LECTURE 11B: ELBOW EXAM/EVAL Flashcards
Elbow evaluation divided anatomically into:
- UQ scanning exam
- C-spine/shoulder vs elbow/forearm complex exam
- Specific joint assessments (i.e. H-U, H-R, prox R-U, distal R-U)
associated body segments to the elbow
Cervical spine
Thoracic spine
Shoulder complex
Wrist/hand
Neurovascular system
Cardiovascular system
In elbow exam: will likely need to assess … often present similarly &/or impact each other
spine, shoulder and wrist complexes
pain w/ activities, history of repetitive motion
*makes you think ____
tendinopathy/ CONTRACTILE TISSUE
Pain w/ prolonged static positions
Pain after activities
(although if pissed off bad enough, will hurt during too)
instability (non-contractile)
What 2 non-MSK systems are really important to screen out in elbow?
cardiac
pulmonary
3 bad non-MSK conditions referring pain to elbow
acute MI
pancoast tumor
esophageal motor disorders
If you suspect non-MSK and they present with acute painful swelling, what is really important to rule out? (Diff Dx)
Have you been sick recently? SEPTIC ARTHRITIS
kids with hemophilia have big likelyhood to get ____ when falling on elbow
hemoarthrosis
acute painful swelling: non-MSK conditions
** Septic arthritis **
* Gout/Pseudogout
* Hemoarthrosis
* Soft tissue abscess
* Cellulitis
* Reactive arthritis
* Carcinoma/metastatic carcinoma
common functional limitations of the elbow
- Unable to turn door knob or key in ignition
- Difficulty or pain w/ pushing and pulling activities (opening and closing doors)
- Restricted hand to mouth activities for eating and drinking
- Restricted hand to head activities for personal grooming, phone use, etc
- Difficulty or pain w/ pushing self up from chair
- Unable to carry objects w/ a straight arm
***carrying groceries!
OSPRO-YF: 3 domains of psychosocial distress
Negative mood
Fear-avoidance
Negative affect/coping
Patient Health Questionnaire (PHQ-2):
Over the past 2 weeks, how often have you had little interest or pleasure in doing things?
Over the past 2 weeks, how often have you felt down, depressed or hopeless?
MOI: trauma –> what injuries could happen?
Acute fractures/dislocations
Muscle strains
Ligament/capsule sprains
Growth plate injuries
Neurovascular injuries
Bursitis
most common elbow fractures
- supracondylar fracture
- olecranon fracture
- coronoid fracture
- radial head fracture
Fall on hyperextended or flexed elbow
Most common in kids → gunstock deformity
lose extension
Supracondylar fracture
Common w/ fall onto elbow or power triceps contraction
Fairly common dx
steroids
Olecranon fracture
heels pretty well
Typically seen in high energy injuries
move posteriorly, coronoid snaps off
Coronoid fracture
FOOSH injury (radial head forced into capitulum)
Serious injury that requires adequate management
radial head fracture
big deal! difficult to manage and difficult surgery
which is the main elbow dislocation?
humero-ulnar joint
Most commonly posterior or postero-lateral
FOOSH injury w/ axial force
*Alex Lee
Nursemaid’s elbow: radial head dislocation 2° to distraction force
radial head slips out of annular ligament
proximal radio-ulnar joint dislocation
associated fractures with elbow dislocations
radial head fx (10%)
less common:
-coronoid
-olecranon
-medial/lat epicondyle
-capitulum (least common)
What is most common MOI of UCL sprain?
acceleration (and deceleration) phase of throwing motion
acute valgus stress to flexed elbow
Patient hx:
Acute pain or “pop” w/ sudden sharp pain over medial elbow
Progressive pain w/ throwing
Acceleration or after ball release
what ligament are you thinking?
UCL sprain
Lateral elbow pain
Mechanical clicking**
Difficult to DDx
what ligament are you thinking?
LCL sprain
clicking –> radial head slipping out/sublux
gymnast/cheerleading: what ligament is hella strained?
LCL
Most commonly, combo of axial compression + shoulder ER + valgus force at the elbow
–> commonly results in postero-lateral rotary instability
kinda need surgery, unlike UCL
aggressive debridement of lateral elbow structures during tennis elbow surgery –> can lead to
iatrogenic LCL sprain
Can you have instability and then develop tendinopathy in the elbow?
yes!
lateral elbow tendinopathy occurs in ___% of athletes participating in OH sports
50%
lateral elbow tendinopathy patients are
___ age?
MOI____?
35-50 YEARS OLD
high level sof physical work
repetitive strain of extensor-supinator mm mass
(ECRB/EDC)
Diff dx of lateral elbow tendinopathy
Radial nerve entrapment (PIN 5% of cases)
Instability or stress at radiocapitellar joint
most common symptom with medial elbow tendinopathy
weak grip
also dull aching pain, ulnar nerve paresthesia
MOI of Medial Elbow Tendinopathy
Forceful work or overuse &/or valgus stress of PT, FCR, FCU
Identification of ulnar neuritis extremely important
MOI: Usually 1 traumatic event involving resistance against arm w/ elbow in about 90° flex
SS: pop, pain, swelling, VISIBLE. DEFECT OF BICEPS RESULTS WITH RUPTURE (but may be difficult to detect due to swelling)
distal biceps tendon rupture
*need surgery right away bc every day without sx, tendon will shorten
Whats the most common injury at elbow?
cubital tunnel syndrome
2nd most common nerve entrapment
MOI of cubital tunnel syndrome
traction (valgus stress)
long standing valgus deformity
sustained flexion psoture (cyclists)
Diff diagnosis of cubital tunnel syndrome
rule out
Cervical radiculopathy
Thoracic outlet syndrome
radial tunnel syndrome has ___ sensory involvement
NO SENSORY, ONLY DEEP BRANCH OF RADIAL NERVE –> deep extensor muscles of forearm
*weakness, pain more distal than tennis elbow
review all the nerve stuff (slide 34-37)
Osteochondrosis of humeral capitulum (kids)
Panner’s Disease
Panner’s disease occurs at what age?
7-10 years old
peak at 9
someone wtih Panner’s disease will have what symptoms?
Fairly sudden onset of lateral elbow pain
Dull, aching pain, worsened by motion
Absence of mechanical symptoms
Locking/catching
Will Panner’s disease go away on its own?
Yeah! self limiting
Probability of remodeling leading to a structurally normal joint is excellent
May result in some limitation of motion
Long-term disability is rare
humeral capitulum: island of subchondral bone & its adjacent articular cartilage (osteochondral fragment) that begins to separate from the rest of the humerus
what disease is this?
Osteochondritis Dissecans
symptoms of osteochondritis dissecans
Gradual onset of lateral elbow pain
Dull, aching pain, worsened by motion
Locking & catching common & highly suggestive of articular injury
