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Ortho Tx 700 > Elbow > Flashcards

Elbow Flashcards

(120 cards)

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1
Q

Elbow flexion and extension adjusts for

A

Proper height and distance of hand

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2
Q

Supination and pronation allow for

A

Complex hand movements and mobility.

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3
Q

Biceps Brachii

A

Origin: (long head) supra glenoid tubercle
(Short head) corocoid process

Insertion: radial tuberosity, bicipital aponeurosis

Action: shoulder and elbow flexion. Supination.

Musculocutaneous nerve
Brachial artery

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4
Q

Brachialis

A

Origin: distal anterior shaft of the humerus

Insertion: ulnar tuberosity, coronoid process of the ulna

Action: elbow flexion (pronated)

Musculocutaneous nerve
Brachial artery

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5
Q

Brachioradialis

A

Origin: lateral supercondylar ridge

Insertion: styloid process of the radius

Action: flexes elbow in neutral; brings forearm to neutral from either supination or pronation

Radial nerve
Brachial and radial arteries

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6
Q

Triceps brachii

A

Origin: (long head) infra glenoid tubercle
(Lateral head) proximal 1/2 of humerus
(Medial head) distal 1/2 of humerus

Insertion: olecranon process of ulna

Action: elbow extension; GH extension

Radial nerve
Deep brachial artery

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7
Q

Anconeus

A

Origin: lateral epicondyle (CET)
Insertion: posterior proximal ulna (lateral to olecranon)

Action: elbow extension (last 15-20°)

Radial nerve
Deep brachial artery

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8
Q

Superficial layer of the posterior forearm:

A

CET (ECRB, extensor digitorum, ECU, EDMinimi)

ECRL

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9
Q

What inserts into the CET

A 
Anconeus 
ECU
ExtDig
ExtDigMini
ECRB
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10
Q

Extensor Carpi Radialis Longus

A

Origin: supercondylar ridge

Insertion:posterior base of MC #2

Action: wrist extension, radial deviation, (elbow flexion?)

Radial nerve
Brachial and radial artery

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11
Q

Extensor Carpi Radialis brevis

A

Origin: lateral epicondyle (CET)
Insertion: posterior base of MC #3

Wrist extension. Radial deviation. (Elbow flexion?)

Radial nerve
Brachial and radial artery

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12
Q

Extensor digitorum

A

Origin: lateral epicondyle (CET)

Insertion: middle and distal phalanges #2-5 (via DDE)

Wrist extension. MCP, DID and PIP extension (2-5). (Elbow extension)

Radial nerve
Posterior interosseus artery

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13
Q

Extensor Digiti Minimi

A

Origin: lateral epicondyle (CET)
Insertion: middle and distal phalanges #5 (DDE)

Wrist extension, MCP/PIP/DIP #5 extension. (Elbow extension)

Radial nerve
Posterior interosseus membrane

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14
Q

Extensor Carpi ulnaris

A

Origins: lateral epicondyle (CET), posterior 1/3 ulna

Insertion: posterior base of MC #5

Wrist extension. Ulnar deviation. (Elbow extension)

Radial nerve
Posterior interosseus artery

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15
Q

Muscles of the deep posterior forearm

A 
ABductor pollicis 
Extensor Poll Brev
Extensor Poll long 
Extensor indices
Supinator
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16
Q

Supinator

A

Origin: 1) lateral epicondyle; 2) supination crest of ulna

Insertion: proximal 1/3 radius

Supination of forearm.

Radial nerve
Radial and posterior interosseus artery

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17
Q

Abductor Pollicis Longus

A

Origin: 1) middle 1/3 posterior ulna; 2) interosseus membrane

Insertion: posterior base MC 1

Abducts thumb at CMC jt.

Radial nerve
Posterior interosseus artery

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18
Q

Extensor pollicis brevis

A

Origin: 1) posterior distal 1/3 radius; 2) distal 1/3 interosseus membrane

Insertion: posterior base proximal phalanx #1

Extends thumb at CMC and MCP

Radial nerve
Posterior interosseus artery

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19
Q

Extensor pollicis longus

A

Origin: 1) posterior middle 1/3 ulna; 2) middle 1/3 interosseus membrane

Insertion: posterior base of distal phalanx #1 (DDE)

Extends thumb at CMC, MCP, IP

Radial nerve
Posterior interosseus artery

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20
Q

Extensor indices

A

Origin: 1)posterior distal 1/3 ulna; 2) interosseus membrane

Insertion: posterior side of middle and distal phalanges #2 (DDE)

Extends index finger at MCP, PIP, DIP
Extends wrist

Radial nerve
Posterior interosseus artery

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21
Q

Superficial muscles of the anterior forearm

A

CFT (pronator teres, FCR, Palm Long, FCU)

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22
Q

Pronator Teres

A

Origin: (humeral) medial epicondyle via CFT
(Ulnar) coronoid process

Insertion: lateral radius (distal to supinator insertion); middle 1/3 interosseus membrane

Pronation. Elbow flexion

Median nerve
Ulnar and radial arteries

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23
Q

Flexor Carpi Radialis

A

Origin: medial epicondyle (CFT)

Insertion: base of 2nd and 3rd metacarpals

Wrist flexion. Radial deviation. (Elbow flexion)

Median nerve
Ulnar and radial arteries.

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24
Q

Palmaris Longus

A

Origin: medial epicondyle (CFT)

Insertion: palmar aponeurosis and flexor retinaculum

Wrist (and elbow) flexion.

Median nerve
Ulnar artery

(Not present in everyone)

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25
Flexor Carpi ulnaris
Origin: medial epicondyle (CFT); proximal ulna Insertion: pisiform, hook of hamate, 5th MC Wrist flexion. Ulnar deviation (elbow flexion) Ulnar nerve Ulnar artery
26
Intermediate muscles of the anterior forearm
Flexor digitorum superficialis
27
Flexor digitorum | Superficialis
Origin: (humeral ulnar head) medial epicondyle (CFT), coronoid process (Radial head). Proximal 1/3 radius Insertion:palmar surface of middle Phalanges 2-5 Median nerve Ulnar and radial arteries.
28
Deep Muscles of the anterior forearm
Flexor digitorum profundus Flexor pollicis Longus Pronator quadratus
29
Flexor digitorum profundus
Origin: median/anterior ulnar; interosseus membrane Insertion: palmar surfaces of distal phalanges 2-5 MCP/DIP 2-5 flexion. (Wrist and PIP flexion) Median AND ulnar nerves Radial, ulnar and anterior interosseus arteries.
30
Flexor pollicis longus
Origin: anterior radius and interosseus membrane Insertion: distal thumb Thumb flexion (CMC, MCP, IP). Wrist flexion. (?elbow flexion?) Median nerve Radial and anterior interosseus arteries.
31
Pronator quadratus
Origin: anterior distal ulna Insertion: anterior distal radius Pronation Median nerve Anterior interosseus artery.
32
Main function of elbow
Serve hand movement
33
MMT Biceps Brachii
Bicep curl position. Elbow flexed to 90°. Apply pressure toward extension
34
MMT Brachioradialis
Elbow flexed to 90°. Cushion under elbow. Forearm neutral between pronation and supination. Apply pressure toward extension
35
MMT Brachialis
Elbow flexed to 90° | Forearm pronated.
36
What happens to the FCU after the pisiform?
It's tendons splay out and become a ligament.
37
Olecranon bursa
Lies between the olecranon and subcutaneous fascia. Becomes very swollen when inflamed. Irritated by weighty bearing or trauma.
38
Radial nerve
C5-T1 As Posterior Interosseus passes between heads of triceps Crosses elbow anterior to lateral epicondyle Passes under ECRL, pierces supinator (Arcade of Frohse) Runs posterior along interosseus membrane Wrist extensors
39
Median Nerve
C5-T1 As Anterior Interosseus branch, travels medial to biceps and along cubital fossa Passes between heads of pronator teres Runs through carpal tunnel. Intrinsic hand muscles
40
Ulnar Nerve
C8-T1 In upper arm travels with brachial artery and median nerve Passes behind median epicondyle in ulnar groove, through cubital tunnel. In forearm runs deep to FCU Innervates FCU, half of FDP
41
Cubital Tunnel
Formed by arcuate ligament | crossing ulnar groove
42
Brachial artery
Major blood vessel of upper arm. Ventral arm to cubital fossa, then bifurcates to radial and ulnar Closely related to median nerve
43
Functions of interosseus membrane
1. Muscle attachment 2. Stabilizes proximal, medial and distal radial-ulnar joints. * 3. Transmits force from radius to ulna Also divided forearm into anterior and posterior compartments.
44
Path of brachial artery (before and after)
``` Subclavian (spine) Axillary (axilla) Brachial (upper arms) -bifurcates at cubital fossa- Radial and Ulnar Arteries ```
45
HumeroUlnar joint
Synovial hinge One degree of freedom (flex/ext) Trochlea of humerus with trochlear notch of ulna OK strength. Resting: 70° flexion, 10° supination Closed pack: full extension and supination Capsular pattern: flex > extension
46
HumeroRadial joint
Synovial Ellipsiod/gliding (or modified ball and socket) 2 degrees of freedom: flex/ext, sup/pro Capitulum of humerus (convex) with head of radius (concave) OK strength Resting: full extension and supination Closed pack: 90° flexion and 5° supination Capsular pattern: flex>ext; sup/pro affected only if severe.
47
Carrying Angle
Abdication of forearm on full extension. The angle measured from midline of ulna to midline of humerus. Greater in women (10-15°) than men (5-10°) Caused because the trochlea of humerus is asymmetrical, creating an oblique axis of motion
48
Axis of motion associated with carrying angle
Sup-Lat to Inf-Med
49
The asymmetrical/oblique axis of motion along the trochlear groove causes what accessory movements?
1. Slight screw action (ulna supinates during flexion; pronates during extension) 2 Abduction, adduction and gliding of radial head on both ulna and humerus
50
On full extension what occurs with the olecranon?
Medial olecranon is not in contact with trochlea --> medial gap.
51
On full flexion what occurs with the olecranon?
The lateral part of the olecranon is not in contact with the trochlea --> lateral gap
52
Middle Radioulnar Articulation
Not a true joint. Radius + ulna + interosseus membrane.
53
Proximal Radio-Ulnar Joint
Synovial pivot Head of radius (convex) on radial notch of ulna (concave) Weak capsule 1 degree of freedom (supination/pronation) Resting: 70º flexion, 35º supination Closed pack: 5º supination and full extennsion Capsular pattern: supination=pronation
54
Elbow ROM/end feel
Flexion: 150º soft (HU, HR) Extention: 5º hard (HU, HR) Supination: 90º firm (HR, PRU) Pronation: 70-90º firm/hard (HR, PRU)
55
How many joint capsules in the elbow?
one
56
Ulnar Collateral Ligament
Resists Valgum stress and checks medial-inferior displacement Stabilizes humeroulnar joint Triangular shape; three bands Anterior: medial epicondyle --> edge of coronoid process Posterior: holds medial epicondyle and olecrenon process together Transverse: stabilizes the distal attachment of anterior and posterior UCL
57
Radial Collateral Ligament
Resists Varum stress and checks lateral-inferior displacement Part of HR joint V-shaped Underside of lateral epicondyle --> annular ligament and radial notch
58
Annular Ligament
Part of Prox RadioUlnar joint Prevents inferior distraction of radius Anchors head of radius to radial notch
59
Quadrate Ligament
Inferior thickening running inferior to annular ligment From inferior radial notch on ulna to neck of radius. Posterior fibres taut with pronation Anterior fibres taut with supination => no matter what the movement, some fibres are always under movement
60
Oblique Cord
Radial notch on ulna --> medial surface of neck of the radius (ulnar tuberosity on radius) Prevents inferior displacement of radius on ulna during pulling movement Runs at right angle to interosseus membrane
61
Ligament of struthers
Only in 1% of population. Can be congenital or acquired Supracondylar process --> medial epicondyle Median nerve and brachial artery pass under and can be compressed there
62
To increase pronation
Posterior glide at prox RadUl
63
To increase supination
Anterior glide at prox RadUl
64
When is the interosseus membrane most taut?
Halfway between supination and pronation
65
What happens to the interosseus membrane and the oblique cord during pronation?
Both go slack
66
How does the interosseus membrane transmit force?
During a push movement, force is transmitted up through the radius. Interosseus membrane checks superior/proximal displacement of the radius on the ulna, and transmits the force to the ulna (which then travels upwards and onwards)
67
What movement does the oblique cord check?
Distal/inferior displacement of the radius on the ulna, during a pulling movement
68
What sort of lever is the elbow?
3rd Order Lever middle of kinetic chain between hand and upper limb
69
How is weight amplified between hand and elbow?
Tenfold (ie a 5lb weight in the hand = 50 lbs of force at the elbow)
70
Cubitus valgus
Greater than normal elbow carrying angle | More evident on full extension
71
Cubitus varus
Less than normal elbow carrying angle
72
Gun Stock Deformity
The anti-carrying angle (marked cubitus varus) Results from fracture or epiphyseal injury to distal humerus Seen on full extension
73
Elbow joint effusion is most evident in
The triangular space between the radial head, tip of the olecranon and lateral epicondyle
74
Most activities are performed between
30-130º flexion/extension | 50º supination/pronation
75
C6 Dermatome
Lateral arm. | Dorsal surface of the proximal phalanx of the thumb.
76
C7 Dermatome
On the dorsal surface of the proximal phalanx of the middle finger.
77
T1 Dermatome
On the medial (ulnar) side of the antecubital fossa, just proximally to the medial epicondyle of the humerus.
78
C6 Myotome
Waiters tray carry | elbow flexion, wrist extension
79
C7 Myotome
Elbow extension wrist flexion
80
C8 Myotome
Finger flexion
81
T1 Myotome
Finger abduction
82
C8 Dermatome
Dorsal surface little finger
83
C5 Reflex Test
Biceps
84
C6 Reflex Test
Brachioradialis
85
C7 Reflex Test
Triceps
86
MMT Triceps & anconeus
Prone, arm abducted 90º (T) or supine, arm flexed 90º. Elbow extended. Apply pressure towards flexion * when prone, abducted arm means long head less effective, so triceps not as strong
87
MMT Supinator
Supine, elbow flexed to 90º (+ biceps) Seated, shoulder and elbow extended (biceps elongated) Supine, elbow fully flexed (biceps shortened) Apply pressure toward pronation
88
MMT Pronator Teres (+ quadratus)
Supine, elbow partially flexed. Forearm pronated. Hold elbow in place to avoid abduction Apply pressure towards supination.
89
MMT Pronator Quadratus
Supine, elbow fully flexed Stabilize elbow and hold arm in flexion to avoid abduction. Apply pressure towards supination
90
Lateral Epicondylitis
Tennis Elbow Occurs at CET Most common elbow injury (7% sports injuries; most common 40-50 yo) Repetition injury of Extension and Supination Repeated tensile loads in pronation/elbow extension/wrist flexion Vibration (they terminate in lateral epicondyle)
91
What muscle is primarily affected in lateral epicondylitis
Extensor Carpi Radialis Brevis | sometimes also ECRL and rarely ECU
92
Why is the ECRB so susceptible to injury?
Tendon runs just over the radial head, gets abraded easily with (hyper)pronation, elbow extension, and elbow flexion (ie bad backhand)
93
Lateral Epicondylitis: Sx
Pain over tendon, which can progress to lateral epicondyle and later supracondylar ridge Pain referring into posterior forearm, digits 2-4 (similar to C7 dermatome pattern)
94
Medial Epicondylitis
Golfers Elbow Caused by medial tendon overload from repeated microtrauma to the flexor-pronator musculature May involve compression neuropraxia of ulnar groove
95
What muscles are primarily involved in medial epicondylitis?
Pronator Teres and FCR Occasionally palmaris longus, FCU, FDS.
96
Medial Epicondylitis: Sx
Pain Weak grip Possible ulnar nerve involvement
97
Triceps Tendinitis
AKA posterior tendon injury, posterior tennis elbow Rare Involves insertion of triceps at tendinous junction Typically involves sudden strain to triceps tendon as the arm is fully extended
98
Triceps Tendinitis: Sx
Pain at resisted elbow extension | Perception of snapping over posteromedial elbow
99
Tendinitis: Presentation
1. local sharp (twinging) pain to tendon 2. associated aching pain to muscle belly 3. history of repetitive use (gradual onset)
100
Tendinitis Grading
1. pain after activity 2. pain at the beginning and after activity 3. pain at the beginning, during, and after activity 4. pain with ADL and continues to get worse
101
Tests for Lateral Epicondylitis
Cozen's Test (RROM) Mill's Test (PROM) Method 3 (ECRB)
102
Test for Medial Epicondylitis
Medial Epicondylitis Test
103
Olecranon Bursitis
Inflammation caused by repetitive weight bearing or trauma Sx: obvious swelling, heat, redness, inflammation
104
Simple Fracture
Skin unbroken
105
Comminuted Fracture
Bone splintered into pieces
106
Impacted Fracture
One section is wedged into the interior of another
107
Incomplete Fracture
Does not include entire cross section of bone
108
Greenstick Fracture
Partially broken and partially bent. In children (bones still soft), esp with Rickets, Vit D deficiency
109
Epiphyseal Fracture
In children; between shaft and epiphysis
110
Colles Fracture
Distal radius, just proximal to wrist Fragments rotate and are displaced dorsally "Dinner Fork" FOOSH
111
Galeazzi Fracture
Fracture of radius with dislocation of distal radioulnar joint.
112
Transverse Fracture of Distal Humerus
From one supracondylar ridge to the other
113
Most common elbow fracture in adults
Radial head | FOOSH
114
Most common elbow fracture in children and seniors
Displaced Supracondylar Fracture Caused by displaced humerus which affects neighbouring arteries and nerves --> pain , often medical emergency
115
Special tests after fracture
Capillary refill Tinells Girth measurement
116
Nursemaids Elbow
Dislocation of radial head from annular ligament Presents with elbow flexion and pronation
117
Elbow relevant ulnar nerve impingement
1. cubital tunnel | 2. under the FCU
118
Elbow relevant median nerve impingement
1. pronator teres | 2. supracondylar spur/ligament of Struthers
119
Elbow relevant radial nerve impingement
1. fracture at shaft of humerus | 2. supinator (Arcade of Frohse)
120
Frictioning tendinitis
Subacute, chronic Poor vascularity --> spontaneous resolution unlikely , fibrosis formation probably

Ortho Tx 700 (12 decks)

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