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P- 2 - Ortho 2 > 3 - Elbow > Flashcards

3 - Elbow Flashcards

1
Q

What is the MC benign neoplasm of the bones of the hand?

A

Enchondromas

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2
Q

What are the MC malignant neoplasms of the hand?

A

Squamous cell carcinoma

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3
Q

What is the MC primary malignant bone tumor in the hand?

A

Chondrosarcomas

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4
Q

Which type of hand tumor of extremely painful and sensitive to cold?

A

Glomus tumor

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5
Q

What is a Giant Cell tumor of the hand?

A

Benign nodular tumor found on the tendon sheath of the hands, MC on palmar surface of radial three digits near DIPJ

Firm, nodular, does not transilluminate

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6
Q

Subungual discoloration in the absence of trauma should raise suspicion for:

A

Melanoma

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7
Q

Describe a lipoma:

A

Superficial, soft, reasonably well-defined, non-tender on palpation

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8
Q

What is a carpal boss?

A

A dorsal prominence at the base of the second or third metacarpal

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9
Q

If olecranon bursitis present with pain over the joint line or with decreased ROM in the presence of spreading edema and erythema should increase suspicion of:

A

Infection

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10
Q

If the origin of olecranon bursitis is slow onset, and look like infection, obtain:

A

Aspirate sample for gram stain and culture

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11
Q

If the origin of olecranon bursitis is traumatic, obtain:

A

Radiographs, to r/o fx of the olecranon process of the ulna

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12
Q

Tx for aseptic olecranon bursitis:

A

Splint, rest, NSAIDs

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13
Q

Tx for septic bursitis:

A

Surgical drainage , ABX

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14
Q

If not recognized and treated promptly, biceps rupture can lead to:

A

Strength of elbow flexion and forearm supination is decreased by 50% in supination and 30% in elbow flexion

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15
Q

Biceps rupture most commonly occurs in which pt population?

A

Men in their 40’s, dominant elbow

7.5x greater risk in smokers

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16
Q

What is the hook test?

A

Physical exam test for biceps rupture

Highly specific and sensitive

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17
Q

What test is usually required to confirm the dx of biceps rupture?

A

MRI

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18
Q

Tx for biceps rupture:

A

Operative repair within 1 to 2 weeks of injury

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19
Q

What is the cubital tunnel?

A

Where the ulnar nerve passes behind the elbow

Osborne’s ligament
Bordered by medial epicondyle and olecranon

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20
Q

Cubital tunnel ulnar neuropathy is more commonly known by laymen as:

A

Whacking the funny bone

That super-weird tingling sensation you get after a direct blow to the ulnar nerve in the area of the cubital tunnel

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21
Q

What is cubital valgus?

A

Lateral deviation of the forearm at the elbow

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22
Q

What is cubital varus?

A

Medial deviation of the forearm at the elbow

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23
Q

Presentation of cubital tunnel:

A

Aching pain at the medial aspect of the elbow and/or numbness-tingling along the ulnar nerve distribution

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24
Q

What is a late finding of cubital tunnel syndrome?

A

Weakness and atrophy of intrinsic muscles (hypothenar atrophy)

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25
Q

What are the first sensations to be affected in cubital tunnel syndrome?

A

Vibration and light touch

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26
Q

How do we test for weakness of cubital tunnel syndrome?

A

Test abduction and adduction of the little and index fingers

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27
Q

Name a provocative maneuver to test for cubital tunnel:

A

Hyperflexion elbow test

Looking for pain

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28
Q

What is Froment Sign?

A

Cubital tunnel

Adductor muscle weakness

IP joint of the thumb will flex with thumb-to-index pinch

(Result of compensatory action)

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29
Q

What is Jeanne’s sign?

A

Simultaneous hyperextension of the thumb MCP joint is indicative of ulnar nerve compromise

Cubital tunnel syndrome

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30
Q

Is the Anterior Interosseous Nerve (AIN) motor, sensory, or both?

A

Motor only

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31
Q

Which injury may result in the inability to make the “ok” sign?

A

Injury to the AIN branch of the median nerve

32
Q

A nerve conduction test showing a reduction in velocity of ___ % or more suggests substantial compression of the ulnar nerve

A

30

33
Q

Tx for cubital tunnel:

A

Activity modification

Night splint

Sports elbow protector

NSAIDS

Steroids NOT recommended

34
Q

If conservative management for cubital tunnel x3 months fails:

A

Surgical decompression and ulnar nerve transposition

35
Q

Describe radial tunnel:

A

Neuropathy of the posterior interosseous nerve (PIN) of the radial nerve

Pain over the dorsoradial proximal forearm and dorsal wrist

36
Q

Resisted long finger extension test, think:

A

Radial tunnel

37
Q

Tx for radial tunnel

A

Activity modification

NSAIDs or APAP

Surgical decompression reserved for pt’s unresponsive to conservative management

38
Q

Lateral epicondylitis is AKA:

A

Tennis elbow

39
Q

Medial epicondylitis is AKA:

A

Golfer’s elbow

40
Q

Describe the presentation of lateral epicondylitis:

A

Insidious onset pain during activities requiring gripping or wrist extension

Lifting, turning a screwdriver, hitting a backhand in tennis

41
Q

Describe the presentation of medial epicondylitis:

A

Pain with wrist flexion and forearm pronation

Golf swings, baseball pitching, bowling, weight-lifting

42
Q

Epicondylitis - palm down:

A

Tennis

43
Q

Epicondylitis - palm up:

A

Golfers

44
Q

Tx for epicondylitis:

A

Activity mod, rest

Electric shock wave therapy

Physical therapy

Injection for LATERAL ONLY

Tension band

45
Q

How often is surgery necessary for epicondylitis?

A

Rarely (90% resolve non-surgically)

46
Q

Which nerves runs along the posterior spiral of the humerus?

A

Radial

47
Q

The majority of elbow dislocations are what direction?

A

Posterior

48
Q

Posterior elbow dislocations are commonly associated with what type of fx?

A

Olecranon

49
Q

What is the most important part of the elbow dislocation exam?

A

NV exam

Check for distal radial pulse and capillary refill

Assess PMS

50
Q

What is the “Terrible Triad”?

A

Refers to elbow dislocations

Radial Head Fracture
Coronoid Process Fracture
Associated Dislocation

51
Q

Which nerve may become entrapped during elbow reduction procedure?

A

Ulnar

52
Q

When to perform elbow reduction?

A

IMMEDIATELY

You get one attempt, then you’re calling ortho

53
Q

After reducing the elbow:

A

Splint in 90 degrees in pronation, an/or in a stable position

NSAID’s helpful to decrease incidence of heterotrophic bone formation

54
Q

Volkmann’s Ischemic Contracture - seen in:

A

Distal humerus fx’s

Brachial artery occlusion

55
Q

Fat pad sign suggests:

A

Distal humerus fx

56
Q

What is the eponym for a fx to the proximal 1/3 of the ulna with an associated radial head dislocation?

A

Monteggia Fracture

57
Q

Management of Monteggia?

A

Adults - surgery

Kids - nonoperative (if closed) - reduction

58
Q

What is a Galeazzi fx?

A

Distal 1/3 radial shaft fx with disruption of the distal radioulmar joint (DRUJ) and TFCC

59
Q

A Galeazzi is considered unstable if:

A

Less than 7.5cm from the articular surface

60
Q

Signs of DRUJ (distal radioulnar joint) injury:

A

Ulnar styloid fx

Widening of joint on AP view

Dorsal or volar displacement on lateral view

Radial shortening (>5mm)

61
Q

Management of Galeazzi fx:

A

CT of DRUJ

Adults - surg

Kids - non-operative (long arm cast in SUPINATION x 6-8 wks)

62
Q

What is the bony prominence of the ulna, posterior elbow?

A

Olecranon

63
Q

Why is the olecranon so easily fractured?

A

There’s like no tissue there to protect it

64
Q

What is the common affected nerve in olecranon fx’s?

A

Ulnar nerve

65
Q

Adverse outcomes of olecranon fx’s?

A

Loss of motion and/or stability is possible

Difficulty with elbow extension (think triceps insertion)

Post-traumatic arthritis is common

66
Q

Non-displaced fx’s of the olecranon can be tx’d with:

A

Posterior splint, elbow in 45 degrees of flexion to reduce pull on triceps

67
Q

What is a type 1 radial head fx?

A

Nondisplaced or minimally displaced

68
Q

What is a type II radial head fx?

A

Displaced more than 2mm at the articular surface -> articular incongruity

69
Q

What is a type III radial head fx?

A

Severely comminuted

70
Q

Components of Essex-Lopresti fx?

A
  1. DRUJ dislocation
  2. Radial head fx
  3. Interosseous membrane disruption
71
Q

What is Terry Thomas Sign?

A

Gap between scaphoid and lunate on radiograph

72
Q

5 things we look for when examining for distal radius fx?

A
  1. Articular step off
  2. Ulnar variance
  3. Volar tilt
  4. Radial height
  5. Radial inclination
73
Q

Ulnar variance more than ___mm is concerning:

A

3

74
Q

What is the Lafontaine Criteria?

A

Distal radial fx’s - likelihood of loss of position regardless of casting (3 or more)

  1. Initial dorsal angulation > 20
  2. Dorsal comminution
  3. Radiocarpal intraarticular involvement
  4. Associated ulna fx
  5. Age > 60 yrs
75
Q

Why is 6 so scared of 7?

A

Because 7 ate 9

P- 2 - Ortho 2 (5 decks)

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