final Flashcards
1
Q
What is defined as “partial or complete injury of the elbow ligamentous complex”?
A
elbow sprain
2
Q
What ligaments are included in the elbow complex?
A
LCL, MCL, annular lig, joint capsule
3
Q
What are the most important stabilizers of the elbow?
A
MCL and LCL
4
Q
What else contributes to elbow stability?
A
bony locking mechanism
5
Q
Why does the elbow have “continual compensatory function”?
A
it is adjacent to GH joint which is inherently unstable
6
Q
Which ligament is especially important during mid-ROM of the elbow?
A
MCL
7
Q
When the elbow is at 90 degrees, what accounts for >50% of valgus stability and 80% of distraction stability?
A
MCL
8
Q
When are both anterior and posterior fibers of the elbow joint capsule taut?
A
fully extended and fully flexed
9
Q
What is considered secondary support for the MCL at the elbow?
A
common flexor tendon
10
Q
Which side of the elbow is more prone to injury?
A
lateral side
11
Q
What is the most common MOI of elbow sprain?
A
FOOSH
12
Q
Which direction of stress is more likely to create a fracture, valgus or varus?
A
varus stress
13
Q
What is an important DDX for elbow sprain?
A
lateral epicondylitis
14
Q
What ortho tests should be done to rule in elbow sprain?
A
valgus and varus stress tests
15
Q
What is the “P” for elbow sprain Tx?
A
sling/brace/tape in resting position
16
Q
What is the “OL” for elbow sprain Tx?
A
technique, work position, AROM (pain free early), isometrics
17
Q
What direction should you do soft tissue massage for an elbow sprain?
A
Start distally, move proximally
18
Q
Which elbow dislocation is direction is rare but very serious?
A
Posterior dislocation. D/t Fx risk, massive contracture, subsequent risk of neurovascular compromise
19
Q
What is also known as tennis elbow?
A
lateral epicondylitis
20
Q
What is lateral epicondlyitis pain usualy d/t?
A
degenerative tendinopathy, periostitis, possible adhesions
21
Q
What muscle/tendon is usually most involved in lateral epicondylitis?
A
ECRB (sometimes ECU, ED and supinator)
22
Q
T/F: Golfers do not get lateral epicondylitis
A
FALSE
23
Q
In golfers, which elbow gets medial epicondylitis?
A
trailing arm
24
Q
In golfers, which elbow gets lateral epicondylitis?
A
leading arm
25
What is the most common elbow condition?
lateral epicondylitis
26
In what age group is lateral epicondylitis most often seen?
40-60 yo
27
What is the etiology of lateral epicondylitis?
repetitive overuse, usually starts with inflammation of tendon
28
how much does the risk of lateral epicondylitis increase in males over 40?
2x
29
how much does the risk of lateral epicondylitis increase in females over 40?
4x
30
Does lateral epicondylitis occur more frequently in tennis players, or as a work related injury?
work related
31
What is one of the most common symptoms of lateral condylitis?
weakness and pain with gripping
32
What ortho tests are used to Dx lateral epicondylitis?
Cozens test, Mills test, long finger test, book test
33
What is a good outcome measure for lateral epicondylitis?
grip strength via dynamometer
34
What kind of supports can be used in early treatment of lateral epicondylitis?
elbow/wrist sleeves (avoid tension braces early)
35
How should the wrist be positioned for splinting of lateral epicondylitis in the late stage of Tx?
hold wrist in extension to take stress of extensors (only in severe cases)
36
What can negatively effect the long term prognosis of lateral epicondylitis?
computer use
37
What increases the possibility of a poor short term outcome to conservative tx?
neuro s/sx
38
medial epicondylitis causes medial elbow pain involving tendinopathy of what?
common flexor tendon
39
what does medial epicondylitis in children lead to?
traction apophysitis of medial epicondyle (salter harris Fx)
40
what is the epidemiology of medial epicondylitis?
>40 yo, caucasian
41
what kind of muscle imbalances occur in medial epicondylitis?
decreased biceps and pronator flexibility, decreased pronator and wrist flexor strength
42
T/F: medial epicondylitis usually occurs from trauma
false - overuse
43
which epicondylitis are baseball pitchers more likely to have?
medial
44
how does the pain location of child vs adult with medial epicondylitis differ?
child = generalized adults = localized
45
what two tests are usually positive with medial epicondylitis?
reverse cozens, reverse mills (both have pain at medial epicondyle)
46
In a pt with lateral elbow pain, what are the common trauma related DDXs?
contusion, bursitis, sprain/strain, radial head subluxation
47
in a pt with lateral elbow pain, what are the common activity related ddxs?
lateral epicondylitis, LCL sprain
48
what is the most common site of DVT in the upper torso?
periscapular
49
in a pt with medial elbow pain, what are the most common trauma related ddxs?
mcl rupture, fracture/avulsion
50
in a pt with medial elbow pain, what are the most common activity related conditions?
medial epicondylitis, mcl sprain
51
what condition usually presents with bishops hand?
ulnar n. entrapment
52
what are the possible ulnar n. entrapment presentations?
n/t/w of 4th and 5th fingers, atrophy of hypothenar, bishops hand
53
in a pt with posterior elbow pain, what are the most common trauma related conditions?
contusion, grade 1-2 strain (triceps), bursitis, radial head subluxation, Fx
54
in a pt with posterior elbow pain, what are the most common activity related ddxs?
lateral and medial epicondylitis, mcl/lcl sprain, triceps tendinopathy (can => bursitis), stress fx
55
how common is anterior elbow pain?
very uncommon - pain usually lateralizes
56
what is olecranon bursitis aka?
miner's elbow, student/draftsman elbow, dart throwers elbow
57
what is the most common superficial bursitis in the body?
olecranon bursitis
58
what is the cause of about 20% of acute cases of olecranon bursitis?
staphylococcus or other gram + infections
59
what are some common causes of olecranon bursitis?
gout, pseudogout, tight triceps, tendinitis
60
what would increase the chance of septic bursitis?
trauma with breaks in skin
61
when palpating the bursa and it feels "gritty" what should you think of?
gout
62
what are the common symptoms of bursitis?
swelling, stiffness, localized to posterior elbow. Pain and tenderness NOT common
63
if when palpating bursa there is pain or tenderness, what should you suspect?
periosteum involved (poss Fx), advanced infection
64
What do 1/3 of olecranon bursitis cases require?
aspiration and culture
65
when should ice be used for olecranon bursitis?
ice is ok in absence of a lot of swelling
66
how quickly does olecranon bursitis heal?
slow
67
what are the follow up procedures for olecranon bursitis?
aspiration (fast RTP), corticosteroid injection, rarely surgery
68
what is elbow osteochondritis dissecans (ocd) aka?
Panner's dz
69
what is elbow OCD?
AVN of capitellum joint surface
70
what is the most common site of OCD in the upper limb?
elbow
71
What is more common, ocd of knee or elbow?
knee
72
What is the epidemiology of elbow ocd?
males (10:1), adolescent athletes
73
what causes elbow ocd?
repetitive valgus stress compressing radial head against capitellum
74
what are 2 common risk factors for elbow ocd?
instability, medial epicondylitis (d/t excess valgus force)
75
what is the onset of symptoms for elbow ocd?
gradual lateral elbow pain
76
what are the common s/sx of elbow ocd?
decreased AROM (esp extension), tender enlarged radial head, lateral elbow pain w/ valgus stress test
77
what do you use to grade severity of elbow ocd?
xrays
78
what are the xray findings of elbow ocd?
stage 1 = subtle, ragged capitellum stage 2= more noticeable, enlarged radial head stage 3= obvious fragmentation(poor prognosis w/ conservative care)
79
what is the most important thing to avoid in elbow ocd tx?
manipulation
80
what is more common, mild wrist sprain or Fx/subluxation/dislocation?
sprain
81
which row of carpals is most vulnerable to sprain?
proximal
82
what wrist positioning is most likely to result in fx?
extension with radial deviation
83
what wrist position is most likely to cause sprain, dislocation, or TFC tear?
extension with ulnar deviation
84
what is the most common MOI for wrist sprain?
hyperextension/FOOSH
85
during a foosh injury, what direction is the proximal row of carpals forced?
anterior
86
which ligamets are sprained in a hyperextension wrist injury?
palmar radiocarpal and scapholunate
87
with a hyperflexion wrist injury, what direction are the proximal carpals forced?
posterior
88
which ligaments are sprained in a hyperflexion wrist injury?
dorsal radiocarpal and lunotriquetral
89
what are the characteristics of bruising and swelling in a wrist sprain?
swelling is less visible than other sprains, bruising is NOT typical
90
what are the most important joint plays in traumatic wrist injury?
scapholunate and lunotriquetral
91
what test is positive with a wrist sprain?
scapholunate and lunotriquetral ballotment/shear test
92
what is the most common form of wrist instability?
dorsal intercalated segmental instability (DISI)
93
what is DISI caused by?
hyperextension
94
what does DISI result in?
disassociation of scaphoid and lunate (+ scapholunate ballotment)
95
what is a Terry Thomas sign?
obvious gap b/t scaphoid and lunate on xray
96
What does a Terry Thomas sign indicate?
DISI
97
what are the 2 types of wrist instability?
DISI and VISI
98
what causes a VISI injury?
hyperflexion
99
what does VISI result in?
disassociation of lunate and triquetrum (+ lunotriquetral ballotment)
100
what is the most frequently dislocated carpal?
lunate
101
what happens to the scaphoid and lunate when wrist is hyperextended?
they move apart
102
what is the most commonly torn ligament in the wrist?
scapholunate
103
what is the most commonly fractured carpal?
scaphoid
104
what are the three most common cysts?
ganglion, bakers, sebaceous
105
what is defined as "a non pathological fluid filled sac"?
bursa
106
what is defined as a "pathological fluid filled sac"?
cyst
107
what are the two types of ganglion cyst?
arthrosynovial (swelling/bulge over joint), tenosynovial (swelling/bulge overlying tendon)
108
which type of ganglion cyst is more common?
tenosynovial
109
what is the epidemiology for ganglion cysts?
females (3:1), teens-late 40s
110
where are ganglion cysts most common?
wrist tendons and wrist joint (usually radiocarpal articulation)
111
what would the ddx be for a cyst located on the ventral side for an older patient?
neurofibromatosis
112
what are the theories for etiology of ganglion cysts?
collagenous degeneration, congenital weakness, or trauma
113
what side of the wrist are ganglion cysts normally located on?
dorsal
114
what is a carpal boss?
osseous overgrowth occasionally mistaken for a ganglion cyst
115
what happens if a ganglion cyst is untreated?
becomes hard
116
which type of ganglion cyst is more likely to have a recurrence?
arthrosynovial
117
which type of ganglion cyst is more likely to need surgery?
arthrosynovial
118
which type of ganglion cyst is usually larger, softer, and more painful?
tenosynovial
119
what is the definition of gamekeepers thumb?
sprain of ulnar/medial collateral lig of 1st metacarpophalangeal joint
120
what is gamekeepers thumb aka?
skiers thumb
121
what is the etiology of gamekeepers thumb?
forceful hyperextension and/or hyperabduction of the thumb
122
what ortho tests are used to dx gamekeepers thumb?
abduction stress test (0/30 flexion), extension msl test, thumb pinch
123
what are the findings and likely treatment for grade 3 gamekeepers thumb?
instability w/o firm end point, >20-30 degrees of instability at full flexion, refer to orthopedist
124
what are the findings and likely treatment for grade 2 gamekeepers thumb?
<20 degrees valgus instability at full flexion, firm endpoint, cast for 2-4 wks
125
what is a stener lesion?
torn UCL and volar plate avulsion, causing significant instability, palpable nodule over UCL helps ID lesion
126
would you adjust gamekeepers thumb?
probably not
127
what type of exercises help with late tx of gamekeepers thumb?
rubber band/squeeze ball/silly putty
128
does skiers thumb involve a sprain or strain?
sprain
129
does Dequervains dzinvolve a sprain or strain?
strain
130
what is dequervains disease?
tenosynovitis of APL and EPB along lateral wrist and base of thumb
131
what is dequervains disease aka?
tenovaginits, stenosing tenosynovitis (severe chronic form)
132
a previous dx of ____ is a common risk factor for dequervains dz
wrist tendonopathy, especially on radial side
133
what is dequervains dz usually d/t?
repetitive overuse of thumb
134
is skiers thumb usually d/t trauma or repetitive overuse?
trauma
135
what is the onset of symptoms for dequervains dz?
gradual
136
what does "squeaky thumb" refer to?
dequervains dz
137
what is the most common site of DJD in the hand?
1st carpometacarpal joint
138
what are the signs of dequervains dz?
swelling w/o bruising, pain w/ resisted thumb extension and when stretching tendons
139
what test is used for dequervains dz?
finklesteins test
140
what does "squeaky wrist" refer to?
intersection syndrome
141
what is intersection syndrome?
repetitive injury to ECRB and ECRL at insertions
142
what is the presentation of intersection syndrome?
lateral wrist pain
143
what is a good indicator of 1st carpometacarpal joint OA?
joint enlargement, grinding crepitus (NOT SQUEAKING)
144
what test should be performed for 1st carpometacarpal jt OA?
thumb grinding test
145
what is boutonniere's deformity?
forced flexion causing extensor tendon rupture at PIP
146
how would you splint boutonniere's deformity?
extension splinting for 6-8 wks
147
what is mallet finger?
forced flexion causing extensor tendon avulsion at DIP
148
which digit is most commonly affected by mallet finger?
3rd digit
149
what is the common ddx for mallet finger?
RA (swan-neck deformity)
150
what type of splint should be used for mallet finger?
short finger splint (10 degrees of extension) for 6-8 wks
151
describe heberdens nodes
OA - DIP - non tender
152
describe bouchards nodes
OA/RA - PIP - non tender
153
describe haygarths nodes
RA - MCP - tender
154
what is madelung deformity?
genetic disorder involving radial growth plate disturbance
155
what is the most common epidemiology for madelung deformity?
adolescent, female dwarves
156
what is madelung deformity predispose the pt to?
kienbocks dz (AVN of lunate) and TFC tears
157
what is seal fin deformity associated with?
RA
158
what is dupuytrens contracture aka?
hypertrophic nodular fiberplasia
159
what is the epidemiology for dupuytrens contracture?
males (3:1), diabetics (RR = 4.0)
160
Which digits are commonly affected by dupuytrens contracture?
4 and 5
161
What is Volkman's ischemic contracture?
forearm flexion contracture commonly caused by supracondylar fx (crush injury), tight fit cast/bandage, or acute compartment syndrome
162
who is volkman's ischemic contracture most common in?
children
163
What are the 6 Ps for volkmans ischemic contracture?
pain, paresthesia, paresis, paralysis, pallor, pulseless
164
what is ape hand?
median neuropathy causing derotation of thumb and atrophy of thenar
165
is ape hand reversible?
no
166
what is claw hand/fingers?
finger and thumb flexion caused by injury to median and ulnar nn., multi level radiculopathy, and/or plexopathy
167
what is jersey finger/sweater sign?
forced finger extension causing rupture of FDP
168
how does jersey finger/sweater sign present?
inability to flex finger completely while making a fist
