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Elbow
Orthopedics
| Question | Answer |
|---|---|
| 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
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