Week 14 - Elbow Flashcards
History Questions?
FOOSH?
Fall w/ bent or hyperextended elbow?
Carrying Angle?
Normal = 5-15 degrees
>15 degrees = cubital valgus
Could indicate lateral epiphyseal pate injury
Could lead to decreased ROM and ulnar neuropathy
Normal ROM?
Sup/pro
Flx
Ext
hyperext
Stability Tests?
Valgus Stress test - UCL
Varus Stress Test - LCL
Medial epicondylitis?
Golfer’s Elbow
pain w/ resisted wrist flexion
Pain w/ active/ passive wrist extension
Later epicondylitis
Tennis Elbow
Pain w/ resisted wrist ext
Pain w/ active or passive wrist flex
Elbow # MOI?
Trauma
FOOSH
Direct blow
Fall on flexed elbow
Elbow # S&S?
Pain, maybe deformity
msc guarding
hemorrhaging
swelling loss of function
Elbow # Tx?
Splint in position found, EMS, check fir distal circulation
Complicaton = Volkmann’s #
Cast or splint
Volkmann’s Contracture?
damaged brachial artery = ischemic msc degenration to wrist flexor compartment
Msc necrosis on 4-6 hours - eventually fibrosis and calcification
Monitor brachial and radial pulses
May also be caused by compartment syndrome in forearm
Lateral/ radial Collateral Lig. Sprain MOI and S&S?
MOI:
* Elbow extended and supinated when falling, or straight arm is
tackled
* Less common than MCL sprains
SSx:
* SHARP
* Lateral elbow pain
* Lateral epicondyle tender on palpation
* Positive varus stress test
* May have radial nerve involvement (numbness, tingling,
positive Tinel’s test)
Lateral/ radial Collateral Lig. Sprain Tx and Prevention?
Immediate Tx:
* POLICE
* Load management
* Surgery if grade 3
Prevention:
* Appropriate protective equipment, as applicable
* Proper falling technique
Olecranon Bursitis MOI, S&S, Tx, Prevention?
MOI:
* Direct trauma to the bursa that is superficial to
the olecranon process
SSx:
* Severe localized swelling
* Point tenderness
* Pain
* Decreased elbow flexion
Immediate Tx:
* Radiograph to rule out fracture
* Protective padding
* Possible aspiration
Prevention:
* Well-fitting elbow pads
Medial/ Ulnar Collateral Lig Sprain S&S and MOI?
MOI:
* Excessive valgus force from repetitive (more common) or
acute trauma
* Examples: late cocking phase of throwing, forearm hitting,
golf swing
SSx:
* SHARP
* Medial elbow pain
* Medial epicondyle tender on palpation
* Positive valgus stress test, medial epicondylitis test
* May have ulnar nerve involvement (numbness, tingling,
positive Tinel’s test)
Medial/ Ulnar Collateral Lig Sprain Tx and Prevention?
Immediate Tx:
* POLICE
* Load management
* Biomechanical correction
Surgery if grade 3
* “Tommy John” surgery for repair of ulnar collateral ligament
* Sling for 10 days post-surgery
* 1 month isometrics
* 8-12 weeks progressive strengthening
* Throwing 4 – 6 months post-surgery
* Full recovery 12 – 18 months
Prevention:
* Appropriate protective equipment, as applicable
* Load management
Little League Elbow?
MOI:
* Microtrauma that occurs from
throwing (not dependant on
type) that includes:
* Medial epicondyle
avulsion/traction apophysitis
* Osteochondrosis of the humeral
capitulum
* Articular cartilage damage,
loose bodies
* Decreased extension, grating,
pain, locking
* Olecranon epiphysis non-union
stress fracture
* Affects 10-25% of young
pitchers
Risk factor- early specialization
Little League Elbow S&S, Tx, Prevention?
SSx:
* Gradual onset
* Decreased ROM (flexion, supination, pronation)
* Possible weakness with extension
* Grating
Immediate Tx:
* Rest (no throwing)
* POLICE
* Increase ROM
* Strengthen triceps, scapular/shoulder/core/wrist muscles, improve
neuromuscular control
* Surgery if not treated in early stages
Prevention:
* Load management
* Avoid sports specialization
Cubital Tunnel Syndrome MOI?
MOI:
* Ulnar nerve compression at
the elbow
* Contributing factors:
* Cubital valgus
* Structural deformities
resulting in subluxation
* Acute valgus force
* Medial collateral ligament
compression of the ulnar
nerve during flexion
Cubital Tunnel Syndrome S&S, Tx, Prevention?
SSx:
* Medial elbow pain
* Referred pain, burning/tingling intermittently in the 4th/5th fingers
* Cubital tunnel tender on palpation
* Positive Tinel’s sign
Immediate Tx:
* Rest and immobilization for 2 weeks (avoiding hyperflexion and
valgus stress)
* Possible surgery (ulnar nerve transposition or surgical
decompression)
Prevention:
* Appropriate protective equipment, as applicable
* Avoid prolonged elbow flexion
Pronator Teres Syndrome MOI?
MOI:
* Entrapment of the median
nerve as it passes through
the two heads (superficial
and deep) of the pronator
teres
* Caused by tightness,
hypertrophy or edema
* Associated with repetitive
wrist flexion/pronation.
Pronator Teres Syndrome S&S?
SSx:
* Aching anterior forearm
* Paresthesia, motor defects on
the anterior aspect of the forearm
and into the thumb, index and
middle fingers
* Weakness: thumb opposition,
finger flexion, forearm pronation
Pronator Teres Syndrome Tx and Prevention?
Immediate Tx:
* Rest, splinting
* Stretch/massage forearm flexors
* Load management
* Biomechanical correction of aggravating
activities
* If severe, decompression surgery
Prevention:
* Appropriate training intensity progression
* Stretching of forearm flexors
General Injury Prevention for Elbow?
Elbow is vulnerable to overuse injuries
* Limit repetitions
* Throwing, racquet sports
* Take recovery time between practices/games
* Cross train for a few months a year
* Correct faulty mechanics
* Maintain strength and endurance of muscles around
elbow, shoulder, scapula
