Flashcards in 02 Elbow 2 Deck (24):
What does VEOS stand for?
During a pitch of any variety, what is the position of the shoulder?
What happens during VEOS?
1. lateral compression
2. medial tension
3. posterior shear
4. **also could get ulnar neuritis
How does posterior shear happen in VEOS?
follow through creates additional shear on the back of the elbow
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!
common UCL surgeries
- arthroscopy (diagnostic)
**This is an exam question!**
- removal of loose bodies
- removal of bony osteophytes
- treatment for OCD
- debridement of intra-articular adhesions with arthrofibrosis
- debridement for synovitis
- bony ankylosis
- severe arthrofibrosis
- concurrent infections
What is the current trend with UCL surgeries?
⅓ of all are young and high school aged kids within the past 20 years
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
For UCL reconstructions, which ligaments are commonly harvested for a graft?
- palmaris longus
During arthroscopy, what is done if there's something in the capsule?
What are the 2 UCL procedures?
- Figure 8
Figure 8 procedure
- hole drilled through medial epicondyle to create bony tunnels
- tendons threaded through
UCL figure 8 procedure
Where is the distal tunnel?
through the sublime tubercle
UCL and isometricity
- creates equal tension through ROM
- at some point, there is tension from at least one of the ligaments
docking technique procedure
- drill bony tunnel through sublime tubercle
- thread tendon through (distal attachment)
- dock tendon into bone and suture posterior
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
What are the options if there's ulnar nerve involvement along with a UCL tear?
- leave it alone (unlikely)
ulnar nerve involvement
What are the methods of transposition?
- subfascial (fascial slings - put the nerve between them)
What is the most common method of ulnar nerve transposition?
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˚)