Ch.38 Upper Extremity Arm

Question 1

Which tendon is MC involved in lateral epicondylosis?

Answer 1

Extensor carpi radialis brevis

Question 2

What disorder can mimic lateral epicondylosis?

Answer 2

PIN syndrome

Question 3

What exercise regimen should be used for tx of lateral epicondylosis?

Answer 3

Eccentric stengthening of wrist extensors

Question 4

What are the MC involved tendons in medial epicondylosis?

Answer 4

Pronator teres and flexor carpi radialis

Question 5

What can be seen on X-ray in Lateral/Medial epicondylosis?

Answer 5

punctuate calcifications at tendon origin

Question 6

Exercises used for treatment of tendonopathy.

Answer 6

Eccentric stengthening

Question 7

History of distal biceps tendonitis

Answer 7

Pain in antecubital fossa with repetive elbow bending & follow through phase of throwing

Question 8

History of distal biceps tendon rupture

Answer 8

Male 30-50, dominant limb, heavy lifting with elbow at 90 deg flexion

Question 9

History of triceps tendonitis

Answer 9

Aching and burning at distal triceps aggravated by throwing, using a hammer, wt lifting

Question 10

How can tricep tendon rupture occur?

Answer 10

FOOSH injury, steroid use

Question 11

Hx of snapping triceps tendon

Answer 11

snapping sensation over medial epicondyle with eblow flexion & extension

Question 12

Hx of aseptic olecranon bursitis

Answer 12

direct blow or repetitive trauma to olecranon process develops small liquid pouch

Question 13

Hx of septic olectranon bursitis

Answer 13

localized or systemic injection l/t infected joint

Question 14

Tx of aseptic olecranon bursitis

Answer 14

Aspiration of bursa followed by compresive dressing and elbow pad

Question 15

Tx of septic olecranon bursitis

Answer 15

Aspiration of bursa for CS and gram stain, followed by compresive dressing and Abx

Question 16

Cause of ulnar collateral ligament strain

Answer 16

valgus stress to the elbow

Question 17

What phases of throwing put stress on the UCL?

Answer 17

late cocking and acceleration phase of overhead throwing

Question 18

PE of UCL strain

Answer 18

5 deg elbow flexion contracture, UCL tenderness and pain w/ or w/o laxity during UCL instability testing

Question 19

Tx of UCL strain

Answer 19

no throwing for 3-6 wks, ROM, medial forearm muscle strengthening, interval throwing program once pain free ROM

Question 20

Definition of valgus extension overload (VEO) disorder

Answer 20

impingement of posteromedial olecran against medial wall of olecranon fossa from valgus elbow stres w/ overhead throwing

Question 21

PE of valgus extension overload (VEO) disorder

Answer 21

Pain over posterior medial tip of olecranon and pasive hyperextension w/ valgus load of elbow

Question 22

What phase of throwing aggravates valgus extension overload (VEO) disorder

Answer 22

acceleration and follow through

Question 23

Rehab of valgus extension overload (VEO) disorder

Answer 23

Scapula/core kinetics, medial forearm muscle strengthening

Question 24

What disorders are referred to as Little Leaguer’s elbow?

Answer 24

Medial epicondolitis, traction apophytiis, stress fx, throught medial epicondylar epiphyses and avulsion fx of medial epicondyle

Question 25

What is Panner's disease?

Answer 25

osteochondrosis of capitellum that occurs in ages 7-10

Question 26

PE of Panner's disease

Answer 26

Dull, aching lateral elbow pain aggravated by throwing, elbow effusion, ROM not restricted

Question 27

Tx of Panner's disease

Answer 27

Stop throwing, posterior long arm splint for pain control

Question 28

Hx of osteochondritis desicans of capitellum

Answer 28

throwing athletes 9-15yo, lateral elbow pain, 15 deg flexion contracture focal lesions to capitellum w/ loose body formation

Question 29

Tx of osteochondritis desicans of capitellum

Answer 29

stop throwing for 6 wks, posterior long arm splint for pain control, surgery for loose bodies

Question 30

MCC of elbow dislocation

Answer 30

FOOSh injury

Question 31

MC direction of elbow dislocation

Answer 31

posterior lateral

Question 32

Injuries associated w/ elbow dislocation

Answer 32

collateral ligament, flexor/pronator forearm muscle, brachial artery, median/ulnar/radial nerve disruptions

Question 33

Hx of FCU tendonitis

Answer 33

volar wrist pain w/ wrist flexion & ulnar deviation (racquet sports, golf)

Question 34

What can be associated with FCU tedonitis?

Answer 34

Pisotriquetral compression sydnrome as pisiform bone embedded in FCU tendon

Question 35

Tx of FCU tendonitis

Answer 35

wrist hand orthoses in 25 deg flexion or surgery to resect pisiform bone w/or w/o Z-plasty lengthening of FCU tendon

Question 36

Hx of FCR tendonitis

Answer 36

Lateral wrist pain w/ wrist flexion, radial deviation and grip

Question 37

Tx of FCR tendonitis

Answer 37

wrist hand orthoses in 25 deg flexion

Question 38

Tendons involved in de Quervain's syndrome

Answer 38

Abductor pollicis longus & extensor pollics brevis over radial styloid

Question 39

Tx of de Quervain's syndrome

Answer 39

rest, thumb spica splint, first dorsal compartment steroid injection

Question 40

What is Intersection syndrome?

Answer 40

Friction b/w abductor pollicis longus & extensor pollicis brevis tedongs 4-6 cm proximal to Lister's tubercle

Question 41

Who is Intersection syndrome seen in?

Answer 41

Oarsmen, racquet sports, wt lifters

Question 42

PE of Intersection syndrome

Answer 42

Dorsoradial distal forearm pain aggravated by wrist extension

Question 43

Tx of Intersection syndrome

Answer 43

neutral wrist-hand orthosis, steroid injection to point at maximal tenderness, rarely surgery

Question 44

Hx of extensor carpi ulnaris tendonitis

Answer 44

dorsoulnar wristpain w/ reptitive wrist extension & ulnar deviation in nondominant hand of tennis two-handed backhand

Question 45

Hx of ECU subluxation

Answer 45

pop after forceful volar wrist flexion & ulnar deviation w/ pain

Question 46

Tx of ECU tendonitis

Answer 46

neutral wrist-hand orthosis

Question 47

What should be assessed for if pt w/ ECU tendonitis does not get better with conservative therapy?

Answer 47

Triangular fibrocartilage complex injury

Question 48

Tx of ECU tendon subluxation

Answer 48

Acute: cast of wrist in pronated and dorsiflexion for 6 wk or surgery Chronic: sugrical reconstruction