Elbow Flashcards
(45 cards)
1
Q
elbow
Elbow trauma fractures:
A
-
Distal forearm Fx:
- Colles and Smith’s
- Frykman classification
- Moteggia: hyperextension-pronation injury
- Direct/indirect Radius and Ulna Fx: distal, mid, prox 3rd (from pronation to supination)
- Olecranon Fx: violent contraction of triceps or direct blow
- Distal humerus Fx: axial loading of the ulna in the trochlear groove
- Radial Head Fx: valgus force on extended elbow
- Posterior elbow dislocation: fall in hyperextension
2
Q
elbow
What are the difference and similarities between a Colles and a Smith’s fractures?
MOI?
A
- Both are distal radius fractures
-
Colles: dorsal displacement of distal radius
- MOI: extension
-
Smith’s: volar displacement of distal radius
- MOI: flexion
3
Q
elbow
What is the treatment for distal forearm fractures?
A
- Intrarticular: ORIF
-
Extrarticular: closed reduction + cast
- If comminuted and displace: then ORIF
4
Q
elbow
What is a Monteggia Fx?
MOI?
A
Fx of the ulna and dislocation of the radial head
MOI: hyperextension + pronation injury
5
Q
elbow
What do you do FIRST in a Monteggia Fx - dislocation?
Tx?
A
Check the radial nerve!
Tx: ORIF in adults, closed reduction + cast in children
then check the radial nerve again
6
Q
elbow
What type of Fx is most likely to occur in a hyperextension + pronation injury?
A
Monteggia Fx
7
Q
elbow
What is the difference between a direct and indirect fracture of radius and ulna?
A
- direct: transverse fx at the same level
- indirect: oblique or spiral at different levels
Closed reduction or ORIF, immobilization baed on:
- Pronation, distal 3rd
- Neutral, mid-3rd
- Supination: proximal 3rd
8
Q
elbow
what is the immobilization position of a Radius and Ulna fracture?
A
- immobilization depends on Fx:
- distal 3rd fx: pronation
- mid 3rd: neutral
- prox 3rd: supination
9
Q
elbow
what are the complications of Radius and Ulna fx?
A
non-union and cross-union
10
Q
elbow
What is the Posterior Interosseus nerve?
A
- deep branch of the radial nerve
- PIN is a branch of the radial nerve that provides motor innervation to the extensor compartment
- Innervates deep and common extensors
11
Q
elbow
Radial Tunnel Syndrome
A
- A compressive neuropathy of the posterior interosseous nerve (PIN) with pain only
- deep aching pain in dorsoradial proximal forearm from lateral elbow to wrist increases during forearm rotation and lifting activities
- muscle weakness because of pain and not muscle denervation
12
Q
elbow
PIN Compression Syndrome:
A
- A compressive neuropathy of the PIN which affects the nerve supply of the forearm extensor compartment
- weakness, no pain
- insidious onset, often goes undiagnosed
13
Q
elbow
PIN Compression Syndrome
A
- A compressive neuropathy of the PIN which affects the nerve supply of the forearm extensor compartment
- weakness, no pain
14
Q
elbow
Olecranon Fx:
MOI?
Tx?
Complications?
A
-
Avulsion Fx (violent contraction of triceps):
- immobilization in 90 degress of flexion
- loss of ROM
-
or direct blow (comminuted):
- ORIF or closed reduction
- Complications: nonunion, DJD
15
Q
elbow
Distal humerus Fx:
More common in who?
MOI?
Tx?
A
- most common in children
- axial loading of the ulna in the trochlear groove
- intrarticular: ORIF
- Extra-articular: cast immobilization or ORIF
- Isolated medial epicondyle Fx
- Tx: cannot agresivelly stretch, do triceps ex to inhibit the flexors
16
Q
elbow
True or false, PT should agresevelly stretch s/p distal humerus Fx
A
False
do active triceps exercise to inhibit flexors
17
Q
elbow
Radial head fractures:
MOI?
Tx?
A
- valgus force on extended elbow/FOOSH
- compression laterally (bony injuries) and tension medially (soft tissue injuries)
- I. Undisplaced: sling for 2 wks
- II. Displaced: ORIF or sling
- III. Comminuted: excision of radial head
18
Q
elbow
a valgus force on extended elbow/FOOSH risk for what type of Fx?
What tissues can become injured medially and laterally?
A
- Radial head Fx
- bony injuries laterally (compression forces) and soft tissues injuries medially (from tension forces)
19
Q
elbow
Posterior elbow dislocation:
Structures damaged?
MOI?
Tx?
Complications?
A
- fall with the elbow in hyperextension
- collateral ligaments torn
- closed reduction, cast for 7-10 days
- complications: brachial artery, median nerve, myositis ossificans, arthrofibrosis (stiffness in both flexion and extension)
20
Q
elbow
Type I (Frykman classification) fracture AKA
A
osteoporotic fx
cast, stiff + swollen, lead to CRPS, refer to pain mgmt specialist, conservative AAROM
21
Q
elbow
Tennis Elbow AKA
A
Elbow Epycondylagia
- The condition first known as “tennis elbow” has been recognized for over a century. Typical signs and symptoms include pain and tenderness over the lateral epicondyle, exacerbated by resisted wrist extension and passive wrist flexion, and impaired grip strength. Although many tennis players may experience this condition, most cases are associated with work-related activities or have no obvious precipitating event. As a result, the term now most widely used is lateral epicondylitis. Yet, this name implies a pathological basis that is contrary to longstanding, albeit evolving, evidence that it is not an inflammatory condition. It is therefore recommended that it is time to adopt a new and more appropriate term, such as epicondylalgia (suffix algiameans pain), that does not reflect such underlying pathology.
22
Q
elbow
Lateral Elbow Epicondylagia (Tennis Elbows):
MOI?
Tx?
A
- repetitive wrist extension, decreases vascularity in ECRB
- rest, ice, injection, avoid predisposing factors, manual therapy, eccentric training
- cross friction massage to increase blood flow
23
Q
elbow
Medial Epicondylagia AKA
A
Golfer’s Elbow
24
Q
elbow
Regional interdependence:
A
regional interdependence is the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient’s primary complaint
25
# elbow
**Common flexor tendon** pain from repetitive use:
Golfer's elbow
26
# elbow
repetitive overhead motion pt presents with pain in the medial elbow and a (+) valgus stress test
Ulnar Collateral Tendon Tear
27
# elbow
Ulnar Collateral Ligament tear treatment:
* Reconstruction: medial incision, ulnar nerve is moved anteriorly, FCU incision, palmaris longus graft secured on medial epicondyle
* 75% success
28
# elbow
Overuse injury on the medial side of the elbow resulting in widening of the
**medial epicondyle growth plate:**
**Little League Elbow:**
29
# elbow
Osteochondritis Dissecans (OCD):
Where does it occur more often?
Cause?
Tx?
* Only in children that have open growth plates
* Portion of cartilage softens, shears or separates
* **Capitellum or Lateral Femoral Condyle**
* Injury (usually from sports) Natural history: usually heals spontaneously
* Tx: nothing, immobilization if symptomatic, arthroscopic stabilization or excision
30
**Osteochondritis Dissecans (OCD)**
31
# elbow
Osteochondral defect:
* When Osteochondritis Dissecans (OCD) occurs in a mature skeleton (growth plate closed)
* Osteochondritis Dissecans is also known as an **osteochondral bone defect**. This condition is one in which a piece of bone and cartilage within a joint are damaged and in some cases separate from the underlying bone. It occurs most often in the knee and next most often in the ankle
32
# elbow
**Bursitis:**
cause?
Tx?
* Due to **infection** or **overuse**:
* Friction casues bursitis
* Aspiration (drain fluid) to determine infecting agent
* Tx: **antibiotics, bursectomy**
33
# elbow
**Nursemaid's Elbow:**
MOI?
Tx?
* Subluxation of radial head from annular ligament
* traction force on child’s arm
* can't supinate
* put the elbow into flexion and gently supinate
* 2nd tech: full extension and hyperpronation
* Sling for 2 weeks, educate parents about the mechanism of injury
34
# elbow
Compression neuropathies of the elbow:
* Ulnar nerve (cubital tunnel)
* Median nerve (pronator syndrome)
* Radial nerve (PIN)
* Musculocutaneous nerve
35
# elbow
\*Pronator teres syndrome:
* Tenderness over the pronator teres in the proximal forearm
* Possible abnormal sensation (two-point discrimination or light touch) in the median nerve distribution: thumb, index finger, long finger, and radial side of ring finger
* On occasion, prolonged resisted pronation reproduces symptoms of weakness of median-innervated muscle
* Rare, but often incorrectly diagnosed as carpal tunnel
* Resisted elbow flexion and forearm supination reproduce symptoms due to compression at the lacertus fibrosus
* Resisted long finger proximal interphalangeal joint flexion reproduces symptoms due to compression by the flexor digitorum superficialis
* Possible weakness of median-innervated muscles
36
# elbow
Anterior interosseous nerve syndrome:
* Weakness of flexor pollicis longus and flexor digitorum profundus to index finger
* Weakness of pronator quadratus
37
# elbow
difference between **pronator teres syndrome** and **anterior interosseous nerve syndrome**:
* PTS is proximal
* AINS: distal (pronator quadratus)
38
# elbow
what is the difference between **PIN compression syndrome** and **radial tunnel syndrome**:
* PINCS: A compressive neuropathy of the PIN which affects the nerve supply of the forearm extensor compartment.
* RTS: A compressive neuropathy of the posterior interosseous nerve (PIN) **with pain only**, no motor or sensory dysfunction
39
# elbow
OBJECTIVE EXAMINATION of the elbow:
1. **Structural inspection**
* Symmetry, scapula position (static, dynamic)
2. **Scanning exam**
* Cervical/thoracic spine screen?
3. **Movement analysis**
* Demonstration of what hurts
* UE and LE functional motions
4. **AROM**
* Position, quality, quantity, meaning?
5. **PROM**
* Position, quality, quantity, meaning?
* Joint mobility assessment:
* GHJ, STJ, SCJ, ACJ
6. **Resistive tests**
* MSTT/MMT
* Rotator cuff, scapula muscles, substitutions
7. **Muscle length if needed**
8. **Special tests:**
* Specificity, sensitivity, likelihood ratios
9. **Palpation**
40
# elbow
What are 2 test for **Cubital Tunnel Syndrome:**
* **Elbow Flexion Test:**
* Patient sitting fully flexes elbow with wrist extension
* Patient should be asked to described any symptoms holding this position for 3 minutes
* +ve test reproduction of pain, tingling, and/or numbness in ulnar nerve distribution
* **Tinel's sign:**
* Patient is sitting examiner applies 4-6 taps to the patient’s ulnar nerve in the cubital tunnel
* +ve test is reproduction of symptoms in ulnar nerve distribution
41
# elbow
Elbow fractures tests:
**Patient lies supine and is asked to perform full AROM:**
* **Elbow flexion test:** Sp: 100%, Sn: 64%
* **Elbow extension test:** Sp: 100%; Sn 100%
* **Elbow pronation test:** Sp: 100%, Sn: 34%
* **Elbow supination test:** Sp: 97%, Sn: 43%
+ve test is inability to perform **full AROM compared to other side**
42
# elbow
**LIGAMENT SPRAINS** tests:
* **Valgus stress test:**
* Patient is sitting with elbow in 20-30 degrees of flexion
* Examiner places one hand at the medial joint line
* The other hand is placed at the wrist
* Examiner exerts a valgus force trying to gap the medial joint line
* **+ve test is pain and or lack of end-feel**
* **Varus stress test:**
* Repeat same procedure exerting a varus force
43
# elbow
**Lateral epicondylagia tests:**
* **Cozen’s test:**
* Patient sitting, with elbow in 90 degrees of flexion, forearm in pronation, and wrist in RD with a full fist
* Patient extends the wrist against resistance
* **Passive wrist flexion test:**
* Patient sitting, with elbow extended and forearm in pronation
* Examiner passively flexes wrist
* **Maudsley’ test**
* Patient sitting, examiner resists 3rd digit extension (EDC)
* +ve test is pain near lat epicondyle
44
# elbow
Fractures of the humerus are very common and are often associated with injury to blood vessels and nerves. A proximal fracture at the anatomic neck can damage the _________ and \_\_\_\_\_\_\_\_\_\_\_\_\_\_, at the midshaft the ___________ may be injured in the radial groove, and distally the _____ and ________ are vulnerable in supracondylar fractures.
* proximal: posterior circumflex artery and axillary nerve,
* midshaft: the radial nerve may be injured in the radial groove,
* distally: the median and ulnar nerves
45
# elbow
PIN
branch of radial nerve
innervates extensors
