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Flashcards in 02 Elbow 2 Deck (24):
1

What does VEOS stand for?

Valgus
Extension
Overload
Syndrome

2

During a pitch of any variety, what is the position of the shoulder?

90˚

3

What happens during VEOS?

1. lateral compression
2. medial tension
3. posterior shear
4. **also could get ulnar neuritis

4

How does posterior shear happen in VEOS?

follow through creates additional shear on the back of the elbow

5

Draw VEOS

6

UCL injury study
- UCL ruptures with more than 33 Nm of force
- There are 64 Nm force on UCL when the arm is at 90˚

What else factors in?

- UCL alone cannot withstand valgus torque during throwing
- flexor pronator muscle mass!

7

common UCL surgeries

- arthroscopy (diagnostic)
- arthroscopy/debridement/OCD
- arthroscopy
- UCL

8

arthroscopy
indications

**This is an exam question!**

- diagnostic
- removal of loose bodies
- removal of bony osteophytes
- treatment for OCD
- debridement of intra-articular adhesions with arthrofibrosis
- debridement for synovitis

9

arthroscopy
contra-indications

- bony ankylosis
- severe arthrofibrosis
- concurrent infections

10

What is the current trend with UCL surgeries?

⅓ of all are young and high school aged kids within the past 20 years

11

Which band of the UCL is usually torn?

UCL has more than one band, but the anterior band is the one that stabilizes and ruptures

12

For UCL reconstructions, which ligaments are commonly harvested for a graft?

- palmaris longus
- gracilis

13

During arthroscopy, what is done if there's something in the capsule?

debridement

14

What are the 2 UCL procedures?

- Figure 8
- Docking

15

UCL
Figure 8 procedure

- hole drilled through medial epicondyle to create bony tunnels
- tendons threaded through

16

UCL figure 8 procedure
Where is the distal tunnel?

through the sublime tubercle

17

UCL and isometricity

- creates equal tension through ROM
- at some point, there is tension from at least one of the ligaments

18

UCL
docking technique procedure

- drill bony tunnel through sublime tubercle
- thread tendon through (distal attachment)
- dock tendon into bone and suture posterior

19

What's the difference between figure 8 and docking? What does the research say?

- figure 8 drills through humerus
- docking drilled into the humerus, but it doesn't go through all the way

**research shows docking is just as effective from a stability standpoint

20

What are the options if there's ulnar nerve involvement along with a UCL tear?

- leave it alone (unlikely)
- transposition

21

ulnar nerve involvement
What are the methods of transposition?

- subcutaneous
- subfascial (fascial slings - put the nerve between them)
- submuscular

22

What is the most common method of ulnar nerve transposition?

subfascial

23

general guidelines for rehab following UCL surgery

1. post-op: go into ROM limiting device
2. week 1: usu immobilized at 90˚
3. increase motion on a weekly basis (i.e. 90˚ » 70˚ » 50˚)

24

For UCL surgeries, when do you need full ROM to be back?

between 4-6 weeks
- don't want to restrict longer
- gets stiff and more difficult to regain motion