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pt momints ver 2.0 > MS1: Affectations of Elbow > Flashcards

MS1: Affectations of Elbow Flashcards

1
Q

describe the elbow

A

modified hinge joint or trochoid ginglymus

stability allows little compensatory adjustments = prone to injury or overuse

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2
Q

what are the 3 joints of the elbow complex

A

humero-radial

humero-ulnar

proximal radioulnar

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3
Q

describe the joint capsule

A

thin and transparent

under tension when extended and relaxed when flexed

30-35 ml at 80 degrees flexion; fully distended

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4
Q

what is the functional ROM of the shoulder

A

supination - 81

pronation - 71

flex/extend - 150

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5
Q

what is the normal carrying angle

A

normal valgus:

5-10 degrees - males
10-15 degrees - females

diminishes w flexion

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6
Q

compare cubitus varus and valgus

A

varus: forearm towards midline

valgus: forearm away from midline

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7
Q

describe cubitus varus

A

decrease in carrying angle

due previous history of trauma - supracondylar fracture

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8
Q

what is gunstick deformity

A

most common type of varus - 3-57 %

cosmetic problem - no functional disability

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9
Q

describe cubitus valgus

A

increase in carrying angle

most common cause is lateral condylar fracture of humerus

usually asymptomatic but can develop tardy ulnar nerve palsy

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10
Q

what is tardy ulnar nerve palsy

A

possible effect of cubitus valgus

more lateral deviated = tension on ulnar nerve

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11
Q

describe the ulnar collateral ligament

A

from anterior inferior 2/3 of medial epicondyle to to proximal ulna

most important ligament against valgus stress

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12
Q

what are the bundles of the ulnar collateral ligament

A

anterior:
- strongest and stiffest = most common injured at media side
- main stabilizer against valgus stress

posterior: primary restraint in max elbow flexion

tranverse: cooper’s lig; least role in staibility

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13
Q

what comprises the lateral collateral ligament complex

A

annular ligament - winds the radius and ulna together

lateral ulnar collateral

radial collateral

accessory collateral

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14
Q

describe the lateral ulnar collateral ligament

A

from posterior lateral condyle to proximal ulna

restraints against varus and external stress during full arc of elbow motion

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15
Q

what is lateral ulnar collateral ligament injury

A

associated w dislocation from falling on supine arm with valgus stress

SSx:
- pain or clicking in elbow extension or pushing using arm
- tenderness
- varus instability

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16
Q

how to test for lateral ulnar collateral ligament injury

A

lateral pivot shift test: pt lies supine w forearm overhead and supinated; valgus stress applied while elbow moes from extension to 40 degrees flexion

x-ray to show dislocations and rule out fractures

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17
Q

what is the treatment for lateral ulnar collateral ligament injury

A

non-operative: casting 5-7 days with elbow flexed at 90 degrees

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18
Q

what is medial ulnar collateral ligament injury

A

anterior band microtrauma from repetitive valgus stress - valgus instability in adults

occurs in cocking phase or bwelo

common in athletes that do overhead throwing; little leaguer’s elbow

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19
Q

what are the symptoms lateral ulnar collateral ligament injury

A

SSx:
- pain or clicking in elbow extension or pushing using arm
- tenderness
- varus instability

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20
Q

what are the symptoms of medial ulnar collateral ligament injury

A

SSx:
- medial elbow pain
- decrease effectiveness in throwing
- tenderness along elbow at MCL origin
- limited ROM

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21
Q

what is the treatment for what is medial ulnar collateral ligament injury

A

rest for 6 weeks then therapy to strengthen pronation and flexors

for high level throwers - surgery

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22
Q

what is nursemaid’s elbow

A

radial head subluxation or pulled elbow

radial head slips through annular ligament

sudden longitudinal traction applied to the hand w elbow extended and forearm pronated or by a fall

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23
Q

what is the epidemiology nursemaid’s elbow

A

most often at ages 1-4 but can happen until 6-7; more common in women

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24
Q

what are the symptoms of nursemaid’s elbow

A

SSx:
- refuse to affected limb
- holds elbow in slight flexion and forearm pronated
- pain and tenderness
- full flexion and extension padin
- pain during supination

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25
Q

what is the treatment of nursemaid’s elbow

A

close reduction of annular ligament subluxation

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26
Q

what are the types of aseptic bursitis

A

acute hemorrhagic and chronic bursitis

common in football and hockey

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27
Q

describe acute hemorrhagic and chronic olecranon bursitis

A

acute: due to direct blow to olecranon

chronic: due to repetitive microtrauma; initial period of swelling that becomes into permanently thickened bursa with intrabursal bands

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28
Q

describe septic bursitis

A

due to localized or systemic infection

SSx:
- edema, erythema and hyperthermia
- systemic symptoms of infection

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29
Q

what is treatment for aseptic bursitis

A

mild: AIF and therapy

severe: remove fluid

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29
Q

what is treatment for septic bursitis

A

aspiration of fluid for lab analysis

w/ systemic symptoms:
IV antibiotics

w/ localized symptoms: oral antibiotics

incision and drainage if doesnt improve from meds

30
Q

what is the epidemiology lateral epicondylitis

A

common in > 35 yo; 40-50 yo

more common in male in tennis only

from excessive repetitive stress on lateral forearm musculature

31
Q

what is the pathophysiology of lateral epicondylitis

A

degenerative and not inflammatory; misnomer

micro tears on common extensor muscles at their origin on lateral epicondyle

mostly affects ECRB and EDC; rarely ECRL and ECU

32
Q

what are the symptoms of lateral epicondylitis

A

SSx:
- pain lateral elbow during gripping, repetitive wrist extension
- point tenderness over lateral epicondyle
- + cozen and mills

33
Q

what is the differential diagnosis for lateral epicondylitis

A

xray: might reveal punctate calcifications
MSUS: reveal partial and complete tears

rule out lateral collateral ligament sprain and radial nerve impingement

34
Q

what is the treatment for lateral epicondylitis

A

rest
cryotherapy
AIF
PT: heating and ultrasound (deep heat)

35
Q

how is the cozen’s test done

A

stabilize pt’s elbow and ask to pronate and extend and radially deviate wrist against manual resistance of clinician

36
Q

how is the mill’s test done

A

palpate pt’s lateral epicondyle while pronating forearm while fully flexing the wrist and elbow extended

pain in are = + test

37
Q

what is the epidemiology of medial epicondylitis

A

occurs 3-7x less frequent than lateral epicondylitis

excessive repetitive stress on medial forearm musculature

38
Q

what are the symptoms of medial epicondylitis

A

tenderness over the medial epicondyle
pain on making a fist, wrist flexion, forearm pronation and supination

39
Q

what is the pathophysiology of medial epicondylitis

A

degenerative

involves tendinopathy affecting the common flexor origin

frequently pronator teres and FCR origins; less frequent FCU and FDS

40
Q

what is the differential diagnosis of medial epicondylitits

A

xray and MSUS to rule out:
- medial ulnar collateral ligament injury
- ulnar nerve entrapment

41
Q

what is the treatment for medial epicondylitis

A

rest
cryotherapy
AIF
PT: heating and ultrasound (deep heat)

42
Q

what is the epidemiology of distal bicep tendonitis

A

not common

eccentric overload of the distal biceps during deceleration of follow through phase of throwing

43
Q

what is the symptoms of distal bicep tendonitis

A

pain in antecubital fossa during elbow bending

pain with resisted elbow flexion

tenderness over distal biceps tendon

44
Q

what is the treatment of distal bicep tendonitis

A

rest
cryotherapy
AIF
PT: heating and ultrasound (deep heat)

45
Q

what is the epidemiology of distal bicep tendon rupture

A

betw 30-50 yo
M > F

46
Q

what is the pathophysiology of distal bicep tendon rupture

A

injury usually occurs during heavy lifting w elbow at 90 degrees flexion

involves the dominant side

distal biceps tendon avulses from radial tuberosity

47
Q

what are the signs of distal bicep tendon rupture

A

acute pain and popping sensation in the antecubital fossa

ecchymosis, erythema, edema in the antecubital fossa

deformity of the biceps muscle belly

proximal retraction of the biceps tendon is apparent - popeye sign

48
Q

what is the treatment of distal bicep tendon rupture

A

nonoperative: only for elderly, sedentary patients who do not require strength and endurance in forearm flexion and supination

operative: for confirmed distal biceps tendon ruptures
- partial tears that fail to respond to nonoperative treatment

49
Q

what are distal humerus fractures

A

2% of all fractures; 1/3 of all humeral fractures

2-column concept:
- medial column
- lateral column
- betw is coronoid fossa ant and olecranon fossa post

has supracondylar, transcondylar, intercondylar

50
Q

describe supracondylar fractures

A

55-75% of all pediatric elbow fractures

FOOSH

treatment: casting/splinting, CR w percutaneous pinning, ORIF

51
Q

describe intercondylar fractures

A

most common distal humeral fracture in adults

comminution is common

force is directed against the posterior aspect of an elbow flexed >90 degrees; driving the ulna into the trochlea

52
Q

what is the indication for non-operative treatment for intercondylar fractures

A

if nondisplaced fractures

elderly with displaced and severe osteopenia

significant comorbid conditions precluding operative management

cast immobilization and traction with an olecranon pin; bag of bones

53
Q

what is the operative treatment for intercondylar fractures

A

ORIF:
- for displaced reconstructible fractures
- restore articular congruity
- interfragmentary screws and dual plate fixation

total elbow arthroplasty:
- for comminuted fractures
- in osteoporotic bone

54
Q

what is montaggia fracture

A

proximal 1/3 ulnar fracture w associated radial head dislocation/instability

rare in adults; common in 4-10 yo

55
Q

what is galleazi fracture

A

distal 1/3 radius shaft fx and associated DRUJ

due to direct wrist trauma at dorsolateral aspect

FOOSH w pronation

56
Q

what is elbow dislocation

A

due FOOSA in posterolateral region

associated with disruption of collateral ligaments of the elbow
- periarticular and intraarticular fractures
- brachial artery or median, ulnar and radial nerve injuries

57
Q

what is treatment of elbow

A

CR - sling or long arm splint for 2-3 days followed by progressive ROM
- cryo and AIF

indication for surgery:
- disrupted ulnar collateral ligament
- disrupted flexor pronation musculature
- chronic recurrent elbow instability

full return in 8 weeks
90% restoration by 3 months post injury

58
Q

what is volkmann’s ischemic contracture

A

untreated necrotic muscle and nerved are replaced with fibrous tissue

59
Q

what is the etiology of volkmann’s ischemic contracture

A

supracondylar fractures of humerus in children

brachial artery held by lacertus fibrosus may get impinged on sharp proximal fragment

deficit in circulation causes ischemia to muscles and affect nerve function

60
Q

what are other causes of VIC

A

crush injuries
prolonged external compression
internal bleeding: hemophilia
burns

61
Q

what are the tolerance of tissues in VIC

A

muscle: 2-4 hrs

nerve: 30 min

62
Q

what are the symptoms VIC

A

pain
paresthesia
pulsenessness
pallor/cyanosis
paresis

63
Q

describe the mild deformities in VIC

A

mild:
- deep flexors semi involved; FPD
- 2 or 3 fingers; no limited loss of sensation
- pronation contracture involving either pronator teres or quadratus

64
Q

describe the moderate deformities in VIC

A
  • involves most of FDP, FPL and part of FDS
  • neurological deficit involving the median nerve more than ulnar
  • deformity is intrinsic minus hand
  • diminished sensations in median and ulnar nerve zones
65
Q

describe the severe deformities in VIC

A
  • all the flexors and extensor muscles are involved
  • neurological deficit is severe
  • joint contractures are marked
  • wasting of forearm muscles
66
Q

how to diagnose VIC

A

pressure monitoring or ICP measurement

> 30 mmHG may be an indication for surgery

67
Q

how to treat VIC

A

explore deeply until FDP and FPL

necrotic muscle must be excised

median nerve freed beneath the lacertus fibrosus

ulnar nerve is freed and transplanted anteriorly

brachial artery must be inspected and decompressed

surgical wound is left open for secondary closure later when swelling subsides

extremity supported w splint in functional position

67
Q

how to treat VIC

A

explore deeply until FDP and FPL

necrotic muscle must be excised

median nerve freed beneath the lacertus fibrosus

ulnar nerve is freed and transplanted anteriorly

brachial artery must be inspected and decompressed

surgical wound is left open for secondary closure later when swelling subsides

extremity supported w splint in functional position

68
Q

what is the cubital tunnel syndrome

A

ulnar nerve lies w/in the postcondylar groove where it is covered by a fibrous roof going from medial humeral epicondyle to the olecranon

2nd most common nerve entrapment in UE

69
Q

what are the symptoms of CTS

A

paresthesia of the ulnar 1 1/2 digits
intrinsic muscle weakness and atrophy
clawing of ulnar digits is a severe late finding of ulnar neuropathy

70
Q

how to test of CTS

A

froment’s
wartenberg
tinel sign
elbow flexion test
EMG-NCV

71
Q

what are the treatments of CTS

A

non operative:
- activity modification
- night splints - elbow held at 45 degrees flexion
- NSAIDs

operative treatment:
- failed conservative treatment for 3 months
types:
- in-situ decompression
- ulnar nerve transposition
- medial epicondylectomy

pt momints ver 2.0 (14 decks)

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