Elbow Lecture Note

Elbow Carrying angle - Male: 5 Female 10-15 Cubital varus: Less than normal carrying angle, gunstock deformity Cubital valgus: Greater than normal Ulnar nerve compression syndrome - Special tests: Tinels sign, ulnar nerve compression test, 5th finger ABD S&S: Pain/achiness at medial elbow, radiating p! down lateral arm, tenderness of ulnar nerve, clicking, EF may cause DX or SX MOI: Compression, traction Sites of compression: Cubital tunnel, FCU aponeurosis, arcade of struthers Median nerve compression - MOI: Compression, traction Due to pronator teres syndrome Sports with repetitive pronation S&S: Pain/aching in volar aspect of arm, paresthesia/motor weakness over median nerve distribution ST: Tinels, Median nerve Radial nerve compression - MOI: Compression, traction, vigorous wrist extension/supinator/pronation S&S: Pain down forearm extensors, pain with resisted supination/extension of middle finger, tender over distal to lateral epicondyle Special test: Resisted wrist extension Forearm compartment syndrome - Elbow S&S: Pain, pallor, paresthesia, paralysis, pulselessness, TTP, tense feeling, shiny skin MOI: Arterial injury, posttraumatic swelling Pressure builds and exceeds vessel walls, causing collapse General compartment - S&S: pain out of proportion, poor skin coloration, decrease skin temp, decreased pulse, loss of sensation/motor function/nerve damage Volkmanns ischemic contracture - Replacement of nonviable necrotic muscle with inelastic & contracted scar tissue Elbow and forearm fx - Occur more in skeletally immature athletes/kids Radial fx - MOI: FOOSH & forearm pronation, axial compression of radius vs capitellum S&S: pain with palpation of radial head, pronation/supination, loss of pronation/supination Distal humeral fx - MOI: FOOSh with elbow extension MEDICAL EMERGENCY due to complications and disability, displacement is a concern Injury to brachial artery, median/ulnar/radial nerves Olecranon fx - MOI: Direct blow to posterior elbow, secondary to violent pull of triceps (most are intraarticular/jt instability) Forearm fx (radius and ulna) - MOI: Axial force & transverse force Pain with AROM WE, pain, crepitus DX: Seen in sports, complex to simple, tx conservatively Elbow Galeazzi and Monteggia fx/dx G: Galeazzi R: Radius I: Inferior M: Monetggia (radial dx with fracture of ulna) U: Ulna S: Superior GRIM= which forearm is fx and whether distal (inferior) or proximal (superior) is fx Humeroulnar jt dx - MOI: HE during axial loading, FOOSH or extended elbow Posterior is more common than anterior rx Olecranon is jammed into fossa Ulna and radius are dx together (can occur posterior which is most common or posteromedial) S&S: pain, swelling of forearm/hand, deformity, wont move, pulse issue, pale/cyanotic, paresthesia with passive finger extension Secondary to: MCL/LCL torn, radial head/neck fx, coronoid process/medial epi can be fx due to rotary forces Worried abt brachial artery occlusion, median/ulnar entrapment Radioulnar jt dx - More common sx in children, isolated dx in adults is rare MOI: direct lateral blow Tearing of annular ligament, distal radioulnar jt capsule, interosseous membrane Pain, limited ROM, effusion, TTP over antecubital, wont supinate, wont move elbow, holding in pronation, pain Special test: Radioulnar joint test Occurs in children its called nursemaids due to traction force with pronation of forearm (radial head is pulled out of annular ligament) Elbow Tennis elbow (lateral epi) - MOI: Activities that place stress and tension on extensor/supinator muscles like ECRB Special test: Lateral epicondylitis test S&S: Gradual over lat epi, aggravated/weakness w gripping, swelling, discoloration are rare Golfers elbow (medial epi) - MOI: Repetitive WF and pronation activity Special test: Medial epicondylitis test S&S: ulnar nerve irritation, passive WE/sup pain, pain over medial epi, swelling Due to skeletal immaturity, need to rule out avulsion in young athl Periostitis - Forearm splints S&S: pain with deep palpation of ulna and radius/resistive action, diffused aching, worse with activity, relieved with rest Olecranon bursitis - MOI: Repetitive fraction, direct trauma S&S: LG fluid filled bursa, limited motion (subcutaneous bursa) No tx= fluid thickens and calcifies Epicondylitis/ tendonitis - Tendinitis: simple inflammatory response Epicondylitis’s: Degeneration with increase fibroblastic activity, and granulation Contusion - MOI: Direct blow Occurs in forearm/bony surfaces S&S: PT tenderness, swelling, discoloration, bursa swelling, limited elbow flexion Serious=compartment syndrome, extensors/flexors contusion=decreased ROM, injury to superficial nerves Elbow UCL sprain - Special test: Valgus special test MOI: Valgus force, FOOSH, chronic due to repetitive valgus stress - Fact: Common in FB or WR, occurs in throwing athls Anatomy: Anterior band of UCL Occurs in late cocking/early acceleration phase in throwing TX: Tommy john, palmaris is used as UCL S&S: Pain w valgus stress, swelling, pain over anterior band, ulnar nerve issues RCL sprain - ST: Varus S&S: swelling over lateral elbow, pt tenderness MOI: FOOSH Less common Osteochondral defects - Compressive forces that damage vascular supply to osteochondral surfaces Chronic elbow pain, tender over capitellum Little league elbow - Traction apophyseal and epiphyseal injuries Distal biceps tendon strain - MOI: Force flexed during active extension, direct blow to post elbow S&S: localized pain, swelling, ecchymosis, wont extend elbow, palpable defect Rare Anterior capsule sprain - Forced HE of elbow Pain on olecranon Flexor/pronator mass strain - MOI: Forceful snapping into F/P Pain with RROM and passive stretching, tender over muscle mass Elbow Actions from muscles originating at lateral epi - Extension/supination Hard end feel with passive elbow flexion - Loose body in joint Most stabilizing structure of lateral elbow - LUCL Muscle of WF group - Palmaris longus Innervated by musculocutaneous nerve - Biceps brachii Anterior band of UCL primarily stressed in over head athletes - True Biceps tendon rupture is at least six times more common in smokers - True Pronator teres syndrome - Median nerve Terrible triad of elbow - Dislocation, radial head/neck fx, coronoid fx Articulations of elbow - Humeroradial Humeroulnar Superior radioulnar Inferior radioulnar