Elbow

Question 1

What is lateral epicondylitis?

Answer 1

“tennis elbow”

Overuse inflammatory injury involving common extensor tendon

Repetitive wrist or combined wrist and finger extension.

Question 2

PE findings in lateral epicondylitis?

Answer 2

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

Question 3

Tendonitis v. tendonosis?

Answer 3

both are tendon overuse injuries

itis: Inflammation, fiber disruption/ degeneration

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

Question 4

Tx of tendonitis?

Answer 4

Steroid injection

Activity modification

NSAIDs

Ice

Therapeutic exercise
(Stretching
Strengthening)

+/- Bracing, PT

Question 5

Tx of tendonosis?

Answer 5

Activity modification

PT, exercise

+/- Bracing

NSAIDs & Steroid injection = NOT beneficial long term

Question 6

Fundamentals of tendonosis tx?

Answer 6

Mod aggravating activity

correct biomechanical
faults

address degenerative component

exercise

Question 7

What can be used to help tendonosis-address degenerative component

Answer 7

ASTYM

Graston

Dry Needling

PRP injections

Question 8

Who is usually affected by distal biceps tendon tear?

Answer 8

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

Question 9

MOA of distal biceps tendon tear?

Answer 9

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

Question 10

Non surg tx for partial distal biceps tendon tear?

Answer 10

Bracing with ROM limitation X 4 weeks

Gradual progression of ROM and strengthening

Question 11

Non surg tx for complete distal biceps tendon tear?

Answer 11

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

Question 12

Surgical tx for distal biceps tendon tear?

Answer 12

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

Elective for partial tears in young active individuals

Question 13

“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

Answer 13

Medial epicondylitis/osis

v.

ulnar collateral ligament tear

v.

Medial epicondyle apophysitis “Little leaguer’s elbow”

Question 14

what tests can you use to test ulnar collateral ligament?

Answer 14

Valgus stress test

Milk maneuver**

moving valgus stress test ***

Question 15

How is the milking maneuver performed?

Answer 15

Tests posterior band of UCL

Assess for pain, medial joint laxity, and end feel

Question 16

How is the moving valgus stress test performed?

Answer 16

Pain throughout ROM = UCL insufficiency

Good s/s

Shear angle 120° to 80°

Question 17

Tx for medial epicondylitis/osis?

Answer 17

similar to lateral epicondylitis/osis

Question 18

Tx for ulnar collateral ligament tear

Answer 18

surg consult

Question 19

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

Answer 19

Activity modification: no throwing 6-8 wks

PT

Gradual return to throwing

Question 20

” I have a golf ball hanging off my elbow”

Answer 20

olecranon bursitis

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

Question 21

Presentation of non-inflammatory bursitis?

Answer 21

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.

Question 22

PE findings seen in non-inflammatory bursitis?

Answer 22

Obvious swelling at the tip of the elbow

no pain, redness or warmth

Full, painless ROM of the elbow.

Question 23

What causes inflammatory bursitis?

Answer 23

Result of infection or any other intense inflammatory process

Question 24

PE findings seen in inflammatory bursitis?

Answer 24

Obvious swelling at the tip of the elbow

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

+/- limitation of elbow flexion

Question 25

Tx for olecranon bursitis?

Answer 25

if small/mild: activity mod + NSAIDS elbow pad avoid hyperflexion against hard surfaces if large/concern for infx: aspiration

Question 26

How do you perform an olecranon bursa aspiration?

Answer 26

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

Question 27

What causes elbow dislocations?

Answer 27

High energy injuries Most common joint dislocation in children

Question 28

What must be ruled out when concerned for elbow dislocation?

Answer 28

olecranon or radial head fracture Coronoid process fractures are commonly seen in posterior dislocations

Question 29

What component is critical for elbow dislocation?

Answer 29

NV exam

Question 30

What is a nursemaid's elbow?

Answer 30

subluxation of the annular ligament

Question 31

How can you reduce a nursemaid's elbow?

Answer 31

supination & flexion

Question 32

How can you dif. a subluxation from a dislocation?

Answer 32

xray

Question 33

What are the 3 types of radial head fractures?

Answer 33

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

Question 34

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

Answer 34

intraarticular swelling within the joint > indicates occult intraarticular fracture

Question 35

Management/tx of Type I radial head fx?

Answer 35

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

Question 36

tx for Type II radial head fx?

Answer 36

If displacement is minimal, splinting for one to two weeks, followed by ROM exercises +/- ORIF depending on size and function

Question 37

Tx for Type III radial head fx?

Answer 37

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