Lecture 10B: Elbow Complex Examination And Evalluation Flashcards
(90 cards)
1
Q
What kind of stress does the radial head resist
A
Valgus stress
2
Q
What is the difference between tendinopathy pain and instability pain
A
Tendinopathy (contractile tissue)
* Pain w/ activities
* Hx of repetitive motions
Instability (non-contractile tissue)
* Pain w/ prolonged static positions
* Pain after activities
3
Q
If a pateint has referred pain to the elbow what 3 things could it be
A
- Acute MI
- Pancoast’s syndrome
- Esophageal motor disorders
4
Q
If a patient has acute onset of non traumatic swelling in the elbow what do we think
A
Septic arthritis
5
Q
If a patient has a. MOI of trauma what 6 things could it be in the elbow
A
• Acute fractures/dislocations
• Muscle strains
• Ligament/capsule sprains
• Growth plate injuries
• Neurovascular injuries
• Bursitis
6
Q
If a patient has a. MOI of over use what 5 things could it be in the elbow
A
- Elbow/forearm tendinopathies
- Growth plate injuries
- Stress fractures
- Neurovascular injuries
- Bursitis
7
Q
If a person is fully grown could they have a growth plate injury at the elbow
A
No
8
Q
If a pateint has anterior elbow pain what are 4 possible disorders
A
- anterior capsule strain
- distal biceps tendon rupture/tendinitis
- dislocation of the elbow
- pronator syndrome (throwers)
9
Q
If a pateint has medial elbow pain what are 7 possible disorders
A
- medial epicondylitis
- ulnar collateral ligament injury (MCL)
- ulna neuritis
- flexor pronator mm strain
- fx
- little leagues elbow
- valgus extension overload overuse syndrome
10
Q
If a pateint has posteromedial elbow pain what are 3 possible disorders
A
- olecranon tip stress fx
- posterior impingement in throwers
- trochlear chondromalacia
11
Q
If a pateint has posterior elbow pain what are 3 possible disorders
A
- olecrannon burtsitis
- olecranon process stress fx
- triceps tendinitis
12
Q
If a pateint has lateral elbow pain what are 10 possible disorders
A
- capiutellum fx
- cervical radic - referred pain
- lateral epi
- lateral collateral injury
- osteochondral degenerative changes
- osteochonrtitis dissecans ( panners disease)
- PIN syndrome
- radial head fx
- radial tunnel syndrome
- synovitis
13
Q
What questionnaire asks these questions
• Over the past 2 weeks, how often
have you had little interest or
pleasure in doing things?
• Over the past 2 weeks, how often
have you felt down, depressed or
hopeless?
A
Patient health questionnaire
14
Q
OSPRO-YF assesses 3 specific
domains of psychosocial
distress:
A
• Negative mood
• Fear-avoidance
• Negative affect/coping
15
Q
If a patient has a HX of trauma it may suggest what 2 things
A
Instability and/or tendinopathy
- do active vs passive testing to determine
16
Q
What are examples of systemic causes for elbow pain
A
- gout
- arthritis
- bursitis
17
Q
What are common nerve entrapments in the elbow
A
• Cubital tunnel syndrome
• Radial tunnel syndrome
• Pronator teres syndrome
• Anterior interosseous nerve syndrome
18
Q
What are common tendinpathies in the elbow
A
• Lateral elbow epicondylitis/tendinopathy
• Medial elbow epicondylitis/tendinopathy
• Distal biceps tendon rupture
19
Q
What are 5 other common elbow injuries
A
• Valgus extension overload syndrome
• Panner’s disease
• Osteochondritis dissecans
• Little league elbow
• Olecranon bursitis
20
Q
What are the 4 types of elbow fx
A
- supracondylar fx
- olecranon fx
- coronoid fx
- radial had fx
21
Q
What is the MOI of supracondylar fx and who is it most common in
A
- fall on hyperextended or flexed elbow
- most common in kids —> can lead to gunstock deformity
22
Q
What is the MOI of olecranon fx
A
- Common w/ fall onto elbow or power triceps
contraction - Fairly common dx
23
Q
A coronoid fx is typically seen in what kind of injuries
A
High energy injury
24
Q
What kind of injury is a radial head fx
A
FOOSH injury ( radial head forced into capitulum)
- serious Injury that required adequate management
25
What way is the **humero ulnar joint dislocated**
Posterior or posterior lateral
FOOSH w axial force
26
What kind of **dislocation** is a **PRUJ**
**Nurse maid elbow** —> radial head dislcoated secondary to distraction force
27
What is the **most common** associated **fractures** with **elbow dislocations**
Radial head
28
What are the **least** common fx with **elbow dislocations**
* Coronoid process
* Olecranon process
* Medial/lateral epicondyle
* Capitulum (least common)
29
With **elbow dislocations** there is **collateral** **ligament** damage, especially where
Anterior bundle of UCL
30
If u think a patient has a **UCL** **strain** what will their **HX** sound like
* Acute pain or “ pop” w/ sudden sharp pain over medial elbow
* Progressive pain w/ throwing (accelation or after ball is released)
31
What is the MOI for a **UCL sprain**
* Acute valgus stress to flexed
elbow —> Especially, during acceleration
phase of throwing motion
32
What phases of pitching is the most common phases for injury
Accelation and deceleration
33
T/F: a normla radio graphic findings does not rule out UCL rupture
True q
34
If a pateint has an arthogram taken and u see leaking dye from torn capsule what are u thinking
UCL sprain
35
What is a patient **HX** with a. **LCL sprain**
* Lateral elbow pain
* Mechanical clicking
36
What is the **MOI** for a **LCL sprain**
* combo of axial compression + shoulder ER + valgus force at the elbow
37
What is **Iatrogenic**
Agressive debridement of lateral elbow structures during tennis elbow sx
38
What kind of **instability** will a **LCL** **sprain** lead to
Posterior lateral rotary instability — most common type of recurrent instability at the elbow
39
What is the most common recurrent instability at the elbow
Postero lateral rotary instability
40
**Tendinopathy** is usually from what 2 things
* degenerative disorder
* represents tissue response to fatigue (overuse) stress
41
What **age** is **lateral elbow tendinopathy** common in
35-50 y/o - older
42
What occurs in **50**% if **athletes** participating in **OH** sports
Lateral tendinopathy
43
For **lateral elbow tend** there is a **repetitive** **strain** of what mm
Extensor supinator mm mass
44
How does the pateint **present** with **lateral elbow tend**
* lateral elbow pain
* point tenderness 1 CM distal to lateral epi
* pain with PASSIVE wrist flexion , gripping and RESISTED wrist ext and finger ext
45
What are 2 DDx for **laterla elbow tend**
* Radial nerve entrapment
(PIN 5% of cases)
* Instability or stress at
radiocapitellar joint
46
What is the **MOI** for **medial elbow tend**
Forceful work or overuse and/or valgus stress of PT , FCU , FCR
47
What is **important to identify** with **medial elbow tend**
Ulnar neuritis
48
What are symptoms of **medial elbow tend**
* Dull, aching pain
* Weak grip (most common)
* Ulnar nerve paresthesia
49
What is the **MOI** for **distal biceps tendon rupture**
* Usually a single traumatic event
involving resistance against arm
w/ elbow in about 90° flex
50
What are **SYMTOMS** of **distal biceps tendon rupture**
* “Popping” sensation experienced
followed by pain & swelling
* Visible, palpable defect of biceps
often results w/ rupture
51
What is **cubital tunnel syndrome**
nflammation of ulnar nerve as it
passes through medial
tunnel of elbow
52
What is the 2nd most common nerve entrapment
Cubital tunnel
53
What is the **MOI** for **cubital tunnel syndrome**
* Traction (valgus stress)
* Long standing valgus deformity
* Sustained flexion postures (cyclists
54
What are **DDx** for **cubital** **tunnel** **syndrome**
* Cervical radiculopathy
* Thoracic outlet syndrome
55
What is **radial tunnel syndrome**
Compression of deep branch of radial
nerve (PIN) as it passes b/t the heads of
supinator
56
Is there motor and sensory invovlment with **radial tunnel syndrome**
no sensory invovlemnt
motor is only affected (test EI and EPL)
57
Is there **motor** and **sensory** invovlment with **cubital tunnel syndrome**
Maybe yes
58
What does the **radial nerve supply**
Deep extensors mm of forearm
59
What muscles do u test for **weakness** for **radial tunnel syndrome**
Extesnor indicis or extensor pollicis longus
60
What is the **pronator teres syndrome**
Compression of medial n between heads of pronator Teres muscle
61
How do u **test** for **pronator teres syndrome**
Use resisted pronation
62
What is the **terminal motor** **branch** of the **median** **n**
Anterior interosseous nerves (only motor never )
63
What mm does the **AIN supply**
* FPL
* pronator quadratus
* FDP of digit is 2 and 3
64
What may. A pateint report with **anterior interosseous nerve syndrome**
Difficulty gripping , buttoning shirts or forming a fist
## Footnote
bc they have flexor probelms
65
What are the **objective findings** with **anterior interosseous nerver syndrome**
* Weakness of innervated muscles
* Positive Pinch Grip Test (Froment’s Sign)
* Difficulty making “OK” sign- median nerve
66
What is the **MOI** for **valgus extension overload syndrome**
Repeated extension
67
What are the **exam finding** for **valgus extension overload syndrome**
* TTP around tip of olecranon
* Pain w/ forced elbow extension
* ↑’d valgus laxity
68
What is **panners disease**
Osteochondrosis of humeral capitilum
## Footnote
on the radial side
69
Is **panners disease** in kids or adults
Kids only !!!
## Footnote
7-10 years old
70
What is the **MOI** of **panners diease**
Repetitive valgus stress causing compressive stress across radiocapitellar joint
71
what age does **panner’s disease** usually occur between
7-10 years of age (peak at 9)
72
Why may the **capitulum** be susceptible at **ages 7-10** for **panners** diease
Bc of limited blood supply
73
What are the **symptoms** of **panners disease**
* Fairly sudden onset of lateral
elbow pain
* Dull, aching pain, worsened by
motion
* Absence of mechanical
symptoms ( locking, catching)
74
What are **complications** for **panners disease**
* self limiting
* remodeling leading to normal joint is good
* may result in some limited ROM
75
What is **osteochondritis dissecans**
Humeral capitulum
76
What is the **MOI** for **osteochondritiis dissecans**
Repeptivie valgus stress casues compressive stress across radio capitellar joint
## Footnote
literally the same as panners disease
77
What does **osteochondrititis dissecans** represent
An island of subchondral bone and its adjacent articular cartilage that begins to separate from the humerus
78
What age is **Osteochondritis Dissecans** usually
12-17 year of age
## Footnote
panners is 7-12 (peak at 9)
79
Who is **Osteochondritis Dissecans** most common in
Throwers and gymnasts
80
What is the **most common etioligcal factor** for **Osteochondritis Dissecans**
Repetitive stress
81
What may a **plan film** show from **Osteochondritis Dissecans**
**Crescent shaped** region of sclerotic **subchrondral bone** in **humeral capitulum** demarcated from rest of the bone by a rim of lucency
82
What are the symptoms of **Osteochondritis Dissecans**
* Gradual onset of lateral elbow pain
* Dull, aching pain, worsened by motion
* Locking & catching common & highly suggestive of articular injury
## Footnote
different from panners bc panners is insiouds onset and does not have locking and cataching
83
What’s are the **physcial examination findings** for **Osteochondritis Dissecans**
* Tender at radio-capitellar joint
* Mild to moderate limitation of extension (5-20°) in >90% of cases
* Crepitus
* Joint effusion
84
What is **little league elbow** related to
Growth plate related stresses while throwing
85
What is the **MOI** from an **olecranon bursitis**
* acute trauma
* repetitive trauma
86
What is the **physcial exam findings** from **olecranon burtsitis**
* Superficial swelling over olecranon
* Full ROM, except extreme flexion
87
What is the **DDx** for **olecranon burtsitis**
* cellulitis
* septic arthritis
* elbow sprain
88
If a 15 y/o baseball player comes in and they have a gradual onset of lateral elbow pain but is worse t with motion and have some locking and catching .. during ur physcial exam they have TTP at the radio capitellar joint with some joint effusion what are u thinking
Osteochondritiis dissecans
89
If a 9 year old pateint comes in with a sudden onset of lateral elbow pain that is worse w motion and they complain of some locking/catching.. what are u thinking
Panners diease (bc 7-10 is peak for kids with here disease)
90
If a 9 year old pateint comes in with a sudden onset of lateral elbow pain that is worse w motion and they complain of some locking/catching.. what are u thinking
