Elbow

Question 1

Describe the most imporant varus stabilizers at 0, 90 degrees

Answer 1

LCL, joint surface (primary) and capsule at 0 – at 90 degrees even more stability comes from the joint surface

Question 2

Describe the most imporant varus and valgus stabilizers at 0, 90 degrees

Answer 2

MCL, joint surface, and anterior capsule are equal 0 – at 90 MCL is the primary

Question 3

What is posterolateral rotatory instability?

Answer 3

typically occurs from FOOSH as the humerus goes into the IR which causes ER and valgus stress at the elbow

Question 4

Which muscle is the primary elbow flexor?

Answer 4

brachialis

Question 5

What is little league elbow?

Answer 5

overuse injury including OCD of the capitellum with or without loose bodies, injury to the proximal radial epiphysis, overgrowth of the radial head

Question 6

what is lateral epicondylitis?

Answer 6

tendonitis in the common extensor tendon but more likley disorganized collegen from micro tears which have failed to heal

Question 7

What 5 tests are commonly used for radial tunnel syndrome

Answer 7

compression of the radial tunnel, long finger test, wrist ext, resisted supination, cuff test

Question 8

Following a simple dislocation what would be expected on exam after relocation:

Answer 8

decreased ROM into ext and UE weakness, possible ligamentous instability that is more promient after acute symptoms resolve

Question 9

Is immobilization recommended after simple dislocation of the elbow?

Answer 9

It may or may not be used – the longer the elbow is immobilized both intrinsic and extrinsic stiffnes increases and decreased healing of the articular cartilage, if the elbow is unstable at 45 degrees flexion then surgery is recommended

Question 10

What are common concomitant injuries with simple elbow dislocation?

Answer 10

ligamentous instability, ulnar or median nerve injury, radial head fracture;

Question 11

IF a patient is presenting with wrist extensor weakness which of the following would be the least likley Dx – lateral tendinosis, posterior interosseous nerve syndrome, posterolateral rotatory instability, radial tunnel syndrome

Answer 11

Radial tunnel syndrome because it is sensory only

Question 12

Wainner test item cluster allows for what?

Answer 12

Detection of nerve root pathology

Question 13

Best retest measure for lateral epicondylitis

Answer 13

grip strength

Question 14

A patient presents with increased cubitus valgus on the R greater than the L. The R elbow is warm to the touch at the medial condyle region with point tenderness in the flexor pronator mass. Tinel is negative. You suspect medial tendinosis with underlying ligamentous instability. What would be the most likely to be present

A) apprehension
B) inadequate wrist ext with fingers extended
C) Negative milking manuver test
D) neural irritation of the radial nerve

Answer 14

B - patients with UCL instability are likely to present with medial tendinosisof the flexor pronator muscles including limitation in ROM and have TTP 2 cm distal to the medial epicondylitis; The milking maneuver tests for UCL instability

Question 15

What techniques should be used to detect ulnar collateral ligament insufficiency?

Answer 15

Moving valgus stress test is the best; valgus stresss, milking, and AROM could be considered

Question 16

What is the most appropriate Tx for ligamentous instbaility of the UCL?

Answer 16

Immobilization of the elbow with protected rest from aggravating activities including gymnastics