Uppers Elbow Flashcards
elbow dislocations
- MOI
- S/S
- “terrible triad of the elbow”
- worry about
- complications
- Tx
MOI -axial force through the forearm with the elbow flexed S/S -extremely painful -obvious deformity --posterior or posterior and lateral -rapid swelling (may mask deformity) "terrible triad of the elbow" -posterior dislocation -fracture of radial head -fracture of coronoid process worry about neurovascular compromise complications -compromise of nerves and blood vessels -damage to stabilizing ligaments and joint capsule Tx -immobilize and refer to physician for reduction -following reduction --hinged brace (eliminates valgus/varus force) --complete immobilization for 1-5 days -isometrics --wrist flexion and extension to work the muscles
supracondylar fracture
MOI
-hyperextension or fall on flexed elbow
olecranon process fracture
MOI: falling on flexed elbow
pain with extension
radial head fracture
MOI: longitudinal compression (FOOSH)
pain with every elbow motion
-flexion/extension, pronation/supination
forearm fracture
open or closed
simple or complex
degree of angulation, rotation or displacement
overarching things to look for with fractures
does it cross a joint surface
angle of displacement
UCL sprain
- MOI
- S/S
- prevention and Tx
MOI -valgus force to the humeroulnar joint -when the forces during the cocking/acceleration phase of throwing are greater than the tensile strength of the UCL, insidious tearing of the ligament begins S/S -pain along medial aspect of elbow -inability to grasp objects -point tenderness over the UCL -possible ulnar nerve involvement --paresthesia through medial forearm into 4th and 5th fingers -pain increases with motion Tx -alleviate repetitive forces -decrease pain and inflammation -increase ROM as pain allows -strengthen arm, shoulder, hip and trunk
valgus extension overload
breakdown of the anterior bundle of the UCL leads to laxity
leads to increased tensile force on the UCL and ulnar nerve
leads to increased shear and compressive forces at the radial head and posterior medial olecranon process
can cause
-osteophyte formation and loose bodies at the posterior medial olecranon process
-loose bodies at the radiohumeral articulation
elbow posterolateral rotatory instability
tears of the LUCL
allows subluxation of the radius/ulna on the humerus
“chair sign”
-can’t push themselves up out of a chair
“push-up sign”
-unable to do a pushup with arms a little wider than shoulder width
Tommy John’s procedure
UCL reconstruction
first performed in 1974
current estimate: 1 in 9 MLB pitchers
return to competition: 12 months
RCL joint sprain
- concurrent with
- MOI
- S/S
- Tx
rare possible concurrent annular ligament damage MOI -varus force S/S -pain -laxity -weakness during pronation/supination Tx -strengthening focused on wrist extensors, supinators, and brachioradialis
osteochondritis dessicans (OCD) of the capitulum
- MOI
- leads to…
- S/S
- loose body
increased valgus leading, compressing the radial head and capitulum with overhead throwing
disrupts blood flow, creating defect over time
S/S
-lateral elbow pain (increases with activity)
-locking
-increased pain with axial load with passive pronation/supination
loose body warrants surgical removal
lateral epicondylagia -what -which muscle -most common S/S
inflammation or repetitive stress at the lateral epicondyle extensor carpi radialis brevis most common in people over 40 S/S -aching after activity -swelling -TTP over lateral epicondyle -decreased grip strength -pain and possible weakness with active wrist extension "tennis elbow"
medial epicondylagia
- what
- MOI
- S/S
- “little leaguer’s elbow”
- Tx
neuropathy of the ulnar nerve
MOI
-repeated forceful flexion of wrist and extreme valgus torque of elbow
S/S
-TTP on medial epicondyle
-pain produced w/ forceful flexion or extension
-point tenderness and mild swelling
Little Leaguer’s elbow
-avulsion of the epiphysis of the medial epicondyle
Tx - medial and lateral
-avoid aggravating activity
-reduce pain
-mobilization and stretching in pain free ranges
-use of a counter force or neoprene sleeve
-proper mechanics
-proper grip size
distal biceps tendon rupture
- most common
- MOI
- S/S
- Tx
most common in males over 40 years of age MOI -eccentric loading of the biceps brachii when the elbow is flexed to 90 complete or partial S/S -pain -loss of strength -"pop" within elbow -palpable defect --Popeye's sign usually treated with surgical repair
nerve pathology
-always…
always determine if there is cervical nerve involvement
-can produce distal pathology bilaterally
ulnar nerve pathology
- S/S
- Tx
"cubital tunnel syndrome" S/S -decreased sensory and motor function in hand and fingers -possible medial elbow pain and paresthesia -symptoms after sleeping on a flexed elbow -+ Tinel's Sign Tx -consider the source -nerve flossing --most common with sciatic nerve --gilding the nerve with movement -surgery
radial nerve pathology
- often occurs…
- nerve branches
- other name
- S/S
- Tx
often occurs secondary to other injury superficial branch (sensory) vs. posterior interosseous nerve (motor) "radial tunnel syndrome" S/S -presents similarly to lateral epicondylagia but Sx more distal -+ Tinel's Sign Tx -consider the source -nerve flossing -surgery
median nerve pathology common name
carpal tunnel syndrome
forearm compartment syndrome
- what
- S/S
- Tx
increased pressure within forearm compartments S/S -pressure in the forearm -sensory disruption in hands/fingers -decreased strength -pain with passive elongation of involved muscles -advanced: decreased pulses Tx -proximal strengthening -stretching of musculature -surgery
olecranon bursitis
- MOI
- S/S
- Tx
MOI -direct blow S/S -pain -swelling -joint tenderness -spontaneous swelling Tx -in acute conditions - ice -chronic cases require protective therapy -if swelling fails to resolve, aspiration may be necessary -can be padded in order to return to competition
forearm “splints” and other strains
- MOI
- -forearm strain
- -splints
- S/S
- Tx
MOI
-forearm strain
–severe contraction
–repeated microtrauma
-splints
–repeated static contraction
–creates microtears in connective tissues of forearm
S/S
-dull ache between extensors which cross posterior aspect of forearm
-weakness and pain with contraction
-point tenderness in interosseous membrane
Tx
-treat symptomatically
-if occurs early in season, strengthen forearm
-if occurs late in season, treat with cryotherapy, wraps, or heat
carrying angle
angle between humerus and ulna females: 10-15 valgus male: 5-10 degrees valgus angle becomes less as you flex the arms -becomes about zero cubitis valgus cubitis varus
cubital fossa
anterior portion of the elbow
swelling common
-can put pressure on vascular strectures
