Arm, Elbow, Cubital Fossa Flashcards
Coracobrachialis
Origin:
1. coracoid process
Insertion:
1. medial humerus
Action:
1. shoulder flexion
innervation:
1. musculocutaneous C5,C7
Biceps Brachii
Origin:
1. long head: supraglenoid fossa (through inter-tubercular groove)
2. short head: coracoid process of the scapula
Insertion:
1. radial tuberosity
action:
1. elbow flexion
2. forearm supination (assists)
3. arm flexion (long head)
Innervation:
1. musculocutaneous C5,C6
Triceps Brachii
Origin:
1. long head: infraglenoid tubercle of scapula
2. lateral head: posterior humerus superior to radial glove
3. medial head: posterior humerus inferior to radial groove
Insertion:
1. olecranon process of ulna
Action:
1. Elbow extension (all three heads)
2. arm extension (long head)
3. arm adduction (long head)
Innervation:
1.radial nerve C6-C8
Brachialis
origin:
1. Anterior humerus (deep to biceps)
Insertion:
1. ulnar tuberosity (just inferior to coronoid process)
Action:
1. elbow flexion
Innervation:
1. musculocutaneous C5,C6
Musculocutaneous Nerve
- comes of lateral cord
- pierces the Coracobrachialis
- Biceps brachii C5-C6
- Coracobrachialis C5-C7
- Brachialis C5-C6
Radial Nerve
- Posterior cord
- C7 nerve root for reflex
- C5-T1
- triceps bachii
Olecranon Bursa
- Friction or excessive pessure can cause inflammation
- students elbow is a common cause of irritation
ligaments of the elbow
- Joint capsule
- Radial Collateral ligament
- Annular ligament
- ulnar ligament
Cubital fossa
Borders:
- pronator teres
- brachioradialis
- “line” between humeral condyles
Contents:
- Median nerve
- biceps brachii tendon
- Medial cubtial vein
- Brachial artery
Tennis elbow
- lateral epicondylitis
- swelling/tearing of tendon
- can be caused by reptitive motions such as the backhand stroke in tennis players
Symptoms of lateral epicondylitis
- pain
- burning
- ache on lateral side of forearm and elbow
- weak grip
Treatment: lateral epicondylitis
- rest and stopping activity that may cause pain
- ice packs
- anti-inflammatory medications to reduce swelling
- braces/steriod injections
- strengthening and stretching
Medical imaging at the elbow
- possibel calcifications at the lateral epicondyle
- MRI can assess severity
- typically used AP view or lateral view
- CT can be used to see any calcifications
PT diagnostic tools for tennis elbow
- dynamometer for grip strength
- patient-rated tennis elbow evaluation questionnaire
- Cozen’s test: elbow at 90º of flexion, therapist palpates the lateral epicondyle and puts the patients hand into RD and pronation
- Mills test
Golfers elbow
- known as medial epicondylitis
- typically caused by excessive motion or force on the elbow => swinging a golf club or throwing a baseball
Golfers Symptoms
- pain
- ache
- burning on ulner side of forearm
Golfers elbow: treatment
- ice
- anti-inflammatory medications
- strengthening
- bracing
- steriod injections
how to tell possible calcifications at medial epicondyle
- US
- CT
- MRI
Golfers Elbow diagnostic tools
- Dynamometer
- Medial epicondylitis test: simila concept to mills
tommy John surgery
- UCL reconstruction
- tends to be needed for overuse injuries of the ligament
Treatment after tommy john surgey
- secured in a brace at around 60-90ºof flexion
- 1-2 weeks afte will start to move the joint
- end of month 1 may be able to extend elbow fully
- for throwing athletes rehab typically takes about a year or more
Medical imaging for UCL
- MRI
- MSK US
UCL injury PT Diagnostic tools
- ligamentous valgus instablity test: therapist applies valgus stress at the elbow
- milking maneuver: patient sits with elbow flexed at 90 and forearm supinated. Therapist grasps thumb unde foerarm and pulls to allow the elbow to undego a valgus stress symptoms that arise such as pain would be a positive sign
Cubital tunnel syndrome
- involved the ulnar nerve becoming entrapped in the cubital tunnel
- can eventually cause ulnar neve subluxation
cubital tunnel syndrome
5 possible sites for entrapment
- medial intemuscular spetum
- arcade of struthers
- medial epicondyle
- osborne ligament
- heads of FCU/ECU aponeurosis
Cubital tunnel syndome:
Clinical features
- paresthesia
- numbness
- pain
- along the pinky and ulna borde of ring finger
- benediction sign
- froment sign
- wartenberg sign
Medical imaging of cubital tunnel syndrome
- US: can detect nerve thickening and changes, can see the nerve move with flexion and extension at the elbow
- MRI: can also dect nerve thickening
- can detect edema-like changes, atrophy of FCU and FDP muscles
Cubtial tunnel diagnostic
- Tinels sign
- wartenbeg
radial nerve entrapment
- uncommon
- proximal to the elbow can be compressed by overuse, trauma or hematoma
- typically is compessed just poximal to the supinator muscle in the radial tunnel
Radial nerve entrapment at the elbow Symptoms
- mimics lateral epicondylitis
- tendeness 2-3 cm distal to radial head
Medical imaging radial nerve entrapment
- pathology cannot directly be seen through an MRI
- however can detect muscle edema, atrophy and fatty depostis that can come with the injury
Diagnostic tools for radial nerve entrapment
- drop wrist sign
- thumb lift off
- hand dynometer
Common pain referment causes
- cardiac ischemia/blockage
- radicular symptoms from herniated disc
- thoracic outlet syndrome
- fibromyalgia
