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Sports Injuries > Elbow Injuries > Flashcards

Elbow Injuries Flashcards

1
Q

We dislocate our elbow in a direction. Which one did we mainly talk about in class?

A

Posterior dislocation

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2
Q

What is a simple dislocation?

A

Just a dislocation, no other main structural damage

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3
Q

What’s a complex dislocation?

A

Dislocation plus some kind of fracture

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4
Q

What’s the clinical presentation of a posterior elbow dislocation?

A
  • deformation
  • Loss of ability to move joint
  • Swelling
  • Bruising
  • might have nerve and ligament damage too
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5
Q

What is the mechanism of injury for a posterior elbow dislocation?

A
  • usually will see them in end range of extension and landing on it (axial load) + a little bit of valgus (fail through medial side more than lateral)
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6
Q

What exactly happens with the bones with a posterior elbow dislocation

A
  • condyle should fit in the concavity on the ulna (ice cream scoop shape)
  • ulna moves posteriorly
  • moves out of the fossa
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7
Q

Is the GH joint or elbow more stable? Why?

A

Humero-ulnar (elbow) joint is a lot more stable, GH is easier to pop out

Humerus and ulna fit tightly together = bony congruency

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8
Q

What other structures might we also damage with a posterior elbow dislocation? Why?

A

Ligament support and joint capsule since we need significant force to go through and dislocate the joint

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9
Q

What structure lie on the medial side of the elbow/ humero-ulnar joint?

A
  • MCL complex, limiting valgus movement
  • series of bands all coming from medial condyle and wrap around medial side of ulna
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10
Q

What structures lie on the lateral side of the elbow joint?

A
  • the one that wraps around radial head = annular ligament
  • radial collateral ligament goes from humerus to radius
  • lateral ulnar collateral ligament
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11
Q

What muscles would get pulled apart with elbow extension?

A
  • biceps tendon - distal (crosses front of elbow)
  • brachioradialis (on right)
  • pronator teres
  • wrist flexors (come across anterior aspect of joint as well)
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12
Q

What does VEOS stand for?

A

Valgus extension overload syndrome

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13
Q

What are some clinical presentations of VEOS? (IE. story from lecture)

A
  • chronic issue (used to hurt but on and off)
  • pain on medial and posteromedial elbow
  • locking/catching/crepitus/grating sensation (hint that something isn’t as smooth as before)
  • throwing velocity decreased (if pitching dude hehe)
  • worst pain at ball release
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14
Q

What structures limit or would get pulled apart with valgus motion in VEOS?

A

MCL complex is primary restraint to try and control/liit and valgus stress that might come along
- pronator teres and some wrist flexors may also experience some stress on medial side
- ulnar nerve goes behind medial epicondyle

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15
Q

Elbow valgus stress peaks at 2 points in the cycle… which ones?

A
  1. Late cocking phase
  2. Acceleration phase
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16
Q

Describe the late cocking phase

A
  • peak external rotation of GH joint
  • ball is still in hand and reach max external rotation, opening up medial elbow (major valgus stress point)
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17
Q

Describe the acceleration phase

A

Coming off of peak external rotation and goes into peak internal rotation and extension before releasing the ball (people who have VEOS tend to release a little later, usually the elbow is a little flexed when the ball is released)

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18
Q

What happens to the medial side of the elbow with VEOS?

A

stretching =DISTRACTION

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19
Q

What happens to the lateral side of the elbow with VEOS?

A
  • more valgus motion = slamming of radial head against humerus = COMPRESSION
20
Q

What happens to the MCL complex in VEOS?

A
  • starts to become looser
  • elbow can valgus more because of this
  • loosing its integrity
21
Q

What happens to olecranon + fossa in VEOS?

A
  • olecranon slams into olecranon fossa
  • olecranon starts to shift and pinch spot on upper fossa (look at slide 14, lec 15)
22
Q

What happens to the radio-humeral joint in VEOS?

A

@ radio- humeral and radio-capitular joint we get some compression

23
Q

What happens with osteophytes in VEOS?

A
  • see osteophyte (bone spur) development where radius meets humerus and mostly in upper olecranon fossa (check slides)
24
Q

Chondromalacia also happens in VEOS… describe

A

Cartilage in radio-humeral area (more so here) and olecranon fossa near ulna starts to become thinner and more fragile

25
Q

We get osteochondritis dissecans … describe

A

(Bone underneath cartilage dies due to lack of blood flow, making it fragile = google)
- bone underneath the cartilage breaks off, floats around in joint (gritty sensation could come from little bits of bone moving around or cartilage snapped off too, kind of like having something a bit bigger than sand in joint)

26
Q

Review… where do we see tissue changes in VEOS?

A
  • mcl complex
  • olecranon process and its fossa
  • radio-humeral joint
  • osteophyte (bone spur) development
  • chondromalacia
  • osteochondritis dissecans
27
Q

What is the difference between ITIS and ALGIA endings?

A

Itis = inflammatory
algia = pain related to tendon fail

28
Q

What’s the clinical presentation of lateral epicondylagia?

A

Chronic lateral elbow pain
- pain can spread into dorsal forearm (upper 1/3) but primarily pain is still in lateral elbow
- feels like someone “stabs” elbow when trying to grip something
- in tennis example it was aggravated by backhand stroke/ gripping tasks

29
Q

In the case of tennis and lateral epicondylagia, what patient sport-related info would we want to know?

A

Equipment changes
- might affect grip, be tighter/heavier, or establish if it had acute onset

30
Q

Describe the functional and structural aspects of lateral epicondylagia

A
  • issue primarily affects lateral epicondyle, periosteum of epicondyle might be irritated and tendons that attach to epicondyle (usually ECRB)
  • another tendinopathy, behaves in the same way as others
  • more tension on ECRB, tendon become less competent to deal with eccentric load
31
Q

Describe the tendinopathy aspect of lateral epicondylagia

A
  • disrepair that leads to progressive degeneration of tendon
  • Constant cycle of laying down low quality tissue. Overtime, this builds up but still poor quality tissue.
  • Becomes less competent to deal with eccentric load
  • tendons absorb eccentric load, don’t have much blood flow
32
Q

Describe the mechanics of this injury in a tennis example

A
  • Ball makes contact with a racket, it’s recent causes flexion
  • Pulls on wrist extensor (esp radial side)
  • if athletes have stronger grip on racquet this often causes more tension of ECRB
  • more skilled player will have more relaxed grip, hit with neutral or less flexed wrists
33
Q

Why do the wrist flexors hurt when you grip something?

A

Every finger flexor flexes the wrist, every time you grip, your wrist extensors have to work harder to contract the wrist flexion that is created

34
Q

Elbow dislocation is an _ injury

A

Acute

35
Q

What’s another name for lateral epicondylitis?

A

Tennis elbow

36
Q

Which 2 ROM tests are most likely to be painful if you have had a posterior elbow dislocation?

A

assuming they can even move it/joint is in place…
- extension (part of MOI)
Active and passive (more annoying), need to pull apart injured ligaments

37
Q

Which 2 active and resisted ROM tests are most likely to be painful if you have strained your distal biceps (brachii) tendon?

A
  • flexion
  • supination
  • passive elbow extension
38
Q

If you experience neurological damage following an elbow dislocation, which nerve is most likely to be affected?

A

Ulnar nerve, median nerve

39
Q

Where will you be most likely to experience tingling or numbness (as potential neurological symptoms)

A

Ulnar side of forearm into pinky (ulnar nerve)
Radial, palmar side of hand - middle to thumb (medial nerve) * on front, pulled apart with hyperextension

40
Q

What 3 areas of the elbow joint are affected by VEOS? Be specific with anatomic terminology

A
  • olecranon process (medial side > pinching)
  • medial epicondyle (attachment for MCL complex)
  • radiohumeral joint > capitulum
41
Q

What do VEOS and posterior elbow dislocation have in common? Hint: what special test is likely to be painful for both of these conditions?

A

Valgus stress test

42
Q

When does valgus elbow stress peak, when throwing a ball? Consider the technical name of each phase/event, and how you would identify this on an image

A

Late cocking phase (max external rotation)
Acceleration phase (ball release)

43
Q

What is the difference between osteochondritis dissecans and chondromalacia?

A

OCD: breaking odd bone and cartilage
CM: attached “sick” cartilage ??? Check but i thought thinning

44
Q

Which 2 active and resisted tests are most likely to be positive for an athlete with lateral epicondylagia?

A

WRIST EXTENSION (active and resisted)
RADIAL DEVIATION (active and resisted)
* think of what will ask ECRB to contract, passive will be ulnar deviation and wrist flexion (think of lab tests!!)

45
Q

posterior elbow dislocation will always have pain with active and passive_

A

extension

46
Q

Which passive test is most likely to be positive for an athlete with lateral epicondylagia?

A

Passive motions: wrist flexion and ulnar deviation
- wrist flexion will be most painful because more movement available, major testing here

47
Q

Lateral epicondylagia is partly a tendinopathy: explai what this means at the tissue level

A
  • tendinopathy is build up over time, chronic issue
  • same tissue changes are happening as before
  • degeneration i happening, this mean that it’s getting stuck in repair phase and unable to transition to remodelling
  • start to build new blood vessels, the unhealthy tendon most of the time has much more blood supply than healthy (some but not a ton)
  • get more sensitivity in that tissue
    SPECIFY WHAT DEGENERATION (bone doesn’t have a buildup of collagen etc)

Sports Injuries (21 decks)

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