Vague about his comfort, lateral elbow pain, clicking, snapping, or clicking it is worse with supination of the forearm
Special tests for posterolateral rotary instability
Lateral pivot shift of the elbow, push-up sign, chair sign, press up maneuver
Phases of throwing with most strain on UCL
Late cocking/cocking to the acceleration phases
Special Tests for UCL insufficiency
Moving valgus stress test – SN = 1.0, SP = .75
Milking test
Valgus stress test
Little leaguers elbow risk factors
Number pitches thrown in the game, less than 25 pitches increased elbow injury to 21% 75 to 99 pitches increased risk to 35%
Valgus extension overload syndrome definition, testing, and signs
Compression of the olecranon against humerus with a valgus stress generating a posterior medial impingement
Milking maneuver with elbow flexed to 90°
Flexion contracture, painful active extension with crepitus, passive range of motion painful and pronation valgus and extension
Tenderness to palpation at posteromedial olecranon
Indications for ucl surgical intervention
Chronic instability, failure of nonoperative rehab, continued pain, sense of movement in elbow with valgus loads, inability to return to previous level of function
Rehabilitation of UCL reconstruction
First one to two weeks range of motion restriction with hinged brace, strengthening introduced after 4 to 6 weeks, throwing not introduced until after four months, not allowed to return to sport until 9 to 12 months
Risk factors for lateral tendinosis
35 to 50 years of age, female, high levels of physical work on a low social support at work, workers belonging to a profession classified as strenuous
Special tests for medial and lateral tendinopathy
Medial – palpation of the medial epicondyles, grip strength, passive positioning test
Lateral – isometric contraction of wrist extension, grip strength, cozen test, mill test, three finger resistance test, handshake test
Nonoperative management of elbow tendinopathy recommendations of evidence
Manual therapy – Mulligan mobilizations, cervical manual therapy
Exercise – eccentric, progressive exercises
Soft tissue mobilization- marginal evidence
Bracing/orthotics – short-term relief
Modalities – short-term relief
Corticosteroid injection- short-term relief
Low level laser – moderate benefit
Shockwave therapy- little or no benefit
Special test for distal biceps tendon rupture
Hook test – SN/SP equals 1.0
Biceps crease interval test – SN = .92, SP = 1.0
Cluster for cervical spine radiculopathy
Cervical spine active range of motion limited in rotation towards involved side
Cervical spine distraction decrease in symptoms
Sperling’s test increase his symptoms
Upper limb tension test difference of greater than 10° elbow extension between extremities
Four out of four = 90% possibility
Three out of four= 65%
Cubital tunnel syndrome mechanisms of injury
Traction, long-standing valgus deformity, or strained postures of flexion contracture
Patient education for nonoperative management of Cubital tunnel syndrome
Avoid activities of elbow flexion greater than 90°, excessive use of wrist and finger flexion, position of valgus stress at elbow
Special test for cubital tunnel syndrome
Tinel test at cubital tunnel – Sn = .70, SP = .98
Elbow flexion test – Sn = .75, SP= .99
Clinical presentation of pronator versus anterior interosseous syndromes
Pronator syndrome – pain volar proximal forearm/sensory changes on Palmar surface/weakness of thumb, index, middle/positive compression at pronator border
Interior interosseous syndrome – pain volar proximal forearm/no sensory symptoms in finger/weak flexor pollicis longus, lateral flexor digitorum profundas, thenar sparing/negative compression at pronator border
Clinical presentation of radial tunnel syndrome
Deep aching distal to lateral epicondyles, pain at belly at brachioradialis, pain with resisted supination, pain with repetitive wrist flexion/pronation, No motor or sensation loss
Clinical presentation of posterior interosseous syndrome
Lateral forearm elbow pain, wrist extension with radio deviation, weakness of finger extensors, extension elicits pain at lateral epicondyle, no sensation loss
Clinical presentation of osteochondritis desiccans
Swelling, limited range of motion and extension, lesser loss of range of motion flexion/supination/pronation and tenderness to palpation at radiocapitular joint
Five Ps of compartment syndrome
Pain, pallor, pain with passive stretch of muscles, paresthesias, pulselessness
Pulse will typically be present until and stage of syndrome
Pronator syndrome versus anterior interosseous syndrome
Pronator syndrome – paid volar proximal forearm, sensory changes on Palmar surface, weakness of thumb index middle, positive compression at pronator border
AIN – pain volar proximal forearm, no sensory symptoms, weakness flexor pollicius longus/ lateral flexor digitorum profundus, thenar sparing, negative compression pronator border
Spontaneous recovery time for AIN syndrome
12 months – therefore surgical intervention will not be administered until after this
Compression sites for AIN
Bicipital aponeurosis, accessory head of the FPL, palmaris profundus muscle, or FCR muscle
Radio tunnel syndrome versus PIN syndrome
RTS – deep ache distal to lateral epicondyle, pain at belly brachioradialis, pain with resisted supination, pain with repetitive flexion and pronation, no loss of motor or sensory
PIN – lateral forearm elbow pain, wrist extension with radial deviation, pain at lateral epicondyle with extension, no sensation loss
Differential diagnosis of lateral tendinopathy versus RTS
Consider RTS with failure for armband with increase in symptoms and loss of grip strength
Hi correlation between the two diagnoses
Indications for surgical intervention for carpal tunnel syndrome
Conservative treatment not affective in three months, thenar atrophy, Simmons Weston monofilament testing exceeds 3.16
