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MS of The Elbow
Clinical Medicine II-Spring 2012
| Question | Answer |
|---|---|
| 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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