Elbow

Question 1

Special Tests: lateral epicondylosis (2)

Answer 1

1. Cozen test
2. Resisted supination

Question 2

Special Tests: Medial epicondylosis

Answer 2

1. Resisted wrist flexion
2. Resisted pronation

Question 3

Special Tests: Radial Tunnel Syndrome

Answer 3

1. Resisted middle finger extension
2. Resisted supination

Question 4

Special Tests: PIN Syndrome

Answer 4

1. Radial deviation w/ wrist extension

Question 5

Special Tests: UCL Injury

Answer 5

1. Valgus stress test
2. Moving valgus stress test (MORE SENSITIVE): Pain is worst from 120-70 degrees of elbow flexion
3. Milking maneuver

Question 6

Special Tests: OCD

Answer 6

1. Active Radiocapitellar compression test: Active pronation/supination + Full elbow extension

Question 7

Special Tests: Ulnar Neuropathy

Answer 7

1. Elbow Flexion Test: 90 degree flexion + Supination + Wrist extension= Reproduction of pain in <60 sec
2. Tinel’s

Question 8

Special Tests: AIN

Answer 8

1. Positive Pinch Grip Test: ok sign

Question 9

Inspection: Carrying angles

Answer 9

Men: 5-10 degrees

Women: 10-25 degrees

Question 10

ROM: Loss of smooth elbow motion in athletes

Answer 10

Osteonecrosis/Osteochondritis dessicans

Question 11

Referred Pain: Elbow

Answer 11

Cervical Radic: C5

Rotator cuff pathology

Key element: Movement has no effect on pain

Question 12

Referred pain: Hand

Answer 12

C6/C7

85% of cervical radiculopathies involve C6 and C7

Question 13

Special Tests: Radial/Lateral Collateral ligament

Answer 13

1. Varus stress test

Question 14

Special Tests: Posterolateral instability (injury to ulnar part of RCL)

Answer 14

1. Lateral pivot shift test: apprehension or impending dislocation w/ arm extended overhead + supination + valgus and axial force (usually under anesthesia)
2. Posterolateral apprehension test
3. Posterolateral rotary drawer test
4. Chair test/stand up test

Question 15

Most common tendon in lateral epicondylosis

Answer 15

ECRB

Question 16

Percentage of pt’s w/ medial epicondylosis w/ ulnar nerve symptoms

Answer 16

50%

Question 17

Compression of radial nerve near elbow

Answer 17

Radial tunnel syndrome

Question 18

• Tenderness 4-5 cm distal to lateral epicondyle
• Pain reproduced w/ middle finger extension + Resisted supination
• No weakness

Answer 18

Radial Tunnel Syndrome

Question 19

Pure motor branch of radial nerve

Answer 19

PIN

Question 20

PIN syndrome common site of compression

Answer 20

Arcade of Frohse: proximal tendinous orgin of supinator muscle

Question 21

Fracture of proximal ⅓ of ulna w/ dislocation on radial head

Answer 21

Monteggia Fracture

Question 22

Fracture associated w/ PIN syndrome

Answer 22

Monteggia fracture: proximal ⅓ of ulna w/ dislocation on radial head

Question 23

PIN Innervation

Answer 23

• EDM
• ECU
• EDC
• ECRB
• EI
• EPB
• EPL
• APL
• Supinator

Question 24

• Radial Deviation w/ wrist extension
• Pain over lateral epicondyle
• Wakness of thumb/finger extension at MCP

Answer 24

PIN Syndrome

Question 25

Positive XR for UCL injury

Answer 25

\>2mm seperation in valgus stress

Question 26

Imaging of choice for UCL injury

Answer 26

MRI

Question 27

Little leaguers elbow

Answer 27

* Repetitive microtrauma to medial epicondyle * Medial epicondyle apophysitis/fragmentation

Question 28

* Pain w/ valgus stress test + no instability * Tenderness over medial epicondyle * Adolescent pitcher

Answer 28

Little Leaguers elbow

Question 29

**Little Leaguer's Elbow:** Surgical indication

Answer 29

Avulsion \>3-4 mm

Question 30

Ostochondrosis/AVN of capitellum

Answer 30

Panner's Disease

Question 31

* Tenderness and swelling of lateral aspect of elbow * Limited elbow extension (lack 20-30 degrees from full extension) * Young boy \<10 yo

Answer 31

Panner's Disease

Question 32

**Elbow Pain:** Adolescent overhead athlete w/o instability

Answer 32

Little Leaguers Elbow

Question 33

**Elbow Pain:** Young boy lacking 20-30 full extension

Answer 33

Panner's Disease

Question 34

Osteochondritis dissicans

Answer 34

Fragmentation on bone/cartilage in capitellum * Older children vs Panner's disease (10-16 yo vs 5-10 yo) * 2/2 throwing

Question 35

Subluxation of radial head

Answer 35

Nursemaids elbow

Question 36

Most common orthopedic injury in kids \<2 yo (Girls \> Boys)

Answer 36

Nursmaids elbow

Question 37

Reduction on nursemaids elbow

Answer 37

Supination + Elbow Flexion Hyper pronation + Elbow at 90 (More successful)

Question 38

**Elbow Impingement:** Cause

Answer 38

Valgus extension overload: * Pinching of soft tissues/cartilage between olecranon tip and posterior fossa w/ repetitive forced elbow extension * May see olecranon spur on imaging * May see UCL laxity

Question 39

* Pain/stiffness over posterior elbow worse w/ elbow extension * +/- Effusion * +/- ROM deficits * Pain over olecranon w/ palpation * Pain w/ active and passive elbow extension * Throwing athlete, racquet athlete, boxer

Answer 39

Elbow impingement

Question 40

Wartenberg sign

Answer 40

Ulnar Neuropathy * Inability to adduct little finger

Question 41

Froment's Sign

Answer 41

Ulnar Neuropathy * Effects innervation to adductor pollicis and interossei muscles, which provide adduction of the thumb and extension of the interphalangeal joint. * The flexor pollicis longus (innervated by the median nerve), will substitute for the adductor pollicis (innervated by the ulnar nerve) and cause the thumb to go into hyperflexion.

Question 42

Pure motor branch of AIN

Answer 42

AIN

Question 43

**AIN:** Muscle innervation

Answer 43

* FPL * FDP * Pronator quadratus

Question 44

**AIN:** Sites of compression

Answer 44

* Pronator Teres Deep Head (MOST COMMON) * Thrombosed radial artery * Thrombosed ulnar artery * Gantzer's muscle (Accessory head to FPL) * Fascial band at origin of FDS