Elbow

Question 1

pain w/ gripping and wrist extension, lifting, shaking hands, screwdriver, tennis backhand
(extensor carpi radialis brevis)

Answer 1

lateral epicondylitis

Question 2

“golfer’s” elbow, pain with pronation and wrist flexion, swing, baseball pitching, bowling, pull-through swim strokes
(flexors/pronators)

Answer 2

medial epicondylitis

Question 3

RF for epicondylitis –

Answer 3

30-50 years

Question 4

What causes epicondylitis?

Answer 4

Chronic, repetitive overuse triggered by an acute event

Question 5

PE: pain on palpation of elbow, resisted ROM causes pain

XR: negative (rule out loose body or arthritis)

Answer 5

epicondylitis

Question 6

How do you treat epicondylitis?

Answer 6

Activity modification
NSAIDS/anti-inflammatory creams
ice/heat
Elbow strap
Stretching + strengthening exercises
Refer to rehab
Consider steroid injection, PRP, shock wave therapy
Refer to specialist after failure of 6 months conservative treatment

Question 7

Numbness and tingling of pinky + ring fingers, numbness at night, decreased grip strength, tenderness over medial elbow, muscle wasting

Answer 7

ulnar nerve entrapment

Question 8

Ulnar nerve entrapment is more common in

Answer 8

Diabetes, ETOH use

Question 9

“Cubital tunnel syndrome”, pressure on nerve as it passes through groove from direct blow or repetitive motion, trauma

Answer 9

ulnar nerve entrapment

Question 10

+ Tinel’s sign, + Froment sign, + elbow flexion test
CXR: rule out other causes

EMG/NVC: reduction of 30% or more = substantial compression

Answer 10

ulnar nerve entrapment

Question 11

how do you treat ulnar nerve entrapment?

Answer 11

Avoid bending, night splints, NSAIDs, change workstation, padding of elbow

Question 12

Swelling, deformity, ecchymosis, pain, effusion, crepitus with flexion in humerus area

Answer 12

distal humerus fracture

Question 13

a distal humerus fracture is — in adults

Answer 13

uncommon

Question 14

Distal humerus fractures are associated with

Answer 14

trauma + high morbidity

Question 15

ALWAYS check — in distal humerus fractures

Answer 15

Check neurovascular status → radial pulse, capillary refill, medial, radial, and ulnar nerves (ulnar MC issue)

Question 16

XR: AP + lat views
Fat pad “sail” sign in kids (occult)

Answer 16

distal humerus fracture

Question 17

How do you treat a distal humerus fracture?

Answer 17

Non-displaced = sling/splint
Displaced = surgery

Early ROM

Question 18

Pain, deformity, swelling, inability to bend elbow

Answer 18

elbow dislocation

Question 19

MC dislocation in children

Answer 19

elbow

Question 20

an elbow dislocation occurs when –

Answer 20

someone falls on their outstretched hand

Question 21

Elbow dislocation is often associated with –

Answer 21

radial head fracture

Question 22

ALWAYS check with elbow dislocation –

Answer 22

Check neurovascular
Radial pulse/capillary refill
Sensation of median/ulnar nerves
Motor function of radial nerve

Question 23

How do you treat elbow dislocaiton?

Answer 23

Reduction
Repeat neurovascular exam
Repeat XRs

Early ROM –
5-7 days post reduction
Block terminal extension w/ brace
NSAIDs to reduce ectopic bone formation

Question 24

Swelling around ball of elbow, ecchymosis, abrasions, poor ROM

Answer 24

olecranon fracture

Question 25

olecranon fracture occurs with

Answer 25

direct blow or fall on elbow in flexion

Question 26

--- nerve is most commonly affected with an olecranon fracture

Answer 26

ulnar - check neurovascular!

Question 27

How do you treat an olecranon fracture?

Answer 27

Non-displaced = posterior splint in **45** degree flexion w/ follow up XR in 10 days Displaced = surgery Early ROM

Question 28

Pain on outside of elbow + loss of flexion, extension, and rotation +/- swelling

Answer 28

radial head fracture

Question 29

associated w/ dislocation of elbow

Answer 29

radial head fracture

Question 30

you will see what on a radial head fracture XR?

Answer 30

fat pad sign

Question 31

Loss of 10-15 degrees of extension is common in

Answer 31

radial head fracture

Question 32

How do you treat a radial head fracture?

Answer 32

Type 1 = splint/sling w/ early ROM Type II + III = surgery

Question 33

Gradual or sudden w/ tender “lumps” of scar tissue described as bits of “gravel” – dramatic swelling, redness, warmth (chronic = not tender), extremely tender w/ acute or infection

Answer 33

olecranon bursitis

Question 34

Inflammation of the bursa between skin + olecranon → trauma, inflammation, infection, or from occupation or chronic lung disease (leaning forward to breathe)

Answer 34

olecranon bursitis

Question 35

Only need what if trauma occured in olecranon bursitis?

Answer 35

XR

Question 36

Recurrence is common/uncommon in olecranon bursitis?

Answer 36

common

Question 37

How do you treat olecranon burisitis?

Answer 37

Mild = leave alone or treat symptoms Activity modification, NSAIDs, padding Symptomatic Aspiration (culture), compression, reassess in 2-7 days Antibiotics (cover MRSA) Surgery >3 recurrences