LECTURE 11B: ELBOW EXAM/EVAL Flashcards by Rebecca Nam

Elbow evaluation divided anatomically into:

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

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associated body segments to the elbow

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

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

spine, shoulder and wrist complexes

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

tendinopathy/ CONTRACTILE TISSUE

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

instability (non-contractile)

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

cardiac
pulmonary

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3 bad non-MSK conditions referring pain to elbow

acute MI
pancoast tumor
esophageal motor disorders

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

Have you been sick recently? SEPTIC ARTHRITIS

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

hemoarthrosis

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acute painful swelling: non-MSK conditions

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

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common functional limitations of the elbow

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

***carrying groceries!

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OSPRO-YF: 3 domains of psychosocial distress

Negative mood
Fear-avoidance
Negative affect/coping

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Patient Health Questionnaire (PHQ-2):

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?

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MOI: trauma –> what injuries could happen?

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

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most common elbow fractures

supracondylar fracture
olecranon fracture
coronoid fracture
radial head fracture

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

Supracondylar fracture

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

Olecranon fracture

heals pretty well

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

Coronoid fracture

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

radial head fracture

big deal! difficult to manage and difficult surgery

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which is the main elbow dislocation?

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

*Alex Lee

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Nursemaid’s elbow

proximal radio-ulnar joint dislocation
radial head dislocation 2° to distraction force
radial head slips out of annular ligament

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most and least common associated fractures with elbow dislocations

radial head fx (10%)

-capitulum (least common)

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What is most common MOI of UCL sprain?

acceleration (and deceleration) phase of throwing motion

acute valgus stress to flexed elbow

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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?

UCL sprain

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

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

gymnast/cheerleading: what ligament is hella strained?

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

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

iatrogenic LCL sprain

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

yes!

tendinopathy is usually a _ disorder

degenerative disorder *tissue response to fatigue stress

most common type of recurrent elbow instability

posterolateral rotary instability (LCL/RCL)

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

50%

lateral elbow tendinopathy patients are ___ age? MOI____?

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

Diff dx of lateral elbow tendinopathy

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

most common symptom with medial elbow tendinopathy

weak grip also dull aching pain, ulnar nerve paresthesia

MOI of Medial Elbow Tendinopathy

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

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)

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

Whats the most common injury at elbow?

cubital tunnel syndrome 2nd most common nerve entrapment

MOI of cubital tunnel syndrome

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

Diff diagnosis of cubital tunnel syndrome

rule out Cervical radiculopathy Thoracic outlet syndrome

radial tunnel syndrome has sensory or no sensory?

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

What muscles should you use to test for radial tunnel syndrome

EI or EPL (PIN compressed between heads of supinator: arcade of Frohse)

Patient has forearm pain with paresthesias to the first 3 and a half fingers

pronator teres syndrome (median nerve compressed btwn heads of pronator teres)

What should you differentiate (diff dx) with pronator teres syndrome

1. carpal tunnel 2. palmar sensory changes, FDS, FCR weakness 3. cervical root compression DDx: resisted pronation

Patient has no sensory involvement difficulty gripping, buttoning shirts, forming ist

AIN syndrome *FPL, PQ, FDP 2nd and 3rd

What objective measures will be positive in AIN syndrome

1. weak FPL, PQ, FDP (2 and 3) 2. positive pinch grip test (Froment's) 3. difficulty with OK sign

Patient has TTP around tip of olecranon pain with forced elbow extension increased valgus laxity

valgus extension overload syndrome MOI: repeated extension

Osteochondrosis of humeral capitulum in kids

Panner's Disease

Panner's disease occurs at what age?

7-10 years old peak at 9

someone wtih Panner's disease will have what symptoms?

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

MOI of panner's disease

repetitive valgus stress causing compression to radio-capitellar joint

MOI of OCD

same as panners (repetitive valgus stress --> compression of radio-capitellar joint) also repeated extension + forceful pronation

Will Panner's disease go away on its own?

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

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?

Osteochondritis Dissecans

symptoms of osteochondritis dissecans

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

OCD is most common in _ and _ between ages _ and _

gymnasts and throwers ages 12-17

XRAY: If you see cresent shaped subcondral bone in humeral capitulum demarcated from the rest of bone by rim of lucency this is...

OCD

Patient has: * tenderness at radio-capitellar joint * mild-mod limitation of extension (5-20) * crepitus * joint effusion gradual onset of lateral elbow pain

OCD

What is little league elbow

growth plate related stress injuries while throwing (pediatrics)

Patient has superficial swelling over olecranon and full ROM except extreme flexion... acute trauma/direct blow or repetitive trauma MOI

olecranon bursitis

Diff dx for olecranon bursitis

cellulitis: cut? septic arthritis/bursitis: infection? elbow sprain

LECTURE 11B: ELBOW EXAM/EVAL Flashcards

(60 cards)