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5 Ortho > L12 Elbow Conditions > Flashcards

L12 Elbow Conditions Flashcards

(52 cards)

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1
Q

ABCs of radiograph

A

alignmnet
bone
cartilage
soft tissue

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2
Q

Primary static constraints of elbow

A

ulnohumeral articulation
MCL
LCL

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3
Q

Secondary static constraints

A

radial head
common flexor and extensor origins
capsule

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4
Q

Dynamic stabilizers of elbow

A

anconeus
triceps
brachialis

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5
Q

Flexor pronator group

A

stabilizes against valgus stress when in supination

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6
Q

Extensor-supinator group

A

stabilizes against varus stress when in pronation

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7
Q

Flexion stability

A

abutment of radial head against capitulum
coronoid process against trochlea

osseous articulations contribute 1/3 jt stability in both flexion and extension

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8
Q

Extension stability

A

coronoid process impacts against the trochlea
olecranon process into olecranon fossa

osseous articulations contribute 1/3 jt stability in both flexion and extension

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9
Q

0° elbow extension valgus/medial resistance to stresses

A

(valgus stress)
MCL: 31%
Ant Capsule: 38%
Bony articulation: 31%

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10
Q

90° elbow flexion resistance to valgus/medial stresses

A

MCL: 54% (mainly ant portion)
Ant capsule: 10%
Bony articulation: 36%

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11
Q

0° elbow extension resistance to varus/lateral force stresses

A

LCL: 14%
Ant Capsule: 32%
Bony articulation: 55%

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12
Q

90° elbow flexion resistance to varus/lateral stresses

A

LCL: 9%
Ant capsule: 13%
Bony articulation: 75%

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13
Q

Biomechanics of elbow dislocation

A
  1. Ulnar portion of LCL is disrupted
  2. Remaining LCL structures, ant and post capsule disrupted
  3. MCL is partially disrupted, involving MCL only or is completely disrupted
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14
Q

Elbow dislocations

A

most frequent in children
second most frequent overall after shoulder

MOI: foosh with axial loading, supination of forearm

posterolateral is most common

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15
Q

Simple dislocation of elbow

A

absence of fractures
named for direction of dislocation

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16
Q

Complex dislocation

A

presence of fractures

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17
Q

Terrible triad

A

posterior dislocation with intra-articular fractures of radial head and coronoid process

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18
Q

Pt presentation of elbow dislocation

A

olecranon tip is prominent
shoulder, wrist, and hand involvementn possible

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19
Q

Neural and vascular complications of elbow dislocation

A

ulnar and median possible with simple dislocations
radial nerve with complex radial head injuries

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20
Q

Non-op management of simple elbow dislocation

A

Closed reduction
check stability and NV involvement
immobilize at 90° for 7-10 days
limit full extension if grossly unstable

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21
Q

Therapy for simple elbow dislocation

Study These Flashcards
A

as soon as day 2
begin with AROM gripping, flex/ext
supervised AAROM in stable arm
limit full extension

do not immobilize for more than 3 weeks, you will lose extension

22
Q

REturn to full activity based on soft tissue damage only

Study These Flashcards
A

light use at 2 weeks
sports up to 3-4 months

23
Q

Pronation makes ___ taut and stabilizes ____

Study These Flashcards
A

supinators
varus

24
Q

Good to excellent prognosis for dislocation

Study These Flashcards
A

immediately reduced
no loss of NV
no fx
wrestlers

25
What decides future stability?
integrity of soft tissue presence of fx
26
Little League Elbow definition
overuse injury due to repetitive valgus loading with throwing resulting in microtrauma to an immature skeleton
27
Tension overload in little league elbow
1. medial epicondyle. Results in altered growth of epicondyle, traction apophysitis, stress fractures 2. UCL anterior band 3. Flexor pronator mass
28
Younger athletes are more likely to have
apophysitis or avulsion injuries instead of UCL sprains
29
Throwing causes
medial tension and lateral compression forces
30
S/S of Little league elbow
m elbow pain in throwing arm decreased throwing speed, accuracy, distance tenderness to palpation at medial elbow pain with valgus stress
31
Differential diagnosis for Little League
Avulsion fx of medial epicondyle UCL sprains or tears Ulnar nerve neuropathy
32
Avulsion fx of medial epicondyle vs LL elbow
point tenderness and swelling over medial epicondyle, lack of full extension are clinical signs
33
Interventions for LL Elbow
relative rest core strengthening ROM and joint mobs joint stabilization biomechanical throwing analysis progressive throwing program at 4-8 weeks of tx
34
Pitching over ____ innings in 1 calendar year increases risk of LL elbow by ____
100 3.5 times limiting the # of innings pitched per year may reduce the risk of injury
35
Indications for Tommy John
(UCL ant band ligament reconstruction) high level throwers that want to continue competitive sports failed non operative management in pts willing to undergo extensive rehab
36
Technique for Tommy John Surgery
muscle splitting approach in-situ ulnar nerve decompression reconstruction: most usually with autograft
37
Valgus extension overload, pitcher's elbow
condition characterized by pathology in poteromedial elbow usually in competitive baseball pitchers MOI: repetitive stress of pitching leads to excessive shear forces on medial aspect of lecranon tip and olecranon fossa and overload tension at MCL
38
Progression of Pitcher's elbow
1. chrondrolysis osteophyte formation loose bodies MCL attenuated with repetitive strain radio-capitellar compression
39
Pitcher's elbow is a combination of
breakdown of lateral epicondyle (compression) and breakdown of medial epicondyle (tension)
40
Lateral Tendinopathy, Tennis Elbow
overuse injury involving eccentric overload at origin of common extensor tendon most common cause for elbow symptoms in pts with elbow pain
41
Demographics of tennis elbow
up to 50% of all tennis players develop it 1-3% of general pop usually age 35 to 54 lasts from 6 mo to 2 years resolves after 2 years regardless of interventions
42
Pathophys of lateral tendinopathy
eccentric overload to ECRB repetitive pronation/supination with elbow extension RF are tools heavier than 1 kg, loads hevier than 20 kg at least 10 times a day, repetitive movements for more than 2 hrs per say
43
Anatomy of tennis elbow
usually begins as a microtear of the origin of ECRB may also involve microtears of ECRL microscopic anatomy reveals angiofibroblastic hyperplasia and disorganized immature collagen
44
S/S of tennis elbow
pain with gripping activities decreased grip strength point tenderness ECRB at lateral epicondyle decreased grip strength weakness and pain with resisted wrist ext
45
Provocative Tests for tennis elbow
resisted wrist extension with elbow fully extended resisted exntesion of middle finger maximal passive flexion of wrist all tell you HOW irritable the lateral elbow is
46
Differential diganosis from tennis elbow
Lateral elbow pain and loss of ROM can be: elbow OA, radial head fx, osteochondritis of capitellum Cervical involvement: radiating pain, neck pain, paresthesias, muscle weakness in myotomal pattern
47
Protected function phase of tx for tennis elbow
limit pain provoking activities keep limb mobile MWMs modalities aren't great
48
Total arm strength rehab phase of tx for tennis elbow
proximal stability before distal stability serratus and lower trap RC post cuff muscles eccentric, endurance, stretching of forearm extensors
49
Return to activity phase of tx for tennis elbow
tolerance to resistance exercises in phase 2 strength functional ROM
50
Radial tunnel syndrome
deep aching distal to lateral epicondyle pain at belly of brachioradialis pain with resisted supination pain with repetitive wrist flexion or pronation initiated and intensified by repetitive movements with pronation uncommon in general pop
51
Distal radioulnar joint
concave ulnar notch of radius articulates with convex head of ulna resting position is with the forearm supinated to 10° treatment place is the articulating surface of radius, parallel to long axis of radius
52
Distal Radioulnar Dorsal/Palmar Glides
forearm on treatment table, begin in resting position and progress to end range pronation or supination stabilize distal ulna by placing fingers of one hand on dorsal surface, thenar eminence and thumb on palmar surface. Other hand goes on radius glide distal radius (concave) dorsally to increase supinsation or palmar to increase pronation

5 Ortho (14 decks)

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