Injury and Disorders of the Elbow Flashcards
What is Lateral Epicondylitis aka “Tennis elbow”?
How is it caused?
Inflammation involving common extensor tendon?
Repetitive wrist or combined wrist and finger extension.
How does Lateral Epicondylitis present on physical exam?
Pain and 3/5 strength with resisted 3rd digit extension
Difference between Tendonitis vs Tendonosis?
Tendinitis
Inflammation
Fiber disruption / degeneration
Tendonosis Mucoid degeneration Sporadic inflammation Inflammatory process “stalled” Fiber disorganization
Treatment for “Tennis Elbow” Tendonitis?
Steroid injection NSAIDs Ice Therapeutic exercise -Stretching -Strengthening Bracing considerations Consider PT
Pros and cons with giving steroid injection with tendonitis?
Pros / cons
- Pro: dec. inflammation
- Con: injection is dangerous into a tendon
What are treatment options for Tendonosis?
Activity modification Physical therapy (more a chronic condition that is not inflammed anymore)
What treatment options are NOT beneficial for Tendonosis
NSAIDs
Steroid injection–> Hypo pigmentation
Feeling a “pop” in the arm is most indicative of what kind of injury?
Tendon injury (bicep tendon tear)
MOI of a Distal biceps tear?
Rapid eccentric contraction of biceps leads to distal tendon tear at radial insertion
What are non-surgical treatments for partial distal bicep tears?
Bracing with ROM limitation X 4 weeks
Gradual progression of ROM and strengthening (loosing of brace downward)
What are non-surgical treatments for complete distal bicep tears in older individuals?
Older patients with sedentary lifestyle who are willing to accept strength loss
Surgical repair for complete bicep tendon care is recommended in which individuals
Young active individuals
Optional if only a partial tear
What special diagnostic test can be used to assess ulnar collateral ligament?
Valgus stress test
Milking maneuver
Moving Valgus stress test (BEST TEST)
Treatment for Medial epicondylitis/osis
Similar to lateral epicondylitis / osis
Ulnar collateral ligament tear
Surgical consult
Medial epicondyle apophysitis “little leaguer’s elbow”
Activity modification (no throwing for 6-8 weeks) Physical therapy Gradual return to throwing
MOI of Non-inflammatory bursitis
How do these present
MOA: As a result of repeated trauma (e.g. persistent leaning on elbows),
Swelling at the tip of the elbow.
Absence of pain, redness or warmth (low fluid collected)
.
Full, painless range of motion of the elbow.
MOI for infectous bursitis?
Result of infection or any other intense inflammatory process
If fluid accumulation is small with mild symptoms how is olecranon bursitis treated
Treat symptomatically with activity modification and NSAIDs
When is aspiration appropriate for bursitis?
Aspiration of bursa is indicated for large effusion or concern for infection
When aspirating olecranon bursa what should you do if concerned with infection?
Send for culture and DO NOT INJECT STEROIDS
After aspirating a bursa what can you inject if not concerned with infection?
corticosteroids
Most common joint dislocation in children?
Elbow dislocation
What is the valgus stabalizing portion of the elbow made up of?
What is the Varus stabalizing portion of the elbow?
Valgus = Medial collateral ligament and radial head
Varus= Lateral collateral ligmaent
What occurs in a Subluxation aka Nursemaid’s elbow
Subluxation is where the radial head gets trapped in the annular ligament
How do you correct a subluxation?
Put the child’s elbow in supination followed by flexion
How is a Type I Radial head fracture treated?
Repeat x-ray in 7 – 10 days after the injury.
Used a splint or sling for a few days, followed by early motion.
How is a Type I radial head fracture described?
Non-displaced
Occult fracture- can see fat pad but can’t see fracture on x-ray
How is a Type II radial head fracture described?
Slightly displaced and involve a larger piece of bone.
How is a Type II radial head fracture treated?
Splinting for one to two weeks, followed by range of motion exercises, is usually successful
How are Type III radial head fractures described?
More than three bone fragments
Usually, there is also significant damage to the joint and ligaments
How is a Type III fracture treated?
Surgery is usually required to remove the broken bits of bone, including the radial head, and repair the soft-tissue damage
