8] Elbow Flashcards
What kind of joint is ulnohumeral and radiohumeral?
Hinge joint
OP for ulnohumeral?
70 flex, 10 sup
CP for ulnohumeral?
Full extension
Full supination
Capsular pattern for ulnohumeral?
Flexion > ext
OP for radiohumeral joint
Full extension
Full supination
CP for radiohumeral joint
90 flex, 5 supination
What kind of joint is proximal RU?
Pivot joint
OP for proximal RU joint?
70 flex
35 supination
CP for proximal RU joint?
5 supination
Capsular pattern for proximal RU joint
Supination > pronation
Pain with active contraction of muscle/tendon,
passive stretch to muscle/tendon,
Resist to muscle/tendon
Tendinopathy
Tennis elbow
Lateral epicondylitis
Overuse injury- repetitive wrist extension and gripping
Latera epicondy
Inflammatory, - patho changes, can resolve
Stage 1 of repetitive microtrauma (Nirschl)
Patho changes —> fibroblasts and neovascularization tendon degeneration
Stage 2 repetitive microtrauma for lateral epicondylitis
Tendinosis, collagen disorientation/disorganization
Stage 3 repeat microtrauma for lat epicondylitis
Stage 3 changes and calcification
Stage 4 of repeat microtrauma of lat epicondylitis
\+ pain with wrist ext Possible + pain with middle finger ext (+) mills and cozens Pain with palpation Possible swelling
Symptoms of lateral epicondylitis
Lateral elbow pain
Stiff and achy
Increased pain with grasping, writing, combined wrist ext/grip, lifting up objects palm down or thumb up
Dropping things
Signs of lateral epicondylitis
What kind of strengthening for wrist extensors do you want to do for lat epicond?
Eccentric first —> passively extend wrist then control lowering into flexion
Golfers elbow
Medial epicondylitis
common flexor tendon origin for medial epicondylitis
FCR, FCU, FDS
Palmaris longus
Humeral head of pronator teres
Golfers elbow happens how?
Overuse injury
Rupture at radial tuberosity or MT junction
Biceps tendon rupture
Muscular male
Middle aged
50s
Biceps tendon rupture
Intervention for distal biceps tendon tear
Usually surgery
When do you begin ROM and strength for distal bicep tear?
After 6-8 weeks post op
Trauma, respective weight bearing on olecranon
Olecranon bursitis
Infection Pain with full passive elbow flex Active possible Painfree resisted tests Pain with palpation
Olecranon bursitis
Rest
Avoid pressure/irritation
Anti-inflammatory modalities
Intervention for olecranon bursitis
If youre doing an exercise but they’re not responding to it =
Tendinopathy
Nerve entrapment syndrome for ulnar
Cubital tunnel syndrome
3 syndromes for radial nerve
High radial nerve compression
Posterior interosseous nerve (PIN) palsy
Radial tunnel syndrome
Syndromes of nerve entrapment for median nerve
Pronator sydnrome
Anterior interosseous nerve (AIN) syndrome
Largest unprotected nerve
Ulnar nerve
Most important nerve for hand function
Ulnar nerve
1st and 2nd most common nerve entrapment
1= carpal tunnel - median nerve 2= cubital tunnel - ulnar nerve
Caused by trauma- laceration or osteophyte, heterotropic bone
Cubital tunnels syndrome
Caused by overuse also:
Repetitive elbow flex/exten
Prolonged elbow flex
Tight FCU muscle
Cubital tunnel syndrome
Unable to make a full fist
PROM full and painless
Grip weak
Intrinsic atrophy of hand if chronic
Cubital tunnel
Claw hand deformity
Cubital tunnel
Visible sign of CUTS
Wartenbergs sign (pinky ABDucted)
Pain/parasthesia: medial elbow, forearm, hand
Ulnar 1 1/2 fingers
Sensation: decreased in ulnar nerve distribution
CUTS
Caused by increasing pain at night (sleeping posture)
CUTS
+ tests for CUTS
Elbow flexion test Pressure provocation Tinel’s Froments Pollocks
Guyons canal is injury to?
Ulnar nerve
Handlebar syndrome Loss of 3 and 4 lumbricals Loss of 1/2 FPB Claw hand Wartenbergs
Guyon canal injury
Entrapment results in a ganglion cyst
Triquetral-hamate joint
Ulnar nerve- guyons canal
Sensory and motor NOT affected
Only palmar side affected
Guyons canal
Dorsal sensory affected
Motor affected of FCU and FDP
- affects both palmar and dorsal side
Cubital tunnel syndrome
Proximal peripheral nerve injury
Radial nerve
Midshaft of humerus
- contusion
- fracture
- weak muscle (innervated distal to injury so wrist, finger, thumb ext)
- decreased sensation
Radial nerve
Examples of radial nerve injury syndromes
Saturday night palsy Crutch palsy Humeral shaft Fx Radial tunnel syndrome PIN Dorsal radial sensory nerve (wartenbergs)
Only sensory changes for ?
Radial nerve Sx distal to wrist
Compression/cast or local surgery
DRUJ dislocation
Repeat pronation/supination
Causes of radial nerve
Weak elbow flexors Loss supination with elbow extended Loss wrist ext Weak ulnar and radial deviation Loss MCP ext Loss ext and ABD of thumb
Saturday night palsy
Weak finger extensions
No sensation loss
PIN syndrom
Pain deep in forearm
No sensory/motor loss
R/O tennis elbow (below it)
Sx of radial tunnel syndrome
Crutch compression
Missile injury
Anterior shoulder dislocation
Lipoma or other neoplasm
Axillary - high median nerve lesion
Stab wounds
Sleep palsy near pec major tendon
Tourniquets
Humeral shaft Fx
Upper arm - high median nerve lesion
Repeated or resisted pronation
Resistance to isolated flex of PIP joint of long and ring fingers
Pronator syndrome Sx
Associated with paresthesias in median innervated fingers- tinel’s sign
Pronator syndrome
Mild or non weakness
Sensory loss - subjective sense of numbness
Pronator syndrome
Radial midshaft Fx Excessive exercise Idiopathic Direct trauma Brachial neuritis Anatomic anomalies
AIN causes
Martin Gruber anastomoses
Intrinsic hand muscles weak - median nerve
Nursemaids elbow
Radial head sublux
