The Elbow and Forearm Lecture Powerpoint

Question 1

4 articulations of elbow and forearm

Answer 1

• Ulnohumoral
• radiocapitellar
• proximal radio-ulnar
• distal radioulnar at the wrist

Question 2

Tinel’s sign ulnar nerve

Answer 2

Test for pain and paresthesia with tapping over the ulner nerve to assess cubital tunnel syndrome in the elbow

Question 3

Elbow arthritis

Answer 3

A noncommon arthritis resulting from trauma, RA, OA, etc. usually symmetric multijoint involvement with end result being unstable elbow, can have pain and restricted motion, progressive pain and loss of motion

Question 4

Elbow arthritis/dislocation diagnostic test (1)

Answer 4

AP and lateral x ray

Question 5

Most common childhood dislocation

Answer 5

Elbow dislocation (most often FOOSH)

Question 6

Elbow dislocation treatment options (2)

Answer 6

• reduction as soon as possible, conscious sedation works well (possible hematoma block)
• splint at 90 degrees with forearm pronated

Question 7

Radial head sublaxation at the annular ligament (nursemaids elbow) peaks at what age?

Answer 7

2-3

Question 8

Radial tunnel syndrome and management

Answer 8

Compression of the posterior interosseous nerve, usually occurring between 35-50 gradual onset overuse injury, often time managed OT but may need surgery

Question 9

Middle finger test

Answer 9

Test for radial tunnel syndrome test where middle finger is extended against resistance resulting in pain if positive

Question 10

Fracture of distal humerus

Answer 10

Rare in adults but has high morbidity and risk of neurovascular injury (progression to compartment syndrome), high probability of injuring the ulnar nerve, sees anterior or posterior fat pad sign

Question 11

Mason classification of fractures of the radial head (4) and how are they treated

Answer 11

Type I - nondisplaced or minimally - sling and splint
Type II - displacement more than 2 mm or angulated neck fractures with block or incongruity - ORIF
Type III - severely comminuted fractures of radial head or neck - surgical excision of fragments
Type IV - radial head fracture with associated elbow dislocation - uhh same?

Question 12

Rupture of distal biceps tendon and management

Answer 12

Uncommon less than 5% of biceps ruptures usually in men greater than 40 with pre-existing degenerative changes, sees shortened biceps muscle popeye sign and puckered skin from shortened tendon, can be complete or incomplete, requires operative repair in complete tears and non op if older, partial, etc, typically do not return to full strength and see radial nerve damage

Question 13

Ulnar nerve compression

Answer 13

Compression of the ulnar nerve 2nd most common source of entrapment in upper extremity, may be acute or chronic from prolonged pressure, can elicit positive tinels sign at the cubital tunnel

Question 14

Diagnostic tests for ulnar nerve compression (2)

Answer 14

• x rays

- nerve conduction tests***

Question 15

Froments sign

Answer 15

Sign for ulnar nerve palsy that tests actuion of the adductor pollocis, have patient hold paper between thumb and fist as you pull away, normally can but with ulnar nerve palsy the thumb is flexed to compensate for weakness