Valgus Instability and Elbow Rehabilitation Quiz
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Questions and Answers

What is typically severe in posterolateral dislocation?

  • Pain response
  • Soft tissue disruption on the medial side (correct)
  • Disruption of lateral ligaments
  • Joint stiffness

    • What forces are recorded during pitching that contribute to valgus instability?

  • 125 N m
  • 85 N m
  • 100 N m
  • 115 N m (correct)

    • What is identified as a common etiology of valgus instability?

  • Traumatic injury (correct)
  • Infection
  • Congenital defects
  • Genetic factors

    • At what torque does the ulnar collateral ligament fail?

    <p>32.1 N m</p> Signup and view all the answers

    Which of the following is necessary before joint dislocation occurs in some cases?

    <p>Failure of the AMCL</p> Signup and view all the answers

    What happens when there is a severe valgus deformity after loading?

    <p>External rotation becomes pronounced</p> Signup and view all the answers

    Which statement about the activity of secondary stabilizers is true?

    <p>They compensate for ulnar collateral ligament failure</p> Signup and view all the answers

    What aspect of external rotation is typically observed in posterolateral rotatory instability?

    <p>It is generally subtle</p> Signup and view all the answers

    What type of exercises should be used to strengthen the elbow at 8 weeks post-reduction?

    <p>Isotonic strengthening of elbow flexors/extensors and shoulder girdle</p> Signup and view all the answers

    Which measure specifically assesses the disability of the arm, shoulder, and hand?

    <p>Dysability of Arm, Shoulder and Hand (DASH)</p> Signup and view all the answers

    What is the recommended approach for protecting the collateral ligaments during rehabilitation?

    <p>Avoiding varus or valgus forces</p> Signup and view all the answers

    What is critical to perform at 4 to 6 weeks post-reduction to enhance stability?

    <p>Strengthening the dynamic stabilizers of the ulnohumeral joint</p> Signup and view all the answers

    What effect does forearm rotation have on joint stability?

    <p>It affects joint stability negatively in certain conditions</p> Signup and view all the answers

    When should varus and valgus loading be introduced in rehabilitation?

    <p>At 12 weeks post-reduction</p> Signup and view all the answers

    What is a positive drop sign indicative of?

    <p>Potential elbow instability or ligament injury</p> Signup and view all the answers

    Which of the following outcomes is NOT associated with elbow performance measurement?

    <p>Joint Range of Motion Assessment</p> Signup and view all the answers

    What is the first-choice treatment approach in the management of neuromusculoskeletal injuries?

    <p>Conservative treatment</p> Signup and view all the answers

    Which factor is NOT mentioned as influencing the pattern of soft tissue injury?

    <p>Duration of the injury</p> Signup and view all the answers

    What is one of the key considerations for the success of surgical interventions?

    <p>Patient selection</p> Signup and view all the answers

    When can athletes typically return to competition after reconstructive surgery for neuromusculoskeletal injuries?

    <p>6.7 months</p> Signup and view all the answers

    Which of the following is a potential complication of surgical intervention?

    <p>Elbow stiffness</p> Signup and view all the answers

    What type of tears are associated with a better prognosis for surgical repair?

    <p>Proximal or distal tears with good quality tissue</p> Signup and view all the answers

    Which test was evaluated by Regan and Lapner in their 2006 study?

    <p>Diagnostic apprehension signs for posterolateral instability</p> Signup and view all the answers

    What is a common consequence of recurrent instability in neuromusculoskeletal injuries?

    <p>Heterotopic ossification</p> Signup and view all the answers

    What was the aim of the treatment strategies discussed by Luchetti et al. in their 2020 publication?

    <p>Determining treatment strategies for elbow fracture-dislocations</p> Signup and view all the answers

    What processes are essential in the decision-making process for treatment of neuromusculoskeletal injuries?

    <p>HISTORY, CLINICAL EXAMINATION AND IMAGING</p> Signup and view all the answers

    In the context of elbow dislocations, what approach does Schreiber et al. propose for conservative management?

    <p>Protocol including overhead motion</p> Signup and view all the answers

    Which clinical test is recognized as a new method for posterolateral rotatory instability of the elbow?

    <p>Table top relocation test</p> Signup and view all the answers

    What type of stability does the 'moving valgus stress test' assess?

    <p>Medial collateral ligament tears</p> Signup and view all the answers

    What is the primary topic of the article by Marinelli et al. published in March 2021?

    <p>State of the art treatment for elbow instability</p> Signup and view all the answers

    Which of the following is a common focus in studies regarding elbow injuries?

    <p>Rehabilitation therapy effectiveness</p> Signup and view all the answers

    What is the primary focus of the systematic review by Bullock et al. concerning baseball pitching?

    <p>Biomechanics related to pain and surgery</p> Signup and view all the answers

    What type of injuries does the article by Dove et al. primarily address?

    <p>Elbow throwing injuries in youth</p> Signup and view all the answers

    Which condition is associated with the elbow according to the work of Chen and Ring?

    <p>Terrible Triad injuries</p> Signup and view all the answers

    What diagnostic aspect is highlighted in Karbach and Elfar's work on elbow instability?

    <p>Biomechanical analysis</p> Signup and view all the answers

    What is a significant concern addressed in the paper by Patel et al. regarding tennis injuries?

    <p>Upper extremity overuse injuries</p> Signup and view all the answers

    Which form of elbow instability is discussed by Willemot et al.?

    <p>Acute and chronic valgus instability</p> Signup and view all the answers

    What medical condition is discussed in the clinical sports medicine article by Rezaie et al.?

    <p>Elbow dislocation</p> Signup and view all the answers

    During which phases of throwing is the most valgus stress applied?

    <p>Late cocking and acceleration phases</p> Signup and view all the answers

    Which symptom is commonly associated with valgus instability?

    <p>Progressive loss of velocity and accuracy</p> Signup and view all the answers

    What does a positive Moving Valgus Stress Test indicate?

    <p>Presence of valgus instability</p> Signup and view all the answers

    Which grading scale is used to evaluate the sensitivity and specificity of the Valgus Stress Test?

    <p>SN 66%, SP 60%</p> Signup and view all the answers

    What is a symptom of Posterolateral Rotatory Instability (PLRI)?

    <p>Recurrent painful clicking or locking</p> Signup and view all the answers

    Which test has the highest sensitivity for diagnosing PLRI when performed in clusters?

    <p>Chair push-up test</p> Signup and view all the answers

    What percentage of radial head fractures occurs in elbow injuries?

    <p>5-10%</p> Signup and view all the answers

    Which imaging method is most effective in detecting occult fractures?

    <p>Computed tomography (CT)</p> Signup and view all the answers

    What type of fracture is included in the 'terrible triad' of injuries?

    <p>Coronoid fracture</p> Signup and view all the answers

    Which of the following is NOT a symptom of valgus instability?

    <p>Progressive loss of flexibility</p> Signup and view all the answers

    Which factor can exacerbate medial elbow pain in valgus instability?

    <p>Glenohumeral internal rotation deficits</p> Signup and view all the answers

    Which test evaluates instability in PLRI?

    <p>Lateral pivot shift test</p> Signup and view all the answers

    What is the sensation associated with valgus instability during throwing?

    <p>Popping or snapping</p> Signup and view all the answers

    What is a common protective attitude observed in individuals with valgus instability?

    <p>Favoring the affected arm</p> Signup and view all the answers

    Study Notes

    Elbow Instability

    • Elbow instability is the second most common large joint dislocation.
    • The annual incidence is 5.21 per 100,000.
    • About a quarter of these dislocations are associated with elbow fractures.
    • The prevalence of elbow dislocations is higher in individuals aged 47% compared to 53% in the elderly.

    Elbow Stabilizers

    • Elbow dynamic stabilizers are composed of muscles that cross the elbow joint.
    • These include the triceps, anconeus, and brachialis.
    • The UCL and LUCL along with the supporting common flexor/pronator and extensor tendons also act as primary static stabilizers.
    • These tissues contribute to the stability of the elbow joint in various movements.

    Ulnar Collateral Ligament (UCL)

    • The medial ulnar collateral ligament (MUCL) acts as a primary restraint against valgus stress.
    • The anterior and posterior bands of the MUCL are crucial for resisting valgus stresses, especially during extension and flexion, respectively.
    • The transverse ligament provides additional support for the medial side.

    Lateral Collateral Ligament Complex (LUCL)

    • The LUCL, radial collateral ligament, and annular ligament act as restraints to varus and posterolateral rotatory instability.
    • The complex is essential for stabilizing the elbow against varus stress.
    • Various ancillary collateral ligaments also support the joint's stability.

    Classification of Elbow Dislocations

    • Elbow dislocations categorized by timing (acute, chronic, recurrent).
    • Classified by direction (anterior, posterior, posterolateral, posteromedial, medial, or lateral).
    • Classified by the associated injury grade (subluxation or perched, simple, or complex).
    • Classified by articulations involved (Ulno-humeral or Radio-humeral joint).

    Etiology of Elbow Instability

    • Traumatic causes, such as falling on an outstretched hand, and axial loading through the forearm.
    • overuse injuries, especially in sports like baseball and tennis

    Mechanism of Injury

    • Common injuries occur when falling on an outstretched hand with an axial load transmitted through the forearm.
    • This force creates a rotational component that can result in the damaging of the elbow soft tissue.
    • This can be a complex event that affects several structures in a complex way.

    Posterolateral Rotatory Instability (PLRI)

    • PLRI involves a combination of axial load, elbow flexion, external rotation, and valgus force.
    • The Horii Circle further demonstrates these events in the disruption of the elbow joint structures.

    Evaluation of Elbow Instability

    • History-taking includes age, sports/work history, details of trauma mechanism, and symptoms description.
    • Observation includes evaluation for bony and soft tissue anomalies, ecchymosis, and swelling, protective postures and ROM (range of motion).
    • Palpation- assessing bony landmarks and painful areas.
    • Instability and special tests include stress tests (valgus, varus, lateral pivot shift), chair and prone push-up, and table-top relocation tests.
    • Imaging includes radiographs (AP, lateral of oblique), CT scans, and MRI.

    Treatment

    • Conservative treatments include immobilization (i.e., casts or splints) and manual therapy in simple or low functional demand cases.
    • Recommendations in case of complex or high functional demand, and/or failure of conservative treatment include surgery.
    • Job/sport-specific activity and targeted muscle strengthening exercises.

    Imaging for Instability

    • Plain anteroposterior, lateral, and oblique X-rays are used to assess the joint for fractures and dislocations
    • Computed tomography (CT) is ideal in checking for hidden fracture fragments and soft tissue disruption
    • MRI also aids in the visibility of fracture fragments and soft tissue injuries
    • Dynamic fluoroscopy and ultrasound are used to evaluate the dynamic motions of the bony and soft tissue structures and are helpful in determining if instability persists.

    Complications

    • Recurrent instability, heterotopic ossification, chronic regional pain syndrome (CRPS), nerve injury, and infections.
    • Elbow stiffness can also be a consequence of improper treatment/management.

    Outcome Measures

    • Disability of Arm, Shoulder, and Hand (DASH) scores
    • Mayo Elbow Performance Score (MEPS)
    • Oxford Elbow Score (OES)

    Bibliography

    • Numerous cited references, each pertaining to a specific aspect of elbow instability, providing supportive research to each point.

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    Elbow Instability PDF

    Description

    Test your knowledge on the severe aspects of posterolateral dislocation and its relationship with valgus instability. This quiz covers critical factors influencing elbow rehabilitation, including the role of the ulnar collateral ligament and specific exercises for strengthening post-reduction. Explore the key concepts essential for understanding elbow stability and recovery.

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