Lecture 10B: Elbow Complex Examination And Evalluation Flashcards by sophia carrasco

What kind of stress does the radial head resist

Valgus stress

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What is the difference between tendinopathy pain and instability pain

Tendinopathy (contractile tissue)
• Pain w/ activities
• Hx of repetitive motions

Instability (non-contractile tissue)
• Pain w/ prolonged static positions
• Pain after activities

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If a pateint has referred pain to the elbow what 3 things could it be

• Acute MI
• Pancoast’s syndrome
• Esophageal motor disorders

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If a patient has acute onset of non traumatic swelling in the elbow what do we think

Septic arthritis

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If a patient has a. MOI of trauma what 6 things could it be in the elbow

• Acute fractures/dislocations
• Muscle strains
• Ligament/capsule sprains
• Growth plate injuries
• Neurovascular injuries
• Bursitis

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If a patient has a. MOI of over use what 5 things could it be in the elbow

• Elbow/forearm tendinopathies
• Growth plate injuries
• Stress fractures
• Neurovascular injuries
• Bursitis

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If a person is fully grown could they have a growth plate injury at the elbow

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If a pateint has anterior elbow pain what are 4 possible disorders

anterior capsule strain
distal biceps tendon rupture/tendinitis
dislocation of the elbow
pronator syndrome (throwers)

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If a pateint has medial elbow pain what are 7 possible disorders

medial epicondylitis
ulnar collateral ligament injury (MCL)
ulna neuritis
flexor pronator mm strain
fx
little leagues elbow
valgus extension overload overuse syndrome

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If a pateint has posteromedial elbow pain what are 3 possible disorders

olecranon tip stress fx
posterior impingement in throwers
trochlear chondromalacia

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If a pateint has posterior elbow pain what are 3 possible disorders

olecrannon burtsitis
olecranon process stress fx
triceps tendinitis

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If a pateint has lateral elbow pain what are 10 possible disorders

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

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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?

Patient health questionnaire

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OSPRO-YF assesses 3 specific
domains of psychosocial
distress:

• Negative mood
• Fear-avoidance
• Negative affect/coping

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If a patient has a HX of trauma it may suggest what 2 things

Instability and/or tendinopathy

do active vs passive testing to determine

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What are examples of systemic causes for elbow pain

gout
arthritis
bursitis

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What are common nerve entrapments in the elbow

• Cubital tunnel syndrome
• Radial tunnel syndrome
• Pronator teres syndrome
• Anterior interosseous nerve syndrome

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What are common tendinpathies in the elbow

• Lateral elbow epicondylitis/tendinopathy
• Medial elbow epicondylitis/tendinopathy
• Distal biceps tendon rupture

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What are 5 other common elbow injuries

• Valgus extension overload syndrome
• Panner’s disease
• Osteochondritis dissecans
• Little league elbow
• Olecranon bursitis

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What are the 4 types of elbow fx

supracondylar fx
olecranon fx
coronoid fx
radial had fx

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What is the MOI of supracondylar fx and who is it most common in

fall on hyperextended or flexed elbow
most common in kids —> can lead to gunstock deformity

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What is the MOI of olecranon fx

• Common w/ fall onto elbow or power triceps
contraction
• Fairly common dx

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A coronoid fx is typically seen in what kind of injuries

High energy injury

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What kind of injury is a radial head fx

FOOSH injury ( radial head forced into capitulum)

serious Injury that required adequate management

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What way is the humero ulnar joint dislocated

Posterior or posterior lateral FOOSH w axial force

What kind of dislocation is a PRUJ

Nurse maid elbow —> radial head dislcoated secondary to distraction force

What is the most common associated fractures with elbow dislocations

Radial head

What are the least common fx with elbow dislocations

• Coronoid process • Olecranon process • Medial/lateral epicondyle • Capitulum (least common)

With elbow dislocations here is collateral ligament damage, especially where

Anterior bundle of UCL

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)

What is the MOI for a UCL sprain

• Acute valgus stress to flexed elbow —> Especially, during acceleration phase of throwing motion

What phases of pitching is the most common phases for injury

Accelation and deceleration

T/F: a normla radio graphic findings does not rule out UCL rupture

True q

If a pateint has an arthogram taken and u see leaking dye from torn capsule what are u thinking

UCL sprain

What is a patient HX with a. LCL sprain

• Lateral elbow pain • Mechanical clicking

What is the MOI for a LCL sprain

* combo of axial compression + shoulder ER + valgus force at the elbow

What is Iatrogenic

Agressive debridement of lateral elbow structures during tennis elbow sx

What kind of instability for a LCL sprain lead to

Posterior lateral rotary instability — most common type of recurrent instability at the elbow

What is the most common recurrent instability at the elbow

Postero lateral rotary instability

Tendinopathy is usually from what 2 things

* degenerative disorder * represents tissue response to fatigue (overuse) stress

What age is lateral elbow tendinopathy common in

35-50 y/o - older

What occurs in 50% if athletes participating in OH sports

Lateral tendinopathy

For lateral elbow tend there is a repetitive strain of what mm

Extensor supinator mm mass

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

What are 2 DDx for laterla elbow tend

• Radial nerve entrapment (PIN 5% of cases) • Instability or stress at radiocapitellar joint

What is the MOI for medial elbow tend

Forceful work or overuse and/or valgus stress of PT , FCU , FCR

What is important to identify with medial elbow tend

Ulnar neuritis

What are symptoms of medial elbow tend

• Dull, aching pain • Weak grip (most common) • Ulnar nerve paresthesia

What is the MOI for distal biceps tendon rupture

• Usually a single traumatic event involving resistance against arm w/ elbow in about 90° flex

What are SYMTOMS of distal biceps tendon rupture

• “Popping” sensation experienced followed by pain & swelling • Visible, palpable defect of biceps often results w/ rupture

What is cubital tunnel syndrome

nflammation of ulnar nerve as it passes through shallow medial tunnel of elbow

What is the 2nd most common nerve entrapment

Cubital tunnel

What is the MOI for cubital runner syndrome

• Traction (valgus stress) • Long standing valgus deformity • Sustained flexion postures (cyclists

What are DDx for cubital tunnel syndrome

• Cervical radiculopathy • Thoracic outlet syndrome

What is radial tunnel syndrome

Compression of deep branch of radial nerve as it passes b/t the heads of supinator

Is there motor and sensory invovlment with radial tunnel syndrome

No just sensory

Is there motor and sensory invovlment with cubital tunnel syndrome

Maybe yes

What does the radial nerve supply

Deep extensors mm of forearm

What muscles do u test for weakness for radial tunnel syndrome

Extesnor indicis or extensor pollicis longus

What is the pronator teres syndrome

Compression of medial n between heads of pronator Teres muscle

How do u test for pronator teres syndrome

Use resisted pronation

What is the terminal motor branch of the median n

Anterior interosseous nerves (only motor never )

What mm does the AIN supply

* FPL * pronator quadratus * FDP of digit is 2 and 3

What may. A pateint report with anterior interosseous nerve syndrome

Difficulty gripping , buttoning shirts or forming a fist

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

What is the MOI for valgus extension overload syndrome

Repeated extension

What are the exam finding for valgus extension overload syndrome

• TTP around tip of olecranon • Pain w/ forced elbow extension • ↑’d valgus laxity

What is panners disease

Osteochondrosis of humeral capitilum

Is panners disease in kids or adults

Kids only !!!

What is the MOI of panners diease

Repetitive valgus stress causing compressive stress across radiocapitellar joint

When does panner’s disease usually occur between

7-10 years of age (peak at 9)

Why may the capitulum be susceptible at ages 7-10 for panners diease

Bc of limited blood supply

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)

What are complications for panners disease

* self limiting * remodeling leading to normal joint is good * may result in some limited ROM

What is osteochondritis dissecans

Humeral capitulum

What is the MOI for osteochondritiis dissecans

Repeptivie valgus stress casues compressive stress across radio capitellar joint

What does osteochondrititis dissecans represent

An island of subchondral bone and its adjacent articular cartilage that begins to separate from the humerus

What age is Osteochondritis Dissecans usually

12-17 year of age

Who is Osteochondritis Dissecans most common in

Throwers and gymnasts

What is the most common etioligcal factor for Osteochondritis Dissecans

Repetitive stress

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

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

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

What is little league elbow related t

Growth plate related stresses while throwing

What is the MOI from an olecranon bursitis

* acute trauma * repetitive trauma

What is teh physcial exam findings from olecranon burtsitis

• Superficial swelling over olecranon • Full ROM, except extreme flexion

What is the DDx for olecranon burtsitis

* cellulitis * septic arthritis * elbow sprain

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

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)

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