MS1: Affectations of Elbow Flashcards
describe the elbow
modified hinge joint or trochoid ginglymus
stability allows little compensatory adjustments = prone to injury or overuse
what are the 3 joints of the elbow complex
humero-radial
humero-ulnar
proximal radioulnar
describe the joint capsule
thin and transparent
under tension when extended and relaxed when flexed
30-35 ml at 80 degrees flexion; fully distended
what is the functional ROM of the shoulder
supination - 81
pronation - 71
flex/extend - 150
what is the normal carrying angle
normal valgus:
5-10 degrees - males
10-15 degrees - females
diminishes w flexion
compare cubitus varus and valgus
varus: forearm towards midline
valgus: forearm away from midline
describe cubitus varus
decrease in carrying angle
due previous history of trauma - supracondylar fracture
what is gunstick deformity
most common type of varus - 3-57 %
cosmetic problem - no functional disability
describe cubitus valgus
increase in carrying angle
most common cause is lateral condylar fracture of humerus
usually asymptomatic but can develop tardy ulnar nerve palsy
what is tardy ulnar nerve palsy
possible effect of cubitus valgus
more lateral deviated = tension on ulnar nerve
describe the ulnar collateral ligament
from anterior inferior 2/3 of medial epicondyle to to proximal ulna
most important ligament against valgus stress
what are the bundles of the ulnar collateral ligament
anterior:
- strongest and stiffest = most common injured at media side
- main stabilizer against valgus stress
posterior: primary restraint in max elbow flexion
tranverse: cooper’s lig; least role in staibility
what comprises the lateral collateral ligament complex
annular ligament - winds the radius and ulna together
lateral ulnar collateral
radial collateral
accessory collateral
describe the lateral ulnar collateral ligament
from posterior lateral condyle to proximal ulna
restraints against varus and external stress during full arc of elbow motion
what is lateral ulnar collateral ligament injury
associated w dislocation from falling on supine arm with valgus stress
SSx:
- pain or clicking in elbow extension or pushing using arm
- tenderness
- varus instability
how to test for lateral ulnar collateral ligament injury
lateral pivot shift test: pt lies supine w forearm overhead and supinated; valgus stress applied while elbow moes from extension to 40 degrees flexion
x-ray to show dislocations and rule out fractures
what is the treatment for lateral ulnar collateral ligament injury
non-operative: casting 5-7 days with elbow flexed at 90 degrees
what is medial ulnar collateral ligament injury
anterior band microtrauma from repetitive valgus stress - valgus instability in adults
occurs in cocking phase or bwelo
common in athletes that do overhead throwing; little leaguer’s elbow
what are the symptoms lateral ulnar collateral ligament injury
SSx:
- pain or clicking in elbow extension or pushing using arm
- tenderness
- varus instability
what are the symptoms of medial ulnar collateral ligament injury
SSx:
- medial elbow pain
- decrease effectiveness in throwing
- tenderness along elbow at MCL origin
- limited ROM
what is the treatment for what is medial ulnar collateral ligament injury
rest for 6 weeks then therapy to strengthen pronation and flexors
for high level throwers - surgery
what is nursemaid’s elbow
radial head subluxation or pulled elbow
radial head slips through annular ligament
sudden longitudinal traction applied to the hand w elbow extended and forearm pronated or by a fall
what is the epidemiology nursemaid’s elbow
most often at ages 1-4 but can happen until 6-7; more common in women
what are the symptoms of nursemaid’s elbow
SSx:
- refuse to affected limb
- holds elbow in slight flexion and forearm pronated
- pain and tenderness
- full flexion and extension padin
- pain during supination
what is the treatment of nursemaid’s elbow
close reduction of annular ligament subluxation
what are the types of aseptic bursitis
acute hemorrhagic and chronic bursitis
common in football and hockey
describe acute hemorrhagic and chronic olecranon bursitis
acute: due to direct blow to olecranon
chronic: due to repetitive microtrauma; initial period of swelling that becomes into permanently thickened bursa with intrabursal bands
describe septic bursitis
due to localized or systemic infection
SSx:
- edema, erythema and hyperthermia
- systemic symptoms of infection
what is treatment for aseptic bursitis
mild: AIF and therapy
severe: remove fluid