chapter 17

Question 1

what bones form the elbow

Answer 1

humerus, radius and ulna

Question 2

to function properly the elbow relies on what

Answer 2

the integrity of four individual articulations the humeroulnar joint, radioulnar joint, and distal radioulnar joint. the elbow relies equally on its bony configuration and ligamentous structure for support.

Question 3

flexion and extension occurs and what joint

Answer 3

humeroulnar and humeroradial joint

Question 4

the mtion supination and pronation

Answer 4

occurs at the humeroradial superior radioulnar and inferior radioulnar joint

Question 5

the humeroulnar articulation

Answer 5

is a hinge joint allows for 1 degree of movement flexion and extension.

Question 6

humeroradial joint

Answer 6

permits 2 degrees of movement flexion and extension and rotation of the radius on the capitellum

Question 7

proximal radioulnar joint

Answer 7

is formed by the convex radial head and the concave radial notch

Question 8

the distal radioulnar joint

Answer 8

is formed by an articular disk between the radius and ulna where the concave ulnar notch of the radius articulates whith the convex region of the ulna

Question 9

the radioulnar joints

Answer 9

have one degree of freedom of movement pronation and supination.

Question 10

ulnar collateral ligament

Answer 10

is also referred to as the medial collateral ligament supports the elbow for valgus support. it is divided up into 3 segments the anterior transverse and posterior bundles.

Question 11

anterior bundle of the ucl

Answer 11

originates from the inferior surface of the medial epicondyle and passes anterior to the axis of the rotation to inserto on the mdial coronoid process

Question 12

transverse bundle

Answer 12

originating from the medial epicondyle and inserting on the oronoid process does not cross the axis of the eblbow and therefore provides little if any medial support.

Question 13

posterior bundle

Answer 13

is taut in flexion beyond 90 degrees and is subject to stress only if the anterior bundle is completely disrupted.

Question 14

Lateral ulnar collateral ligament LUCL

Answer 14

is the most important lateral stabilizing structure. this structure is the only lateral stabilizing structure that is independent of all other lateral ligaments.

Question 15

radial collateral ligament

Answer 15

is a thickend area in the lateral joint capsule between that lateral epicondyle and the annular ligament.

Question 16

annular ligament

Answer 16

is a fibro-osseous sstructure that permits internal and external rotation of the radial head on the capitellum of the humerus. both ends attach to the coronoid process and form a four fifth of a circle. the remaining one fifth of hte circle is formed by the radial notch

Question 17

accessory lateral collateral ligament

Answer 17

assists the annular ligament and the RCL in preventing the radius from separating from the ulna

Question 18

biceps brachii and the brachioradialis

Answer 18

are the primary elbow flexors.

Question 19

the muscles the extend the elbow are:

Answer 19

the tirceps brachii and anconeus

Question 20

Median nerve

Answer 20

crossing the anterior elbow in the same path as the bracial artery, the median nerve travels deep within the forearm muscles to follow the flexor digitorum superficialis down the middle of the anterior forearm.

Question 21

ulnar nerve

Answer 21

enters the elbow via the arcade of struthers located approximately 8 cm proxximal to the medial epicondyle and then passes betwee the olecranon process and the medial epicondyle

Question 22

radial nerve

Answer 22

courses distally on the posterior aspect of the humerus and then coresses the lateral aspect of the elbos joint line between the prachioradialis and brachialis muscles.

Question 23

what is the most important history findings surrounding the elbow trauma.

Answer 23

the onset and the location of the symptoms

Question 24

carrying angle

Answer 24

is the angle formed by the long axis of the humerus and the ulna the carrying angle in women are 10-15 degrees of valgus and 5-10 degrees of valgus in men

Question 25

cubitus valgus

Answer 25

is and increased in carrying angle

Question 26

cubitus varus

Answer 26

is when the carrying angle is decreased.

Question 27

cubital fossa

Answer 27

is a triangular area demarcated by the brachioradials pronator teres and the

Question 28

cubital recurvatum

Answer 28

the alignment of the forearm and humerus when the elbow is fullly extended normally is hyperextention.

Question 29

terrible triad of the elbow

Answer 29

posterior dislocation of the elbow, fractureof the radial head, and fracture of the coronoid

Question 30

elbow dislocation

Answer 30

is acute the pain is localized to the elbow radicular symptoms may be described in the forearm wrist and hand axial load placed on the forearm when the arm is weightbearing. inspection obvious bony deformity and edema. palpation the disarticulation by be readily palpable the area is tender AROM: limite or absent do to bony displacement MMT not done PROM not done. stress test not done as well as joint play and special tests

Question 31

moving valgus stress test

Answer 31

identifies UCL instability within the range of maximal dynamic presure normally between the 120 to 70 degrees

Question 32

elbow fractures

Answer 32

acute localized pain the the elbow mechanism is by falling on the elbow hyperextension. inspection swelling and ecchymosis may be noted. point tender over the fracture site. AROM: limited by pain and possibly instability. MMT: painful and weak with muscle attachment on involved bone. PROM: pain with movement olecranon process fractures elicit pain with passive overpressure. radial head fracture elicits pain with pronation and supination. Stress test: apparent ligamentous laxity may be cause by bony instability. joint play apparent increased joint mobility may be cause by bony instability special test none

Question 33

Ulnar collateral ligament sprain

Answer 33

acute or insidious pain on the medial aspect of the elbow mechanism acute vlagus stress placed on the ulnar collateral ligament insidious repeated valgus loading of the elbow. inspection: effusion may be present in the anterior medial aspects ofthe elbow ecchymosis may be present over teh medial aspect of the elbow. palpation: of the medial elbow from the medial epicondyle to the coronoid process may elicit tenderness and crepitus. AROM: motion is limited secondary to pain because of streching of the ligaments or joint instability especially moving into extension. MMT: decreased and pain PROM: pain at end ROM extension may be limited by a flexion contracture in chronic cases wrist extension is painful. Stress test valgus testing increased pain and laxity special test: posterolateral rotatory instability test of the elbow movieng valgus stress test

Question 34

moving valgus stress test

Answer 34

sitting should at 90 elbow is flexed to end rom examiner next to pationg stabilize the humerus the opposite hand grasps the ulnar forearm apply a valgus stress externally rotates teh humerus the examiner extends the elbow to approximately 30 degrees while maintaining valgus stress and moves the arm flex and extend pt: pain ate medial elbow pain at 120 to70 im: partial tear of UCL

Question 35

posterior rotatory instability

Answer 35

supine should to 90 forearm supinatedapply a valgus stress as well as a axial stress pt: elbow subluxates as it is extended and can be felt to relocate as it is flexed. IM: chronic instability of the elbow.

Question 36

test for lateral epicondyalgia

Answer 36

seated with the elbow flexed to 90 the forearm pronated and the fingers flexed standing later to patiend resist reist extension while palpating the lateral epicondyle and common attachment of the wrist extensors. PT: pain in the lateral epicondyle IM: later epicondylalgia tennis elbow

Question 37

lateral epicondylagia

Answer 37

onset insidious, lateral epicondyle and proximal portion of the common tendons of the wrist extensors will have pain. mechanism overuse syndrome. AROM: pain with combined wrist extension and elbow flexion radial deviation as well as pronation and supination limited. MMT: pain with wrist extension and MCP joint especially with elbow extended. stress test unremarkable joint play restriced radioulnar and radiohumeral glide special test Tennis elbow test.

Question 38

medial epicondylalgia

Answer 38

insidious pain on the medial eqicondyle and procximal portion of the adjacent wrist flexor and pronator muscles mechanism repeated forcefull flexion or pronation of the wrist inspection swelling, point tenderness and crepitus over the medial epicondyle tenderness in the proximal portion of the wrist flexor group. AROM: pain during wrist flexion wrist extension possible resulting in pain secondary to stretching the involved muscles MMT: decreased sstrength and pain during testing of the wrist flexors and forearm pronators. PROM: pain at the end range of wrist extension joint stability and stress test urremarkable no special test

Question 39

osteochondritis dessecans

Answer 39

of the capitellum develops gradually because of increased valgus loading compressing the radial head and capitellum with overhead throwing. develops second to disrupted blood flow to the area.

Question 40

distal biceps tendon rupture

Answer 40

acute onset pain in the cubital fossa that decreases over time mechanism eccentric loading of the biceps brachii inspection swelling and ecchymosis in the cubital fossa a palpable defect in the distal biceps tendon AROM: possibly within normal limits or slightly decreased during elbow flexxion and extension and forearm pronation and supination MMT: decreased strength PROM: within normal limits

Question 41

osteochondritis dessecans of the capitellum

Answer 41

insidious dull lateral elbow pain that is increased with activity mechanism repetitive forces inspection arm possibly postured with the elbow in flexion palpation tenderness over the capitellum AROM: decreased extension MMT: pain secondary to compression PROM: decreased extension flexion contracture possible. joint stability test vlagus stress

Question 42

ulnar nerve

Answer 42

medial forearm little finger and medial one half of ring finger

Question 43

ratial nerve

Answer 43

proximal forearm wrist extensor region

Question 44

median nerve

Answer 44

anterior forearm

Question 45

forearm compartments

Answer 45

volar, dorsal, mobile wads.