Upper Extremity-Elbow Injuries

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Author:
ae_228
ID:
283902
Filename:
Upper Extremity-Elbow Injuries
Updated:
2014-09-26 15:46:40
Tags:
upper extremity elbow injuries
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Description:
Injuries to the Elbow
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  1. Olecranon Bursitis- Etiology
    • ⇾Most frequently injured bursa in the elbow
    • ⇾prone to acute and chronic injury from direct blow
  2. Olecranon Buritis-S&S
    • ⇾pain, swelling, point tenderness
    • ⇾possibly w/out pain or heat
  3. Olecranon Bursitis-Mgmt
    • ⇾Acute: cold compress for 1 hour
    • ⇾Chronic: some type of compression to reduce swelling....aspiration if swelling persists
  4. Ulnar Collateral Ligament Injuries-Etiology
    • ⇾Resulting from a valgus force and/or repetitive trauma (overhead throwing, high velocity)
    •    ↳ulnar nerve can be damaged with the ligament injury
    • ⇾may be misdiagnosed as muscle tendinitis or strain
  5. Ulnar Collateral Ligament Injuries-S&S
    • ⇾pain along medial elbow over the collateral ligament (distal insertion mostly)
    • ⇾parasthesia may be present
    • ⇾laxity compared bilaterally
  6. Ulnar Collateral Ligament Injuries-Mgmt
    • ⇾conservative: rest, NSAIDs, rehab after symptoms subside
    •   ↳monitor throwing motion during rehab
    • ⇾surgical treatment: complete repair of the UCL (Tommy John), may involve a nerve transposition
    •   ↳recovery 18-24 months
    • ⇾may have a regular reconstruction of UCL (not recommended for throwing athletes)
  7. Lateral Epicondylitis "Tennis Elbow"-Etiology
    • ⇾one of the most common elbow problems
    • ⇾repetitive microtrauma involving wrist extension, w/ overuse to the extensors
    • ⇾tendinitis is likely
    • ⇾AKA Tennis Elbow
  8. Lateral Epicondylitis "Tennis Elbow"-S&S
    • ⇾complains of paind during and after activity with gradual increast
    • ⇾point tenderness over lateral epicondyle
    • ⇾pain with resistive extension
    • ⇾decreased ROM
  9. Lateral Epicondylitis "Tennis Elbow"-Mgmt
    • ⇾RICE, NSAIDs and analgesics
    • ⇾work ROM, PRE and avoid pronation movements
  10. Medial Epicondylitis-Etiology
    • -->repeated forceful flexion
    • -->extreme valgus torques of elbow causing tendinitis of flexor tendons
    • -->May have associated neuropathy of ulnar nerve
  11. Medial Epicondylitis-S&S
    • -->pain over medial epicondyle with palpation and resisted wrist flexion
    • -->swelling
  12. Medial Epicondylitis-Mgmt
    • -->sling, rest
    • -->cryotherapy
    • -->ultrasound
    • -->NSAIDs and analgesics
  13. Osteochondritis Dissecans-Etiology
    • -->cause is unknown
    • -->fragmentation and separation of articular cartilage and bone due to impairment of blood supply
    • -->creates loose bodies within the joint
    • -->seen mostly in patients 10-15 years old who engage in throwing and racquet sports (anything leading to radial head compression)
    • -->patients younger than 10 with this is called "Panner's Disease"
  14. Osteochondritis Dissecans-S&S
    • -->sudden pain and a locking of the elbow joint, ROM returns slowly
    • -->swelling, pain and crepitation may occur
    • -->decreased ROM in full extension, tenderness at radiohumeral joint
  15. Osteochondritis Dissecans-Mgmt
    • -->beginning stage: restricted activity for 6-12 weeks and NSAIDs
    • -->with increased degeneration: splint or cast, refer to Dr.---loose bodies removed with repeated locking
  16. Little League Elbow-Etiology
    • -->occurs in 10-25% of young pitchers
    • -->caused by repetitive microtrauma from throwing
    • -->disorders caused:
    •  ----->an accelerated apopyseal growth region plus a delay in the medial epicondylar growth plate
    • ------>a traction apophysitis with a possible fragmentation of the medial epicondylar apophysis
    • ------>an avulsion of the medial epicondyle
    • ------>osteochondrosis of the humeral capitellum
    • ------>a non union stress fracture of the olecranon epiphysis
  17. Little League Elbow-S&S
    • -->slow onset
    • -->possible flexion contracture, including anterior joint capsule tightness
    • -->locking or catching sensation
    • -->decreased ROM of pronation and supination
  18. Little League Elbow-Mgmt
    • -->RICE, NSAIDs, with analgesics as needed
    • -->throwing is stopped
    • -->loose bodies removed
    • -->when throwing begins, observe proper mechanics
  19. Cubital Tunnel Syndrome-Etiology
    • -->traction injury from a valgus force
    • -->irregularites within the tunnel
    • -->subluxation of the ulnar nerve
    • ------>lax ligament (UCL)
    • ------>torn retinaculum
    • -->progressive compression of the nerve
  20. Cubital Tunnel Syndrome-S&S
    • -->pain over medial aspect of elbow
    • -->tenderness over the cubital tunnel with palpation
    • -->intermittent parasthesia
  21. Cubital Tunnel Syndrome-Mgmt
    • -->rest and immobilization for 2 weeks
    • -->NSAIDs
    • -->surgical decompression or transposition of a subluxing nerve
    • -->avoid hyperflexion and valgu stresses
    • -->immobilized in full extension
  22. Elbow dislocations-Etiology
    • -->caused by FOOSH with hyperextension or a severe twist with elbow in flexion
    • -->may displace posterior, anterior, or lateral (posterior displacement is more common)
  23. Elbow dislocations-S&S
    • -->hemorrhage and swelling
    • -->severe pain, disability and deformity
  24. Elbow dislocations-Mgmt
    • -->apply cold and pressure immediately
    • -->sling and swath
    • -->check pulse above and below injured site, along with sensation
    • -->Refer to Dr
    • ----->should be in a sling for 3 weeks, if minimal ligament damage, start ROM at end of week 1
  25. Elbow Fractures-Etiology
    • -->Cause:
    • ----->FOOSH or fall on flexed elbow
    • ----->direct blow
    • -->young individuals are more prone
    • -->can heppen in one or more of the 3 bones
    • -->FOOSH can cause a fracture of the humerus
    • ------>above the condyles
    • ------>the condyles proper
    • ------>the area between the condyles
    • ------>condylar fx at the elbow may cause a gunstock deformity
  26. Elbow Fractures-S&S
    • -->hemorrhage, swelling, muscle spasm
    • -->may or may not have a visual deformity
  27. Elbow Fractures-Mgmt
    • -->monitor circulation above and below injured site, as well as sensation
    • -->refer to Dr.
    • -->surgery required for an unstable joint
    • -->splint 6-8 weeks
  28. Volkmann's Contracture-Etiology
    • -->forearm ischemic contracture, resulting from brachial artery injury
    • ----->assoc. with supracondylar fracture of humerus
    • -->may have motor and sensory function loss
    • ----->involving the median nerve
    • -->insufficient arterial perfusion and venour stasis followed by degeneration of the muscle
    • irreversible muscle necrosis begins 4-6 hours
  29. Volkmann's Contracture-S&S
    • -->pain in the forearm that's greater when fingers are passively extended
    • -->followed by ceasing of brachial and radial pulses
  30. Volkmann's Contracture-Mgmt
    • -->with beginning signs of pressure reflected by pain, coldness and decreased ROM (mainly in wrist flexion)
    • ----->remove any wraps, casts...do not elevate
    • -->Refer to Dr.
    • -->must be monitored closely
    • -->can be permanent
  31. Pronator Teres Syndrome-Etiology
    • -->entrapment of the median nerve at or above the elbow or between the 2 heads of the muscle
    • -->can be entrapped due to edema and/or hypertrophy
  32. Pronator Teres Syndrome-S&S
    • -->neuropathies
    • -->numbness, tingling, pins/needles sensation in thumb and first finger
    • -->motor deficiencies including thumb and first finger
  33. Pronator Teres Syndrome-Mgmt
    • -->NSAIDs, rest and modification of activities
    • -->pain reduction and splinting
    • -->surgical decompression (results vary)

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