Chapter 18 Upper Arm, Elbow, and Forearm Conditions Flashcards
what causes contusions to the upper arm and forearm and what are the S/S?
Direct blow to the arm and forearm
S/S – ecchymosis if hemorrhage is superficial, significant trauma – internal hemorrhage, rapid swelling, hematoma formation that can limit ROM, chronic blows – myositis ossificans (deltoid or brachialis common), exostosis
What is tackler’s exostosis?
not a true myositis ossificans because ectopic formation is not infiltrated into the muscle but is an irritative exostosis arising from bone – painful bony mass with a sharp edge
What is the MOI and the S/S of an olecranon bursitis?
MOI – a fall on flexed elbow (acute), constantly leaning on one’s elbow (chronic), repetitive pressure and friction (chronic), repetitive flexion and extension (chronic), infection
S/S – immediate, tender, swollen area of redness at posterior elbow, limited flexion
What is a septic bursa?
Septic – related to seeding from an infection at a distant site such as paronychia, cellulitis of hand or forearm infection
What is a non-septic bursa?
Non-septic – caused by crystalline deposition disease or rheumatoid involvement, atopic dermatitis
What is a collateral ligament sprain?
Acute tears to ligamentous and joint structures at the elbow are rare
MOI – FOOSH, elbow hyperextension, valgus/varus force
UCL damaged 🡪 ulnar nerve may be affected
S/S feeling of instability, pain
What is anterior capsulitis?
Anterior joint pain caused by hyperextension is usually attributed to acute anterior capsulitis rather than chronic, repetitive throwing
S/S – diffuse, anterior elbow pain presents after a traumatic episode, deep tenderness on palpation especially anteromedial side, rule out pronator teres strain and median nerve entrapment
What are the dislocations possible for the upper arm, elbow and forearm?
Proximal radial head subluxation/dislocation common, associated with immature annular ligament (adolescents)
Results from longitudinal traction of an extended and pronated upper extremity
Small tear in annular ligament – radial head migrates out
Ulnar dislocations – teenage years, MOI = hyperextension or sudden unidirectional valgus force that drives the ulna posterior
60% associated with fractures to medial epicondyle, radial head, coronoid process, or olecranon process
Terrible triad of elbow – ulna dislocation, radial head fracture, coronoid process fracture
What are flexor and extensor strains?
repetitive tensile stresses to the elbow flexors or pronator teres due to inadequate warm-up or fatigue
S/S: pain increases with active and RROM
What is a rupture of biceps brachii?
Majority proximal, degenerative changes in tendon make it vulnerable to rupture following eccentric load, men > women with history of steroid injections
What is a rupture of triceps Brachii?
Direct blow to the posterior elbow or uncoordinated triceps contraction during a fall
80% involve olecranon avulsion fracture
What is compartment syndrome?
Secondary to elbow fracture or dislocation, crushing injury, forearm fracture, postischemic edema, excessive muscle exertion
Anterior 🡪 flexors
Posterior 🡪 extensors
S/S – rapid swelling, discolouration, absent radial pulse, paralysis, severe pain at rest
Referral to physician, don’t compress
What is medial epicondylitis?
Caused by repeated, medial tension/lateral compression forces placed on the arm during the acceleration phase of the throwing motion
Medial humeral epiphyseal growth plate in pediatric athletes affected – Little League Elbow
Pronator teres and flexor carpi radialis mostly affected
What is lateral epicondylitis?
Pain over at the lateral epicondyle denotes extensor tendon overload and is the most common overuse injury in adults
Caused by eccentric loading of the extensor muscles (extensor carpi radialis brevis)
What are neural entrapment injuries?
Ulnar nerve vulnerable to compression and tensile stress
Cubital tunnel syndrome – shocking sensation along the medial aspect of the elbow (crazy/funny bone)
Pronator syndrome – pain/numbness felt in anterior proximal forearm, aggravated with pronation activities
Radial tunnel syndrome – radial nerve damage during a midshaft humeral fracture or direct trauma
Wrist drop – extensor weakness
What are epiphyseal and avulsion fractures?
Closing of growth plate of the medial epicondyle – sensitive to tension stress/repetitive/sudden contraction of flexor-pronator muscle group 🡪 avulsion of medial epicondyle
What is osteochondritis dissecans?
Unusual complication of repetitive stress to the skeletally immature elbow
MOI – lateral compressive forces exerted during the throwing motion – damage radial head or capitellum or both
Leading cause of permanent elbow disability in adolescents
Open growth plates 🡪 destruction of cartilage, softening of bone
Panner disease – chronic lateral elbow pain
What are supracondylar fractures?
FOOSH 🡪 complication = Volkmann contracture is ischemic necrosis due to damage of brachial artery or median nerve
What are nightstick fracture?
caused by direct blow to the forearm that fractures the ulna
