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P- 2 - Ortho 2 > 3 - Elbow > Flashcards

3 - Elbow Flashcards

(75 cards)

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1
Q

What is the MC benign neoplasm of the bones of the hand?

A

Enchondromas

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2
Q

What are the MC malignant neoplasms of the hand?

A

Squamous cell carcinoma

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3
Q

What is the MC primary malignant bone tumor in the hand?

A

Chondrosarcomas

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4
Q

Which type of hand tumor of extremely painful and sensitive to cold?

A

Glomus tumor

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5
Q

What is a Giant Cell tumor of the hand?

A

Benign nodular tumor found on the tendon sheath of the hands, MC on palmar surface of radial three digits near DIPJ

Firm, nodular, does not transilluminate

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6
Q

Subungual discoloration in the absence of trauma should raise suspicion for:

A

Melanoma

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7
Q

Describe a lipoma:

A

Superficial, soft, reasonably well-defined, non-tender on palpation

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8
Q

What is a carpal boss?

A

A dorsal prominence at the base of the second or third metacarpal

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9
Q

If olecranon bursitis present with pain over the joint line or with decreased ROM in the presence of spreading edema and erythema should increase suspicion of:

A

Infection

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10
Q

If the origin of olecranon bursitis is slow onset, and look like infection, obtain:

A

Aspirate sample for gram stain and culture

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11
Q

If the origin of olecranon bursitis is traumatic, obtain:

A

Radiographs, to r/o fx of the olecranon process of the ulna

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12
Q

Tx for aseptic olecranon bursitis:

A

Splint, rest, NSAIDs

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13
Q

Tx for septic bursitis:

A

Surgical drainage , ABX

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14
Q

If not recognized and treated promptly, biceps rupture can lead to:

A

Strength of elbow flexion and forearm supination is decreased by 50% in supination and 30% in elbow flexion

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15
Q

Biceps rupture most commonly occurs in which pt population?

A

Men in their 40’s, dominant elbow

7.5x greater risk in smokers

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16
Q

What is the hook test?

A

Physical exam test for biceps rupture

Highly specific and sensitive

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17
Q

What test is usually required to confirm the dx of biceps rupture?

A

MRI

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18
Q

Tx for biceps rupture:

A

Operative repair within 1 to 2 weeks of injury

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19
Q

What is the cubital tunnel?

A

Where the ulnar nerve passes behind the elbow

Osborne’s ligament
Bordered by medial epicondyle and olecranon

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20
Q

Cubital tunnel ulnar neuropathy is more commonly known by laymen as:

A

Whacking the funny bone

That super-weird tingling sensation you get after a direct blow to the ulnar nerve in the area of the cubital tunnel

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21
Q

What is cubital valgus?

A

Lateral deviation of the forearm at the elbow

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22
Q

What is cubital varus?

A

Medial deviation of the forearm at the elbow

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23
Q

Presentation of cubital tunnel:

A

Aching pain at the medial aspect of the elbow and/or numbness-tingling along the ulnar nerve distribution

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24
Q

What is a late finding of cubital tunnel syndrome?

A

Weakness and atrophy of intrinsic muscles (hypothenar atrophy)

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25
What are the first sensations to be affected in cubital tunnel syndrome?
Vibration and light touch
26
How do we test for weakness of cubital tunnel syndrome?
Test abduction and adduction of the little and index fingers
27
Name a provocative maneuver to test for cubital tunnel:
Hyperflexion elbow test Looking for pain
28
What is Froment Sign?
Cubital tunnel Adductor muscle weakness IP joint of the thumb will flex with thumb-to-index pinch (Result of compensatory action)
29
What is Jeanne’s sign?
Simultaneous hyperextension of the thumb MCP joint is indicative of ulnar nerve compromise Cubital tunnel syndrome
30
Is the Anterior Interosseous Nerve (AIN) motor, sensory, or both?
Motor only
31
Which injury may result in the inability to make the “ok” sign?
Injury to the AIN branch of the median nerve
32
A nerve conduction test showing a reduction in velocity of ___ % or more suggests substantial compression of the ulnar nerve
30
33
Tx for cubital tunnel:
Activity modification Night splint Sports elbow protector NSAIDS Steroids NOT recommended
34
If conservative management for cubital tunnel x3 months fails:
Surgical decompression and ulnar nerve transposition
35
Describe radial tunnel:
Neuropathy of the posterior interosseous nerve (PIN) of the radial nerve Pain over the dorsoradial proximal forearm and dorsal wrist
36
Resisted long finger extension test, think:
Radial tunnel
37
Tx for radial tunnel
Activity modification NSAIDs or APAP Surgical decompression reserved for pt’s unresponsive to conservative management
38
Lateral epicondylitis is AKA:
Tennis elbow
39
Medial epicondylitis is AKA:
Golfer’s elbow
40
Describe the presentation of lateral epicondylitis:
Insidious onset pain during activities requiring gripping or wrist extension Lifting, turning a screwdriver, hitting a backhand in tennis
41
Describe the presentation of medial epicondylitis:
Pain with wrist flexion and forearm pronation Golf swings, baseball pitching, bowling, weight-lifting
42
Epicondylitis - palm down:
Tennis
43
Epicondylitis - palm up:
Golfers
44
Tx for epicondylitis:
Activity mod, rest Electric shock wave therapy Physical therapy Injection for LATERAL ONLY Tension band
45
How often is surgery necessary for epicondylitis?
Rarely (90% resolve non-surgically)
46
Which nerves runs along the posterior spiral of the humerus?
Radial
47
The majority of elbow dislocations are what direction?
Posterior
48
Posterior elbow dislocations are commonly associated with what type of fx?
Olecranon
49
What is the most important part of the elbow dislocation exam?
NV exam Check for distal radial pulse and capillary refill Assess PMS
50
What is the “Terrible Triad”?
Refers to elbow dislocations Radial Head Fracture Coronoid Process Fracture Associated Dislocation
51
Which nerve may become entrapped during elbow reduction procedure?
Ulnar
52
When to perform elbow reduction?
IMMEDIATELY You get one attempt, then you’re calling ortho
53
After reducing the elbow:
Splint in 90 degrees in pronation, an/or in a stable position NSAID’s helpful to decrease incidence of heterotrophic bone formation
54
Volkmann’s Ischemic Contracture - seen in:
Distal humerus fx’s Brachial artery occlusion
55
Fat pad sign suggests:
Distal humerus fx
56
What is the eponym for a fx to the proximal 1/3 of the ulna with an associated radial head dislocation?
Monteggia Fracture
57
Management of Monteggia?
Adults - surgery Kids - nonoperative (if closed) - reduction
58
What is a Galeazzi fx?
Distal 1/3 radial shaft fx with disruption of the distal radioulmar joint (DRUJ) and TFCC
59
A Galeazzi is considered unstable if:
Less than 7.5cm from the articular surface
60
Signs of DRUJ (distal radioulnar joint) injury:
Ulnar styloid fx Widening of joint on AP view Dorsal or volar displacement on lateral view Radial shortening (>5mm)
61
Management of Galeazzi fx:
CT of DRUJ Adults - surg Kids - non-operative (long arm cast in SUPINATION x 6-8 wks)
62
What is the bony prominence of the ulna, posterior elbow?
Olecranon
63
Why is the olecranon so easily fractured?
There’s like no tissue there to protect it
64
What is the common affected nerve in olecranon fx’s?
Ulnar nerve
65
Adverse outcomes of olecranon fx’s?
Loss of motion and/or stability is possible Difficulty with elbow extension (think triceps insertion) Post-traumatic arthritis is common
66
Non-displaced fx’s of the olecranon can be tx’d with:
Posterior splint, elbow in 45 degrees of flexion to reduce pull on triceps
67
What is a type 1 radial head fx?
Nondisplaced or minimally displaced
68
What is a type II radial head fx?
Displaced more than 2mm at the articular surface -> articular incongruity
69
What is a type III radial head fx?
Severely comminuted
70
Components of Essex-Lopresti fx?
1. DRUJ dislocation 2. Radial head fx 3. Interosseous membrane disruption
71
What is Terry Thomas Sign?
Gap between scaphoid and lunate on radiograph
72
5 things we look for when examining for distal radius fx?
1. Articular step off 2. Ulnar variance 3. Volar tilt 4. Radial height 5. Radial inclination
73
Ulnar variance more than ___mm is concerning:
3
74
What is the Lafontaine Criteria?
Distal radial fx’s - likelihood of loss of position regardless of casting (3 or more) 1. Initial dorsal angulation > 20 2. Dorsal comminution 3. Radiocarpal intraarticular involvement 4. Associated ulna fx 5. Age > 60 yrs
75
Why is 6 so scared of 7?
Because 7 ate 9

P- 2 - Ortho 2 (5 decks)

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