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5 Ortho > L12 Elbow Conditions > Flashcards

L12 Elbow Conditions Flashcards

1
Q

ABCs of radiograph

A

alignmnet
bone
cartilage
soft tissue

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2
Q

Primary static constraints of elbow

A

ulnohumeral articulation
MCL
LCL

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3
Q

Secondary static constraints

A

radial head
common flexor and extensor origins
capsule

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4
Q

Dynamic stabilizers of elbow

A

anconeus
triceps
brachialis

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5
Q

Flexor pronator group

A

stabilizes against valgus stress when in supination

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6
Q

Extensor-supinator group

A

stabilizes against varus stress when in pronation

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7
Q

Flexion stability

A

abutment of radial head against capitulum
coronoid process against trochlea

osseous articulations contribute 1/3 jt stability in both flexion and extension

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8
Q

Extension stability

A

coronoid process impacts against the trochlea
olecranon process into olecranon fossa

osseous articulations contribute 1/3 jt stability in both flexion and extension

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9
Q

0° elbow extension valgus/medial resistance to stresses

A

(valgus stress)
MCL: 31%
Ant Capsule: 38%
Bony articulation: 31%

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10
Q

90° elbow flexion resistance to valgus/medial stresses

A

MCL: 54% (mainly ant portion)
Ant capsule: 10%
Bony articulation: 36%

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11
Q

0° elbow extension resistance to varus/lateral force stresses

A

LCL: 14%
Ant Capsule: 32%
Bony articulation: 55%

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12
Q

90° elbow flexion resistance to varus/lateral stresses

A

LCL: 9%
Ant capsule: 13%
Bony articulation: 75%

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13
Q

Biomechanics of elbow dislocation

A
  1. Ulnar portion of LCL is disrupted
  2. Remaining LCL structures, ant and post capsule disrupted
  3. MCL is partially disrupted, involving MCL only or is completely disrupted
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14
Q

Elbow dislocations

A

most frequent in children
second most frequent overall after shoulder

MOI: foosh with axial loading, supination of forearm

posterolateral is most common

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15
Q

Simple dislocation of elbow

A

absence of fractures
named for direction of dislocation

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16
Q

Complex dislocation

A

presence of fractures

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17
Q

Terrible triad

A

posterior dislocation with intra-articular fractures of radial head and coronoid process

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18
Q

Pt presentation of elbow dislocation

A

olecranon tip is prominent
shoulder, wrist, and hand involvementn possible

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19
Q

Neural and vascular complications of elbow dislocation

A

ulnar and median possible with simple dislocations
radial nerve with complex radial head injuries

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20
Q

Non-op management of simple elbow dislocation

A

Closed reduction
check stability and NV involvement
immobilize at 90° for 7-10 days
limit full extension if grossly unstable

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21
Q

Therapy for simple elbow dislocation

A

as soon as day 2
begin with AROM gripping, flex/ext
supervised AAROM in stable arm
limit full extension

do not immobilize for more than 3 weeks, you will lose extension

22
Q

REturn to full activity based on soft tissue damage only

A

light use at 2 weeks
sports up to 3-4 months

23
Q

Pronation makes ___ taut and stabilizes ____

A

supinators
varus

24
Q

Good to excellent prognosis for dislocation

A

immediately reduced
no loss of NV
no fx
wrestlers

25
Q

What decides future stability?

A

integrity of soft tissue
presence of fx

26
Q

Little League Elbow definition

A

overuse injury due to repetitive valgus loading with throwing resulting in microtrauma to an immature skeleton

27
Q

Tension overload in little league elbow

A
  1. medial epicondyle. Results in altered growth of epicondyle, traction apophysitis, stress fractures
  2. UCL anterior band
  3. Flexor pronator mass
28
Q

Younger athletes are more likely to have

A

apophysitis or avulsion injuries instead of UCL sprains

29
Q

Throwing causes

A

medial tension and lateral compression forces

30
Q

S/S of Little league elbow

A

m elbow pain in throwing arm
decreased throwing speed, accuracy, distance
tenderness to palpation at medial elbow
pain with valgus stress

31
Q

Differential diagnosis for Little League

A

Avulsion fx of medial epicondyle
UCL sprains or tears
Ulnar nerve neuropathy

32
Q

Avulsion fx of medial epicondyle vs LL elbow

A

point tenderness and swelling over medial epicondyle, lack of full extension are clinical signs

33
Q

Interventions for LL Elbow

A

relative rest
core strengthening
ROM and joint mobs
joint stabilization
biomechanical throwing analysis
progressive throwing program at 4-8 weeks of tx

34
Q

Pitching over ____ innings in 1 calendar year increases risk of LL elbow by ____

A

100
3.5 times

limiting the # of innings pitched per year may reduce the risk of injury

35
Q

Indications for Tommy John

A

(UCL ant band ligament reconstruction)

high level throwers that want to continue competitive sports
failed non operative management in pts willing to undergo extensive rehab

36
Q

Technique for Tommy John Surgery

A

muscle splitting approach
in-situ ulnar nerve decompression
reconstruction: most usually with autograft

37
Q

Valgus extension overload, pitcher’s elbow

A

condition characterized by pathology in poteromedial elbow

usually in competitive baseball pitchers

MOI: repetitive stress of pitching leads to excessive shear forces on medial aspect of lecranon tip and olecranon fossa and overload tension at MCL

38
Q

Progression of Pitcher’s elbow

A
  1. chrondrolysis
    osteophyte formation
    loose bodies
    MCL attenuated with repetitive strain
    radio-capitellar compression
39
Q

Pitcher’s elbow is a combination of

A

breakdown of lateral epicondyle (compression)
and breakdown of medial epicondyle (tension)

40
Q

Lateral Tendinopathy, Tennis Elbow

A

overuse injury involving eccentric overload at origin of common extensor tendon

most common cause for elbow symptoms in pts with elbow pain

41
Q

Demographics of tennis elbow

A

up to 50% of all tennis players develop it
1-3% of general pop

usually age 35 to 54
lasts from 6 mo to 2 years
resolves after 2 years regardless of interventions

42
Q

Pathophys of lateral tendinopathy

A

eccentric overload to ECRB
repetitive pronation/supination with elbow extension

RF are tools heavier than 1 kg, loads hevier than 20 kg at least 10 times a day, repetitive movements for more than 2 hrs per say

43
Q

Anatomy of tennis elbow

A

usually begins as a microtear of the origin of ECRB
may also involve microtears of ECRL

microscopic anatomy reveals angiofibroblastic hyperplasia and disorganized immature collagen

44
Q

S/S of tennis elbow

A

pain with gripping activities
decreased grip strength
point tenderness ECRB at lateral epicondyle
decreased grip strength
weakness and pain with resisted wrist ext

45
Q

Provocative Tests for tennis elbow

A

resisted wrist extension with elbow fully extended
resisted exntesion of middle finger
maximal passive flexion of wrist

all tell you HOW irritable the lateral elbow is

46
Q

Differential diganosis from tennis elbow

A

Lateral elbow pain and loss of ROM can be:
elbow OA, radial head fx, osteochondritis of capitellum

Cervical involvement: radiating pain, neck pain, paresthesias, muscle weakness in myotomal pattern

47
Q

Protected function phase of tx for tennis elbow

A

limit pain provoking activities
keep limb mobile
MWMs
modalities aren’t great

48
Q

Total arm strength rehab phase of tx for tennis elbow

A

proximal stability before distal stability
serratus and lower trap
RC post cuff muscles
eccentric, endurance, stretching of forearm extensors

49
Q

Return to activity phase of tx for tennis elbow

A

tolerance to resistance exercises in phase 2
strength
functional ROM

50
Q

Radial tunnel syndrome

A

deep aching distal to lateral epicondyle
pain at belly of brachioradialis
pain with resisted supination
pain with repetitive wrist flexion or pronation
initiated and intensified by repetitive movements with pronation
uncommon in general pop

51
Q

Distal radioulnar joint

A

concave ulnar notch of radius articulates with convex head of ulna

resting position is with the forearm supinated to 10°

treatment place is the articulating surface of radius, parallel to long axis of radius

52
Q

Distal Radioulnar Dorsal/Palmar Glides

A

forearm on treatment table, begin in resting position and progress to end range pronation or supination

stabilize distal ulna by placing fingers of one hand on dorsal surface, thenar eminence and thumb on palmar surface. Other hand goes on radius

glide distal radius (concave) dorsally to increase supinsation or palmar to increase pronation

5 Ortho (14 decks)

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