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MSK 1 > Elbow > Flashcards

Elbow Flashcards

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1
Q

What is the functional range of the elbow?

A

30-130 degrees

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2
Q

What is convex and what is concave in the Humeroulnar Joint?

A

Convex trochlea of the humerus

Concave trochlear notch on ulna

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3
Q

How does the ulna move during extension? Why?

A

Laterally

Due to the articular groove and the distal medial aspect

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4
Q

What is a normal carrying angle?

A

5-15 degrees

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5
Q

In closed chain exercise, does the radius or the ulna get the most WB? How much? Why?

A

Radius
60-70%
Has the most congruency at the wrist region

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6
Q

What provides stability for the humeroulnar joint?

A

Medial (ulnar) collateral ligament
-Anterior band: biggest stabilizer against valgus force
-Posterior band: stabilizer against valgus force past 90 degrees of flexion
-Oblique Band
Capsule

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7
Q

Resting Position of the Humeroulnar Joint

A

70 degrees flexion

10 degrees supination

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8
Q

Close Packed Position of the Humeroulnar Joint

A

Full extension

Full supination

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9
Q

Capsular Pattern of the Humeroulnar Joint

A

More limitation in flexion than extension

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10
Q

What is convex and concave in the humeroradial joint?

A

Convex: capitulum of the humerus
Concave: head of the radius

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11
Q

What provides the stability for the humeroradial joint?

A

Lateral collateral ligament

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12
Q

What are the three parts of the lateral collateral ligament of the humeroradial joint?

A

Radial collateral ligament
Lateral ulnar collateral ligament (humerus to ulna)
Annular ligament (around radial head to ulna)

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13
Q

Resting Position of the Humeroradial Joint

A

Full extension

Forearm supination

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14
Q

Closed Packed Position of the Humeroradial Joint

A

90 degrees elbow flexion

5 degrees supination

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15
Q

Capsular Pattern of the Humeroradial Joint

A

Flexion > extension

Equal limitation of supination and pronation

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16
Q

What is convex and concave in the Proximal Radioulnar Joint

A

Convex: radial head held by the annular ring
Concave: radial notch of the ulna

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17
Q

What provides the stability for the Proximal Radioulnar Joint?

A

Annular ligament
Interosseus membrane
Quadrate ligament
Oblique cord

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18
Q

Resting Position for the Proximal Radioulnar Joint

A

70 degrees flexion

35 degrees forearm supination

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19
Q

Closed Packed Position for the Proximal Radioulnar Joint

A

5 degrees of forearm supination

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20
Q

Capsular Pattern for the Proximal Radioulnar Joint

A

Pronation = supination
Minimal to no loss of motion
Pain at the end ranges of pronation and supination

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21
Q

What is convex and concave in the Distal Radioulnar Joint?

A

Convex: ulnar head
Concave: ulnar notch of the radius

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22
Q

What provides the stability for the Distal Radioulnar Joint?

A

Interosseus membrane
Articular disc
Anterior radioulnar ligament
Posterior radioulnar ligament

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23
Q

Close Packed Position of the Distal Radioulnar Joint

A

5 degrees supination

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24
Q

Loose Packed Position of the Distal Radioulnar Joint

A

10 degrees supination

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25
Capsular Pattern Position of the Distal Radioulnar Joint
Pronation = supination Full ROM Pain at extreme ranges
26
Ulnar abduction occurs with....
Pronation | Extension
27
Ulnar adduction occurs with...
Supination | Flexion
28
Ulnar Nerve's area of entrapment
Wraps around posterior to elbow at ulnar groove
29
When is the Ulnar Nerve the most stressed?
Flexion
30
The Median Nerve can go through which muscle?
Pronator teres
31
When is the Median Nerve the most stressed?
Extension
32
The Radial Nerve can go through which muscle?
Supinator
33
Cubitus valgus
Excessive angulation of the carrying angle
34
Cubitus Valgus stresses...
MCL | Ulnar N
35
Cubitus varus
Decreased carrying angle
36
Cubitus Varus stresses...
LCL | Radial N
37
Epicondylitis
Inflammation of the epicondyle | Has fallen out of favor due to lack of evidence that these tissues become inflamed
38
Epicondylagia
Preferred to lack of inflammatory condition | Histological degeneration similar to that of the RC
39
Lateral Epicondylitis Pathology
"Tennis Elbow" 4-7 times more common than medial epicondylitis Tendinitis of wrist extensor at common origin on lateral epicondyle EDC, ECRB involved
40
Lateral Epicondylitis History
Repetitive wrist extension and/or grasp Dull ache at rest, sharp pain at lateral epicondyle with lifting Acute: recognizable mechanisms with acute pain, occasional bruising, and feeling of "giving away" Chronic: associated with gradual onset
41
Lateral Epicondylitis Examination
Pain with resisted wrist extension Tenderness over lateral epicondyle Elbow extension, forearm pronation, wrist flexion
42
Lateral Epicondylitis Intervention
Radial head mobility Soft tissue mobilization Ergonomic assessment
43
Deep Friction Massage
Reduce pain and promote tissue healing Promote hyperemia and collagen realignment Reduce scar formation Perpendicular to tissue fibers 5-10 min
44
Medial Epicondylitis Pathology
"Golfer's Elbow" Tendinitis of wrist flexors at common origin on med epicondyle FCR and Pronator teres
45
Medial Epicondylitis History and Examination
Gradual Onset Repetitive wrist flexion Dull ache at rest, sharp pain at medial epicondyle with lifting Pain with resisted wrist flexion and/or pronation Tenderness over medial epicondyle Elbow extension, forearm supination, wrist extension
46
Medial Epicondylitis Intervention
Biomechanics assessment Joint mobility Activity modifications Modalities
47
Little Leaguer's Elbow
Epiphysitis of medial epicondyle
48
Little Leaguer's Elbow History and Examination
``` Pain or tenderness of medial epicondyle Gradual onset History of forceful pronation Loss of full extension Pain with resisted flexion ```
49
Little Leaguer's Elbow Intervention
Decrease inflammation Gentle ROM May immobilize Throwing technique
50
Panner Disease
Begins as degeneration or necrosis of capitulum and followed by regeneration, decalcification Ages 7-12 Non-traumatic, self-limiting
51
Panner Disease Examination
Acute onset, no locking/catching in elbow Dull lateral ache of elbow Possible swelling Loss 5-20 degrees extension
52
Panner Disease Intervention
Rest Avoid valgus stress Symptomatic splinting Healing may require up to 3 years
53
Osteochondritis Dissecans Pathology
Possibly arterial injury with subsequent bone necrosis results in increased radiohumeral lateral compression forces Causes: ischemia, trauma, genetic predisposition High risk: adolescent boy baseball pitchers and adolescent girl gymnasts
54
Osteochondritis Dissecans History and Examination
``` Gradual onset Trauma, changes in circulation Diffuse pain lateral or anterior elbow Limited AROM and PROM extension Clicking/locking Pain increased with supination and pronation ```
55
Osteochondritis Dissecans Intervention
Rest from stress Emphasize biceps/triceps strength and muscle balance Possible motion-limiting brace Full activity at 6 months Possible surgery if loose bodies, fracture or articular cartilage Long term: loss extension, large radial heads, degenerative changes
56
Olecranon Bursitis
Inflammation of the olecranon bursa
57
Olecranon Bursitis History and Examination
``` Continuous pressure on olecranon Direct trauma or repetitive grazing Obvious swelling posterior elbow Limited ROM Pain to palpation of bursa ```
58
Olecranon Bursitis Intervention
RICE Padding Iontophoresis
59
Arthritis
Most common: RA Joint swelling Differentiate from bursitis (lab tests)
60
Arthritis Intervention
Pain control Joint mobilization Low-load strengthening Biomechanics
61
Biceps Tendon Rupture
Disruption of biceps from attachment (usually distal)
62
Biceps Tendon Rupture History and Examination
``` Quick, forceful biceps contraction Trauma Usually occurs in males in 5th decade Pain at area of biceps Discontinuity of biceps with bulge Loss of elbow flexion and supination strength Ecchymosis in antecubital fossa ```
63
Biceps Tendon Rupture Intervention
May need surgical intervention - May require palmaris longs or semitendinosus graft - Posterior splint at 90 degrees 1-2 weeks - Full ROM at post-op week 4 - Unrestricted activity 8 weeks
64
Cubital Tunnel Syndrome
Ulnar nerve compression distal to the medial epicondyle Repetitive motion increases inflammation that inhibits normal gliding of the nerve Traction forces caused by elbow flexion contribute to compression
65
Cubital Tunnel Syndrome History and Examination
``` Paresthesia radiating to dorsal 4th and 5th digits Trauma Pain or paresthesias worse at night Decreased sensation in ulnar distribution of hand Weak pinch grasp Claw hand Neurodynamics Rule out cervical ```
66
Cubital Tunnel Syndrome Intervention
``` Relative rest Splinting Joint mechanics Elbow pad Stretch FCU ```
67
Pronator Teres Syndrome
Median nerve compression at pronator teres
68
Pronator Teres History and Examination
Paresthesia in thumb, index finger, middle finger aggravated with activity Pain volar aspect of forearm Not nocturnal Possible dislocation Weakness in muscles of forearm innervated by median N Pain reproduced with pressure at pronator teres with resistance against pronation, elbow flexion and wrist flexion Rule out cervical spine
69
Pronator Teres Syndrome Intervention
Relative rest Splinting Joint mechanics Stretch pronator teres
70
Radial Nerve Entrapment
Most frequently injured nerve associated with humeral fractures
71
Radial Tunnel Syndrome
Radial nerve compression at the elbow
72
Posterior Interosseus Syndrome
Radial nerve compression at arcade of Frohse
73
Radial Tunnel Syndrome History and Examination
``` Pain over lateral humeral epicondyle Tender radial head Numb radial head Trauma Resisted middle finger extension reproduces pain No motor loss ```
74
Posterior Interosseus Syndrome History and Examination
``` Tender to palpation distal from lateral epicondyle Trauma History old lateral epicondylitis Symptoms with resisted wrist extension Unable to extend thumb or fingers at MCP No sensation loss ```
75
Radial Nerve Entrapment Intervention
Relative rest Splinting Joint mechanics Activity modification
76
Subluxation of radial head
Annular ligament is torn when arm extended and pronated | Torn surface slips into radiohumeral joint and gets trapped
77
Posterior dislocation
Ulna and radius are displaced posterior to the humerus Caused by fall on outstretched hand with elbow extended Rapid edema usual Nerve injuries common Splinting or surgical intervention Outcomes: lack extension ROM, weakness
78
MCL Instability
Posttrauma (FOOSH) Overuse: rapid/forceful extension, valgus stress, forceful pronation Overhead athletes and pitchers
79
MCL Instability Examination
May be confounded by muscle strain, inflammation, tendinsosis Medial elbow pain "Pop" at time ligament rupture Tender at ulnar insertion ligament 2 cm distal of epicondyle Gradual onset of pain aggravated by throwing or pain following episode with inability to complete maximal effort Valgus stress test Instability worse in pronation
80
MCL Rupture Intervention
``` Without surgery: -Immobilization -Activity modification Surgical: -Repair vs reconstruction -Recovery longer than 26 weeks -Return sport for elite athletes ~12 months ```
81
Extension Valgus Overload Syndrome
Compression of the olecranon against the humerus with a valgus stress
82
Extension Valgus Overload Syndrome Examination
Flexion contracture and painful active extension | Posterior pain with passive elbow pronation, valgus, extension
83
Extension Valgus Overload Syndrome Intervention
Rest NSAIDs Correct throwing mechanics Eccentric strength of elbow flexors
84
Radial head fracture
Adults From a fall Start active motion within 7-10 days since immobilization can lead to permanent loss of motion
85
Olecranon fracture
Avulsion Fall onto elbow, outstretched hand or strong triceps contraction ORIF
86
Intercondylar fracture
Wedge fracture of humerus associated with a lot of tissue swelling and damage
87
Supracondylar fracture
Children Hyperextension or fall on flexed elbow Humeral fragment displaced posteriorly and can injure muscles, arteries and nerves
88
Fracture Intervention
Dependent on stability of joint Dependent on physician's protocol Dependent on patient's functional needs Usually addresses ROM, strength, tissue flexibility and joint mobility

MSK 1 (15 decks)

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