L10 UE Surgery

Question 1

Negative predictive factors for healing

Answer 1

age >65
smoking
diabetes
obesity
hyperlipidemia
steroid use

Question 2

Proximal fractures

Answer 2

common in older patients
more common in women
two part surgical neck is most common

majority are nonoperative

Question 3

Proximal Fx Tx

Answer 3

Non-op: sling for 6 weeks, PROM

ORIF: young patients, displaced with small amounts

Reverse: older pts, head split or large fracture

Question 4

Shaft Fractures

Answer 4

may be associated with radial nerve injury (usually young pts)

treatment depends on if its transverse, spiral, comminuted

Question 5

Tx for Shaft Fx

Answer 5

Majority are non-op

Op: for short oblique/transverse, distracted during surgery. associated injuries are possible, usually using plate fixation.

Nail is used if there’s a tumor, poor bone health, poly trauma, segmental fx

Question 6

Distal Biceps Rupture

Answer 6

dominant elbow in men 40-60s
sudden excessive eccentric contraction of biceps
loss of supination MMT
need an MRI to determine if its complete/partial

Question 7

Non-operative tx for distal biceps rupture

Answer 7

low/mod grade tears
low demand or willing to sacrifice function
will retreat over time without surgery

Question 8

Surgical tx for distal biceps rupture

Answer 8

high grade, full thickness.
repair within 10-14 days

complications: nerve involvement, ossfications, re-rupture, loss of ROM

Question 9

Full tear classification

Answer 9

40-50% loss supination
30% flexion

Question 10

Static stabilizers of elbow

Answer 10

anterior capsule
ulnar collateral ligament
radial collateral ligament

Question 11

Dynamic stabilizers of elbow

Answer 11

flexor pronator mass–> all muscles

Question 12

mUCL injuries

Answer 12

increasing incidence in young athletes (overhead)
uncommon in skeletally immature

Question 13

Little League Elbow

Answer 13

risks are high pitch count, early specialization, high pitch veloctiy, shoulder weakness, reduced shoulder ROM, poor trunk rotation, kinetic chain defects

usually a chronic microtruama

Question 14

Biomechanics of Throwing Stages

Answer 14

Windup
early cocking
late cocking
acceleration
deceleration
follow-through

Question 15

Wind-up

Answer 15

early stage, muscles prepare/tense

Question 16

Early cocking

Answer 16

elbow flexes, forearm pronates while shoulder is abducted and ER

Question 17

Late cocking

Answer 17

elbow flexion increases 90-120°, max shoulder abduction and ER occurs

high elbow valgus force is generated, with very high compression forces at radiocapitellar jt

Question 18

Acceleration

Answer 18

elbow rapidly extends, humerus adducts and IR as trunk and upper extremity shift forward

elbow accelerates at up to 600,000 deg/s, all valgus load

varus force is generated, 50% is produced by mUCL

Question 19

Decerleration

Answer 19

initiated at ball release, shoulder maximally IR, flexor pronator mass contracts to prevent impingement of olecranon

greatest amount of GHJ loading, with high tensile force generated on post shoulder

occurs at 500,000 deg/s over a span of 50ms

Question 20

Follow-through

Answer 20

arm slows, muscles relax

Question 21

IN acceleration phase…

Answer 21

high valgus force, rapid elbow extension

tensile force on medial stabilizers
compression on lateral radius

medial shear on posterior shoulder

Question 22

Valgus Extension Overload Causes

Answer 22

1. Repetitive stress on UCL causes microtrauma and valgus instability
2. Postmedial elbow becomes critical to stability, causing posteromedial impingement
3. Lateral compression, which causes radicapitellar joint damage

Question 23

Valgus extension overload is the

Answer 23

root cause of most elbow problems

Question 24

Nonoperative tx of mUCL

Answer 24

reccommended for partial tears, non-athletes, acute injury, chronic tears

6 weeks complete rest, 6 weeks strengthening w/out pain, progression

Question 25

Operative tx of mUCL

Answer 25

recommended for high level throwers, partial tear failure, acute avulsions off ulna, chronic tear failing with nonoperative (usually requires Tommy John’s)

Question 26

Operative mUCL rehab

Answer 26

first 6 weeks: ROM
second 6 weeks: strengthening
4 mo: throwing
return to sports: 12-15 months