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MM Test 4 > B6.083 The Elbow > Flashcards

B6.083 The Elbow Flashcards

1
Q

elbow bone

A

humerus
radius
ulna

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2
Q

elbow ligaments

A

radial collateral ligament complex

ulnar collateral ligament complex

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3
Q

muscles with attachments at the elbow

A 
biceps
brachialis
brachioradialis
supinator
pronator teres
triceps
anconeus
extensor carpi radial longus / brevis
extensor digitorum
flexor carpi radialis
palmaris longus
flexor carpi ulnaris
flexor digitorum superficialis
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4
Q

bursae in the elbow

A

olecranon

bicipital

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5
Q

4 quadrants of elbow pain

A

medial
lateral
anterior
posterior

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6
Q

components of elbow physical exam

A 
inspection
palpation
ROM
manual muscle testing
neuro exam
joint above / joint below
special tests
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7
Q

anterior view inspection/ palpation of elbow

A 
carrying angle (5-8 degrees)
biceps tendon
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8
Q

carrying angle deformities

A 
cubital varus (<5 deg)
cubital valgus (>15 deg)
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9
Q

posterior view inspection/ palpation of elbow

A

swelling
olecranon tenderness
defect (triceps rupture)

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10
Q

lateral view inspection/ palpation of elbow

A

effusion
radial head
lateral epicondyle
PIN (5cm distal)

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11
Q

medial view inspection/ palpation of elbow

A

effusion
medial epicondyle
Tinels

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12
Q

elbow flexion ROM

A

140-150 deg

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13
Q

elbow extension ROM

A

0-5 deg
5 deg in females
up to 15 deg hyperextension in females and children

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14
Q

elbow supination / pronation ROM

A

80 deg

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15
Q

elbow flexion muscles

A

biceps brachii
brachioradialis
brachialis
coracobrachialis

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16
Q

elbow extension muscles

A

triceps

anconeus

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17
Q

elbow supination muscles

A

biceps
supinator
brachioradialis

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18
Q

elbow pronation muscles

A

pronator teres

pronator quadratus

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19
Q

lateral elbow dermatome

A

C5-6

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20
Q

medial elbow dermatome

A

C8-T1

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21
Q

Cozen’s test

A

resisted wrist extension

pain at lateral epicondyle

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22
Q

Long finger test

A

forearm in pronation

resisted extension of 3rd digit

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23
Q

Milking Maneuver

A

examiner pulls on the patient’s thumb to create a valgus stress with the forearm supinated and the elbow flexed 90 deg

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24
Q

varus stress test

A

evaluate ligament of the lateral elbow

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25
valgus stress test
evaluate ligaments of the medial elbow
26
lateral elbow pain ddx
``` ligamentous injury -lateral collateral ligament tear tendinopathy -later epicondylitis muscle strain -extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, anconeus, brachioradialis bones -radial head fracture mononeuropathy -PIN syndrome radiculopathy -C5 ```
27
lateral epicondylitis history
lateral elbow pain with radiation to forearm
28
exams for lateral epicondylitis
Cozens long finger pain with resisted wrist extension
29
diagnosis of refractory lateral epicondylitis
MRI or EMG
30
treatment of lateral epicondylitis
NSAIDs RICE physical therapy injection (steroids vs PRP)
31
PIN syndrome history
insidious onset of forearm pain +/- finger weakness
32
exam for PIN syndrome
pain with resisted supination | finger extensor / wrist extensor weakness
33
diagnosis of PIN syndrome
EMG/NCS | all dorsal extensors except ECRL, anconeus and brachioradialis (innervated above PIN)
34
medial elbow pain ddx
``` ligamentous injury -ulnar (medial) collateral ligament tear tendinopathy -medial epicondylitis muscle strain -flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis bones -fracture mononeuropathy -cubital tunnel syndrome / ulnar neuropathy radiculopathy -T1 ```
35
medial epicondylitis history
insidious medial elbow pain which radiates into the proximal forearm
36
exams for medial epicondylitis
pain with resisted flexion / pronation
37
diagnostics for medial epicondylitis
not indicated | radiographs to rule out fracture
38
treatment of medial epicondylitis
NSAIDs RICE therapy biomechanical correction
39
refractory treatment of medial epicondylitis
operative debridement of the degenerative proximal portion of the pronator teres and FCR
40
medial epicondyle stress lesion history
medial elbow pain with throwing loss of throwing speed diminished throwing effectiveness
41
exams for medial epicondyle stress lesion
point tenderness pain with valgus stressing milking test +
42
diagnostics of medial epicondyle stress lesion
Xray can show widening of apophyseal line
43
treatment of medial epicondyle stress lesion
6 weeks cessation of throwing ice NSAIDs
44
UCL injury history
insidious medial elbow pain | provoked by valgus stresses and relieved by rest
45
exams for UCL injury
swelling, pain, tenderness 2 cm distal to medial epicondyle | milking test _
46
diagnostics of UCL injury
radiographs can show avulsion fracture, MCL ossification, or > 2mm gapping with valgus stress view MRI useful for tear evaluation
47
treatment of UCL injury
``` rest NSAIDs PT correction of throwing mechanics limit pitch count full tear = season ending post surgical rehab is 12-18 months, 80% good to excellent results ```
48
throwing mechanics
80% prep & cocking 2% acceleration 18% deceleration / follow through
49
preparation / wind up phase of throwing
establishes the rhythm | rotates the body so the hip and shoulders are at 90 deg to the target
50
cocking phase of throwing
shoulder moves into abduction through full horizontal extension and then into maximal external rotation ends with the planting of the lead leg, with the body positioned for energy transfer through the legs, trunk, and arms to the ball
51
acceleration phase of throwing
explosive - rapid release of 2 forces -stored elastic force of the tightly bound fibrous tissue of the capsule -forceful internal rotation from the internal rotators -valgus forces on the elbow concludes with ball release
52
deceleration / follow through phase of throwing
high forces pull forward on glenohumeral joint following ball release
53
pitching errors
opening up too soon - arm lags behind and is not fully externally rotated - increases stress to the anterior shoulder which leads to increased valgus stress at elbow
54
anterior elbow pain ddx
``` tendinopathy -biceps tendinopathy muscle strain -biceps brachii, brachialis bursitis -bicipital bursitis bones -fracture mononeuropathy -median radiculopathy -C5 ```
55
posterior elbow pain ddx
``` tendinopathy -triceps tendinopathy muscle strain -triceps bursitis -olecranon bursitis bones -olecranon fracture mononeuropathy -radial radiculopathy -C7 ```
56
olecranon bursitis history
pain and swelling at olecranon | associated with frequent irritation or trauma
57
exam of olecranon bursitis
swelling over olecranon
58
diagnostics of olecranon bursitis
radiographs demonstrate fluid collection
59
treatment of olecranon bursitis
``` NSAIDs RICE elbow pads compression aspiration ```
60
muscle attachment most likely involved in lateral epicondylitis
extensor carpi radialis brevis

MM Test 4 (20 decks)

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