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Upper Extremit #3

Epiphyseal and Avulsion FX Medial epicondyle growth plate fx – due to repetitive flexion and pronation.
Little League Elbow not medial epicondylitis, classified as an avulsion fracture at medial epicondyle.
Lateral epicondyle growth plate fx repetitive stress of extensors.
Epiphyseal and Avulsion FX signs and symptoms Achiness w/ use, con't to increase in sev@ beginning: achy while playing, stops when play stops, As the injury progresses: pain constant, performance will begin to deteriorate, TTP over affected spot, + edema, + ecchymosis, more with more severe injury.
Epiphyseal and Avulsion FX TX Modify activity if catch it early enough, decrease activity, if too late, immobilize 2-3 weeks, can only begin to throw after 6-12 weeks, Surgery will prematurely close plate, try to avoid, do if unstable.
Osteochondritis Dessicans Younger pop, Bony fragment injury, Damage to the articular surface, articular cartilage, radial head and capitulum most susceptable, MOI – compression, valgus stress, Weakening of blood supply (specific part of bone) avascular necrosis, Avulsion fx.
Osteochondritis Dessicans Signs and SX Sim to little league elbow, pn increases w/play & decreases after stops, diff b/c complain of clicking, locking, popping in joint, If fragment lodges, can locked up elbow, TTP over humeral radial, ROM only if lock, other full, crep w/pronat & supination.
Osteochondritis Dessicans TX Referral, Conservative, Rest, pull 6-18 months, Aggressive, Loose body present, go in and remove, new is laser surgery.
Supracondylar Fx Common in children, FOOSH, fall on flexed elbow, Volkmann’s aschemic Contracture – claw hand.
Olecranon Process Fx Direct blow, Pn w/extension, Aggressive Tx pin two bones back together.
Radial Head Fx Valgus stress, Compression forces, Type I, - non displaced, Type II, displaced Type III – lot of bony fragments, communited, TTP over radial head, Full AROM, limited due to pain, pronation and supination will be limited, flexion and extension, not PROM.
Nightstick Fx- ulnar fracture Direct blow, Closed Reduction and cast, Radial head dislocation: ORIF.
Colles’ Fx distal radius and or ulna, FOOSH, Displace hand posteriorly.
Reverse Colles’ Fx Fall on wrist flexion, Displace hand anterorily.
Colles’ Fx Signs and Sx +deformity, Neuro damage, +edema, +ecchymosis.
Colles’ Fx Tx Referral, Immobilize.
Dislocation: Radial Head Pulled-elbow syndrome, Traction, Small tears in annular ligament, Inability to pronate and supinate.
Radial Head Dislocation TX splint and send, reduce ,immobalize elbow flexed for 3-6 weeks.
Dislocation: Ulnar Usually under age of 20, Hyperextension, FOOSH, axial load with slight elbow flexion, Associated Fx - number of different ones, volkmann’s aschemic contracture can be a big complication, can reduce if doc says yes, try.
Ulnar Dislocation Signs and Sx +deformity, Extreme pn, Audible sound, +edema; quick, Inability to move, Neuro disruptions.
Ulnar Dislocation Tx Closed reduction, w/no complications: immobilize for short time, flexor contracture – lose extension up to 30 degrees, w/associated fx: ORIF, Reoccurring dislocations common.
Contusions Direct blow, Bony prominences, Volleyball.
Tackler’s Exostosis antrolateral humerus, myositis ossificans (bone in muscle) can occur.
Contusions Signs and Sx +edema, +ecchymosis, ROM limitations.
Myositis ossificans crepitous in muscle belly,Exostosis.
Myositis ossificans Tx Conservative, PRICE, NSAIDs, Gentle ROM, Pad; Aggressive, Visible after 2-3 weeks - Wait 12-18 months before can remove, if remove too early it will come back.
Olecranon Bursitis Superficial, Macrotrauma, Microtrauma.
Olecranon Bursitis Signs and SX Inflammed Bursa, TTP, +edema, Ruptured Bursa, ROM, Spontaneous.
Olecranon Bursitis Tx PRICE, Aspiration, Elbow cushion, Removal.
Septic and Nonseptic Bursitis Septic– related to seeding from an infection at a distant site, such as paronychia (cellulitis of the hand) or forearm infection; Nonseptic – caused by crystalline deposition disease or rheumatoid involvement, has been associated with atopic dermatitis.
Septic and Nonseptic Bursitis Signs and SX Septic Signs of infection: traditional signs, lethargy, fever, pn, localized heat, ROM, tenderness and swelling @ elbow, ~1 week, TTP, Peribursal cellulitis–40 to 100% have; Nonseptic - Only have tenderness in 45% of cases, Only have cellulitis in 23-25%.
Bursitis TX Referral, Aspirate and culture, Sling, Heat pack, Antibiotics.
Sprains Rare – tears at elbow, FOOSH, Acute – collateral ligament sprain, repetitive tensile forces irritate and tear ligament, ulnar nerve may be affected, anterior capsulitis – hyperextension, Chronic – repetitive throwing.
UCL Sprain Pn w/ late cocking and acceleration phase, TTP in joint line, +valgus stress test, increased pain at 15-20 degrees, Conservative vs Aggressive – con- standard acute care, protected rest, stretch forearm flexor-pronator group and extensors.
Compartment Syndrome sep w/interosseous membrane b/w radius & ulna, flexors in ant comp, extensors in post comp; 2nd to elbow fx or dislocation, crush inj, forearm fx, postischemic edema, excessive pressure by hemmorage or edema, ex pressure on neurovascular & tissues
Compartment Syndrome Signs and Sx rapid onset, absent or diminshed distal pulse, sensory changes and paralysis, +edema, +ecchymosis, Sensory changes, Severe pn at rest, aggrivated by passive stretching of muscles in compartment.
Compartment Syndrome TX Immediate Referral; Medical Emergency, Immob, elevation, no external compression, Ice, Decompression of area through fasciotomy.
Flexor Strains Elbow flexors, Brachialis, Biceps brachii, brachioradialis.
Flexor Strains Signs and Sx TTP, Pn w/passive motion, Pn w/resisted motion, +ecchymosis.
Flexor Strains Tx PRICE, Activity modification, Gradual stretching program, Gradual strengthening program.
Extensor Strains Triceps Brachii, Tennis and Baseball players, Steroid users.
Extensor Strains Signs and Sx Pn w/passive motion, Pn w/resisted motion, +edema, +ecchymosis; TX -Same as flexor strain.
Epicondylitis Chronic pronation and supination, fatigue and overuse, Tendinosis degeneration rather than inflammatory; Medial-Valgus force–acceleration,“little league elbow”, collateral ligament sprain & ulnar neuritis, pro teres,flex carpi radialis common affected
Medial Epicondylitis Signs and Sx TTP over humeroulnar joint, medial epicondyle, +edema, +ecchymosis, ROM, +valgus, Possible neuro, tingling, numbness in 4th 5th fingers; TX, Ice, NSAIDs, Immobilization w/ TENS, Modalities, TENS, ultrasound, ROM, PRE, Functional Brace.
Lateral Epicondylitis Most common overuse injury in tennis players (racquet sports), Eccentric overload of extensor muscles, Poor mechanics – leading with elbow or off-center hits, Equipment – poorly fitted, Age 30-50.
Lateral Epicondylitis Signs and Sx ROM, TTP, +edema, +coffee cup test; TX, PRICE, NSAIDs, Cho pat, Avoid grasping, PRE
Neural Entrapment +neuro–shocking sensation medially, Repro of sx w/palp or percussion in ulnar groove, +Tinel’s Sign–tingling or numbness down medial aspect of the forearm into 4th and 5th digit, ROM–wrist drop “carpel tunnel”, strength–gradual grip and pinch weakeness
Neural Entrapment Median Nerve travels across Cubital fossa, b/w two heads of pronator teres and two heads of flexor digtorum superficialis.
Pronator Syndrome pain felt in anterior proximal forearm and is aggrivated with pronation, +neuro, numbness in anterior forearm and middle, index or thumb.
Neural Entrapment Radial Nerve can be damaged with fx, Humeral fx, Cubital fossa – radial tunnel syndrome, Sx can mimic, Achy, +neuro, Drop Wrist; TX - Immediate referral, Early - Complete rest, NSAIDs, Padding, Late -Surgery
Neural Entrapment Ulnar nerve Rests against posterior portion of ulnar collateral ligament, Trauma – acute or chronic, Cubital valgus – deformity, Ulnar groove – irregularities within.
Created by: adalmadge
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