Ferril's UE DSA Flashcards
ddx of elbow pain in children
- buckle or greenstick fracture of distal humerus
- growth plate injury of distal humerus or proximal radius (Salter-Harris)
- elbow dislocation
- avulsion fracture
- nursemaid’s elbow
radiocapitellar line on XR indicates
radial dislocation
anterior humeral line on XR indicates
supracondylate fractures
fat pad sign on XR indicates
sign of effusion and occult fracture
define greenstick fracture of distal humerus
fracture w/o cortical bone disruption, most common type of fracture in children
is imaging needed for elbow pain?
not indicated if diagnosis is clear. If diagnosis is not clear, then AP and lateral films to rule out fracture or discloation
nursemaid’s elbow pathology
subluxation and entrapment of annular ligament over the radial head
SD for elbow pain
look for fascial strain in the UE, upper ribs, upper thoracic, and cervicals
OMT tx for elbow pain
- rib BLT
- thoracic myofascial release
- clavicle BLT
- cervical FPR
- extremity Still technique
reciprocal tension ligaments
role of ligaments in joints - throughout the physio range of motion of any given joint, the associated ligament maintains a constant level of tension
reciprocal tension mechanism
shared tension within the ligamentous articular mechanism of any given joint remains constant as long as the ligament is not damaged
dx in BLT
determine the restriction of the joint
principle of tx of BLT
the point in the ROM of an articulation where the ligaments and membranes are poised between the normal tension present throughout the free ROM and increased tension preceding the strain
humerus BLT dx
- have arm at 45-90 degrees laterally from body and elbow flexed
- compare external and internal rotation
- restriction in on direction indicates lesion in the opposite position
humerus BLT tx
- physicians’ hands reach around the humerus with the fingers as superior a contact on the humerus into the axilla as possible (caution about placement as brachial plexus is vulnerable to compression)
- patient reaches the hand of the involved side across chest to opposite clavicle and hold shoulder
- patient move uninvolved shoulder posteriorly, carrying with it the hand of the lesioned side
- BLT established by gently internally or externally rotateing the humerus with a slight superior motion to help engage the entire joint capsule
scapulothoracic BLT dx
- physician assesses position of scapula on thorax
2. hypertonic serratus anterior will produce elevation and lateral displacement of scapula
scapulothoracic BLT tx
- physician places pad of thumb on the ribs at the mid-axillary line as superior as possible, and then slides the thumb posteriorly along the patient’s ribs until it is under the scapula
- patient lean towards the physician so the physician’s thumb slides further under the scapula until reach the resistance of serratus anterior
- physician place other hand on top of the scapula, grasping the spine of the scapula with her fingers
- inferior traction is placed on the scapula to achieve balance between the serratus anterior, rhomboids, and teres mm
- position held until serratus anterior relaxes
mechanism of Still technique
- move restricted joint or tissue into position of ease and exaggerate position of ease until tissue relax
- introduce vector of force (compression or traction) through the affected tissue
- using the force vector as level, tissue is taken through its ROM towards and through the initial restriction
- force vector is released an tissue is passively returns to neutral
posterior radial head restriction dx
radial head resists anterior motion and supination
posterior radial head restriction tx
initial position: forearm is brought into pronation until tissue balance is sensed at radial head
final position: gentle axial force is put through the distal radius to the radial head. Maintaining that compression, the forearm is brought into supination. Release the compression
anterior radial head restriction dx
radial head resists posterior motion and pronation
anterior radial head restriction tx
initial position: forearm is brought into supination until tissue balance is sensed at the radial head
final position: gentle axial force is put through the distal radius to the radial head. Maintaining that compression, the forearm is brought into pronation. Release the compression
nursemaid’s elbow PE
- anxious child who is protective of affected arm
- anxiety > pain
- forearm flexed 15-20 degrees and partially pronated
- resistance to move digits or wrists to prevent pain
- tenderness at head of radius
- patient resists supination/pronation and flexion/extension of the forearm
