Block 4 Rheumatology - ORTHO Elbow.pdf

Name Summary Etiology Signs Special Tests XRAY: - AP - Lateral Anterior Elbow Pain Elbow Osteoarthritis Rheumatoid arthritis Osteoarthritis Gout tophus Septic joint MC: Rheumatoid arthritis General OA Traumatic OA General: - Pain at site - Swelling - Effusion - Nodules - W/ or w/o fever Tests Aspira...

Name Summary Etiology Signs Special Tests XRAY: - AP - Lateral Anterior Elbow Pain Elbow Osteoarthritis Rheumatoid arthritis Osteoarthritis Gout tophus Septic joint MC: Rheumatoid arthritis General OA Traumatic OA General: - Pain at site - Swelling - Effusion - Nodules - W/ or w/o fever Tests Aspiration OA: joint space narrowing +/osteophytes Gout: Aspirate Septic: Aspirate! - Culture - CBC for WBC count Treatment All: - Attempt CS injections RA Etiology: GOLD: DMARD if not already - Optimize NSAIDs - TEA if needed OA Etiology: - PT - Arthroscopic repair - TEA Gout: - XOI/Steroids Septic: - IV antibiotics - Surgical intervention - Probably just admit them Overall TEA = total elbow arthroplasty (elbow replacement) Anterior Elbow Pain Depends on patient: Distal Biceps Tendon Rupture Lifting heavy stuff causes excessive force on distal tendon attachment so it tears Cubital Tunnel Syndrome Posterior Elbow Pain > 40YO Males < 5% of all bicep ruptures General: - Weakness in supination - Sudden, sharp pain (ant. elbow) - Bruising - Muscle bulging MRI: determine completeness of tear Posterior Elbow Pain (and medial) Pressure on ulnar nerve at the elbow Posterior Elbow Pain Olecranon Bursitis Swelling within the olecranon bursa leading to limiting symptoms Trauma General: Prolonged pressure (driving, desk - Pain in medial/post elbow jobs) - Paresthesis in ring & small finger Posterior Elbow Pain Trauma Infection Gout Insidious General: - Pain & limited ROM - +/- erythema - visually obvious Heat = infection! Posterior Elbow Pain Fracture of the Olecranon FOOSH fracture and/or dislocation Lateral Epicondylitis Lateral Elbow Pain "Tennis Elbow" Repetition injury manifesting in lateral elbow pain Conservative: - Adapt mechanism if possible (+) Tinel's EMG/NCS FOOSH General: - Pain & limited ROM - +/- neuro sx Lateral Elbow Pain Repetitive wrist extension - Pain with wrist extension/ supination Surgical: - Create new space for nerve - Reduce impingement If concerned for infection: Aspirate and test sample Otherwise: - Compression - Bursectomy if recurrent - NSAIDs Posterior Elbow Pain MC: 90% displaced! - May allow to scar and self-repair - Surgical reattachment/repair - 1-2wk post injury for best results XRAY: - AP - Lateral Clinical: - Wrist supination - Wrist extension Nondisplaced: - Splint - Closely monitor to prevent displacement Displaced: 90%! - Surgical fixation/repair - Post-op splinting Conservative: - RICE - NSAID - CS Injection - Splinting - PT Surgical: not preferred as it is not as effective as lifestyle management Fracture of Distal Humerus (Supracondylar) Lateral Elbow Pain Mot common elbow fracture in kids in th distal protion of the humerus Trauma - "Sail's sign" (posterior fat pad) - Pain XRAY: - AP - Lateral Surgical: - Fixation (pins) - Post-op splinting/casting Type I: - Sling for 3-5 days - Early ROM exercise Fracture of Radial Head Lateral Elbow Pain FOOSH Valgus force - Pain - Swelling at lateral elbow - Limited ROM XRAY: - AP - Lateral - Oblique Type II: Displaced - Treat like Type I - Refer to ortho for possible surgery Type III: comminuted - Must surgically address Radial Head Subluxation Nursemaid's Elbow Lateral Elbow Pain < 6YO Kids Radial head slips partially out of the annular ligament resulting in significant pain Swinging/extension MOI Must reduce! - Pain - Refusal to use arm 1. Fully extend elbow 2. Fully flex Medial Elbow Pain Medial Epicondylitis "Golfer's Elbow" Repetition injury manifesting in medial elbow Less common than tennis elbow Golfer's.... Weightlifters - Pain in medial aspect (MCL) with flexion and pronation Clinical: - Wrist flexion - Wrist pronation Conservative: - Compression brace - NSAID - CS Injection - Stretching Surgical: not preferred as it is not as effective as lifestyle management Can also happen at Guyon's Canal Name Ulnar Collateral Ligament Tear (UCL Tear) Summary Etiology Signs 1. Review the major anatomy of the shoulder. Review lmao 2. Determine important components of the patient history that are essential in the evaluation of a patient with suspected shoulder pathology. Mechanism of injury, location, handedness 3.Recognize pertinent clinical landmarks utilized in examination of the shoulder. 4.Describe normal range of motion and strength for the shoulder. 5.Perform special tests to assist in the diagnosis of disorders of the shoulder. 6.Demonstrate an appropriate musculoskeletal and focused neurologic examination of the shoulder. 7.Create a differential diagnosis of shoulder pathologies based on the localization of symptoms (i.e. superior shoulder, over the deltoid, etc…) 8.Compare and contrast the presentation, diagnosis, and initial treatment of common abnormalities of the shoulder encountered in the primary care setting. 9.Recognize the patient presenting with a shoulder disorder that requires hospital admission or referral to orthopedic surgery. Special Tests Tests Treatment Tommy John Surgery! Overall