Wrist and Elbow Injuries Flashcards
(48 cards)
What is another name for Lateral Epicondylitis and what is it?
“Tennis Elbow”
It is Tendinitis/Tendinosis of the extensor wad of the elbow - MC to the ECRB (Extensor Carpi Radialis Brevis).
Who gets Tennis Elbow?
30-50 y/o; M=F - laborers w/frequent heavy lifting/gripping/grasping, tennis players.
Clinical Presentation of Tennis Elbow?
- Pain w/gripping/grasping.
- Focal lateral elbow pain; may radiate into proximal forearm and described as dull/achy/toothache type pain; may feel like dropping an object they are holding.
- Aggravated w/activity.
- Alleviate w/Rest/Ice/NSAIDs.
- Insidious onset.
PE of Tennis Elbow?
- No abnormality on inspection.
- Mild - Severe TTP to lateral epicondyle.
- Pain reproduced w/resisted wrist extension.
What is Cozen’s Test?
Test for Tennis Elbow - pain that is reproduced w/resisted wrist extension.
Diagnostics for Tennis Elbow?
- X-ray = likely normal; may see changes such as cystic or enthesopathic.
- U/S = can eval integrity of the tendon, low cost, noninvasive.
- MRI = surgical planning; not required for Dx.
Treatment for Tennis Elbow?
- Treatment is listed from least invasive to most invasive:
- Rest, activity modification, bracing, compression sleeves.
- NSAIDs.
- PT (strengthening, massage, taping, dry needling).
- CS Injections.
- PRP (platelet rich plasma).
- Surgery, which is reserved for pt’s who have exhausted the above options; have severe tendon degradation.
What is Olecranon Bursitis? What are the causes?
Inflammation of the bursa of the elbow.
-Bursa is the thin-fluid filled sac acting as a cushion b/t bony prominences and soft tissue structures.
Causes:
- Trauma (acute injury to the elbow).
- Repetitive microtrauma.
- Infection = injury to tip of elbow breaking skin and inoculating the bursa w/bacteria.
- Rheumatoid, Gout.
Clinical Presentation of Olecranon Bursitis?
- Likely an inciting even or pertinent medical condition.
- Focal swelling about posterior elbow; unilateral.
- Aggravated w/direct pressure, elbow flexion.
- Alleviated w/compression, activity modification, aspiration.
- May or not be painful - infx/gout are usually painful.
- Infection (erythematous, warm to touch, +/- wound, +/-purulence.
- Gout/Pseudogout; tophi may be present.
Diagnostic tests for Olecranon Bursitis?
- X-ray = eval for any bony trauma, retained FB.
- Fluid analysis = cell count/sed rate, ESR/CRP, gram stain, crystals, culture.
- MRI/US = less common; better to eval assoc. injuries, abscess, osteomyelitis, tumor, etc.
Treatment for Olecranon Bursitis?
- Rest, activity modification, reassurance.
- NSAIDs, compression sleeve, elbow pad - the mainstay for acute trauma and chronic bursitis.
- Aspiration, +/- CS injection (can be diagnostic and therapeutic).
- Surgery - reserved for chronic noninfectious bursitis and infectious bursitis (septic pt’s).
- *Trial of Abx in healthy pt’s w/infectious olecranon bursitis.
What is Distal Biceps Rupture and who gets it?
A rupture of the insertion of the biceps from the radial tuberosity.
- *Accounts for 10% of bicep ruptures (rare compared to proximal long head biceps rupture).
- Men»_space; Women (93%) in 40-60 y/o.
Clinical Presentation of Distal Biceps Rupture?
- Acute injury - typically eccentric injury (flexed elbow forced into extension); can occur lifting a heavy object.
- Focal anterior elbow pain - may have felt a “pop.”
- Aggravated w/motion.
- Alleviated = may be none; Rest/Immobilization.
- Pain described as sharp/stabbing/throbbing pain.
PE of Distal Biceps Rupture?
Inspection:
-Reverse Popeye Sign (tendon retraction), ECCHYMOSIS at ant. elbow/AC space.
Palpation:
- Complete rupture will have a palpable defect.
- Weakness w/supination, some loss of elbow flexion strength.
- (+) Hook Test.
What is the Hook Test?
Used to identify a distal biceps rupture.
*Pt. flexes elbow to 90 degrees, full supination, examiner is able to place their finger 1 cm beneath the tendon.
Will a pt with a distal biceps rupture be able to flex their elbow?
Yes - the problem is with supination.
Diagnostic tests to order for a distal biceps rupture?
X-ray = may have an avulsion from the radius. U/S = identify ruptured tendon. MRI = non-contrast; operative planning - GOLD Standard.
Treatment for a distal biceps rupture?
Non-Operative mgmt:
- reserved for partial tears, pt’s who are low demand.
- PT, bracing, analgesia (NSAIDs).
Surgery:
- pt’s who are high functioning and active that will benefit from operative intervention.
- will require PT post-op to regain ROM, strength.
- surgery should occur w/in a few days to weeks from injury.
What is an Ulnar Collateral Ligament tear (UCLT)? Who gets it?
It is a rupture of the ulnar collateral ligament of the medial elbow from acute trauma (dislocation) or repetitive microtrauma.
Overhead athletes placing excessive valgus stress on the elbow (baseball, javelin thrower); high-velocity trauma (dislocation - wrestler, MVC, fall from height).
Clinical presentation of an Ulnar Collateral Ligament Tear?
- Usually an acute injury - elbow dislocation, one pitch “felt a pop,” may have anteceded elbow pain.
- Focal medial elbow pain; no radiation.
- Aggravated w/motion.
- Alleviated by mostly rest/immobilization.
- Pain described as sharp/stabbing/throbbing pain and may describe a feeling of “tightness” in the elbow, which is due to hemarthrosis.
PE of an Ulnar Collateral Ligament Tear?
- may have an abnormality to inspection.
- +/- swelling, ecchymosis.
- Tenderness at medial epicondyle of humerus.
- Laxity to valgus stress:
- -flex elbow to 30 degrees, apply valgus stress to elbow and will have soft endpoint w/complete tear.
Diagnostic tests to order for UCLT?
- Xray - may have bony avulsion, but uncommon.
* MRI - GOLD standard; operative planning. w/an arthrogram - will allow for eval of partial vs full thickness tear.
Treatment of UCLT?
Non-operative:
- Rest, PT, activity modification.
- Often 1st line therapy for most pt’s.
Surgery:
- “Tommy John” surgery; UCL reconstruction.
- Reserved for high level athletes; those who want to continue high level overhead sports.
- Lengthy recovery, extensive PT.
What is Radial Nerve Palsy? Who gets it?
It is an injury to the radial nerve in the upper arm (radial nerve courses through the spiral groove of the humerus); it results in inability to extend the wrist, digits and 1st dorsal web space numbness.
Often associated w/humerus fractures; nerve injury may occur at time of Fx, during reduction or operative intervention.
