Upper Extremity Injuries - Elbow/Forearm

Question 1

what commonly causes an olecranon fx?

Answer 1

a fall directly onto flexed or extended elbow

Question 2

radiology needed in olecranon fx

Answer 2

• 2-3 view of elbow

- need true lateral to see olecranon

Question 3

initial tx of olecranon fx

Answer 3

-splint w/ long arm posterior

Question 4

tx of olecranon fx w/ less than 1-2 mm of displacement

Answer 4

can be splinted and treated conservatively

Question 5

tx of olecranon fx w/ > 2 mm displacement

Answer 5

need ORIF

Question 6

common cause of radial head fx

Answer 6

FOOSH w/ elbow extended

Question 7

PE of radial head fx

Answer 7

• TTP of radial head

- swelling and decreased ROM

Question 8

radiology for radial head fx

Answer 8

• 3 view of elbow
• look for “fat pad” sign and “sail” sign for subtle injuries
• type I-IV

Question 9

tx for type I radial head fx

Answer 9

• no displacement

- can be tx conservatively w/ splinting and early ROM

Question 10

tx for type II-IV radial head fx

Answer 10

need ORIF

Question 11

ulnar head dislocation

• MC kind
• typical pt
• cause

Answer 11

• MC is posterior lateral dislocation
• children more common
• FOOSH

Question 12

PE of ulnar head dislocation

Answer 12

• obvious deformity w/ loss of ROM

- check neurovascular status

Question 13

radiology for ulnar head dislocation

Answer 13

• true lateral w/ 3 view of elbow

- look for other fx b/c of the “terrible triad”

Question 14

“terrible triad” in elbow dislocations

Answer 14

• elbow dislocation in combo with radial head fx and coronoid process fx
• Prone to early recurrent instability and posttraumatic arthritis.

Question 15

tx of ulnar head dislocation

Answer 15

• closed reduction
• splinting (long arm)
• referral to ortho

Question 16

radial head dislocation are also called?

Answer 16

nurse maid’s elbow

Question 17

radial head dislocation is commonly caused by?

Answer 17

• axial traction on a pronated forearm in full extension (grabbing kid by arm)
• common in young children

Question 18

PE of radial head dislocation

Answer 18

painful joint that the child does not want to move

Question 19

radiology for radial head dislocation

Answer 19

• clinical diagnosis

- no films needed unless suspect fx

Question 20

tx of radial head dislocation

Answer 20

• reduction by:

- supination/flexion and hyperpronation

Question 21

epicondylitits types

Answer 21

• medial (golfer’s elbow)

- lateral (tennis elbow)

Question 22

medial epicondylitis aka golfer’s elbow

Answer 22

• overuse injury from repetitive eccentric force
• pronator teres and flexor carpi radialis
• localized TTP of medial elbow

Question 23

lateral epidondylitis aka tennis elbow

Answer 23

• overuse injury
• extensor carpi radialis brevis
• TTP lateral elbow

Question 24

tx of epicondylitis

Answer 24

• conservative
• bracing / spinting
• PT/OT
• they must stop activity or it won’t get better

Question 25

bicep tendonitis is more common in who?

Answer 25

-people who perform frequent pulling or lifting

Question 26

PE of bicep rupture

Answer 26

-tendon can be visible w/ a palpable mass or hematoma | tendonitis w/ no rupture produces pain at insertion site

Question 27

special tests for biceps tendonitis/rupture

Answer 27

- speed test | - yergasons test

Question 28

speed's test

Answer 28

- pts elbow is extended, forearm supinated and the humerus elevated to 60 degrees - the examiner resists humeral forward flexion - pain located to bicipital groove = positive

Question 29

yergasons test

Answer 29

- elbow flexed to 90 degrees - start in pronated position - active supination and flexion against resistance - palpate biceps tendon - pain or painful pop = positive

Question 30

tx for bicep tendonitis

Answer 30

- basic ortho tx | - activity restriction

Question 31

tx for biceps rupture

Answer 31

-operative

Question 32

types of forearm fxs

Answer 32

- nightstick - monteggia - galeazzi - both bone

Question 33

forearm fxs

Answer 33

- commone - can be isolated or in combination - mechanism: high energy trauma or falls

Question 34

night stick fx

Answer 34

-midshaft ulnar fx (from blocking a nightstick)

Question 35

galeazzi fx

Answer 35

radial midshaft fx associated w/ radioulnar joint instability

Question 36

monteggia fx

Answer 36

fx of the proximal third of the ulnar shaft associated w/ dislocation of the radial head

Question 37

tx of isolated midshaft radius fx

Answer 37

-ORIF recommended w/i 1-2 days

Question 38

non-operative casting/splinting can be used as tx for nighstick fx if the following criteria are met:

Answer 38

- >50% apposition - <10 degrees angulation - no radial head dislocation - fx w/i distal 2/3 of ulna

Question 39

tx of galeazzi and monteggia fx

Answer 39

-splinted w/ well molded double sugar tong and ORIF