Elbow Flashcards

1
Q

What is lateral epicondylitis?

A

“tennis elbow”

Overuse inflammatory injury involving common extensor tendon

Repetitive wrist or combined wrist and finger extension.

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2
Q

PE findings in lateral epicondylitis?

A

Significant pain and 3/5 strength with resisted 3rd digit extension.

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3
Q

Tendonitis v. tendonosis?

A

both are tendon overuse injuries

itis: Inflammation, fiber disruption/ degeneration

osis: Mucoid degeneration, Sporadic inflammation
Inflammatory process “stalled”, fiber disorganization

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4
Q

Tx of tendonitis?

A

Steroid injection

Activity modification

NSAIDs

Ice

Therapeutic exercise
(Stretching
Strengthening)

+/- Bracing, PT

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5
Q

Tx of tendonosis?

A

Activity modification

PT, exercise

+/- Bracing

NSAIDs & Steroid injection = NOT beneficial long term

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6
Q

Fundamentals of tendonosis tx?

A

Mod aggravating activity

correct biomechanical
faults

address degenerative component

exercise

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7
Q

What can be used to help tendonosis-address degenerative component

A

ASTYM

Graston

Dry Needling

PRP injections

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8
Q

Who is usually affected by distal biceps tendon tear?

A

Men > 40 years of age with preexisting degenerative changes in biceps tendon

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9
Q

MOA of distal biceps tendon tear?

A

Rapid eccentric contraction of biceps leads to distal tendon tear at radial insertion

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10
Q

Non surg tx for partial distal biceps tendon tear?

A

Bracing with ROM limitation X 4 weeks

Gradual progression of ROM and strengthening

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11
Q

Non surg tx for complete distal biceps tendon tear?

A

Older patients with sedentary lifestyle who are willing to accept strength loss

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12
Q

Surgical tx for distal biceps tendon tear?

A

Complete tendon rupture in young active individuals (quick surg consult is imperative for best outcomes)

Elective for partial tears in young active individuals

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13
Q

“hurts when I throw a baseball” + mild swelling in region of medial epicondyle and focal tenderness over medial joint line, medial epicondyle and adjacent portion of the common flexor tendon

A

Medial epicondylitis/osis

v.

ulnar collateral ligament tear

v.

Medial epicondyle apophysitis “Little leaguer’s elbow”

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14
Q

what tests can you use to test ulnar collateral ligament?

A

Valgus stress test

Milk maneuver**

moving valgus stress test ***

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15
Q

How is the milking maneuver performed?

A

Tests posterior band of UCL

Assess for pain, medial joint laxity, and end feel

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16
Q

How is the moving valgus stress test performed?

A

Pain throughout ROM = UCL insufficiency

Good s/s

Shear angle 120° to 80°

17
Q

Tx for medial epicondylitis/osis?

A

similar to lateral epicondylitis/osis

18
Q

Tx for ulnar collateral ligament tear

A

surg consult

19
Q

Tx for Medial epicondyle apophysitis “Little leaguer’s elbow”?

A

Activity modification: no throwing 6-8 wks

PT

Gradual return to throwing

20
Q

” I have a golf ball hanging off my elbow”

A

olecranon bursitis

due to repetitive trauma to elbow (i.e. typing with elbow on armrest)

21
Q

Presentation of non-inflammatory bursitis?

A

As a result of repeated trauma (e.g. persistent leaning on elbows), excess fluid can develop within the bursa, causing it to become very apparent on direct observation.

22
Q

PE findings seen in non-inflammatory bursitis?

A

Obvious swelling at the tip of the elbow

no pain, redness or warmth

Full, painless ROM of the elbow.

23
Q

What causes inflammatory bursitis?

A

Result of infection or any other intense inflammatory process

24
Q

PE findings seen in inflammatory bursitis?

A

Obvious swelling at the tip of the elbow

(+) warmth, redness, and pain on palpation of the bursa.

+/- limitation of elbow flexion

25
Q

Tx for olecranon bursitis?

A

if small/mild: activity mod + NSAIDS

elbow pad

avoid hyperflexion against hard surfaces

if large/concern for infx: aspiration

26
Q

How do you perform an olecranon bursa aspiration?

A

27 G needle over lateral aspect of bursa, aspirate contents until bursa is flat

if concern for infx: culture, NO steroids

if no infx: steroids

27
Q

What causes elbow dislocations?

A

High energy injuries

Most common joint dislocation in children

28
Q

What must be ruled out when concerned for elbow dislocation?

A

olecranon or radial head fracture

Coronoid process fractures are commonly seen in posterior dislocations

29
Q

What component is critical for elbow dislocation?

A

NV exam

30
Q

What is a nursemaid’s elbow?

A

subluxation of the annular ligament

31
Q

How can you reduce a nursemaid’s elbow?

A

supination & flexion

32
Q

How can you dif. a subluxation from a dislocation?

A

xray

33
Q

What are the 3 types of radial head fractures?

A

Type 1: non-displaced
Type 2: mod displaced
Type 3: comminuted

34
Q

What does a fat pad sign on x-ray indicate? ***

A

intraarticular swelling within the joint > indicates occult intraarticular fracture

35
Q

Management/tx of Type I radial head fx?

A

Repeat x-ray in 7 – 10 days after the injury

Nonsurg tx involves using a splint or sling for a few days, followed by early motion

36
Q

tx for Type II radial head fx?

A

If displacement is minimal, splinting for one to two weeks, followed by ROM exercises

+/- ORIF depending on size and function

37
Q

Tx for Type III radial head fx?

A

Usually sig damage to the joint and ligaments

Surg usually required to remove the broken bits of bone, including the radial head, and repair the soft-tissue damage

Early movement to stretch and bend the elbow to avoid stiffness