lecture 10: elbow and forearm Flashcards
1
Q
which of the following is NOT a static GH joint stabilizer (deltoid, labrum, capsule, GH lgs)
A
deltoid
2
Q
arm elevation in the plane of the scapula occurs why
A
beacuse the scapula sits on the curved surface of the thorax
3
Q
what does the elbow do
A
controls the movement within the spheres (position of the arm and hand) to carry out functional activties
4
Q
what are the movements of the elbow
A
flexion/extension
pronation/supination
5
Q
define valgus at the elbow
A
lateral deviation of a distal segment with respect to proximal segment
6
Q
define varus at the elvow
A
medial deviation of a distal segment with respect to proxima lsegment
7
Q
what is normal ROM at the elbow for flexion/extension
A
flexion: 140-145
extension: 0
8
Q
what is normal ROM for elbow for sup/pron
A
80-90
9
Q
what is the arc of movement required for most ADLs at the elboe
A
30-130 (100 degrees) in flexion/extension
50 degrees of pronation and supination
10
Q
what are the bones of the elvow
A
humerus
radius
ulna
11
Q
the medial epicondyle of the hum is an attachment for what muscles
A
flexors and pronators
12
Q
the lateral epicondule of the hum is an attachment for what muscles
A
extensors
supinators
13
Q
the trochlea is located medially or lateral
A
medial
14
Q
the capitellum is located medially or lateral
A
lateral
15
Q
what part of the humerus articulates with the radius
A
capitellum
16
Q
what bony parts lock to form stability at the elbow
A
coronoid fossa with coronoid
olecrannon fossa with olectronon
17
Q
during flexion, what bony segments lock together
A
in flexion, coronoid with coronoid fossa anterior
18
Q
during extension, what bony segments lock together
A
olecrannon with olecrannon fossa (posteriorly)
19
Q
what nerve passes medially to the elbow and wh=y is that a problem
A
ulnar nrve passes medially and it can get injured/entrapped
20
Q
cubital tunnel is located medially or laterally
A
medial
21
Q
the distal humerus has a 30 degree anterior or posterior curve
A
anterior
22
Q
the distal humerus has a BLANK degree anterior curve
A
30 degree
23
Q
because of the anterior curve of the distal humerus favours movement in flexion or extension
A
flexion (greater contact area during flexio)
24
Q
true or false: the distal humerus only has an anterior curve
A
false, also has a tilt
25
what degrees of tilt is there at the distal humerus
6 degrees of tilt
26
what is there 6 degrees of tilt at the distal humerus
beacuse of trochlea protruding
27
what are the important aspects of the proximal ulanr
trochlea notch
olecreannong
coronoid process
28
olecreannon locks with olecrannon fossa in flexion or extension
extension
29
olecreannon locks with blank in extension
olecreannon fossa
30
coronoid process locks with coronoid fossa fossa in flexion or extension
flexion
31
coronoid process locks with BLANK in flexion
coronoid fossa
32
what are the important aspects of the proximal radius
radial head
radial neck
radial tub
fovea
33
what bone is commonly fractured at the elbow
radius
34
what is the radial tuberosity an attachment for
biceps
35
the fovea of the radius articulars with what surface
the humerus
36
what are the joints of the elbow joint
humeroulnar
humeroradial
proximal radioulnar
37
what type of joint is the humeroulnar joint
ginglymus (hinge)
38
what are the movments of the humeroulnar joint
flexion/extension
39
explain the joint space of the humeroulnar jt
assymetrical
40
they boney shape of the humeroulnar joint favours what
favors flexion excursion vs extension excursion
41
what type of joint is the humeroradial joint
ginglymus (hinge)
42
what are the movements possible at the humeroradial jt
flexion/extension
43
in the humeroradial joint, there is greater contact with elbow during extension of flexion and why
during flexion beause of anterior rotation of humerus (distally)
44
what type of joint is the superior radioulnar
trocchoid (pivot)
45
what is the movements possible at the superior radioulnar joint
pronation/supination
46
true or false: the superior radioulnar joint has no support from bone structure-only soft tissues
true
47
what are the soft tissues that support the superior radioulnar jt
annular lig (around the radial head)
interosseus membrane
48
what is the function of the interosseus membrane
interosseus membrane an important static longitudinal stabilizer of the forearm (less contribution to forearm rotation)
49
the COR during flexion and extension goes where
oblique through the capitulum anfd trochlea
50
why is knowing the COR at the elbow important
for orthotic hinge alignment
hinge needs to allgin with anatomical COR
axis of orthosis needs to allign with axis of arm
51
the COR during pronation and supination
rotaiton about a longitudninal axis between the raidl head and the ulnar head
52
explain joint contact with an applies compressive force during extension
there is more humeroradial contact than humeroulnar
53
the medial trochlea extends farther where
distally
54
the medial aspect of trochlear notch of ulna ectrends further where
distally
55
true or false: there is medial deviation of ulna with respect to humerus
false, there is lateral
56
there is lateral deviation of ulna with respect of humerus known ask what
carrying angle
57
what is the valgus/carrying angle
men=women
valgus 10-15 degrees
58
what are the 3 primary static constraints of the elbow
ulnohumeral articulation
anterior bundle of the medial collateral ligaments
lateral collateral ligaments
59
what are the 4 secondary constraings
radiocapitellar articulation
common origin of the flexors
common origin of the extensiors
capsule
60
when are the secondary elbow constaints going to be able to support
muscles are additional support while in tension
61
radial head stabilizers with stress in waht direction
valgus
62
olecrannon stabilizes with stress in what direction
valgus
63
coronoid stabilies with stres on what direction
varus direction
64
what are the 3 bundles of the MCL at the elbow
anterior
posterior
and tranverse
65
which is the most important bundle of the medial collateral ligament
anterior
66
what ligament is an important stabilizer at the elbow of valgus stress
medial colalteral
67
MCL ligaments is an important stabilizer with what kind of stress
valgus (lateral)
68
what are the bundles of the lateral collateral lig
lateral ulnar collateral
accessory lateral collateral
radial collateral
annular
69
the LCL stabilies with what stress
varus (stops it from moving medially)
70
the MCL deficient elbow should be rehabilitation in what postion and why
in supination as the medial muscles are taut generating greater passive tension enhancing medial sided stability
71
the LCL deficient elbow should be rehabilitated in what position and why
in pronation as the lateral muscles are taut generating greater passive tension enhancing lateral sided stability
72
in pitching, is there high valgus or varus stress
valgus
73
what is the average valgus torque during pitching
64 NM
74
when is valgus force highest during pitching
highest at late coking and acceleration phases
75
professional pitchers have what newtons of valgus stress during pitching
290 of force across elbow joint
76
what are the consequences of the fact that professional pitchers pitch at 290 N and ligamentous tensile strength is 260 N
possible rupture of ligaments.
77
what are the muscles that crontol the elbow
flexors
extensiors
pronators
supinators
78
what are the elbow flexors
biceps brachii
brachialis
brachioradiualis
pronator teres
79
when are biceps less active
less active with arm in full pronation
80
what ar ethe elbow extensir muscles
triceps brachii
anconeus
81
what are the pronators and supinators
pronator teres
pronator quadratus
supinator
biceps
82
what is the fancy name for tennis elbow
lateral epicondilyis
83
what is the fancy name for golfers elbow
medial epicondylitis
84
lateral epicondylitis affects what muscles
wrist extensors
85
medial epicondylitus affecst what muscles
wrist flexors
86
what is the cause of lateral epicondylitis and what position
overuse of the ECRB and EDC
resistance with arm and wrist in extension
87
according to EMG, there is decreased exntsor activity in tennis for what position
for two handed back hand
88
what are the consdierations of lateral epicondylitis and tennis
arm position
grip diameter
weight of item help in hand
repetition
89
medial epicondylistis is overuse of what muscle
flexor pronator musculature
90
medial epicondulitis is caused by excess what
excess valgus force and medial tension
91
what are the considerations of medial epicondylitis in golfing
appropriate technique
lightweigth equipment
repetition
92
which is harder to correct, lateral or medial epicondylitis
medial
93
which muscle has the longest moment arm : biceps, brachialis, pronator teres and brachiiradialis
brachioradialis
94
place these muslces in order of longest to shortest moment arms : biceps, brachialis
pronator teres
brachioradialis
brachioradlis
biceps
brachioalis
pronator teres
95
the moment arms are at peaks when arm flexed between what degrees
100-120 degrees
96
maximum isometris elbow flexion forec as peaks when
midrange between 75-90 degrees of flexion
97
what is active insuffieciency
Active insufficiency is the decreased tension of a multiarticular muscle when it is shortened across one or more of its joints.
98
true or false: when muscle if at shortest length, it is at strongest length
false, weakest
99
what is the active insuffiecieny for biceps
shoulder flexion
elbow flexion
supination
100
what are the movements of the wrist
flexion/extension
radial/ulnar dev
circumduction
101
what is the functional axis of movement of the wrist
dart throw motion
"a plane in which functional oblique motion occurs, spefically from radial extension to ulnar flexion:
102
why is "dart throw motion important
less movment of the scaphoid and lunate compared to pure flexion/extension or ulnar/radial devaltion
=good for people who may have instabilities
=safe protected ROM
103
what is the common path of motion in many daily activities of the elbow
oblique plane of movement
dart through motion
104
what is the ROM for flexion/extension at wrist
70-80
105
what is the ROM for ulnar dev at wrist
30-50
106
what is the ROM for radial dev at wrist
20-30
107
what is the functional wrist ROM
40 degrees flexion and extension should be good
108
what are the 6 biomechanical requirements of distal UE function
adequate flexion and extension
adequate radial and ulnar dev
adequate forearm rotation
function oblique movement
adequate ligamentous contraint (translation, rotaiton, distrcation, compression)
independant wrist and finger movement
109
what are the main wrist flexors
flexor carpi radialus
flexor carpi ulnaris
110
what are the main wrist extensors
ECRB ECRL
ECU
111
the variable bone geometry of the wrist does what
accomodates movement
=multifaceted articulations accomodate movement and stability
112
distal radius is inclined 15 degrees palmarly or dorsally
palmarly
113
distal radius is inclined BLANK degrees palmarly
15
114
distal radius is inclined 15-20 degrees ulnarly or radially
ulnary
115
distal radius is inclined BLANK degrees ulnarly
15-20
116
what is the most common upper extremity fracture in people over 50
distal radius fracture
117
what is the MOI for distal radius fracture
fall on outstretched hand (bending and compressive force)
118
what is the common fracture of the distal radius fracture
compressed and dispalced
119
what are the important aspects of the distal ulna
stylod process
head of ulna
120
what does distal ulna articulate with
TFCC
121
what is the movment of the radius/ulna during pronation
radius crosses over ulna with anterior roll
122
what is the movment of the radius/ulna during supination
radius uncrosses from ulna with posterior roll
123
during supination, radius uncrosses from ulna with posterior or anterior roll
posterior
124
during pronation, radius crosses over ulna with anterior or posterior roll
anterior
125
the forearm supinates maximalyl with elbow is in what postiion
elbow flexed
126
the forearm pronates maximalyl with elbow is in what postiion
elbow extended
127
elbow extension increased or decreased the transmitted forces of the DRUJ and PRUJ
increases
128
normally, what percentage of load is taken by the distal radius
80%
129
true or false: there is normally alt of difference between radial height/ulnar variation
false, not a lot
130
in negative ulnar variance, does more of the load get transmissted to ulna or radius
radius
131
with 2-5 mm of ulnar variance (negative ulnar variance) explain the load transmission
95% load transmission via radius and 5% through ulna
132
with negative ulnar variance there is increased risk for what
lunate injury
133
explain load tranmission with positive ulnar variance
60% of load transmission via radius and 40% via ulna
134
in positive ulnar variance, does more of the load get transmissted to ulna or radius
still more radius, but decreased from 80 to only 60%
ulna
135
with positive ulnar variance there is increased risk for what
ligamentous tears
136
what do u need to be cautious for distal radius fractures
beware of excessive hand squeezing and forceful ROM if distal radiu. does not have solid fixation
137
during forearm pronation, the radius crosses the ulna or oppsite
radius over ulna
