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Ortho Test 4 > elbow patho > Flashcards

elbow patho Flashcards

(45 cards)

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1
Q

what two structures do you imagine will be implicated in a central/deep posterior elbow symtpoms?

A

HUJ or C7 root

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2
Q

what causes an elbow dislocation?

A

high energy trauma directly to elbow or FOOSH

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3
Q

which direction is most common in elbow dislocations and why?

A

posterior dislocation of the ulna due to shape of the articulations

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4
Q

describe a simple elbow dislocation

A

acute soft tissue injury named for the direction of displacement

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5
Q

describe the terrible triad

A

aka complex elbow dislocation - posterior dislocation, radial head fx, and coronoid fx

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6
Q

what neurovascular structures must we be concerned with in simple dislocations? complex?

A

simple: median and ulnar

complex - radial

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7
Q

what is heterotopic ossificans?

A

ectopic bone formation in paraarticular soft tissues

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8
Q

what causes HO?

A

56% following elbow fx/dislocations peaking around 2 months following incident

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9
Q

what increases your risk for HO (and thus causes physicians to treat pts prophylactically following an elbow trauma)

A
  1. excess bone development
  2. anky spine
  3. pagets
  4. hx of HO
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10
Q

what is the primary sxs of HO? secondary?

A

pain with progressive loss of ROM; hyperemia, swelling, warmth

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11
Q

comment on radiographs for HO

A

bone scan: increased uptake by wk 2

xray: may not show evidence until wk 5

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12
Q

although varus instability is less common than valgus instability, what three typical scenarios lead to varus instability?

A
  1. varus stress
  2. iatrogenic - tennis elbow surgery or multiple cortisone injections
  3. dislocations
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13
Q

Posterolateral Rotary Instability is related to varus instability… so what is it

A

persistent insufficiency of the LCL causing posterior dislocation without compromising the PRUJ

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14
Q

what is the MOI for posterolateral rotary instability?

A

humerus IR/valgus stress, compression, and supination

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15
Q

how does a patient with varus instability/posterolateral rotary instability present?

A
  • vague discomfort and clicking/popping/clunking
  • difficultly with elbow extension and supination
  • giving out during loading
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16
Q

how do you manage varus instability/posterolateral rotary instability?

A
  • protect and deload
  • hinged brace for 4-6 weeks
  • avoid abd/IR acts
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17
Q

what causes valgus instability? pt profile?

A

FOOSH or chronic valgus stress - overhead throwers

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18
Q

what structure is at greatest risk for valgus instability?

A

anterior UCL

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19
Q

how does a pt present with valgus instability?

Study These Flashcards
A
  • medial elbow pain
  • may have been an instant pop, after a day of pitching/spiking, insidious
    • tendinosis may or may not be present
20
Q

what does radiography show for UCL insufficient pts with valgus instability?

Study These Flashcards
A

gapping on the effected joint line

21
Q

what is valgus extension overload syndrome

Study These Flashcards
A

the olecranon compresses the humerus causing medial impingement leading to medial elbow pain and thus arthroscopic debridement

22
Q

what can repetitive valgus stress lead to?

Study These Flashcards
A
  1. chrondrolysis (cartilage damage)
  2. osteophytes
  3. loose bodies
  4. MCL tensioning
  5. lateral compression
23
Q

what are the sxs of valgus extension overload syndrome?

Study These Flashcards
A
  • flexion contracture
  • painful active extension w crepitus
  • PROM painful: pronation, valgus, extension
  • TTP post med elbow
24
Q

how do you treat valgus extension overload syndrome?

Study These Flashcards
A

RICE > address ROM and strengt > surgery

25
what is lateral tendinosis?
tennis elbow - lesion at the common extensor origin at the lateral epicondyle - overuse of extensors particularly ECRB
26
what is the pt profile for lateral tendinosis?
35-50yrs female with high physical work or computer work
27
what clues you in to lateral tendinosis?
* pain with gripping * pain with passive wrist flexion stretching * tenderness 1 cm distal to lateral epicondyle
28
what are the primary muscles involved in golfers elbow
PT, FCR, and PL
29
what provokes medial tendinosis?
wrist flexion resistive testing, TTP, and wrist extension stretching
30
how do you treat medial or lateral tendinosis
self stretching and eccentric strengthening injections, bracing, and modalities
31
what mechanisms typically cause ulnar cubital tunnel syndrome
traction from throwing and long standing valgus deformity
32
how does a patient present with cubital tunnel syndrome?
* paresthesia esp waking from sleep * clumsiness or lost finger coordination * sublux during flexion/extension
33
advanced cubital tunnel can show atrophy where?
interosseus and first web space; wartenberg sign (not shown)
34
what is wartenberg sign
abducted 5th digit due to weak adductors
35
which three tests can be performed to indicate cubital tunnel syndrome
tinnel's, froment, and elbow flexion
36
how do you manage cubital tunnel?
night splinting at 20-45 flexion and full supination for 4-6 weeks avoid aggressive stretching early kinetic chain mobiliity
37
what is AIN syndrome
entrapment of the median nerve due to trauma, causes motor-only issues (ok sign)
38
what is pronator teres syndrome
high median nerve compression caused by overuse pronation/supination
39
how does pronator teres syndrome present?
* anterior elbow pain * no specific MOI * anterior forearm/hand weakness * sensory complaints * pronator teres unaffected
40
how do you treat pronator teres syndrome?
avoid aggs, rest, immobilization gentle ROM for 2 weeks
41
what does ligament struthers syndrome impact?
median nerve
42
what is radial tunnel syndrome?
* deep ache distal lateral epicondyle * pain with resisted supination * no motor or sensation loss
43
what are the clinical features of PIN syndrome
* finger drop * wrist ext with radial dev * sensation intact * pain increased with supination
44
what does saturday night palsy affect?
radial nerve
45
how does saturday night palsy present?
drop wrist with normal triceps with some pain at the superficial entrapment site

Ortho Test 4 (7 decks)

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