PT Inquest is an online journal club. Hosted by Jason Tuori, Megan Graham, and Chris Juneau, the show looks at an article every week and discusses how it applies to current physical therapy practice.
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Orthopedics: Elbow to Phalanges
MP3•Episode home
Manage episode 199946117 series 2108787
Content provided by PA Study Sesh. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by PA Study Sesh or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://player.fm/legal.
This week on PA Study Sesh, we will be finishing the upper extremity.
* Supracondylar fx
* MOI: FOOSH with hyperextended elbow
* Kids 5-10
* X-Ray:
* Normal: anterior humeral line must intersect capitulum (lateral view)
* May still be in alignment with fx
* Fat Pad sign=refer
* Anterior to humerus = sometimes normal
* Posterior to humerus = always abnormal
* Darkness=blood
* Anterior interosseous nerve @ risk (branch of median n)
* “ok” sign (A-ok)
* if not=immediate surgery
* Brachial artery @ risk
* Can lead to Volkmann Ischemic Contracture
* Contracture of wrist 2/2 ischemia
* Radial Head fx
* #1 elbow fx in adults
* MOI: FOOSH
* Xray:
* Often difficult to see
* + fat pad sign
* Unable to fully extend elbow
* Elbow Dislocation
* Rare
* Posterior most common (olecranon goes backwards)
* Often associated with medial condyle fx
* R/o brachial a, median, ulnar, radial n injury
* Tx: emergent reduction, splint/sling
* Nursemaid’s elbow
* Dislocation of radial head, stretched annular ligament
* Annular= ring shaped, radius=circle
* MOI: sudden pull of a pronated arm
* Grabbing from street
* Playing airplane
* Kids 1-4
* Presentation:
* Arm fully extended or slightly flexed and pronated
* REFUSES to use
* Pain increases with supination. Mild tenderness
* Usually no swelling
* Reduction:
* hyperpronation with pressure over radial head
* supination and flexion with pressure over radial head
* Lollipop test
* Imaging after 2 failed reduction of child continues to refuse to use arm.
* Olecranon fx
* Ulnar n at risk
* Olecranon bursitis
* Repetitive trauma or rhematologic conditions
* “goose egg” swelling
* +/- decreased ROM and tenderness
* Erythema and warmth may suggest infection
* Tx:
* Ice
* NSAIDS
* Avoid pressure
* Pads/sleeves
* Lateral epicondylitis
* “tennis elbow”
* extensor/supination muscle group
* local pain and swelling
* pain with wrist extension against resistance (elbow fully extended)
* Medial epicondylitis
* “golfer’s elbow”
* flexors & pronators (golf & flexor both have f)
* pain with wrist flexion against resistance (elbow fully extended0
* Tx: for epicondylitis (both)
* Acute: sling, wrist brace, Ice, NSAIDS
* Preventative: forearm strap
* Recurrent: steroid injections, surgical debridement
* Nightstick fx:
* Ulnar shaft fx
* Defensive injury
* Tx: Cast or ORIF
* Monteggia fx
* Proximal ulnar shaft with radial head dislocation
* May have radial n injury (wrist drop)
* Galeazzi fx
* mid distal radial shaft f x with dislocation of DRUJ
* both Galeazzi & Monteggia are unstable (any joint dislocation)
* TAKE HOME; evaluate elbow and wrist with forearm injury
* Cubital tunnel
* Ulnar nerve compression
* RF/SM tingling/numbness
* Increases with elbow flexion
* Decreased grip strength
* Tinel’s sign:
* Tap groove between olecranon process and medial epicondyle
…
continue reading
* Supracondylar fx
* MOI: FOOSH with hyperextended elbow
* Kids 5-10
* X-Ray:
* Normal: anterior humeral line must intersect capitulum (lateral view)
* May still be in alignment with fx
* Fat Pad sign=refer
* Anterior to humerus = sometimes normal
* Posterior to humerus = always abnormal
* Darkness=blood
* Anterior interosseous nerve @ risk (branch of median n)
* “ok” sign (A-ok)
* if not=immediate surgery
* Brachial artery @ risk
* Can lead to Volkmann Ischemic Contracture
* Contracture of wrist 2/2 ischemia
* Radial Head fx
* #1 elbow fx in adults
* MOI: FOOSH
* Xray:
* Often difficult to see
* + fat pad sign
* Unable to fully extend elbow
* Elbow Dislocation
* Rare
* Posterior most common (olecranon goes backwards)
* Often associated with medial condyle fx
* R/o brachial a, median, ulnar, radial n injury
* Tx: emergent reduction, splint/sling
* Nursemaid’s elbow
* Dislocation of radial head, stretched annular ligament
* Annular= ring shaped, radius=circle
* MOI: sudden pull of a pronated arm
* Grabbing from street
* Playing airplane
* Kids 1-4
* Presentation:
* Arm fully extended or slightly flexed and pronated
* REFUSES to use
* Pain increases with supination. Mild tenderness
* Usually no swelling
* Reduction:
* hyperpronation with pressure over radial head
* supination and flexion with pressure over radial head
* Lollipop test
* Imaging after 2 failed reduction of child continues to refuse to use arm.
* Olecranon fx
* Ulnar n at risk
* Olecranon bursitis
* Repetitive trauma or rhematologic conditions
* “goose egg” swelling
* +/- decreased ROM and tenderness
* Erythema and warmth may suggest infection
* Tx:
* Ice
* NSAIDS
* Avoid pressure
* Pads/sleeves
* Lateral epicondylitis
* “tennis elbow”
* extensor/supination muscle group
* local pain and swelling
* pain with wrist extension against resistance (elbow fully extended)
* Medial epicondylitis
* “golfer’s elbow”
* flexors & pronators (golf & flexor both have f)
* pain with wrist flexion against resistance (elbow fully extended0
* Tx: for epicondylitis (both)
* Acute: sling, wrist brace, Ice, NSAIDS
* Preventative: forearm strap
* Recurrent: steroid injections, surgical debridement
* Nightstick fx:
* Ulnar shaft fx
* Defensive injury
* Tx: Cast or ORIF
* Monteggia fx
* Proximal ulnar shaft with radial head dislocation
* May have radial n injury (wrist drop)
* Galeazzi fx
* mid distal radial shaft f x with dislocation of DRUJ
* both Galeazzi & Monteggia are unstable (any joint dislocation)
* TAKE HOME; evaluate elbow and wrist with forearm injury
* Cubital tunnel
* Ulnar nerve compression
* RF/SM tingling/numbness
* Increases with elbow flexion
* Decreased grip strength
* Tinel’s sign:
* Tap groove between olecranon process and medial epicondyle
22 episodes
MP3•Episode home
Manage episode 199946117 series 2108787
Content provided by PA Study Sesh. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by PA Study Sesh or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://player.fm/legal.
This week on PA Study Sesh, we will be finishing the upper extremity.
* Supracondylar fx
* MOI: FOOSH with hyperextended elbow
* Kids 5-10
* X-Ray:
* Normal: anterior humeral line must intersect capitulum (lateral view)
* May still be in alignment with fx
* Fat Pad sign=refer
* Anterior to humerus = sometimes normal
* Posterior to humerus = always abnormal
* Darkness=blood
* Anterior interosseous nerve @ risk (branch of median n)
* “ok” sign (A-ok)
* if not=immediate surgery
* Brachial artery @ risk
* Can lead to Volkmann Ischemic Contracture
* Contracture of wrist 2/2 ischemia
* Radial Head fx
* #1 elbow fx in adults
* MOI: FOOSH
* Xray:
* Often difficult to see
* + fat pad sign
* Unable to fully extend elbow
* Elbow Dislocation
* Rare
* Posterior most common (olecranon goes backwards)
* Often associated with medial condyle fx
* R/o brachial a, median, ulnar, radial n injury
* Tx: emergent reduction, splint/sling
* Nursemaid’s elbow
* Dislocation of radial head, stretched annular ligament
* Annular= ring shaped, radius=circle
* MOI: sudden pull of a pronated arm
* Grabbing from street
* Playing airplane
* Kids 1-4
* Presentation:
* Arm fully extended or slightly flexed and pronated
* REFUSES to use
* Pain increases with supination. Mild tenderness
* Usually no swelling
* Reduction:
* hyperpronation with pressure over radial head
* supination and flexion with pressure over radial head
* Lollipop test
* Imaging after 2 failed reduction of child continues to refuse to use arm.
* Olecranon fx
* Ulnar n at risk
* Olecranon bursitis
* Repetitive trauma or rhematologic conditions
* “goose egg” swelling
* +/- decreased ROM and tenderness
* Erythema and warmth may suggest infection
* Tx:
* Ice
* NSAIDS
* Avoid pressure
* Pads/sleeves
* Lateral epicondylitis
* “tennis elbow”
* extensor/supination muscle group
* local pain and swelling
* pain with wrist extension against resistance (elbow fully extended)
* Medial epicondylitis
* “golfer’s elbow”
* flexors & pronators (golf & flexor both have f)
* pain with wrist flexion against resistance (elbow fully extended0
* Tx: for epicondylitis (both)
* Acute: sling, wrist brace, Ice, NSAIDS
* Preventative: forearm strap
* Recurrent: steroid injections, surgical debridement
* Nightstick fx:
* Ulnar shaft fx
* Defensive injury
* Tx: Cast or ORIF
* Monteggia fx
* Proximal ulnar shaft with radial head dislocation
* May have radial n injury (wrist drop)
* Galeazzi fx
* mid distal radial shaft f x with dislocation of DRUJ
* both Galeazzi & Monteggia are unstable (any joint dislocation)
* TAKE HOME; evaluate elbow and wrist with forearm injury
* Cubital tunnel
* Ulnar nerve compression
* RF/SM tingling/numbness
* Increases with elbow flexion
* Decreased grip strength
* Tinel’s sign:
* Tap groove between olecranon process and medial epicondyle
…
continue reading
* Supracondylar fx
* MOI: FOOSH with hyperextended elbow
* Kids 5-10
* X-Ray:
* Normal: anterior humeral line must intersect capitulum (lateral view)
* May still be in alignment with fx
* Fat Pad sign=refer
* Anterior to humerus = sometimes normal
* Posterior to humerus = always abnormal
* Darkness=blood
* Anterior interosseous nerve @ risk (branch of median n)
* “ok” sign (A-ok)
* if not=immediate surgery
* Brachial artery @ risk
* Can lead to Volkmann Ischemic Contracture
* Contracture of wrist 2/2 ischemia
* Radial Head fx
* #1 elbow fx in adults
* MOI: FOOSH
* Xray:
* Often difficult to see
* + fat pad sign
* Unable to fully extend elbow
* Elbow Dislocation
* Rare
* Posterior most common (olecranon goes backwards)
* Often associated with medial condyle fx
* R/o brachial a, median, ulnar, radial n injury
* Tx: emergent reduction, splint/sling
* Nursemaid’s elbow
* Dislocation of radial head, stretched annular ligament
* Annular= ring shaped, radius=circle
* MOI: sudden pull of a pronated arm
* Grabbing from street
* Playing airplane
* Kids 1-4
* Presentation:
* Arm fully extended or slightly flexed and pronated
* REFUSES to use
* Pain increases with supination. Mild tenderness
* Usually no swelling
* Reduction:
* hyperpronation with pressure over radial head
* supination and flexion with pressure over radial head
* Lollipop test
* Imaging after 2 failed reduction of child continues to refuse to use arm.
* Olecranon fx
* Ulnar n at risk
* Olecranon bursitis
* Repetitive trauma or rhematologic conditions
* “goose egg” swelling
* +/- decreased ROM and tenderness
* Erythema and warmth may suggest infection
* Tx:
* Ice
* NSAIDS
* Avoid pressure
* Pads/sleeves
* Lateral epicondylitis
* “tennis elbow”
* extensor/supination muscle group
* local pain and swelling
* pain with wrist extension against resistance (elbow fully extended)
* Medial epicondylitis
* “golfer’s elbow”
* flexors & pronators (golf & flexor both have f)
* pain with wrist flexion against resistance (elbow fully extended0
* Tx: for epicondylitis (both)
* Acute: sling, wrist brace, Ice, NSAIDS
* Preventative: forearm strap
* Recurrent: steroid injections, surgical debridement
* Nightstick fx:
* Ulnar shaft fx
* Defensive injury
* Tx: Cast or ORIF
* Monteggia fx
* Proximal ulnar shaft with radial head dislocation
* May have radial n injury (wrist drop)
* Galeazzi fx
* mid distal radial shaft f x with dislocation of DRUJ
* both Galeazzi & Monteggia are unstable (any joint dislocation)
* TAKE HOME; evaluate elbow and wrist with forearm injury
* Cubital tunnel
* Ulnar nerve compression
* RF/SM tingling/numbness
* Increases with elbow flexion
* Decreased grip strength
* Tinel’s sign:
* Tap groove between olecranon process and medial epicondyle
22 episodes
All episodes
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