elbow

Neurological injuries

- 7-16% incidence with posterior vascular compromise - ulnar, radial, median nerve - lots of nerves because of the fine motor skills in the hands and wrist

Supracondylar fracture

- above condyles of the humerus - bad news for blood supply and growth plate in kids - kids must get surgery or else will end up with a gunstock deformity

signs of lateral epicondylitis

- aching pain of the lateral epicondyles during and after activity (hurting at the elbow) - pain gets worse and causes weakness in the wrist and hand (trouble gripping and extending - pain with resistive wrist extension

what is an elbow dislocation

- complete disunion of the ulna and/or radius and the humerus - rupture and tearing of most of the stabilizing ligaments

most common way to strain elbow/arm

- forceful contraction -FOOSH with elbow extended - when you are sore and you extended it to fast

what the does the athlete experience when they rupture their bicep

- hears a snap - feels sudden and intense pain

how to distinguish fracture from an elbow dislocation

- in a dislocation lateral and medial epicondyles are normally aligned with shaft of humerus - fracture will cause some out of like breaks in the humerus

S&S of Volkmann's contracture

- pain in forearm - increased when fingers are passively extended - brachial and radial pulse are absent, coldness in arm (caused by the impingement closing up blood flow)

S/S of medial epicondylitis

- pain produced with forceful flexion point tenderness over medial epicondyles and mild swelling

S&S of little league elbow

- pain, swelling, grating - locking and catching ( from a possible bone spur)

how can the bicep be rupture ?

- powerful concentric or eccentric muscle contraction

medial epicondylitis is aka

- racquetball elbow - golfer elbow - javelin thrower elbow

ulnar collateral ligament sprain

- stretch or tear of the ulnar collateral ligament

what can be fracture with a forearm fracture

- ulna -radius -humerus

which bones are most commonly fractured in a colles fracture ?

- ulna -radius

sign of elbow dislocation

- ulna and radius look deformed - olecranon process extended posteriorly well beyond normal alignment

what nerve is injured in an ulnar collateral ligament sprain

- ulnar nerves (funny bone) is inflamed or impairment may be caused

brachial artery impingement

-5-20% incidence of temporary vascular compromise -pinching of the brachial artery (main blood supply of the arm) -once the injury is reduced the blood supply will be back to normal if it is not flix the blood supply will lead to losing function of the arm

MOI: fracture of the elbow/upper arm

-FOOSH (humeral condyles) growth plate -falling on a flexed elbow (olecranon process) -direct blow (olecranon process or radial head) -forced transitted to head of radius

what do you have to do to show you a sign of elbow/upper arm strain

-active or resistance motion produces pain; point tenderness in muscle, tendon, lower part of muscle belly

what sports cause forearm splints

-baseball -weight-lifting -gymnastics -construction

what are the 2 elbow fracture complications

-brachial artery impingement -neurological injuries

MOI of forearm fracture

-direct blow -foosh

what is a strain the elbow/upper arm

-distal bicep, tricep, brachialis muscles or tendon

s/s of forearm splints

-dull aching posterior forearm - pain with muscle contraction - wrist movement, gripping/grasping -palpable pain

MOI of elbow dislocation

-high incidence in sports caused by FOOSH with elbow extended (snowboarding skiing) -severe twist while flexed -falling with arm behind you

which bones are typically involved in fracture of the elbow/upper arm

-humerus -radius -ulna

how does strip foot contact affect trunk rotation

-open: arm lags behind trunk rotation -too closed: have to throw across body to hit target

sign of biceps tendon rupture

-protruding bulge may appear near the middle of the bicep - definite weakness with elbow flexion and supination

where is the most common place to get an biceps brachia rupture

-proximally -near origin of bicipital groove

symptoms of an elbow dislocation

-swelling -severe pain -disability

myth buster of tommy john

-that it will make the player come back better than before - players often hurt themselves more when they come back too soon

what surgery is done with an ulnar collateral ligament sprain

-tommy john - they will try to stop the pain and swelling and remove from all valgus activity if they don't get better or if the ligament is torn then they will perform the surgery

list of s/s of fractured elbow/upper arm

-visual deformity -serve pain, disability -hemorrhaging, swelling, muscle spasm -gunstock deformity - following after supracondylar fracture

what action is done repetitively to cause lateral epicondylitis

-wrist/forearm hyperextension -backhand, gymnastic, hammer throwing

what is a collet fracture

FOOSH, forcing radius and ulna into hyperextension - hand forced posteriorly

Little League Elbow

acceleration apophyseal growth region plus a delay in medial epicondyle growth plate

tommy john surgery is similar to what other surgery

all surgery and the structure as well

what can volkmann's contracture result in

any fracture in the elbow or upper arm

why do kids get nursemaid's elbow

because their joints are still lose and soft and have not yet developed strong tight ligaments to support the and hold the bones in place

which is the most common forearm fracture

colles fracture

what is the cause of a reverse colles fracture ?

falling back on the back of the hand causing hyperflexion

what can the pain of forearm splints be caused by

forearm compartment syndrome

what does lower extremity muscle weakness and flexibility cause

forward trunk lean during wind-up which can cause SLAP (labrum tear)

in little league elbow, where does osteochondrosis happen

humeral capitulum

why is timing of trance rotation important in a pitch

if you rotate your trunk before your front foot lands you will cause there to be a whip of the shoulder and will cause more forceful external rotation and valgus stress

MOI of volkmann's contracture

impingement or squeezing of the brachial artery

where is the largest elbow valgus tongue created

in the pitching velocity not the pitch type

lateral epicondylitis (tennis elbow)

inflammation of the lateral epicondyle at the origin of the wrist extensor muscles

Medial epicondylitis (pitcher's elbow)

inflammation of the medial epicondyles at the origin of the wrist flexor muscles

what is found within an ulnar ligament sprain

loose bodies in posterior compartment

what happens in little league elbow in detail

lots of throwing when growth is still occurring, the throwing causes lots of vagus on the elbow and pulling on the MCL and compressing on the Lateral side of the elbow causing miss growth or abnormal growing

where is there pain with an ulnar collateral ligament sprain

medial aspect of the elbow

in little league elbow, where does traction apophysitis happpen

medial epicondyle

in little league elbow, where does the avulsion happen

medial epicondyle or radial head

where will you get complication with an elbow dislocation

median and radial nerves a blood vessels - caused by something being stretched or pinched with dislocation happened

in little league elbow, where does nonunion stress fracture occur

olecranon epiphysis

where is there point tenderness with an ulnar collateral ligament sprain

over the MCL - mainly in the distal insertion - more pain on the ulna than on the humerus

what is a forearm splint

overuse of forearm musculature and irritation of periosteum from repetitive wrist movement

What is a Volkmann's contracture?

permanent flexion contracture of the wrist and fingers caused by ischemia of brachial artery aka blocking of the brachial artery for too long

most common place to get an elbow dislocation

posterior displacement of the ulna and radius

what fracture often occurs in a elbow dislocation

radial head fracture

what action causes medial epicondylitis

repeated forceful flexion of wrist and extreme valgus torque of elbow

what is the cause of getting little league elbow

repetitive microtrauma from overhead throwing (not the type of pitch throw)

a smith's fracture is also know as what ?

reverse colles fracture - with volar displacement of radius

Volkmann's contracture is a consequence of what ?

supracondylar fracture of humerus - someone has a supracondylar fracture and it's no treated properly so they end up with ischemia of the brachial artery and the impingement caused the contracture

where are the neurological symptoms in an ulnar collateral ligament sprain

ulnar nerve (pinky pain)

what is the cause of an ulnar collateral ligament sprain

valgus force from repetitive trauma - late cocking and early acceleration phase of throwing and forehand stroke in tennis

what causes pain with an ulnar collateral ligament sprain

valgus stress test at 20-30 degrés of flexion with possible end-point laxity

What is nursemaid's elbow?

with chronic traction it will loosen up the articulations between the radius and the humerus and result of a radial head dislocation

colles fracture is what kind of fracture

wrist fracture

can you still flex your elbow when you rupture the bicep

yes, other muscles can help

which population is common for forearm fractures

young active children