Elbow Flashcards by Nayla Mansoor

Per normal anatomy, the anterior humeral line should intersect what

The middle of the capitellum

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Per normal anatomy, the middle of the capitellum should have a straight line going through

the proximal radial shaft

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What is the MOI of lateral epicondylitis (tennis elbow)

Overuse inflammatory injury from repetitive wrist or wrist finger extension
Involves common extensor tendon

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Lateral epicondylitis will show what on PE

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

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What is tendonITIS vs tendonOSIS

itis: inflammation; fiber disruption and degeneration
osis: sporadic inflammation (process is stalled); mucoid degeneration; fiber disorganization (basically degeneration inside that doesn’t yield inflammation usually)

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How do you treat tendonitis

Steroid injection 
Activity modification 
NSAIDs 
Ice 
Stretching and strengthening 
Bracing considerations 
\+/- PT

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How do you treat tendinosis

Activity mod 
PT
Stretching and strengthening 
\+/- Bracing 
NO NSAIDs or steroid injections because this is more chronic

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The fundamentals of treating tendonosis are

modify aggravating activity
correct biomechanical faults
Astym, Graston, Dry needling, and PRP injections to help degeneration
Stretching and Eccentric strengthening as therapy

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What movements are associated with distal biceps tendon tear

Rapid eccentric contraction (catch something falling) and a pop

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What deficit is felt with a distal biceps tendon tear

Flexion at elbow is diminished

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How do you test biceps brachii

With patient’s arm extended and pronated, ask them to resist supination

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How do you test brachialis

Put them in neutral (like they are holding a coke can) and ask them to resist as you apply pressure inferiorly

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Who is more likely to get a distal biceps tendon tear

men >40 with pre-existing degenerative changes

rapid eccentric contraction of biceps at radial insertion

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How do you treat distal biceps tendon tears, NON-surgically

Partial: brace and limit ROM x 4 weeks. Gradual progression of ROM and strengthening
Complete: only non-surg if older sedentary, and willing to accept strength loss

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Who should have distal biceps tendon tears treated surgically

Complete tear in young, active individuals

Elective for partial tear in young active adults

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What does medial epicondylitis affect

Common flexor muscle group
Common flexor tendon
Colateral ulnar ligament
Ulnar nerve

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What is you ROM loss with medial epicondylitis

Reduced wrist flexion and arm flexion

BUT- you can’t make your Dx based on Sx, you ned more testing to r/o ulnar collateral ligament pathology, etc.

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What are the parts of the ulnar collateral ligament

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Anterior, intermediate, and posterior band

What is the Valgus stress test

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Perform at 0 and 30 degrees flexion

Move distal arm lateral while stabilizing the elbow. This mainly tests the anterior band of the UCL

What is the Milking maneuver

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Test for posterior band of UCL

Assess pain, medial joint laxity, and end feel

Best test for testingUCL is

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Moving Valgus test!

If they have pain throughout

Best test for testingUCL is

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Moving Valgus test!
If they have pain throughout the ROM= UCL insufficiency
“Shear” angle is where the most pain is felt; 120-80 degrees

How do you treat medial epicondylitis/osis

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Similar to Lateral!

If there is a UCL tear, need surgical consult bc it does not heal well on it’s own

What is medial epicondyle apophysitis (little leaguers elbow)

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When the growth plate in the medial epicondyle widens due to traction to the area

How do you treat medial epicondyle apophysitis

Activity modify PT GRadual return to throwing (no throwing 6-8 weeks, then PT, then 1 month of gradual return)

What is in the region of the posterior elbow

Olecranon bursa triceps tendon olecranon process

MOS for olecranon bursitis is commonly

constant pressure to the area (like resting on an arm rest)

How does non-infectious bursitis present

as a result of repeated trauma, fluid develops in the bursa causing obvious swelling

Non-infectious bursitis on PE is remarkable for

Obvious swelling at the tip of the elbow Absence of pain, erythema, warmth Full painless ROM of elbow

Infectious bursitis is a result of

Infection or other intense inflammatory process

On PE, infectious bursitis will show

Obvious swelling at tip of elbow marked warmth, erythema, and pain when palpating the bursa Limitation of elbow flexion

How do you treat olecranon bursitis

Small fluid and mild Sx: activity modify + NSAIDs wear elbow pad avoid hyperflexion against hard surfaces Aspirate bursa if effusion is large or you are concerned for infection

What is the procedure for olecranon bursa aspiration

inject lidocaine w/ 27g needle aspirate w/ 18g 10ml syringe until bursa is flat Send fluid for C&S if concerned for infx NO steroids if you suspect infection!!! If infection not present, may inject 40mg Kenalog (steroid) Keep compression to prevent refilling

What causes elbow dislocations

High energy injuries MC joint dislocation in kids MC posterior dislocation

When suspecting an elbow dislocation, you must r/o

olecranon or radial head fractue! Coronoid process fractures are very common in posterior dislocations MUST do a neurovascular exam

What structures provide stability to the elbow

Valgus: medial collateral ligament and radial head Varus: lateral collateral ligament Coronoid process Sigmoid fossa

What is Nursemaid's elbow

Radial head dislocation! Can occur with parents lifting child by the arms Essentially subluxation of radial head

How can you correct radial head dislocation

They will come in pronated. | Place your hand posteriorly over the radial head. Quickly supinate and flex the elbow

What are the types of radial head fractures

I: NOT displaced, fat pad sign. Repeat XR in 7-10 days b/c Fx may not be visible on XR II: displaced III: comminuted, >3 fragments. + damage to ligaments and joints

What sign is associated with fracture on XR

fat pad sign surrounding the affected area | Indicated blood seeping out

How do you treat a type I radial head Fx

Non-surgical: splint or sling for a few days, they implement early motion

How do you treat type II radial head fracture

Minimal displacement: splint 1-2 wks, then ROM exercises | +/- open reduction internal fixation depending on size and function

How do you treat type III radial head fracture

Surgery to remove broken bone fragments and repair soft tissue damage Early movement to stretch and bend elbow and avoid stiffness

Elbow Flashcards

(43 cards)