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UE Ortho

Common Disorders of Elbow-forearm I

QuestionAnswer
What kind of musculotendinous changes involve collagen, vasculature, and fibroblasts? degenerative
What is defined by the presence of angiofibroblastic hyperplasia and absence of cellular components associated with acute inflammation? degenerative musculotendinous changes
The following describes what?...Pain at the lateral elbow. Pain frequently aggravated with resisted wrist extension or passive wrist flexion. Pain with gripping. Lateral Epicondylalgia
What is caused by repeated forceful contractions of wrist extensors, Primarily ECRB. Lateral Epicondylitis (tennis elbow)
Inflammation of the common extensor tendon, Typically from overuse, Forceful repetitive motion, heavy lifting, Increased age, decreases tissue resilience, 35 -60 yrs average age, Younger athletes...what does this describe? lateral epicondylitis (tennis elbow)
What does the following describe? Degenerative condition, Lacks cellular components associated with acute, inflammation, substance P, cytokines, glutamate, Evidence of fibrosis and inflammation in the paratenon and degeneration in the central tendon Lateral Tendinosis (Lateral Epicondylagia)
Most common work-related injury of the elbow, common in construction workers, mechanics,butchers, meat processing industries, also consider athletic activities,and wheelchair users...what is it? lateral tendinosis
What are the three indicators of poor prognosis with Lateral Tendinosis? 1. Forceful, repetitive mvmts, 2. awkward postures, 3. unskilled or untrained workers
The major muscles involved with this are flexor carpi radialis & pronator teres, palmaris longus, flexor carpi ulnaris & FDS. Medial Elbow Pain
Forceful repetitive contractions of the Pronator teres, FCR, and FCU can lead to what? Medial Epicondylitis (Golfer’s Elbow)
This is associated with Associated with golf, throwing sports and repetitive activity. Symptoms include: pain over medical epicondyle, pain with resisted wrist flexion, pain with passive wrist extension Medial Epicondylitis
What is the most common site of a biceps rupture? musculotendonous juncture or from the radial tuberosity
What are the s/s of a biceps tendon rupture? ecchymosis, loss of strength, deformity (“balling up”)
What is the MOI for a biceps tendon rupture? painful pop following eccentric overload
Biceps tendon ruptures are most common in what population? males 50-60 years old involved in weight lifting, athletics or manual labor.
What increases one's risk of having a biceps tendon rupture? smoking(increases risk by 7.5%), anabolic steroid use
What is another name for the medial collateral ligament? Lateral collateral ligament? Ulnar collateral ligament, radial collateral ligament
What are the primary STATIC elbow stabilizers? humeroulnar articulation, LCL, MCL
What are the secondary STATIC elbow stabilizers? radial head, common flexor & extensor origins, capsule
What are the DYNAMIC elbow stabilizers? anconeus, triceps, and brahialis
What band of the MCL(UCL) provides primary restraints to valgus and internal rotary forces? anterior
What can be caused by a loss of valgus stability? ulnar neuritis, valgus extension overload with radiocapitellar disease, and loose bodies
pain medial elbow: late cocking/acceleration,may describe sensation of “opening up”,may describe weakness,possible Ulnar n. sxs(tenderness more likely than paresthesias or intrinsic weakness),(+) Valgus Stress Test,(+) TTP: MCL. What does this describe? MCL instability
This can be caused by Valgus-Extension Overload, may be secondary to medial instability, involves impingement of medial olecranonon trochlea and olecranon fossa, may lead to osteophyte formation, loose bodies, and/or chondromalacia. Posteromedial Compression Injury
What are the sxs of a posteromedial compression injury? pain in full extension, accentuated by valgus stress
This is also known as Radiocapitellar Overload Syndrome, it is secondary to Medial Instability, involves abutment of radial head against capitellum, and may lead to chondromalacia, osteophyte formation, loose bodies. Lateral compression injury
What are two tests you would do to assess the MCL? valgus stress test and moving valgus stress test
__% of athletes treated non-operatively can return to previous level of competition at __ weeks s/p dx. 42, 25
T or F...With surgical intervention of the MCL, it is more reliable to perform a graft than a repair? T
In the "Ulnar Collateral Ligament Reconstruction: Systematic Review" by Purcell et all, what technique provided the greatest outcomes? figure of eight and docking technique
In the "Ulnar Collateral Ligament Reconstruction: Systematic Review" by Purcell et all, what was the most common complication? associated ulnar nerve problems
pain medial elbow during late cocking/acceleration, may have sensation of “opening up”, may describe weakness, possible Ulnar n sxs(tenderness more likely than paresthesias or intrinsic weakness),(+) Valgus Stress Test,(+) TTP: MCL. What is this? MCL instability
After a UCL(MCL) reconstruction, pts are usually splinted at __ degrees or flexion for _ weeks. 40, 2
After a UCL(MCL) reconstruction, when would active motion in a hinged elbow brace with a 20 deg ext stop be applicable? at 2-6 wks
After a UCL(MCL) reconstruction, when would you unlock the elbow brace? at 6 wks
After a UCL(MCL) reconstruction, when can the pt return to light activity? at 3 months
After a UCL(MCL) reconstruction, when can return to full activity be expected? at 1 year
Is laxity more or less common in the LCL vs the MCL? less
What is the sensitivity and specificity of moving valgus stress test at elbow? Sn= 1.0; Sp= .75
What level was the systematic review for MCL repairs by Purcell et al.? Level III
RCL instability is ____common than UCL instability is and is most likely attributed to _____ as opposed to _______. less; traumatic MOI; laxity
LUCL (Postero-lateral Rotary Instablity-PLRI) is a result of combo of ________________ ? __________________, imparting rotational force on HU jt, resulting in LUCL disruption axial load on supinated forearm w/ valgus stress
How do you test for LUCL instability? Test- supinat elbow, apply valgus stress, elbow flex past 40 deg
How common are elbow dislocations compared to other large jts of the body? Second only to shldr
What is the most common MOI for elbow dislocation? hyperextension w/ axial load that causes coronoid process to be levered over the trochlea
Which is preferred, surgical or nonsurgical treatment of simple elbow dislocations? Nonsurgical, no matter the ligamentous or muscular damage to the elbow
What occurs w/ Nurse Maid’s Elbow? Distraction force of radius, which causes it to slip out of annular lig, due to the underdevelopment of the child’s radial head, it’s ability to move distally w/o spontaneous reduction, and laxity of LCL and annular ligs. Common in children under 10 yrs
Created by: txst fall 2009