Elbow APTA Flashcards
(96 cards)
1
Q
What are 3 nonmusculoskel conditions that may refer pain to the elbow?
A
- MI
- Pancoast’s syndrome
- Esophageal motor disorders
2
Q
What is Pancoast syndrome?
A
- pain, paresthesias, and potential atrophy of the thenar musculature due to superior sulcus tumors (above the lungs)
- can be associated with Horner’s syndrome at the same time
3
Q
What are 7 non-neuromuscular conditions that may present with acute, painful swelling?
A
- Gout/pseudogout
- septic arthritis
- hemarthrosis
- soft tissue abscess
- cellulitis
- reactive arthritis
- CA
4
Q
What’s a minimum of total elbow ROM to be able to complete most ADLs?
A
- 30-130*
5
Q
What is the “carrying angle” of the elbow?
A
- the angle of the elbow in the frontal plane; between the long axis of the humerus and ulna
- typically 13-16* for females and 11-13* for males
- thought to decrease with taller people
6
Q
Which epicondyle is more prominent? Medial or lateral?
A
- medial
7
Q
What structures attach to the medial epicondyle?
A
- common flexor tendon
- pronator teres
- ulnar collateral ligament (MCL)
8
Q
What structures attach to the lateral epicondyle?
A
- supinator
- extensor muscles of the fingers/wrist
- radial (lateral) collateral ligament
9
Q
The _____ is the articulating surface of the humerus that communicates with the ______ of the ulna. The _________ is located on the distal lateral aspect of the humerus, with the _____ located just proximal to the trochlea.
A
- trochlea of the humerus to the greater sigmoid notch of the ulna
- the capitellum is distal/lateral, and the coronoid fossa is proximal to the trochlea
10
Q
During flexion, the _________ of the ulna articulates with the __________ of the humerus, while the _______ of the radius articulates with the ___________, eventually restrained by the __________ on the anterolateral side of the humerus.
A
- The coronoid process of the ulna articulates with the coronoid fossa of the humerus, with the radial head of the radius articulating with the capitellum, eventually restrained by the radial fossa of the humerus
11
Q
What is optimal ROM for pronation/supination?
A
- 70* of pronation
- 80* of supination
12
Q
T or F;
The elbow capsule surrounds all three articulations at the elbow (humeroulnar and radial, proximal radioulnar).
A
- T
13
Q
The elbow capsule is loosest between what ROM?
A
- 70-90* flx
14
Q
What are the 3 portions of the UCL complex?
A
- anterior: anterior band primarily taut between full extension to 60* flexion; posterior band primarily taut between 60-120* flx
- posterior: fan-like structure, most taut at 90* flx. Anatomically best positioned to restrain gapping during pronation
- transverse (Cooper’s); only variably present
15
Q
What portion of the UCL is considered the greatest restraint to valgus?
A
- anterior portion
16
Q
What are the 4 portions of the RCL complex?
A
- annular ligament: surrounds the radial head
- radial portion of RCL
- ulnar portion of the RCL: thought to play a role in posterolateral rotary instability
- accessory ligament: only variably present
17
Q
What ligamentous structure has the greatest role in elbow stabilization?
A
- the radial collateral ligamentous complex
- joint capsule and common extensors play a secondary role
18
Q
Which major muscles of the elbow are innervated by the musculocutaneous nerve?
How about the radial nerve?
A
- musculocutaneous n: biceps brachii and brachialis
- radial n: brachioradialis
19
Q
The major elbow flexors are innervated by what nerve(s)?
A
- musculocutaneous and radial
20
Q
What are the attachments of the brachialis?
Brachioradialis?
A
- brachialis: under the biceps brachii. Anterior humerus to the ulna tuberosity and coronoid px. Large muscle mass, but small mechanical advantage
- brachioradialis: lateral supracondylar ridge (next to the lateral head of the triceps) to the styloid px of the radius; essentially a forearm muscle. Largest mechanical advantage
21
Q
What are 3 secondary elbow flexors?
A
- pronator teres
- extensor carpi radialis longus (ECRL)
- flexor carpi radialis (at elbow flx of 50* and >)
22
Q
What are the two major elbow extensors? What nerve(s) are they innervated by?
A
- triceps
- anconeus
- Radial n
23
Q
What are the 3 proximal attachments of the triceps?
A
- long head attaches to infraglenoid tubercle on scapula
- medial and lateral heads are on the proximal posterior humerus, with the medial head underneath the lateral head
24
Q
What are the attachments of the anconeus? What is its general function?
A
- it’s an elbow extender, but functionally it’s a joint stabilizer
- lateral epicondyle to the posterolateral surface of the olecranon and proximal fourth of the ulna
25
What are the lateral forearm extensors/supinators? (6) What nerve(s) are they innervated by?
- extensor carpi radialis longus (ECRL)
- extensor carpi radialis brevis (ECRB)
- extensor digitorum
- extensor digiti minimi
- extensor carpi ulnaris
- supinator
- all by the radial nerve
26
What muscles are attached to the common extensor tendon at the lateral epicondyle?
- Extensor carpi radialis brevis
- extensor digitorum
- extensor digiti minimi
- extensor carpi ulnaris
27
Which extensor muscle is not part of the common extensor tendon? What is it's action?
- extensor carpi radialis longus
| - wrist extension with radial deviation; small role in elbow flexion
28
The supinator muscle acts as a benchmark for the radial nerve in what way?
- the radial nerve pierces the supinator, exiting as the posterior interosseous nerve
29
What is the primary supinator of the forearm?
- biceps brachii; although supinator does help
30
What two muscles are responsible for forearm pronation? What are their general locations?
What nerve innervates them?
- pronator teres; proximal forearm
- pronator quadratum; distal forearm
- median nerve
31
What is the pronator teres able to do based on it's location for joint stability?
- resist valgus forces
32
What are the forearm flexors?
- flexor carpi radialis
- flexor carpi ulnaris
- flexor digitorum superficialis
- flexor digitorum profundus
- palmaris longus
33
Which forearm flexors are innervated by the median nerve?
- flexor carpi radialis
- flexor digitorum superficialis
- flexor digitorum profundus (dual innervation)
- palmaris longus
34
What forearm flexors are innervated by the ulnar nerve?
- flexor carpi ulnaris
| - ulnar side of the flexor digitorum profundus
35
What forearm flexor muscle flexes the distal phalangeal joints?
- flexor digitorum profundus
36
What is the function of the palmaris longus muscle?
- tenses the palmar aponeurosis to assist gripping activities
- can also assist with wrist flexion
37
The brachial artery is found next to which nerve? What arteries branch off of it?
- found lateral to the median n., palpable in the antecubital fossa
- ulnar and radial aa.
38
Which nerve roots contribute to the radial nerve?
- C5-8
39
What is thought of as a common site for entrapment of the radial nerve?
- supinator
40
After the radial nerve transitions to the posterior interosseous nerve, what does it innervate? (4)
- abductor pollicis longus
- extensor pollicis longus
- extensor pollicis brevis
- extensor indicis
41
Which nerve roots contribute to the ulnar nerve?
- C8-T1
42
What is thought of as a common site of entrapment for the ulnar nerve?
- cubital tunnel
43
What muscles other than the FCU and FDP are innervated by the ulnar n.? (4)
- hypothenar muscle
- interosseous muscles
- adductor pollicis
- ulnar lumbricals
44
Thenar refers to _____, hypothenar refers to ______
Thenar: thumb side
hypothenar: pinky side
45
Which nerve roots contribute to the median nerve?
- C5-6, C8-T1
46
Which forearm nerve(s) do not have C7 contributions?
| C5-6? T1?
- C7: median n.
- T1: radial n.
- C5-6: ulnar n.
47
What are the cutaneous innervation patterns for the median, ulnar, and radial nerves?
- median: digits 1-3 (A/P), and digit 4 (P) proximally; and lateral palm
- ulnar: medial palm/wrist
- radial: posterior hand/medial digits
48
What muscles are innervated by the musculocutaneous nerve?
- corocobrachialis
- biceps brachii
- bracialis
49
What nerve roots contribute to the musculocutaneous nerve?
- C5-7
50
What are typical ROMs associated with the elbow?
- flexion: 150
- extension: 0
- pronation: 90*
- supination: 80*
51
Generally, there is thought to be a bit of ________ with elbow flexion, and _________ with extension.
- supination with flexion
- pronation with extension
- probably not all that relevant; more pedantic
52
At least __% of the coronoid is required for elbow stability toward extension.
- 50%. Takeaway is that the coronoid is important for stability in the sagittal plane
53
The olecranon is important for what stability at the elbow?
- resisting varus/valgus
54
What joint at the elbow takes the majority of loading?
- radiocapitellar joint; up to 60% of load transmission
55
T or F;
In a healthy elbow, the radial head does not have significant contributions to valgus stability.
- T
| - however, in the presence of a UCL defect, it can act as a secondary stabilizer against valgus forces
56
A pt comes in with acute onset, non-traumatic swelling and pain at the elbow. What is of concern in the differential?
- septic arthritis
57
Most of the literature surrounding elbow tendon injury looked at what tendon?
- lateral elbow tendons
58
What more commonly occurs; medial or lateral elbow tendon injury?
- more often lateral tendinopathy
| - medial happens about half the time when it's an epicondylitis
59
What structure is considered involved with lateral elbow tendinopathy?
- common extensor tendon
| - the ECRB and extensor digitorum communis have not been shown to be involved in most presentations
60
What is the typical presentation for pts with a lateral epicondylitis (tendinopathy)?
- point pain at the lateral humerus; typically ~1cm distally from the lateral epicondyle
- pain with gripping, passive stretch into wrist flexion, and contraction of wrist/finger extensors
61
What are the typical pt demographics associated with a lateral epicondylitis?
- 35-50 yo
- female
- high levels of physical work
- low social support at work
- workers belonging to professions classified as strenuous
62
T or F;
Diagnostic tests to differentiate between specific lateral musculature that are involved with lateral epicondylitis are fairly reliable.
- F; most of them do not have established stats
63
Differential diagnosis for lateral tendinopathy should include:
(6)
- cervical radiculopathy (C6-7)
- radial tunnel syndrome
- posterolateral rotary instability
- compression of PIN
- intraarticular disease
- lateral antebrachial nerve injury
64
Is there a gender difference in prevalence for medial tendinopathy?
- nope; fairly equal
65
What are the 3 common reasons thought to produce a medial tendinopathy?
- flexor-pronator fatigue due to repeated stress
- sudden change in level of stress that predisposes the elbow to ligamentous injury
- UCL failure
66
What are the primary muscle groups involved with a medial tendinopathy?
- pronator teres
- flexor carpi radialis
- palmaris longus
67
Differential diagnosis for medial tendinopathy should include:
- cervical radiculopathy (C7-T1)
- TOS
- musculoskeletal conditions of the shoulder
- ulnar nerve injury
- medial elbow ligamentous instability
68
What is important to clear or rule in with a medial tendinopathy, and why?
- ulnar neuritis. Concurrent ulnar decompression during a surgical intervention for medial elbow tendinopathy may significantly improve outcomes
69
T or F;
There is agreement in the literature for the appropriate interventions for tendinopathy.
- F; more research needed
70
What are the 4 basic tenets of tendinopathy management?
- relieve pain, while controlling swelling
- promote healing
- promote general fitness
- control loading through affected tissue
- if unable to have an effect, then surgery
71
What is the potential pitfall of using an acute inflammatory control approach to initial epicondylitis management?
- while a pt may have severe initial pain, they may not actually have an acute inflammatory process, thus relative rest, icing, splinting, etc may not make a differencej
- it may be appropriate, but the pt should be presenting with signs of an acute inflammatory process
72
Is there support for use of kinesiotape for elbow tendinopathy?
- not really. Current research wasn't up to par. Doesn't necessarily mean that one shouldn't use it.
73
Is there support for various injection therapies for elbow tendinopathy?
- research is evolving.
| - platelet rich plasma, autologous whole blood, prolotheraphy, polidocanol, are all being looked at
74
Strengthening and flexibility should involve what structures when dealing with elbow tendinopathy?
- proximal; basically look at the shoulder as well for its influence on loading at the elbow
75
What type of manual/mobilizations have an effect on elbow tendinopathy?
- Mulligan's mobilizations w/ movement; short and long-term outcome improvements
- some research looking at cervical mobs, but it's not conclusive
76
Is eccentric exercise appropriate for elbow tendinopathy?
- yes, it's appropriate, however current research does not show it to be superior to other interventions, when looking at pain or function
77
Is progressive exercise appropriate for elbow tendinopathy?
- potentially. Not much research.
| - probably not a bad idea.
78
Is soft tissue mobilization appropriate for elbow tendinopathy?
- marginal evidence that deep friction massage is helpful when combined with other interventions in PT.
- however, if soft tissue impairments are present, it's more overtly easy to justify
79
What may bracing (orthotics/taping) be helpful with for elbow tendinopathy?
- short term pain-relief with gripping activities
| - may be effective, more research is needed
80
Are modalities appropriate for treatment of elbow tendinopathy?
- some evidence for improvement within the first 3 months, however not much good research beyond that point.
- SR with meta-analysis, looking at iontophoresis, US, or phonophoresis. Wide variety of treatment applications (volume, etc)
81
Is corticosteroid injection appropriate for elbow tendinopathy? Is it better than physical therapy?
- it has been found to be better than PT in the short term
- however, PT was better in the moderate to long term
- was looking at pain-free grip strength
82
Is low level laser appropriate for tendinopathy treatment?
- has been shown to have positive effects when used with specific parameters.
- was not specific to elbow tendinopathy
83
Is shock wave therapy appropriate for tendinopathy treatment?
- little to no benefit found
84
Is self-stretching appropriate for elbow tendinopathy management?
- sure, if there are muscle length impairments present;
| no specific research
85
What patients with elbow tendinopathy are appropriate for surgical intervention?
- after failure of rehab > 1 year
- failure after multiple cortisone injections
- constant pain
- other intraarticular pathology
86
Is there a difference in outcomes between open, percutanous, or arthroscopic surgical intervention for elbow tendinopathy?
- nope, they're pretty equivalent with outcomes
87
What are the demographics associated with distal biceps tendon rupture?
- more typical in males in their 4th-6th decades
| - in athletic populations, most common with weight lifting and body builders
88
What is the common mechanism of injury for a distal biceps tendon rupture?
- Rapid eccentric loading
89
Are partial biceps ruptures common?
- not really; the failure often occurs at the insertion site, not the musculotendinous junction
90
What lifestyle factors may increase risk for biceps tendon rupture?
- anabolic steroid use
| - smoking
91
What is the typical initial presentation for a biceps tendon rupture?
- pop and acute onset weakness
92
Is it ok to wait for operative management following a biceps tendon rupture? What are some potential complications?
- eh. probalby not. Ideally should be repaired within 10 days of the rupture; typically an outpatient procedure
- if there is too much of a delay, there could be: neural pathology due to long duration retraction of the nerve; heterotopic ossificans
93
What are typical benchmarks one can expect for rehab timeline following distal biceps tendon rupture repair?
- ROM
- begin strengthening
- unrestricted activity
- achieve full ROM by 4 weeks
- begin strengthening at 6-8 weeks; or when full ROM
- unrestricted activity at 8-16 weeks
94
A pt reports some muscle weakness into elbow flexion. When they actively pronate the forearm, their distal biceps looks like it stays in the same spot. Is this concerning?
- yes, for distal biceps tendon rupture. Normally, the biceps muscle belly should migrate distally.
- should compare to other side
95
What are typical outcomes for biceps rupture repair?
- usually good; near-normal ROM/strength achieved
96
When is the risk highest for re-rupture of the biceps tendon following repair?
- first 3 weeks
