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Elbow

Orthopedics

QuestionAnswer
Ulnar n. symptoms numbness, paresthesia, thenar wasting
Carrying angle (M/F) Men 5 degrees, women 10-15 degrees
Elbow Radiographs: Order: AP, lateral, oblique
Elbow Radiographs: Inspect for: Cortical defects; Radiocapitellar line; Ant. humeral line; fat pad sign
Anterior fat pad = Usually normal (Sail sign)
Posterior fat pad = Always pathologic
Posterior fat pad sign in adults may indicate: radial head fx
Posterior fat pad sign in kids = supracondylar fx
Lateral Epicondylitis: Hx: Elbow pain from repetitive wrist extension
Lateral Epicondylitis: Anatomy: Site of origin of wrist extensors-supinators
Lateral Epicondylitis: PE: Pain over lateral epicondyle with resisted wrist extension & supination
Lateral Epicondylitis: Other Care: Ice, stretch, strap, iontophoresis, surgical release
Lateral Epicondylitis: Injection: At the tender pt at lateral epi.; Marcaine, Kenalog, 25 g needle, down to the bone
Radial Head Subluxation AKA Nursemaids Elbow
Radial Head Subluxation = Annular ligament entrapment
Radial Head Subluxation MOA: Traction (swinging kids by wrists)
Radial Head Subluxation Presentation: Flexed and IR
Radial Head Subluxation Rx: Tx x-ray; Hyper-pronation; Flexion/ supination/ extension; Feel a pop; Quick relief
Elbow Instability: UCL sprain or tear (UCL primary valgus stabilizer)
Elbow Instability: Seen in: throwing athletes
Elbow Instability S/S: Pop while throwing & medial elbow pain & hand paresthesia; Pain on valgus testing
Elbow Instability tests: X-ray, MRI
Elbow Instability Rx: Rest, NSAIDs, PT, slow return to sports; poss Tommy John Surgery; education
Olecranon Bursitis: Hx: May be traumatic or insidious
Olecranon Bursitis: Diff Dx: Infection, Gout, triceps rupture
Olecranon Bursitis: PE: Red, swollen joint, + pain
Olecranon Bursitis: Other Care: Compressive sleeve; ant. splint if recur; Bursectomy if chronic
Olecranon Bursitis: Caution: infection
Olecranon Bursitis: Aspiration (high threshold for this): 18g needle, poss 60 ml syringe
Olecranon Bursitis: Aspiration: if cloudy: suspect infection; send for crystal, cx, gm stain
Olecranon Bursitis: Injection (high threshold for this): Marcaine/ Kenalog
TEA = Total elbow arthroplasty
Distal Humerus Fx: use ____ Classification Mehne & Matta
Distal Humerus Fx: Location Supracondylar; Transcondylar; Intracondylar; T condyle fracture; lateral, medial condylar fractures
Stable, non-displaced fx may be tx with: splinting for 10 days, then protected ROM
Distal Humerus Fx: stability Most are unstable and require ORIF
Most common elbow fracture in children Supracondylar Fx
Supracondylar Fx: MOA Extension, distal fragment posterior; N/V injury common
Supracondylar Fx: Tx Casting vs. ORIF vs. CRPP
3rd most common child fx = Medial epicondyle fx
Epicondyle Fx: which is uncommon? Lateral epicondyle fx
Epicondyle Fx: Rx: Non displaced Cast immobilization
Epicondyle Fx: Rx: Displaced (>30 degree angulation, or 1mm) CRPP vs. ORIF
CRPP = closed reduction & percutaneous pinning
Radial Head Fx: Hx FOOSH, valgus force
Radial Head Fx: PE Swelling lateral elbow; Pain over radial head; Limited pronosupination & extension
Radial Head Fx: Radiographs: AP, lat, obliq
Radial Head Fx: Mgmt: Type I (non-displaced) Posterior splint/sling for 3-5 days; Early ROM exercises
Radial Head Fx: Mgmt: Type II (displaced) Tx as in Type I if < 30% head displaced (Otherwise: ORIF)
Radial Head Fx: Mgmt: Type III (comminuted) Excision of frags or complete radial head
Radial Head Fx: Mgmt: Type IV (dislocated) Same as III
Olecranon Fx: Check: N/V function; Ulna n.
Olecranon Fx: Rx: Non-displaced: Posterior splint @ 45 degrees; Re-image 1 week; ROM at 2 wks
Olecranon Fx: Rx: Displaced: ORIF
Olecranon Dislocation: MOA FOOSH
Olecranon Dislocation: 90% are: posterior
Olecranon Dislocation: May also have radial head or distal humerus fracture
Olecranon Dislocation: Check: N/V status
Olecranon Dislocation: Tx Reduction / fx care
Lateral Epicondylitis: Other Care: Ice, stretch, strap, iontophoresis, surgical release
Radial Head Subluxation AKA Nursemaids Elbow; Annular ligament entrapment
Radial Head Subluxation Presentation: Flexed and IR
Radial Head Subluxation Rx: Tx x-ray; Hyper-pronation; Flexion/ supination/ extension; Feel a pop; Quick relief
Olecranon Bursitis: PE: Red, swollen joint, + pain
Olecranon Bursitis: Caution: infection
Olecranon Bursitis: Aspiration (high threshold for this): 18g needle, poss 60 ml syringe
Distal Humerus Fx: use ____ Classification Mehne & Matta
Stable, non-displaced fx may be tx with: splinting for 10 days, then protected ROM
Distal Humerus Fx: stability Most are unstable and require ORIF
Most common elbow fracture in children Supracondylar Fx
Supracondylar Fx: MOA Extension, distal fragment posterior; N/V injury common
Supracondylar Fx: Tx Casting vs. ORIF vs. CRPP
Epicondyle Fx: which is uncommon? Lateral epicondyle fx
Epicondyle Fx: Rx: Non displaced Cast immobilization
Epicondyle Fx: Rx: Displaced (>30 degree angulation, or 1mm) CRPP vs. ORIF
Olecranon Fx: Rx: Non-displaced: Posterior splint @ 45 degrees; Re-image 1 week; ROM at 2 wks
Olecranon Fx: Rx: Displaced: ORIF
Olecranon Dislocation: MOA FOOSH
Olecranon Dislocation: 90% are: posterior
Olecranon Dislocation: May also have radial head or distal humerus fracture
Olecranon Dislocation: Check: N/V status
Created by: Abarnard