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MS of The Elbow

Clinical Medicine II-Spring 2012

Muscles that Flex the forearms, innervation? Brachialis, Biceps, Brachioradialis, C5-C6
Muscles that Extend the forearm, innervation? Triceps, anconeus, C7-C8
Muscles that supinate the forarm, innervation Biceps, supinator, C5-C6
Muscles that pronate the forearm , innervation Pronator quadratus: C7,8 T1 and pronator teres: C6
Darkening in a plain film around the bone in a joint Fat pad sign, or sail sign: means blood in joint capsule
Anterior and Posterior fad pad sign suggests intrarticular fracture
Posterior Fat Pad sign or “sail sign” suggests supracondylar fracture
MC elbow condition seen in primary care lateral epicondylitis “tennis elbow”
Some causes of lateral epicondylitis repetitive gripping(and lifting)-extending wrist, squeezing, extension of the wrist
Flexor and extensor muscles of the forearm originate where? Flexor: medial epicondyle, Extension: lateral epicondyle
MC tendon that is damaged w/ lateral epicondylitis ECRB extensor carpi radialis brevis
SXS of Lateral epicondylitis dull ache of lateral side of elbow that increases w/ grasphing, twisting and resisted extension of wrist or fingers
PE signs of Lateral Epicondylitis tenderness over lateral epicondyle, ^pain w/ extension/supination of wrist
Do we need xrays for lateral epicondylitiy take an Xray to r/o other causes of pain, especially radio-capitellar arthritis
Tx of lateral epicondylitis rest, avoid aggravating activities, ice, PT-iontophoresis/friction massage, compression, anti-inflammatories, +/- steroid injections, surgery
What do we have to be careful about with compression tennis elbow bands
What is Golfer’s, Pitcher’s, or Bowler’s elbow Medial epicondylitis
What is MOI with medial epicondylitis microtrauma to flexor carpi radialis tendon insertion on lat epi
Physical exam findings w/ med epicondylitis tender to palpation of medial epi, ^ pain w/ resisted flexion/pronation of wrist
Tx med epicondylitis rest, ice, NSAIDS, NO injections, PT?,
Why don’t we want to do injections with med epicondylitis ulnar nerve lives there
Inflammation, swelling, and +/- pain over olecranon process Olecranon Bursitis
Causes of olecranon bursitis trauma, infection:break in skin, fever, puncture, inflammation: gout, RA, uremia in renal failure:sitting in chair w/ dialysis
RF’s of olecranon bursitis DM, Chronic alcohol abuse, occupation/hobbies, gout
Diagnosis of Olecranon bursitis XR if trauma or suspicion of gout (crystals), CBC, ESR, CRP for gout
Tx for Olecranon Bursitis non-infectious: nothing, rest. Resolves 2-4wks, infectious: aspiration by a specialist, gram stain, do infectious workup w/ a SURGICAL I & D
What can cause an acute cubital tunnel syndrome elbow dislocation: ulnar n. entrapment
Ulnar neruropathy after an injury at the condylar groove “Tardy Ulnar Palsy”
Signs of ulnar n. entrapment pope’s blessing, froment’s sign (1st), weakness of 5th abduction digit
Dx of ulnar n. entrapment, tx clinical: refer, EMG, tx: splint, NSAIDS, surgery
Signs of radial n. entrapment wrist drop, loss of dorsal web bw/ thumb and index finger sensation
Dx of radial n. entrapment hx, “Saturday night palsy” could be ganglion, lypoma
Tx for radial n. entrapment cock-up splint for wrist, ortho follow up, OT,
Pressure on posterior interosseous n. in forearm radial tunnel syndrome, can be caused by lat epi straps
Subluxation of the radial head out from under annular ligament Nursemaid’s elbow
Dx of Nursemaid’s elbow arm usually held in slight flexion and pronation, offer kid something they want, won’t grab for it
Reduction of nursemaid’s elbow completely supinate the arm, and then completely flex the arm: then leave the room
What must be done prior to reduction if trauma is suspected XR first if suspect fracture
Follow up for nursemaid’s elbow sling 1-2 days, get ROM and movement quickly after
Most common type of dislocation of elbow posterior, d/t fall on nearly extended elbow: note radial head fractures,
Sxs of elbow dislocation won’t want to move at all, nerve sensation
Mangmt of elbow dislocation initial immobilization, XR, reduction
Reduction of elbow dislocation press on olecranon process, axial pressure and fully if not hyperextend the elbow
MOI of fracture of radial head FOOSH, radial head into capitellum
Types of radial head fracture and tx radial head, conservative w/ sling, early AROM. FU: XR wk 1,3,6 Transverse radial neck, need long arm post. Splint, prevent sup/pronation, Refer to ortho
Worst type of all elbow fractures supracondylar fracture of humerous, caused by fall backward on extended elbow
Tx of supracondylar fracture REFER, could have ulnar, radial, median n. or brachial a. injury, MANY complications!
Silver fork deformity supracondylar fracture, looks like an S above elbow joint
Tx supracondylar fracture closed reduction, MANY complications, REHAB!! In all elbow injuries even minor
Most common complication of elbow injuries elbow arthritis, steroid injections common, interventinal radiologists help here
Created by: streetsmarts
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