Elbow & Forearm Flashcards Preview

Orthopaedics > Elbow & Forearm > Flashcards

Flashcards in Elbow & Forearm Deck (13):
1

What is the look component of the elbow exam?

Carrying angle
- male: 5-10 degrees
- female: 10-15 degrees

Fixed flexion deformity

Skin: scars, bruising, sinuses, swellings

Rashes: psoriatic plaques, rheumatoid nodules

Wasting

2

What is the feel component of the elbow exam?

Skin = temperature, effusions/swellings e.g. olecranon bursitis

Bony landmarks = olecranon tip, medial epicondyle, lateral epicondyle, radial head

Tendons = common extensor origin (just distal to lateral epicondyle), common flexor origin (just distal to medial epicondyle)

3

What is the move component of the elbow exam?

Flexion (150 degrees)

Extension (0 degrees)

Pronation (70 degrees) = while elbow flexed to 90 degrees

Supination (80 degrees) = while elbow flexed to 90 degrees

4

What are the special tests of the elbow exam?

Lateral collateral ligament = flex elbow to 30 degrees and apply varus force whilst forearm supinated

Medial collateral ligament = flex elbow to 30 degrees and apply valgus force whilst forearm pronated

Tennis elbow = with forearm pronated and wrist fully flexed, ask patient to extend wrist whilst applying resistance

Golfer's elbow = with forearm pronated and wrist fully extended, ask patient to flex wrist whilst applying resistance

Posterolateral rotary instability = with patient supine, flex the elbow and shoulder to 90 degrees and fully supinate wrist, then extend elbow and flex shoulder whilst applying valgus force and axial compression ---> subluxation of radial head

5

Describe some common presentations of elbow disorders.

Lateral epicondylitis (tennis elbow) = pain on resisted wrist extension, worsens with use of extensor muscles (Mx = splints, NSAIDs, steroid injections, surgery)

Medial epicondylitis (golfer's elbow) = pain on resisted wrist flexion, worsens with use of flexor muscles (Mx = see above)

Posterior interosseous nerve compression

Referred pain

Locking (loose bodies - OA)

Stiff elbow:
- OA
- RA

Olecranon bursitis

Cubital tunnel syndrome (ulnar nerve entrapment)

6

What is the result of a lesion at the elbow affecting the median nerve e.g. supracondylar fracture?

Paralysis of flexors and supinators supplied by median nerve ---> forearm constantly supinated, weak flexion, adduction

Paralysis of flexor pollicis longus and brevis ---> thumb cannot flex

Paralysis of radial two lumbricals ---> cannot flex at MCP or extend at IP of index and middle fingers

Wasted thenar eminence

= hand of Benediction (when trying to make a fist, can only flex little and ring fingers)

7

What is the result of a lesion at the elbow affecting the ulnar nerve e.g. fracture of medial epicondyle?

Loss of sensation of all branches

Paralysis of flexor carpi ulnaris and ulnar half of flexor digitorum profundus ---> when wrist is flexed, it also abducts

Paralysis of interossei ---> fingers cannot abduct or adduct

Paralysis of ulnar two lumbricals ---> cannot flex at MCP or extend at IP joints

No ulnar claw

8

What is the result of a lesion at the elbow affecting the radial nerve in the radial groove e.g. humeral shaft fracture?

Superficial branch damaged ---> loss of sensation on dorsal surface, thumb, and radial two and a half digits

Weakened triceps brachii, paralysis of muscles in pos. compartment ---> unable to extend the wrist and fingers ---> unopposed wrist flexion ---> wrist drop

9

What is the result of a lesion at the elbow affecting the deep branch of the radial nerve e.g. radial head fracture?

No sensory function lost

All muscles in pos. compartment except supinator and extensor carpi radialis longus ---> extension can still occur

10

What is the result of a lesion at the elbow affecting the superficial branch branch of the radial nerve?

Sensory loss of dorsum, thumb, and radial two and a half digits

No motor function lost

11

Contrast Monteggia's and Galeazzi's fractures.

Monteggia's: ant. dislocation of radial head and fractue of prox. ulnar with ant. angulation

Galeazzi's: fracture of distal radius with dislocation of distal radioulnar joint

12

What is the 22-11-11 rule of the radius?

Radial inclination (angle between long axis of radius and line along articular surface of radius) should be 22 degrees +/- 2 degrees

Radial length (distance between tangents of radial styloid and ulnar head) should be 11mm +/-2mm

Radialt tilt (angle between articular surface of radius and radial shaft) should be 11 degrees +/- 2 degrees

13

What is the sail sign on the elbow?

Elevation of ant. fat pad to create sail silhouette, indicates presence of elbow joint effusion (inflamed synovial membrane forces fat pad into olecranon)

note: cannot normally see pos. fat pad, therefore presence indicates humeral or radial head fracture or distal radius (Stener's injury)