Sm Caq - Elbow

Front 1

lateral epicondylitis pathology?

Back 1

ECRB>ECRL>EDC microtears
Angiofibroblastic hyperplasia
NO INFLAMMATORY CELLS

Front 2

medial epicondylitis path?

Back 2

pronator teres, FCR microtears

Front 3

is extracorporeal shock wave therapy recommended for medial or lateral epicondylitis?

Back 3

NO. NOT recommended and has not been proven to work

Front 4

Compression sites cubital tunnel syndrome?

Back 4

-Acrade of Struthers
-intermuscular septum
-cubital tunnel retinaculum
-fascial origin FDS
-Heads of FCU
-Space occupying lesions

Front 5

%ulnar nerve subluxation/dislocation?

Back 5

16%

Front 6

"mimicker" of ulnar nerve instability?

Back 6

snapping medial head of triceps

Front 7

cubital tunnel syndrome simple release indications?

Back 7

Mild injury with clear evidence of compressive lesion

Front 8

Cubital tunnel transposition choice?

Back 8

Submuscular

Front 9

Pronator Syndrome compression site?

Back 9

-2 heads of Pronator Teres
-Lacertus figrosis
-Ligament of Struthers

Front 10

Pronator Syndroms physical findings?

Back 10

-forearm percussion test
-NEGATIVE Phalen's, cubital Tinel's
-weak thenar nuscles
-Anterior interossei muscles (FDP, FPL) spared.

Front 11

Pronator syndrome surgical Rx?

Back 11

simple decompression:
-humeral head of pronator
-superficialis bridge

Front 12

Radial Tunnel Syndrome:
compression sites?

Back 12

-Arcade of Frohse (midportions of supinator, exit of PIN Posterior Interosseous Nerve)
-Leash of Henry (radial recurrent vessels)

Front 13

Radial Tunnel Syndrome:
clinical presentation?

Back 13

-mimics lateral epicondylitis
-exacerbated by pro/sup
-tender at radial tunnel DISTAL to LE
-Pos Maudsley's test
-weak wrist/finger extension
-wrist drop/radial drift
-NO SENSORY DEFICITS

Front 14

**Maudsley's test?

Back 14

for radial tunnel syndrome
long finger resisted extionsion indicates compression by origin of long finger extensor

Front 15

Radial tunnel EMG/NCV?

Back 15

usually Normal except PIN.

Front 16

Radial tunnel conservative Rx?

Back 16

rest/NSAIDS
counterstrap may exacerbate

Front 17

Radial tunnel surgical treatment?

Back 17

must release compression site;
-arcade of Frohse
-Leash of Henry

Front 18

Operative indications for Flexor-Pronator injury?

Back 18

significant (>2.5 cm) retraction

Front 19

Distal biceps tendon rupture mechanism?

Back 19

(look up)
Eccentric contraction, strong extension moment, elbow in flexion

Front 20

What deficits will nonoperative treatment of distal biceps tendon rupture likely create?

Back 20

loss of supinaton>flexion strength and endurance

Front 21

Distal Biceps rupture repair 2-incision technique complications?

Back 21

higher incidence radioulnar synostosis

Front 22

Distal Biceps rupture repair single incision technique complications?

Back 22

higher incidence PIN unjury

Front 23

risk factors triceps rupture?

Back 23

-anabolic steroids
-chronic renal failure
-prior triceps injection

Front 24

Rx triceps rupture?

Back 24

Non-Operative Contraindicated
disabling loss of extension power
**Treat with primary tendon repir to olecranon

Front 25

Posteromedial Impingement - valgus extension overload elbow -symtoms, PE?

Back 25

throwers, posteromedial elbow pain, pain w full extension, loss of elbow extension
PE: flexion contracture, +Bounce test, +valugus extension overload in pronation

Front 26

Elbow Valgus Extension Overload Pathoanatomy?

Back 26

-Posteromedial olecranon osteophytosis
-Chondromalacia posterior ulnohumeral articulation

Front 27

Other considerations on Posteromedial Impingement?

Back 27

may be symptom of occult UCL insufficiency

Front 28

Surgical treatment of Valgus Extension Overload syndrome?

Back 28

resect osteophyte only, open or arthroscopic.
Max 3mm bone

Front 29

Olecranon Stress Fx - symptoms?

Back 29

pain more distal that val ext overload
pain w active extension
pain at release phase

Front 30

Olecranon stress fx PE?

Back 30

olecranon tenderness
flexion contracture
Valgus stress test, VEO test, bounce test
pain w resisted triceps activity

Front 31

Olecranon stress fx indications for surgery?

Back 31

tension band + bone grafting if significant Sclerosis on xray

Front 32

MCL force to failure?

Back 32

260-420N (body st =780N)

Front 33

MCL tensile forces?

Back 33

peak valgus force @30 deg up to 4x BW
medial tensile forces approx 2x BW

Front 34

Ant band MCL?

Back 34

strongest portion
primary valgus stabilizer
provides 54% varus torque

Front 35

Provocative tests for MCL injury?

Back 35

valgus stress test (Jobe)
Milking Maneuver (O'Brien)
Dynamic Valgus Stress (O'Driscoll)

Front 36

Radiographic findings for chronic MCL injury?

Back 36

humeral hypertrophy
olecranon hypertrophy
Medial epicondyle hypertrophy
sigmoid rim hypertrophy
valgus deformity
osteophytes.

Front 37

Stress radiograph findings for MCL laxity?

Back 37

relative laxity >2mm
absolute laxity >3mm

Front 38

MCL injury management?

Back 38

rest, NSAIDs, etc
re-examine p 6 weeks, if asymptomatice ok to attempt to throw. If symptomatic rest another 6 weeks.

Front 39

What constitutes failure of non-surgical treatment for MCL elbow injury?

Back 39

Continued pain with throwing after 3 months of appropriate treatment.

Front 40

Approach to elbow MCL reconstruction?

Back 40

internervous plane between median/ulnar nerves. Post 1/3 flexor group. Split anterior to FCU.

Front 41

Surgical options for elbow MCL reconstruction?

Back 41

-Modified Tommy John (80-90% RTP)
-Docking (85-92%RTP)
-DANE and interference screws (limited clinical validation)

Front 42

LUCL origin/insertion?

Back 42

Origin- inferior surface lateral epicondyle
Insertion- tubercle of supinator crest

Front 43

PE findings for LUCL laxity?

Back 43

-Posterolateral rotatory apprehension
-Lateral pivot shift test
-Posterolateral rotatory drawer test
-Stand-up/Push-up test

Front 44

How determine if LUCL stress views abnormal?

Back 44

radial head should align w capitellum on Every View!

Front 45

Essex-Lopresti Lesion?

Back 45

Disruption of the interosseous membrane between radius and ulna w proximal radius fx's

Front 46

Radial head Fx Type I?? (Mason)

Back 46

minimal or no displacement

Front 47

Radial head Fx type II?

Back 47

Marginal fx with displacement

Front 48

Radial head Fx type III?

Back 48

Comminuted and displaced. May be ass'd w ligament injury

Front 49

Rx Mason I?

Back 49

early ROM

Front 50

Rx Mason II?

Back 50

Aspiration and assess for ROM block: Neg, early ROM, Pos, fragment excision + ORIF

Front 51

Rx Mason III?

Back 51

ORIF, radial head excision (if irreparable and no UCL, DRUJ, UM injury

Front 52

Diagnostic radiograph sign for capitellum fx?

Back 52

Sail sign.

Front 53

Capitellum fx type I:

Back 53

complete capitellum involvement. Non-displaced early ROM, Displaced ORIF w variable pitch screws

Front 54

Capitellum fx type II:

Back 54

Thin layer subchondral bone
ORIF vs excision

Front 55

Capitellum fx type III:

Back 55

Comminuted.
ORIF vs Excision

Front 56

PE immature medial apophysitis

Back 56

+/- mild flexion contracture
+/- pain on resisted wrist flexion
+/- pain but NO LAXITY on valgus load.

Front 57

Medial apophyseal avulsion absolute indications for surgery?

Back 57

incarcerated fragment
ulnar nerve symptoms

Front 58

OCD def:

Back 58

condition involving focal injury to subchondral bone resulting in loss of structureal support for overlying articular cartilage

Front 59

OCD arthroscopic classification?

Back 59

Gr I: smooth but soft intact articular cartilage
Gr II: Cartilage fibrillations or fissuring
Gr III: Exposed bone with stable osteochondral fragment
Gr IV: Loose but non-displaced fragment
Gr V: Displaced fragment with loose body

Front 60

OCD Gr I Rx? (elbow)

Back 60

drilling of lesion

Front 61

OCD Gr II Rx?

Back 61

debridement and microfracture

Front 62

OCD Gr III Rx?

Back 62

Debridment and microfracture

Front 63

OCD Gr IV RX?

Back 63

Debridement and microfracture, in-situ fixation (technically demanding)

Front 64

OCD Gr V Rx?

Back 64

removal loose bodies
Debridement
microfracture

Front 65

Elbow Arth anterolateral portal:
1)location?
2) nerve/vessel?
3) distance?

Back 65

1) 1cm distal, 1 cm lateral
2) posterior branch, radial nerve
3)2mm, 7-11mm

Front 66

Elbow Arth low anteromedial portal:
1) location?
2) nerve/vessel?
3) distance?

Back 66

1) 2cm distal, 2 cm anterior
2) median nerve, brachial a
3) 6-14 mm, 17mm

Front 67

Elbow arth High anteromedial portal:
1) location?
2) nerve/vessel?
3) distance?

Back 67

1) 1 cm prox, 1cm anterior
2) median nerve
3) 23mm

Front 68

Elbow Arth Posterolateral portal:
1) location?
2) nerve/vessel?
3) distance?

Back 68

1) 1-3 cm prox, lat to tricep
2) med br cut, post antebrach
3) 20mm, 25mm

Front 69

Elbow Arth Straight posterior portal;
1) location?
2) nerve/vessel?
3) distance?

Back 69

1) 3cm prox to olecranon
2) ulnar nerve
3) 20mm

Front 70

pathology of lateral epicondylitis?

Back 70

angiofibroblastic hyperplasia

Front 71

32yo RHD male softball player w volar forearm pain w throwing and intermittent numbness radial 3 fingers. Weak thenar muscles but sparing of ant interossei, FPL, FDP. EMG's Normal. Dx?

Back 71

...pronator syndrome

Front 72

29yo tennis s/p lat epi x 6mos, Maudsley's +, + radial tunnel syndrome: most likely site of compression?

Back 72

Arcade of Frohse

Front 73

25yo RHD pitcher to have UCL reconstruction via muscle-splitting approach. Nerves approach is between?

Back 73

ulnar and median nerves

Front 74

49yo with several lateral epi injections, persistend lateral elbow pain, painful "popping" and sense of instab @ radiocapitellar jt: compromised anatomic strucure is...?

Back 74

LCL

Front 75

19yo w R elbow arth via anterolateral portal 3cm distal to epicondyle. Nerve @ risk is...?

Back 75

Radial nerve