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Flashcards in Conditions Of The Elbow & Forearm Deck (66)
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What type of joint is the Humeroulnar Joint?

Hinge Joint

1

What are the actions of the Humeroulnar Joint?

Flexion & Extension
Women = 5* - 15* hyperextension

2

What is the closed pack position of the Humeroulnar Joint?

Extension

3

Where do you find the Humeroradial Joint?

Between spherical capitulum & proximal radius

4

Closed packed Position of the Humeroradial Joint?

Elbow at 90* & forearm, supinated 5*

5

What is a carrying angle?

Angle between long axis of humerus & ulna when arm is in anatomical position
Males = 5-10*
Females = 10-15*

6

What are the functions of the elbow?

Mobility
Stability - modified hinge joint that encompasses 3 articulations

7

What are the 3 articulations of the Elbow?

Humeroulnar
Humeroradial
Proximal Radioulnar

8

What muscles contribute to FLEXION of the arm?

Brachialis
Biceps Brachii
Brachioradialis
FCU
FDS

9

What muscles contribute to elbow EXTENSION?

Triceps
Anconeous

10

What muscles contribute to PRONATION?

Pronator Quadratus
Pronator Teres

11

What muscles contribute to SUPINATION?

Supinator
Biceps Brachii

12

Contusions Etiology

Direct blows to arm/forearm

13

Contusions S&Sx

Ecchymosis
Myositis ossification
Tacklers exostosis

14

Contusions Management

PIER
Avoid aggressive strengthening/stretching

15

What is Tacklers Exostosis.

Anterolateral proximal humeral cortex after repeated injuries cause periosteal stripping & new bone formation

16

What is Myositis Ossification?

Separated from cortex, occurring in muscle belly

17

Olecranon Bursitis MOI

Fall on flexed elbow
Constantly leaning on elbow
Repetitive pressure & friction, flexion & extension
Infection

18

Acute & Chronic Bursitis MOI

Fall on flexed elbow
Constantly leaning on elbow

19

Acute & Chronic Bursitis S&Sx

Immediate, tender, swollen area of redness
If bursa ruptures, discrete, sharply demarcated goose egg is visible
Limited ROM at end of flexion

20

Acute & Chronic Bursitis Management

PIER
Compressive wrap
Chronic- cryotherapy, NSAIDs
- elbow cushions
- bursa may be aspirated

21

Septic & Non-septic Bursitis MOI

Infection in absence of trauma
Septic bursitis maybe related to seeding from infection at a distant site
Non-septic (RA)

22

Septic & Non-septic Bursitis S&Sx

Infection: malaise, fever, pain, localized heat, restricted ROM, tenderness

23

Septic & Non-septic Bursitis Management

Refer to MD
Aspiration to culture
Sling

24

Collateral Ligament Sprain MOI

Rare
FOOSH
Repetitive tensile forces irritate & tear lig't part of UCL
If UCL is damaged, ulnar nerve may have damage

25

Collateral Ligament Sprain S&Sx

Pain localized at medial aspect w/late cocking & early acceleration
Point tenderness at joint line
Increase pain & instability w/ valgus/varus/milking sign

26

Collateral Ligament Sprain Management

Standard care
Strengthening flexor-Pronator group

27

Anterior Capsulitis MOI

Anterior joint pain cause by hyperextension, usually attributed to anterior capsulitis rather than chronic repetitive throwing

28

Anterior Capsulitis S&Sx

Diffuse anterior elbow pain after traumatic episode
TOP (deep) particularly anteromedial side
-R/O strain to point tenderness & entrapment of median nerve

29

Anterior Capsulitis Management

Standard care
Immobilization 3-5 days
Flexion contracture may result w/ repetitive injury

30

Dislocations MOI

Adolescents most common traumatic injury to elbow are subluxations/dislocations of proximal radial head often associated w/immature annular ligament

31

What is Nurse Maids elbow?

Dislocation of the radial head, accompanied by a decrease in pronation/supination w/o pain refer to ER

32

Dislocations S&Sx

-Snapping/cracking w/impact, severe pain, rapid swelling, loss of function & obvious deformity
-Nerve palsie are also common

33

Dislocations Management

Stabilize in position found
-R/O circulatory impairment, neuro impairment
-check vitals, treat for shock
refer to MD

34

Flexor/Extensor Strains MOI

Repetitive tensile stress to muscle (elbow flexion/extension)

35

Flexor/Extensor Strains S&Sx

Palpable pain over muscle mass

36

Flexor/Extensor Strains Management

Standard acute management
Proper technique

37

Rupture of Biceps Brachii MOI

97% of ruptures are proximal
Pre-existing degenerative changes in tendon make it vulnerable following sudden eccentric load
- men <30 w/ Hx of steroid use

38

Rupture of Biceps Brachii S&Sx

Tenderness, swelling
Biceps tendon is not palpable b/c tendon retracts
Able to flex/supinate but weak

39

Rupture of Biceps Brachii Management

May involve non-operative approach
- studies indicate significant loss
- May be sufficient for ADL but not sports
Surgical repair involves attachment of tendon

40

Rupture of Triceps MOI

Direct blow to posterior aspect of elbow
Uncoordinated tricep contraction during fall
80% of ruptures involve Olecranon #

41

Rupture of Triceps S&Sx

Pain, swelling over distal attachment on Olecranon process
Palpable defect in triceps
AROMA present, but weak/non-existent

42

Rupture of Triceps Management

Standard care w/immobilization
Refer to MD
Partial tears treated conservatively
Surgical reattachment is necessary for total rupture
Avulsion # requires extensive surgery

43

Compartment Syndrome MOI

Secondary to elbow # or dislocations, crushing injury! forearm # or excessive muscular contraction
Hemorrhage/edema, increase pressure within the compartment
- excessive pressure on neuro vascular structures

44

Compartment Syndrome S&Sx

Onset of symptoms is rapid
-swelling, discolouration, absent/diminished pulse leading to sensory changes & paralysis
- severe pain at rest, aggravated by PROM of muscles in compartment

45

Compartment Syndrome Management

-immobilization of forearm & wrist
-ice & elevation
-no external compression
-immediate referral b/c fasciotomy may be needed to decompress the area

46

Medial Epicondylitis (Golfers Elbow) MOI

Med/late tension compression forces places on elbow during acceleration phase of throwing
Medial humeral apophyseal growth plate of paediatric athlete
Valgus force produce a combined w/flexor muscle strain or UCL sprain & ulnar neuritis

47

Medial Epicondylitis (Golfers Elbow) S&Sx

Swelling, ecchymosis TOP Humeroulnar jt./flexor/Pronator origin slightly distal & lateral to medial epicondyle
Pain w/RROM wrist flexion & pronation & by valgus stress at 20-30*
Ulnar nerve involvement
4th&5th digits

48

Medial Epicondylitis (Golfers Elbow) Management

Standard care
Prevention w/proper mechanics & throwing

49

What tendons are usually involved in Golfers Elbow?

Pronator Teres & FCU

50

Lateral Epicondylitis MOI

Pain in lateral epicondyle is most common
Caused by eccentric loading of extensor muscles during deceleration of forearm extension
Caused by mechanical errors (leading w/elbow) poorly fitted equip & age (30-50) years

51

Lateral Epicondylitis S&Sx

Pain anterior or just distal
Pain often subside & becomes more severe w/repetition
Tennis Elbow

52

How do you test for Lateral Epicondylitis?

Coffee cup test

53

Lateral Epicondylitis Management

Standard care
Counter force strap/tape
Find the cause treat the cause

54

Cubital Tunnel Syndrome S&Sx

Shocking sensation along medial aspect of elbow (hitting funny bone)
(+) Tinel Sign
Pt. may develop hand weakness FCU & 5th digit (intrinsic muscle innervation)
Decrease grip&pinch strength

55

Where does the Median Nerve travel through?

Passes through Cubital fossa, between 2 heads if Pronator Teres & FDS

56

Pronator Syndrome S&Sx

Pain is felt in anterior proximal forearm & aggravated w/ pronation activities
Numbness anterior forearm of middle index fingers & thumb

57

Radial Tunnel Syndrome S&Sx

Often mimic lateral epicondyle
Aching lateral elbow pain that radiates down posterior forearm
TOP Supinator muscle
Resisted supination is more painful than wrist extension
Wrist drop (ext weakness) seen in extreme cases but no sensory loss

58

Radial Tunnel Syndrome Management

Refer to MD
Rx depends on Fx & NSAIDs can help in acute cases
Injury 2nd to direct blows, protect from further injury
Chronic nerve damage may require surgery to release pressure on nerve

59

Epiphyseal & Avulsion # MOI

Growth plate in adolescents are sensitive to tension stress, repeated or sudden contraction of flexor-Pronator muscle group result in Avulsion # of medial epicondyle
" Little League Elbow " (forceful pronation)

60

Epiphyseal & Avulsion # S&Sx

Initially individual complains of aching activity but no limitations in performance & no residual pain
Conditions progresses aching pain w/activity limitations & mild post-exercise pain, some TOP on epicondyle

61

Epiphyseal & Avulsion # Management

Acute care w/activity modification
If performance limited due to pain & post exercise pain is present refer to MD
Conservative management rest & immobilization for >2 weeks
No throwing for 6-12 weeks
Surgery only if valgus instability is present or neural Sx

62

Osteo-chondritis Desecans (OCD) MOI

Due to repetitive stress in skeletally immature elbow
Lat compressive forces exerted during throwing motion which can damage Radial head, capitulum or both
Leading cause of permanent elbow disabilities in adolescents
Causes fragmentation & softening of under lying subchondral bone
Leads to microfracture & eventual avascular necrosis

63

Panner Disease

Associated w/OCD
Most common cause of chronic lateral elbow pain encompassing entire capitulum in athletes <10
Pain lat & ant elbow
Pain increase w/deep Palpation or pron/supination
Resolves w/rest
Elbow ext. limited by 20*

64

Panner Disease S&Sx

Mirror little league elbow
Insidious onset of dull activity related & poorly localized pain
Eventually locking, decrease ROM & flex contraction are more than 15*
Swelling TOP over radiocapitellar joint
Decrease elbow extension

65

Panner Disease Management

Refer to MD
Rest 16-18 mos.
no loose fragments resume activity
Fragment displacement may be warranted to reattach or excise small fragments