Upper Extremit #3
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| Epiphyseal and Avulsion FX | Medial epicondyle growth plate fx – due to repetitive flexion and pronation.
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| Little League Elbow | not medial epicondylitis, classified as an avulsion fracture at medial epicondyle.
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| Lateral epicondyle growth plate fx | repetitive stress of extensors.
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| 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.
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| 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.
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| 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.
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| 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.
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| Osteochondritis Dessicans TX | Referral, Conservative, Rest, pull 6-18 months, Aggressive, Loose body present, go in and remove, new is laser surgery.
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| Supracondylar Fx | Common in children, FOOSH, fall on flexed elbow, Volkmann’s aschemic Contracture – claw hand.
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| Olecranon Process Fx | Direct blow, Pn w/extension, Aggressive Tx pin two bones back together.
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| 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.
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| Nightstick Fx- ulnar fracture | Direct blow, Closed Reduction and cast, Radial head dislocation: ORIF.
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| Colles’ Fx | distal radius and or ulna, FOOSH, Displace hand posteriorly.
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| Reverse Colles’ Fx | Fall on wrist flexion, Displace hand anterorily.
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| Colles’ Fx Signs and Sx | +deformity, Neuro damage, +edema, +ecchymosis.
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| Colles’ Fx Tx | Referral, Immobilize.
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| Dislocation: Radial Head | Pulled-elbow syndrome, Traction, Small tears in annular ligament, Inability to pronate and supinate.
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| Radial Head Dislocation TX | splint and send, reduce ,immobalize elbow flexed for 3-6 weeks.
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| 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.
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| Ulnar Dislocation Signs and Sx | +deformity, Extreme pn, Audible sound, +edema; quick, Inability to move, Neuro disruptions.
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| 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.
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| Contusions | Direct blow, Bony prominences, Volleyball.
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| Tackler’s Exostosis | antrolateral humerus, myositis ossificans (bone in muscle) can occur.
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| Contusions Signs and Sx | +edema, +ecchymosis, ROM limitations.
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| Myositis ossificans | crepitous in muscle belly,Exostosis.
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| 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.
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| Olecranon Bursitis | Superficial, Macrotrauma, Microtrauma.
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| Olecranon Bursitis Signs and SX | Inflammed Bursa, TTP, +edema, Ruptured Bursa, ROM, Spontaneous.
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| Olecranon Bursitis Tx | PRICE, Aspiration, Elbow cushion, Removal.
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| 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.
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| 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%.
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| Bursitis TX | Referral, Aspirate and culture, Sling, Heat pack, Antibiotics.
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| 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.
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| 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.
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| 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
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| 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.
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| Compartment Syndrome TX | Immediate Referral; Medical Emergency, Immob, elevation, no external compression, Ice, Decompression of area through fasciotomy.
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| Flexor Strains | Elbow flexors, Brachialis, Biceps brachii, brachioradialis.
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| Flexor Strains Signs and Sx | TTP, Pn w/passive motion, Pn w/resisted motion, +ecchymosis.
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| Flexor Strains Tx | PRICE, Activity modification, Gradual stretching program, Gradual strengthening program.
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| Extensor Strains | Triceps Brachii, Tennis and Baseball players, Steroid users.
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| Extensor Strains Signs and Sx | Pn w/passive motion, Pn w/resisted motion, +edema, +ecchymosis; TX -Same as flexor strain.
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| 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
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| 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.
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| 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.
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| Lateral Epicondylitis Signs and Sx | ROM, TTP, +edema, +coffee cup test; TX, PRICE, NSAIDs, Cho pat, Avoid grasping, PRE
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| 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
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| Neural Entrapment | Median Nerve travels across Cubital fossa, b/w two heads of pronator teres and two heads of flexor digtorum superficialis.
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| Pronator Syndrome | pain felt in anterior proximal forearm and is aggrivated with pronation, +neuro, numbness in anterior forearm and middle, index or thumb.
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| 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
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| Neural Entrapment | Ulnar nerve Rests against posterior portion of ulnar collateral ligament, Trauma – acute or chronic, Cubital valgus – deformity, Ulnar groove – irregularities within.
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