Lecture 7: The Elbow Flashcards
Why are the arm muscles so susceptible to myositis ossificans?
well vascularized
What is lateral epicondylitis and how does it present?
- Inflammation of the elbow extensor (mostly extensor carpi radialis brevis) tendons (at their origin at the lateral epicondyle)
- Tenderness on palpation just distal to lateral epicondyle, some swelling
How does the treatment for lateral epicondylitis differ for traumatic compared to gradual onset?
Gradual: Fix ergonomic issues and modify activity
Traumatic: The usual acute stuff (PRICE, Physical/Active Therapy, NSAIDs, Steroid injection)
A weightlifter comes into the clinic with swelling and pain at the olecranon that gets worse with elbow extension. What is their injury, and what is a likely cause for this injury? How would you treat this injury?
- Triceps tendonitis
- Steroids make people feel that they don’t need as much recovery, so they push themselves more to the point where injure their triceps.
- Usual elbow stuff (same as acute lateral epicondylitis)
How do you treat radial tunnel syndrome?
Usual elbow stuff + nerve flossing
What causes the symptoms of radial tunnel syndrome?
The deep branch of the radial nerve gets compressed by the supinator as it passes through the radial tunnel.
After weeks of putting in windows on an apartment, a construction worker goes to their doctor with a burning sensation and shooting pain in the radial aspect of their proximal forearm. What condition do they have?
Radial tunnel syndrome
A baseball player goes to his physiotherapist with posterior elbow pain, stiffness, and reduced ROM in elbow extension. What condition does he likely have?
Olecranon impingement
List 4 etiologies for olecranon impingement, and explain how each one would be treated.
- Inflammation => Control inflammation
- Tightness => Stretch & Strengthen surrounding soft tissue
- Bone Spur => Surgery
- Rupture of surrounding structures => Debride
What causes de Quervain’s Tenosynovitis?
Inflammation of the abductor pollicis longus and extensor pollicis brevis tendons passing through their tendon sheath.
What motion can you use as a diagnostic indicator for De Quervain’s tenosynovitis?
Wringing out a towel
A housekeeper comes to you with pain in his lateral wrist during grasping and thumb extension, and you note that he experiences pain with palpation over his wrist. What condition does he likely have?
De Quervain’s syndrome (gamekeeper’s)
Explain the pathophysiology of carpal tunnel syndrome.
Fibrous hypertrophy of the synovial flexor sheath causes compression on the median nerve.
A patient goes to her doctor with pain and tingling into the palmar surface of her thumb, index finger and middle finger, and notes that the symptoms are worse at night. Her occupation is violinist for the VSO. What condition does she have?
Carpal tunnel syndrome
List the 3 areas where compression of the brachial plexus and subclavian artery can occur.
- Interscalene triangle
- First rib, clavicle, and subclavius
- Coracoid process, pectoralis minor
A person comes to their doctor complaining of diffuse left shoulder and arm pain, saying that their arm feels “heavy”. They work a desk job at ICBC, and upon examination you notice that they have a very rounded, “forward” posture. What condition do they likely have?
Thoracic outlet syndrome
Explain the pathophysiology of trigger finger.
Node on flexor tendon sheath gets inflamed ⇒ cannot glide smoothly (gets stuck) back and forth under a pulley
List 2 risk factors for trigger finger.
- Diabetes
- Rheumatoid arthritis
What about the anatomy of the elbow makes olecranon bursitis so common?
Olecranon bursa is very superficial
A student experiences swelling over her right posterior elbow, pain when her elbow is flexed past 90 degrees, and discomfort resting on her elbow. What condition does she have, and how should it be managed?
- Olecranon bursitis
- Don’t touch it and it will go away
A patient comes in with weakness in elbow extension and wrist flexion. She informs you that she has been working a desk job for the past 10 years. What injury does she likely have (be specific)?
Cervical radiculopathy (C7 nerve root)
List the 2 main causes of cervical radiculopathy.
- Postural dysfunction
- Pathologies causing lateral stenosis (usually with age)
How do you treat cervical radiculopathy?
- Physio/active rehab
- Steroid injection or oral
- Surgery
- Correct posture
Should you use Cozen’s test, Mill’s test, or the Maudley test? Explain your rationale.
No! Don’t use them. No diagnostic accuracy studies have been completed on Mills’ Test, Maudsley Test or Cozen’s Test.
