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pt momints ver 2.0 > MS1: Affectations of Elbow > Flashcards

MS1: Affectations of Elbow Flashcards

1
Q

describe the elbow

A

modified hinge joint or trochoid ginglymus

stability allows little compensatory adjustments = prone to injury or overuse

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2
Q

what are the 3 joints of the elbow complex

A

humero-radial

humero-ulnar

proximal radioulnar

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3
Q

describe the joint capsule

A

thin and transparent

under tension when extended and relaxed when flexed

30-35 ml at 80 degrees flexion; fully distended

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4
Q

what is the functional ROM of the shoulder

A

supination - 81

pronation - 71

flex/extend - 150

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5
Q

what is the normal carrying angle

A

normal valgus:

5-10 degrees - males
10-15 degrees - females

diminishes w flexion

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6
Q

compare cubitus varus and valgus

A

varus: forearm towards midline

valgus: forearm away from midline

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7
Q

describe cubitus varus

A

decrease in carrying angle

due previous history of trauma - supracondylar fracture

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8
Q

what is gunstick deformity

A

most common type of varus - 3-57 %

cosmetic problem - no functional disability

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9
Q

describe cubitus valgus

A

increase in carrying angle

most common cause is lateral condylar fracture of humerus

usually asymptomatic but can develop tardy ulnar nerve palsy

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10
Q

what is tardy ulnar nerve palsy

A

possible effect of cubitus valgus

more lateral deviated = tension on ulnar nerve

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11
Q

describe the ulnar collateral ligament

A

from anterior inferior 2/3 of medial epicondyle to to proximal ulna

most important ligament against valgus stress

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12
Q

what are the bundles of the ulnar collateral ligament

A

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

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13
Q

what comprises the lateral collateral ligament complex

A

annular ligament - winds the radius and ulna together

lateral ulnar collateral

radial collateral

accessory collateral

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14
Q

describe the lateral ulnar collateral ligament

A

from posterior lateral condyle to proximal ulna

restraints against varus and external stress during full arc of elbow motion

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15
Q

what is lateral ulnar collateral ligament injury

A

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

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16
Q

how to test for lateral ulnar collateral ligament injury

A

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

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17
Q

what is the treatment for lateral ulnar collateral ligament injury

A

non-operative: casting 5-7 days with elbow flexed at 90 degrees

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18
Q

what is medial ulnar collateral ligament injury

A

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

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19
Q

what are the symptoms lateral ulnar collateral ligament injury

A

SSx:
- pain or clicking in elbow extension or pushing using arm
- tenderness
- varus instability

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20
Q

what are the symptoms of medial ulnar collateral ligament injury

A

SSx:
- medial elbow pain
- decrease effectiveness in throwing
- tenderness along elbow at MCL origin
- limited ROM

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21
Q

what is the treatment for what is medial ulnar collateral ligament injury

A

rest for 6 weeks then therapy to strengthen pronation and flexors

for high level throwers - surgery

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22
Q

what is nursemaid’s elbow

A

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

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23
Q

what is the epidemiology nursemaid’s elbow

A

most often at ages 1-4 but can happen until 6-7; more common in women

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24
Q

what are the symptoms of nursemaid’s elbow

A

SSx:
- refuse to affected limb
- holds elbow in slight flexion and forearm pronated
- pain and tenderness
- full flexion and extension padin
- pain during supination

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25
what is the treatment of nursemaid's elbow
close reduction of annular ligament subluxation
26
what are the types of aseptic bursitis
acute hemorrhagic and chronic bursitis common in football and hockey
27
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
28
describe septic bursitis
due to localized or systemic infection SSx: - edema, erythema and hyperthermia - systemic symptoms of infection
29
what is treatment for aseptic bursitis
mild: AIF and therapy severe: remove fluid
29
what is treatment for septic bursitis
aspiration of fluid for lab analysis w/ systemic symptoms: IV antibiotics w/ localized symptoms: oral antibiotics incision and drainage if doesnt improve from meds
30
what is the epidemiology lateral epicondylitis
common in > 35 yo; 40-50 yo more common in male in tennis only from excessive repetitive stress on lateral forearm musculature
31
what is the pathophysiology of lateral epicondylitis
degenerative and not inflammatory; misnomer micro tears on common extensor muscles at their origin on lateral epicondyle mostly affects ECRB and EDC; rarely ECRL and ECU
32
what are the symptoms of lateral epicondylitis
SSx: - pain lateral elbow during gripping, repetitive wrist extension - point tenderness over lateral epicondyle - + cozen and mills
33
what is the differential diagnosis for lateral epicondylitis
xray: might reveal punctate calcifications MSUS: reveal partial and complete tears rule out lateral collateral ligament sprain and radial nerve impingement
34
what is the treatment for lateral epicondylitis
rest cryotherapy AIF PT: heating and ultrasound (deep heat)
35
how is the cozen's test done
stabilize pt's elbow and ask to pronate and extend and radially deviate wrist against manual resistance of clinician
36
how is the mill's test done
palpate pt's lateral epicondyle while pronating forearm while fully flexing the wrist and elbow extended pain in are = + test
37
what is the epidemiology of medial epicondylitis
occurs 3-7x less frequent than lateral epicondylitis excessive repetitive stress on medial forearm musculature
38
what are the symptoms of medial epicondylitis
tenderness over the medial epicondyle pain on making a fist, wrist flexion, forearm pronation and supination
39
what is the pathophysiology of medial epicondylitis
degenerative involves tendinopathy affecting the common flexor origin frequently pronator teres and FCR origins; less frequent FCU and FDS
40
what is the differential diagnosis of medial epicondylitits
xray and MSUS to rule out: - medial ulnar collateral ligament injury - ulnar nerve entrapment
41
what is the treatment for medial epicondylitis
rest cryotherapy AIF PT: heating and ultrasound (deep heat)
42
what is the epidemiology of distal bicep tendonitis
not common eccentric overload of the distal biceps during deceleration of follow through phase of throwing
43
what is the symptoms of distal bicep tendonitis
pain in antecubital fossa during elbow bending pain with resisted elbow flexion tenderness over distal biceps tendon
44
what is the treatment of distal bicep tendonitis
rest cryotherapy AIF PT: heating and ultrasound (deep heat)
45
what is the epidemiology of distal bicep tendon rupture
betw 30-50 yo M > F
46
what is the pathophysiology of distal bicep tendon rupture
injury usually occurs during heavy lifting w elbow at 90 degrees flexion involves the dominant side distal biceps tendon avulses from radial tuberosity
47
what are the signs of distal bicep tendon rupture
acute pain and popping sensation in the antecubital fossa ecchymosis, erythema, edema in the antecubital fossa deformity of the biceps muscle belly proximal retraction of the biceps tendon is apparent - popeye sign
48
what is the treatment of distal bicep tendon rupture
nonoperative: only for elderly, sedentary patients who do not require strength and endurance in forearm flexion and supination operative: for confirmed distal biceps tendon ruptures - partial tears that fail to respond to nonoperative treatment
49
what are distal humerus fractures
2% of all fractures; 1/3 of all humeral fractures 2-column concept: - medial column - lateral column - betw is coronoid fossa ant and olecranon fossa post has supracondylar, transcondylar, intercondylar
50
describe supracondylar fractures
55-75% of all pediatric elbow fractures FOOSH treatment: casting/splinting, CR w percutaneous pinning, ORIF
51
describe intercondylar fractures
most common distal humeral fracture in adults comminution is common force is directed against the posterior aspect of an elbow flexed >90 degrees; driving the ulna into the trochlea
52
what is the indication for non-operative treatment for intercondylar fractures
if nondisplaced fractures elderly with displaced and severe osteopenia significant comorbid conditions precluding operative management cast immobilization and traction with an olecranon pin; bag of bones
53
what is the operative treatment for intercondylar fractures
ORIF: - for displaced reconstructible fractures - restore articular congruity - interfragmentary screws and dual plate fixation total elbow arthroplasty: - for comminuted fractures - in osteoporotic bone
54
what is montaggia fracture
proximal 1/3 ulnar fracture w associated radial head dislocation/instability rare in adults; common in 4-10 yo
55
what is galleazi fracture
distal 1/3 radius shaft fx and associated DRUJ due to direct wrist trauma at dorsolateral aspect FOOSH w pronation
56
what is elbow dislocation
due FOOSA in posterolateral region associated with disruption of collateral ligaments of the elbow - periarticular and intraarticular fractures - brachial artery or median, ulnar and radial nerve injuries
57
what is treatment of elbow
CR - sling or long arm splint for 2-3 days followed by progressive ROM - cryo and AIF indication for surgery: - disrupted ulnar collateral ligament - disrupted flexor pronation musculature - chronic recurrent elbow instability full return in 8 weeks 90% restoration by 3 months post injury
58
what is volkmann's ischemic contracture
untreated necrotic muscle and nerved are replaced with fibrous tissue
59
what is the etiology of volkmann's ischemic contracture
supracondylar fractures of humerus in children brachial artery held by lacertus fibrosus may get impinged on sharp proximal fragment deficit in circulation causes ischemia to muscles and affect nerve function
60
what are other causes of VIC
crush injuries prolonged external compression internal bleeding: hemophilia burns
61
what are the tolerance of tissues in VIC
muscle: 2-4 hrs nerve: 30 min
62
what are the symptoms VIC
pain paresthesia pulsenessness pallor/cyanosis paresis
63
describe the mild deformities in VIC
mild: - deep flexors semi involved; FPD - 2 or 3 fingers; no limited loss of sensation - pronation contracture involving either pronator teres or quadratus
64
describe the moderate deformities in VIC
- involves most of FDP, FPL and part of FDS - neurological deficit involving the median nerve more than ulnar - deformity is intrinsic minus hand - diminished sensations in median and ulnar nerve zones
65
describe the severe deformities in VIC
- all the flexors and extensor muscles are involved - neurological deficit is severe - joint contractures are marked - wasting of forearm muscles
66
how to diagnose VIC
pressure monitoring or ICP measurement > 30 mmHG may be an indication for surgery
67
how to treat VIC
explore deeply until FDP and FPL necrotic muscle must be excised median nerve freed beneath the lacertus fibrosus ulnar nerve is freed and transplanted anteriorly brachial artery must be inspected and decompressed surgical wound is left open for secondary closure later when swelling subsides extremity supported w splint in functional position
67
how to treat VIC
explore deeply until FDP and FPL necrotic muscle must be excised median nerve freed beneath the lacertus fibrosus ulnar nerve is freed and transplanted anteriorly brachial artery must be inspected and decompressed surgical wound is left open for secondary closure later when swelling subsides extremity supported w splint in functional position
68
what is the cubital tunnel syndrome
ulnar nerve lies w/in the postcondylar groove where it is covered by a fibrous roof going from medial humeral epicondyle to the olecranon 2nd most common nerve entrapment in UE
69
what are the symptoms of CTS
paresthesia of the ulnar 1 1/2 digits intrinsic muscle weakness and atrophy clawing of ulnar digits is a severe late finding of ulnar neuropathy
70
how to test of CTS
froment's wartenberg tinel sign elbow flexion test EMG-NCV
71
what are the treatments of CTS
non operative: - activity modification - night splints - elbow held at 45 degrees flexion - NSAIDs operative treatment: - failed conservative treatment for 3 months types: - in-situ decompression - ulnar nerve transposition - medial epicondylectomy

pt momints ver 2.0 (14 decks)

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