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Musculoskeletal pathophysiology > Elbow cards > Flashcards

Elbow cards Flashcards

1
Q

Ulnar Variance

A

Radius should be longer at wrist than ulna

Critical for normal wrist function.

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2
Q

Most carpal bones articulate with _______.

A

Radius

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3
Q

Normal radiograph positioning at elbow & forearm

A

A/P view: shoulder ER, elbow ext
Lat view, elbow flexed
A/P view: forearm supinated
Lat view: forearm

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4
Q

RA at elbow

A

Flexion contractures
Ligamentous laxity, with 2º instability
Crepitation at RH joint
Diffuse synovial thickening

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5
Q

Total Elbow Replacement

A

Most commonly performed for RA

Hard to get right, due to arthrokinematics of elbow

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6
Q

OA/DJD at elbow

A

Often 2º trauma, sports injuries, or heavy labor
Osteophytes
Loose bodies, crepitus (noise in joint)
Joint space narrowing (articular cartilage wearing away)
Flexion contractures with loss of terminal extension

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7
Q

Severe Elbow OA management

A

Arthroscopic capsular release

Arthroscopic removal of osteophytes and/or loose bodies

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8
Q

Soft Tissue injuries

A 
Tendinitis
* Tennis elbow (Lateral)
* Golfer’s elbow (Medial)
* Triceps
Ligamentous injuries
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9
Q

Muscle most commonly involved in Lateral Epicondylitis

A

Extensor Carpi Radialis Brevis

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10
Q

Lateral Epicondylitis Signs & Sx’s

A

Pain with grip, especially with extended elbow

No loss of ROM

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11
Q

Conservative Rx for Lat Epicondylitis

A 
RICE
NSAIDs
PT:
 * Ionto/phono-phoresis
 * DFM
 * Stretching
 * Strengthening
 * Eccentric exercise
 * Elbow Support
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12
Q

Rx’s for recalcitrant Lat Epicondylitis

A

Cortisone injection

Surgical release of tendon

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13
Q

Medial Epicondylitis

A

Inflammation of wrist flexor muscles
1º: Pron. Teres, FCR
2º: PL, FCU, FDS
Rx: same as Lat Epicondylitis

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14
Q

Triceps Tendinitis

A

2º sudden stress, w/ fully extended elbow.

Pain at insertion to olecranon w/resisted extension, and passive flexion.

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15
Q

Olecranon Bursitis Signs & Sx’s

A

Boggy, hot, swollen posterior elbow

2º trauma, gout, or prolonged pressure @ olecranon

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16
Q

Rx for Olecranon Bursitis

A

Ice, rest, NSAIDS, may need cortisone injection

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17
Q

Valgus stress at the elbow injures which ligament?

A

MCL

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18
Q

Varus stress at the elbow injures which ligament?

A

LCL

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19
Q

Where do Biceps tendon ruptures usually happen?

A

Musculotendinous OR tendoperiosteal junctures.
If proximal, 50% in bicipital groove near shoulder.
Middle age+, usually no surgery.

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20
Q

Rx’s for Biceps tendon ruptures

A

Velpeau bandage in 90º flexion for 3-6 weeks

Surgical repair with suturing

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21
Q

What stress is related to most adolescent elbow injuries?

A

Valgus stress from throwing sports.
Medial injuries: traction at flexor forearm group.
Lateral injuries: compression on lat joint.

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22
Q

Traction apophysitis

A

Medial epicondyle.
“Little Leaguer’s Elbow”.
Inflammation, tears at wrist flexor insertions.

23
Q

Signs/Sx & Rx Traction apophysitis

A

Tenderness at med elbow, 15º lost ext ROM

Rest from activity, ice, strengthening after Sx subside

24
Q

Avulsion Fx of Med Epicondyle

A

2º forceful valgus stress from fall, violent muscle contraction.
Sx’s: pain/tenderness on Med epicondyle
< 1cm separation – conservative Rx 3-6 weeks
> 2cm separation – ORIF with K wire

25
Q

Who usually gets Osteochondritis Dessicans, and where?

A

Adolescents, at the Capitellum

26
Q

What causes Osteochondritis Dessicans?

A

Trauma or avascularity, cause avasc necrosis from pressure.
Osteochond. piece of Capitellum breaks off into joint
Rx arthroscopy
12-16 weeks before sports

27
Q

What does effusion on X-ray indicate?

A

Injury or Fx (ma be occult) at elbow complex.

28
Q

Causes of Distal Humeral Fx

A

FOOSH esp in kids

Either extra or intra-articular

29
Q

Rx for extra-articular Dist. Humeral Fx

A

Closed reduction.

Concerns: laceration of capsule, nerve, vessels, muscle, tendon.

30
Q

Intra-Articular Distal Humeral Fx

A

Single condylar Fx, usually Lateral

T or Y Fx’s usually need ORIF beyond Type I

31
Q

Fx Complications

A

Limitation of motion
Myosisis ossificans (esp if Brachialis involved or bleeds)
Soft Tissue scarring
Nerve injury

32
Q

Radial Head Fx

A

50% of all elbow Fx’s.
FOOSH, often with other Fx’s.
Pain w/ sup/pron

33
Q

What can Radial Head Fx affect?

A

Radial-Ulnar ligament and length.

Sx’s at wrist, due to change in Ulnar Variance.

34
Q

How are Adult Elbow Dislocations described?

A

Direction of movement of Radius and Ulna.

Posterior in 80% of cases.

35
Q

What causes recurrent Adult Elbow Dislocations?

A

Incomplete post-lat capsulo-ligamentous healing.

36
Q

What are Divergent elbow dislocations?

A

Radius displaced from ulna.

Rare, 2º severe trauma.

37
Q

Rx for Elbow Dislocations

A

Prompt realignment

Immobilization in sling 3-5 weeks, then gradual mobility

38
Q

Complication of Elbow Dislocations

A
  • Nerve injury 20%.
  • Vascular injury
  • Often 15º lost extension.
39
Q

Nursemaid’s Elbow

A

Radial head dislocation

Usually resolves without problem

40
Q

What are the 3 goals of Forearm Fx Management?

A
  1. restore normal length of Radius and Ulna
  2. restore normal rotary alignment
  3. restore axial alignment
41
Q

Monteggia Fx

A
  • Fx of proximal 1/3 - ½ of ULNA with Radial Head dislocation
42
Q

Galleazi Fx

A

Fx of mid-distal RADIAL shaft with sublux of distal RU joint

43
Q

Which nerve is compressed with Cubital Tunnel Syndrome?

A

Ulnar nerve, at medial elbow.

44
Q

Sx’s of Cubital Tunnel Syndrome

A
  • Paresthesia, decreased light touch 4th & 5th digits.

* Cubital Tunnel Sign: weakness in Ulnar N distribution below elbow.

45
Q

Which nerve is compressed in Anterior Interosseous Syndrome?

A

Median Nerve, under Pronator Teres.

46
Q

Sx’s of Anterior Interosseous Syndrome

A
  • Motor: weakness of FPL, FDP, + O Sign at hand

* Sensory: Median N. distribution in hand, forearm achiness.

47
Q

Which nerve is compressed with Posterior Interosseous Syndrome?

A
  • Radial Nerve, under Supinator and “Arcade of Frohse” (bet they don’t have Pac-man)
48
Q

Sx’s of Posterior Interosseous Syndrome

A

Weakness in wrist extensors, MCP extensors

49
Q

What causes Myositis Ossificans, and where is it usually?

A
  • Bony inflammatory tissue in muscle.

* Brachialis (or quad) after injury with bleeding.

50
Q

Signs & Sx’s of Myositis Ossificans

A
  • @ elbow: more lost ext than flx

* Hematoma, excessive tenderness in Brachialis

51
Q

PT precautions for Myositis Ossificans

A

No vigorous stretching, US, or massage.

52
Q

Volkmann’s Ischemic Contracture

A
  • Oh crap, you ruptured your Brachial Artery!
  • Good luck getting blood to the muscles and nerves in your forearm, bro!
  • Bet you’ve also go a supracondylar Fx, too…
  • Must check & monitor often. Emergency!
  • Irreversible damage after 4-6 hours.
53
Q

Signs & Sx’s of Ischemia

A

FPHIR (“fir”)

  1. Finger motion limited & painful
  2. Pain in forearm muscles
  3. Pallor
  4. Paralysis eventually
  5. Hand: purple with big veins
  6. Initial paresthesia, eventual sensory loss
  7. Radial pulse: adios!

Musculoskeletal pathophysiology (3 decks)

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