Upper Extremity Injuries - Elbow/Forearm Flashcards
what commonly causes an olecranon fx?
a fall directly onto flexed or extended elbow
radiology needed in olecranon fx
- 2-3 view of elbow
- need true lateral to see olecranon
initial tx of olecranon fx
-splint w/ long arm posterior
tx of olecranon fx w/ less than 1-2 mm of displacement
can be splinted and treated conservatively
tx of olecranon fx w/ > 2 mm displacement
need ORIF
common cause of radial head fx
FOOSH w/ elbow extended
PE of radial head fx
- TTP of radial head
- swelling and decreased ROM
radiology for radial head fx
- 3 view of elbow
- look for “fat pad” sign and “sail” sign for subtle injuries
- type I-IV
tx for type I radial head fx
- no displacement
- can be tx conservatively w/ splinting and early ROM
tx for type II-IV radial head fx
need ORIF
ulnar head dislocation
- MC kind
- typical pt
- cause
- MC is posterior lateral dislocation
- children more common
- FOOSH
PE of ulnar head dislocation
- obvious deformity w/ loss of ROM
- check neurovascular status
radiology for ulnar head dislocation
- true lateral w/ 3 view of elbow
- look for other fx b/c of the “terrible triad”
“terrible triad” in elbow dislocations
- elbow dislocation in combo with radial head fx and coronoid process fx
- Prone to early recurrent instability and posttraumatic arthritis.
tx of ulnar head dislocation
- closed reduction
- splinting (long arm)
- referral to ortho
radial head dislocation are also called?
nurse maid’s elbow
radial head dislocation is commonly caused by?
- axial traction on a pronated forearm in full extension (grabbing kid by arm)
- common in young children
PE of radial head dislocation
painful joint that the child does not want to move
radiology for radial head dislocation
- clinical diagnosis
- no films needed unless suspect fx
tx of radial head dislocation
- reduction by:
- supination/flexion and hyperpronation
epicondylitits types
- medial (golfer’s elbow)
- lateral (tennis elbow)
medial epicondylitis aka golfer’s elbow
- overuse injury from repetitive eccentric force
- pronator teres and flexor carpi radialis
- localized TTP of medial elbow
lateral epidondylitis aka tennis elbow
- overuse injury
- extensor carpi radialis brevis
- TTP lateral elbow
tx of epicondylitis
- conservative
- bracing / spinting
- PT/OT
- they must stop activity or it won’t get better
bicep tendonitis is more common in who?
-people who perform frequent pulling or lifting
PE of bicep rupture
-tendon can be visible w/ a palpable mass or hematoma
tendonitis w/ no rupture produces pain at insertion site
special tests for biceps tendonitis/rupture
- speed test
- yergasons test
speed’s test
- pts elbow is extended, forearm supinated and the humerus elevated to 60 degrees
- the examiner resists humeral forward flexion
- pain located to bicipital groove = positive
yergasons test
- elbow flexed to 90 degrees
- start in pronated position
- active supination and flexion against resistance
- palpate biceps tendon
- pain or painful pop = positive
tx for bicep tendonitis
- basic ortho tx
- activity restriction
tx for biceps rupture
-operative
types of forearm fxs
- nightstick
- monteggia
- galeazzi
- both bone
forearm fxs
- commone
- can be isolated or in combination
- mechanism: high energy trauma or falls
night stick fx
-midshaft ulnar fx (from blocking a nightstick)
galeazzi fx
radial midshaft fx associated w/ radioulnar joint instability
monteggia fx
fx of the proximal third of the ulnar shaft associated w/ dislocation of the radial head
tx of isolated midshaft radius fx
-ORIF recommended w/i 1-2 days
non-operative casting/splinting can be used as tx for nighstick fx if the following criteria are met:
- > 50% apposition
- <10 degrees angulation
- no radial head dislocation
- fx w/i distal 2/3 of ulna
tx of galeazzi and monteggia fx
-splinted w/ well molded double sugar tong and ORIF
