Elbow Injuries

Question 1

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

Answer 1

Posterior dislocation

Question 2

What is a simple dislocation?

Answer 2

Just a dislocation, no other main structural damage

Question 3

What’s a complex dislocation?

Answer 3

Dislocation plus some kind of fracture

Question 4

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

Answer 4

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

Question 5

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

Answer 5

• 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)

Question 6

What exactly happens with the bones with a posterior elbow dislocation

Answer 6

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

Question 7

Is the GH joint or elbow more stable? Why?

Answer 7

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

Humerus and ulna fit tightly together = bony congruency

Question 8

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

Answer 8

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

Question 9

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

Answer 9

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

Question 10

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

Answer 10

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

Question 11

What muscles would get pulled apart with elbow extension?

Answer 11

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

Question 12

What does VEOS stand for?

Answer 12

Valgus extension overload syndrome

Question 13

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

Answer 13

• 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

Question 14

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

Answer 14

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

Question 15

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

Answer 15

1. Late cocking phase
2. Acceleration phase

Question 16

Describe the late cocking phase

Answer 16

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

Question 17

Describe the acceleration phase

Answer 17

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)

Question 18

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

Answer 18

stretching =DISTRACTION

Question 19

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

Answer 19

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

Question 20

What happens to the MCL complex in VEOS?

Answer 20

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

Question 21

What happens to olecranon + fossa in VEOS?

Answer 21

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

Question 22

What happens to the radio-humeral joint in VEOS?

Answer 22

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

Question 23

What happens with osteophytes in VEOS?

Answer 23

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

Question 24

Chondromalacia also happens in VEOS… describe

Answer 24

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

Question 25

We get osteochondritis dissecans … describe

Answer 25

(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)

Question 26

Review… where do we see tissue changes in VEOS?

Answer 26

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

Question 27

What is the difference between ITIS and ALGIA endings?

Answer 27

Itis = inflammatory algia = pain related to tendon fail

Question 28

What’s the clinical presentation of lateral epicondylagia?

Answer 28

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

Question 29

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

Answer 29

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

Question 30

Describe the functional and structural aspects of lateral epicondylagia

Answer 30

- 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

Question 31

Describe the tendinopathy aspect of lateral epicondylagia

Answer 31

- 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

Question 32

Describe the mechanics of this injury in a tennis example

Answer 32

- 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

Question 33

Why do the wrist flexors hurt when you grip something?

Answer 33

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

Question 34

Elbow dislocation is an _ injury

Answer 34

Acute

Question 35

What’s another name for lateral epicondylitis?

Answer 35

Tennis elbow

Question 36

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

Answer 36

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

Question 37

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

Answer 37

- flexion - supination - passive elbow extension

Question 38

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

Answer 38

Ulnar nerve, median nerve

Question 39

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

Answer 39

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

Question 40

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

Answer 40

- olecranon process (medial side > pinching) - medial epicondyle (attachment for MCL complex) - radiohumeral joint > capitulum

Question 41

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

Answer 41

Valgus stress test

Question 42

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

Answer 42

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

Question 43

What is the difference between osteochondritis dissecans and chondromalacia?

Answer 43

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

Question 44

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

Answer 44

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!!)

Question 45

posterior elbow dislocation will always have pain with active and passive_

Answer 45

extension

Question 46

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

Answer 46

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

Question 47

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

Answer 47

- 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)