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5 Ortho > L9 Elbow Exam > Flashcards

L9 Elbow Exam Flashcards

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1
Q

Radiocapitellar Line

A

when a line is drawn through the proximal radial shaft AND neck, and extended through the joint, it should pass through to the articulating capitellum

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2
Q

Anterior humeral line

A

on lateral view, when a line is drawn along the anterior surface of the ulnar cortex and extended, it should pass through the middle third of the capitellum

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3
Q

Immobilization causes individuals to lose

A

extension within a few weeks

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4
Q

Annular ligament

A

limits distraction and dislocation of radial head

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5
Q

Radial collateral ligament (LCL or RCL)

A

primary lateral stabilzer followed by capsule and common extensor group

taught through flexion and extension, tension increases in supination

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6
Q

Interosseous membrane

A

prevents proximal displacement of radius on ulna

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7
Q

Ulnar/medial Collateral Ligament Complex

A

has three different bands; anterior, posterior, and oblique

the anterior portion of UCL is the strongest, provides greatest restrain to valgus stress

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8
Q

Ant band of UCL

A

Ant portion: taut 0-60° flexion
Post portion: taught 60-120° flexion

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9
Q

Post band of UCL

A

taut at 90°

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10
Q

Oblique band of UCL

A

can be absent, blends with capsule

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11
Q

When the UCL is impaired

A

lateral structures can become overstressed

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12
Q

Arcade of Frohse

A

semicircular arch at the proximal edge of supinator muscle, about 2 cm distal to radiohumeral joint

deep radial nerve travels under the AOF

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13
Q

Common sites of r. nerve entrapment

A
  1. tendinous margin, origin ECRB
  2. arcade of frohse
  3. distal border of supinator

s/s: finger drop and radial wrist deviation on extension

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14
Q

Radial head dislocation

A

children 3-6
elbow pain and lacking supination
also known as nursemaid’s elbow

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15
Q

Osteochondriditis dissecans

A

12-20 yo
pain usually lateral, insidious onset, may have click or catch, loss of extension

MOI: repetitive stress. localized fragmentation of bone and cartilage

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16
Q

Distal Biceps Rupture MOI/RF

A

MOI: rapid eccentric contraction of biceps
load takes elbow from flexion into extension in supinated position

factors that could dispose you to it are degenerative changes, spurring of bicipital tuberosity, use of steroids, smoking

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17
Q

Distal Biceps Rupture population + S/S

A

males 4th to 6th decade of life OR young weightlifters and bodybuilders, manual labor

complains of painful pop at front of elbow, loss of supination, positive hook test, deformity, bruising

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18
Q

pain in multiple joints?

A

most likely RA

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19
Q

Joint pathology is relieved by

A

holding elbow into side and supporting wrist, it takes load off extensor group

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20
Q

Clicking or locking indicate

A

loose bodies
chondral injury
osteophytes
instability

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21
Q

Compression ulnar nerve locations

A

above elbow in region of intermuscular septum
medial epicondylar region
ulnar groove
region of cubital tunnel
where ulnar nerve exits from FCU

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22
Q

Observation of elbow

A

Swelling
Soft tissue contours
carrying angle
anterior view
posterior view
deformities
guarding

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23
Q

Swelling at elbow

A

olecranon bursitis

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24
Q

Tennis players age 55 and over may

A

have a loss of 10° of extension

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25
Carrying angle
males: 5 to 10° females: 10 to 15°
26
Anterior view of elbow
proximal rupture distal rupture erb's palsy
27
Proximal rupture of biceps
popeye's sign muscle belly springs down
28
Distal rupture of biceps
muscle belly springs up
29
Erb's palsy
C5 C6, (musculotaneous and axillary nerve) elbow is extended, pronated. Shoulder is IR and adducted. Wrist is flexed (waiter's tip)
30
What radigraphic guide should you use for a posterior dislocation of elbow?
radio-capetellar
31
Techniques for reducing nursemaid's elbow
1. Elbow ext, supination, traction, flexion 2. elbow extension, hyperpronation
32
When should you exam the C-spine?
over 30 yrs old 1. no hx of trauma 2. radicular signs 3. trauma with radicular signs 4. altered sensation
33
Would you clear the c-spine as part of your standard elbow exam?
no the joint is above the shoulder
34
Capsular pattern for elbow
flexion more limited than extension
35
Biceps length test
1. supine w/shoulder at edge of table 2. passively extend shoulder to end range, then extend elbow normal: elbow extension passively is the same range as AROM -->overpressure can't go past bone to bone
36
Triceps length test
1. sitting passively forward flex arm to full elevation with elbow in extension 2. passively flex elbow normal: elbow flexion is passively and actively in same range
37
Cubital fossa contains
coronoid process head of radius biceps and brachialis
38
Palpation of Radial tunnel
forearm is in neutral, palpate in line anterior to radiohumeral jt to the midpoint between the radius and ulna on posterior aspect of forearm, ECRB. tunnel is about 4 fingertips wide tenderness should be expected over radial tunnel, not lateral epicondyle. should perform special tests if both are painful
39
Joint play movements of elbow
radial deviation of the ulna and radius on humerus ulnar deviation of the ulna and radius on humerus distraction of olecranon from humerus in 90° flexion anteroposterior glide of the radius on humerus
40
Biceps referral pattern
bicipital groove to anterior elbow
41
Brachialis referral pattern
anterior arm, elbow to lateral thenar eminence
42
Triceps referral pattern
posterior shoulder, arm, elbow, forearm to medial epicondyle
43
Brachioradialis referral pain
lateral epicondyle, lateral forearm to posterior web space BT thumb and index finger
44
Anconeus referral pain
lateral epicondyle area
45
Supinator referral pain
lateral epicondyle, post web space, BT thumb, index finger
46
ECRB referral pain
posterior forearm to posterior wrist
47
FCR pain referral
anteromedial wrist
48
FDS pain referral
palm to appropriate digit
49
Diagnostic imaging
should be used in conjunction with a physical exam to determine diagnosis should not be used as sole method of diagnosisS
50
Supracondylar fracture
51
Cozen's test
patient is asked to move the wrist to dorsal flexion and the therapist provides resistance to this movement positive is pain in lateral epicondyle testing for lateral epicondylitis
52
Mill's test
clinician palpates the patient’s lateral epicondyle with one hand while pronating the patient’s forearm, fully flexing the wrist, the elbow extended positive is pain over lateral epicondyle testing for lateral epicondylitis
53
Tests for Lateral Epicondylitis
Cozen's Mill's Tennis Elbow
54
Golfer's Elbow Test
palpate medial epicondyle passively supinate forearm, extend elbow and wrist positive is indicate by pain over medial epicondyle of humerus
55
Hook Test
patient actively flexes elbow to 90° and fully supinates therapist uses index finger to approach lateral side, attempts to hook finger under lateral edege of biceps tendon positive is no biceps tendon to hook
56
Tinel's sign at the elbow
tap the ulnar nerve in the groove between the olecranon process and medial epicondyle positive sign is indicated by tingling sensation in the ulnar distribution of forearm and hand distal to the point of compression of the nerve
57
Testing for TFCC injury
Impingement: elbow on table, palpate TFCC, then UD rotate forearm. Positive is clicking Compression: as above, load as wrist is UD
58
Watson's test
Thumb of one hand holds palmar aspect of scpahoid and index finger on radial tubercle dorsally. maintaining firm pressure, push the pt into radial deviation proximal pole will jump over the dorsal lip of radius with a clunk if positive
59
Grind Test for OA
hold patient thumb between your thumb and index finger and place your opposite hand over CMC joint. Apply axial compression and rotation to the mc base on trapezium palpate for instability or crepitus, which is a positive for this test
60
Froment's sign
as paper is pulled away by the examiner, thumb will either IP joint flex or not. Positive would be IP joint flexion tests for ulnar nerve
61
Wartenberg's sign
passively place all of pts fingers in abducted position and then ask to bring fingers together while keeping them flat on the table positive if little finger remains in abduction watch for other fingers moving towards little finger to compensate
62
Phalen's test
place dorsum of hands together and lower elbows to create bilateral wrist flexion dorsum of hands are pressed together for 1 minute. Positive if patient reports pain in median nerve distribution testing carpal tunnel
63
Reverse Phalen's test
place palmar surface of hands together and raise elbows to create bilateral wrist flexion, pressed together for a minute positive if pain in median nerve distribution
64
Tinel's median test
tap over carpal tunnel at median nerve for 10s. Positive if pt reports pain in median nerve distribution
65
Testing of FDP and FDS
FDP: hold distal IP joint and flick with other hand. Should be tense FDS: hold all fingers down except for affected. Flick finger into extension, should be flaccid
66
Elson Test
testing rupture of central slip, not boutonniere deformity passively flex PIP to 90 over edge of a table and asks pt to extend the PIP while examiner resists. Positive would be no extension power and extension at DIP
67

5 Ortho (14 decks)

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