LECTURE 11B: ELBOW EXAM/EVAL

Question 1

Elbow evaluation divided anatomically into:

Answer 1

1. UQ scanning exam
2. C-spine/shoulder vs elbow/forearm complex exam
3. Specific joint assessments (i.e. H-U, H-R, prox R-U, distal R-U)

Question 2

associated body segments to the elbow

Answer 2

Cervical spine
Thoracic spine
Shoulder complex
Wrist/hand
Neurovascular system
Cardiovascular system

Question 3

In elbow exam: will likely need to assess … often present similarly &/or impact each other

Answer 3

spine, shoulder and wrist complexes

Question 4

pain w/ activities, history of repetitive motion
*makes you think ____

Answer 4

tendinopathy/ CONTRACTILE TISSUE

Question 5

Pain w/ prolonged static positions
Pain after activities
(although if pissed off bad enough, will hurt during too)

Answer 5

instability (non-contractile)

Question 6

What 2 non-MSK systems are really important to screen out in elbow?

Answer 6

cardiac
pulmonary

Question 7

3 bad non-MSK conditions referring pain to elbow

Answer 7

acute MI
pancoast tumor
esophageal motor disorders

Question 8

If you suspect non-MSK and they present with acute painful swelling, what is really important to rule out? (Diff Dx)

Answer 8

Have you been sick recently? SEPTIC ARTHRITIS

Question 9

kids with hemophilia have big likelyhood to get ____ when falling on elbow

Answer 9

hemoarthrosis

Question 10

acute painful swelling: non-MSK conditions

Answer 10

** Septic arthritis **
* Gout/Pseudogout
* Hemoarthrosis
* Soft tissue abscess
* Cellulitis
* Reactive arthritis
* Carcinoma/metastatic carcinoma

Question 11

common functional limitations of the elbow

Answer 11

1. Unable to turn door knob or key in ignition
2. Difficulty or pain w/ pushing and pulling activities (opening and closing doors)
3. Restricted hand to mouth activities for eating and drinking
4. Restricted hand to head activities for personal grooming, phone use, etc
5. Difficulty or pain w/ pushing self up from chair
6. Unable to carry objects w/ a straight arm

***carrying groceries!

Question 12

OSPRO-YF: 3 domains of psychosocial distress

Answer 12

Negative mood
Fear-avoidance
Negative affect/coping

Question 13

Patient Health Questionnaire (PHQ-2):

Answer 13

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?

Question 14

MOI: trauma –> what injuries could happen?

Answer 14

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

Question 15

most common elbow fractures

Answer 15

1. supracondylar fracture
2. olecranon fracture
3. coronoid fracture
4. radial head fracture

Question 16

Fall on hyperextended or flexed elbow
Most common in kids → gunstock deformity
lose extension

Answer 16

Supracondylar fracture

Question 17

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

Answer 17

Olecranon fracture

heels pretty well

Question 18

Typically seen in high energy injuries
move posteriorly, coronoid snaps off

Answer 18

Coronoid fracture

Question 19

FOOSH injury (radial head forced into capitulum)
Serious injury that requires adequate management

Answer 19

radial head fracture

big deal! difficult to manage and difficult surgery

Question 20

which is the main elbow dislocation?

Answer 20

humero-ulnar joint
Most commonly posterior or postero-lateral
FOOSH injury w/ axial force

*Alex Lee

Question 21

Nursemaid’s elbow: radial head dislocation 2° to distraction force
radial head slips out of annular ligament

Answer 21

proximal radio-ulnar joint dislocation

Question 22

associated fractures with elbow dislocations

Answer 22

radial head fx (10%)
less common:
-coronoid
-olecranon
-medial/lat epicondyle
-capitulum (least common)

Question 23

What is most common MOI of UCL sprain?

Answer 23

acceleration (and deceleration) phase of throwing motion

acute valgus stress to flexed elbow

Question 24

Patient hx:
Acute pain or “pop” w/ sudden sharp pain over medial elbow
Progressive pain w/ throwing
Acceleration or after ball release

what ligament are you thinking?

Answer 24

UCL sprain

Question 25

Lateral elbow pain Mechanical clicking**** Difficult to DDx what ligament are you thinking?

Answer 25

LCL sprain clicking --> radial head slipping out/sublux

Question 26

gymnast/cheerleading: what ligament is hella strained?

Answer 26

LCL Most commonly, combo of axial compression + shoulder ER + valgus force at the elbow --> commonly results in postero-lateral rotary instability | kinda need surgery, unlike UCL

Question 27

aggressive debridement of lateral elbow structures during tennis elbow surgery --> can lead to

Answer 27

iatrogenic LCL sprain

Question 28

Can you have instability and then develop tendinopathy in the elbow?

Answer 28

yes!

Question 29

lateral elbow tendinopathy occurs in ___% of athletes participating in OH sports

Answer 29

50%

Question 30

lateral elbow tendinopathy patients are ___ age? MOI____?

Answer 30

35-50 YEARS OLD high level sof physical work repetitive strain of extensor-supinator mm mass (ECRB/EDC)

Question 31

Diff dx of lateral elbow tendinopathy

Answer 31

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

Question 32

most common symptom with medial elbow tendinopathy

Answer 32

weak grip also dull aching pain, ulnar nerve paresthesia

Question 33

MOI of Medial Elbow Tendinopathy

Answer 33

Forceful work or overuse &/or valgus stress of PT, FCR, FCU | Identification of ulnar neuritis extremely important

Question 34

MOI: Usually 1 traumatic event involving resistance against arm w/ elbow in about 90° flex SS: pop, pain, swelling, VISIBLE. DEFECT OF BICEPS RESULTS WITH RUPTURE (but may be difficult to detect due to swelling)

Answer 34

distal biceps tendon rupture | *need surgery right away bc every day without sx, tendon will shorten

Question 35

Whats the most common injury at elbow?

Answer 35

cubital tunnel syndrome 2nd most common nerve entrapment

Question 36

MOI of cubital tunnel syndrome

Answer 36

traction (valgus stress) long standing valgus deformity sustained flexion psoture (cyclists)

Question 37

Diff diagnosis of cubital tunnel syndrome

Answer 37

rule out Cervical radiculopathy Thoracic outlet syndrome

Question 38

radial tunnel syndrome has ___ sensory involvement

Answer 38

NO SENSORY, ONLY DEEP BRANCH OF RADIAL NERVE --> deep extensor muscles of forearm *weakness, pain more distal than tennis elbow

Question 39

review all the nerve stuff (slide 34-37)

Question 40

Osteochondrosis of humeral capitulum (kids)

Answer 40

Panner's Disease

Question 41

Panner's disease occurs at what age?

Answer 41

7-10 years old peak at 9

Question 42

someone wtih Panner's disease will have what symptoms?

Answer 42

Fairly sudden onset of lateral elbow pain Dull, aching pain, worsened by motion Absence of mechanical symptoms Locking/catching

Question 43

Will Panner's disease go away on its own?

Answer 43

Yeah! self limiting Probability of remodeling leading to a structurally normal joint is excellent May result in some limitation of motion Long-term disability is rare

Question 44

humeral capitulum: island of subchondral bone & its adjacent articular cartilage (osteochondral fragment) that begins to separate from the rest of the humerus what disease is this?

Answer 44

Osteochondritis Dissecans

Question 45

symptoms of osteochondritis dissecans

Answer 45

Gradual onset of lateral elbow pain Dull, aching pain, worsened by motion Locking & catching common & highly suggestive of articular injury