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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
Q

valgus stress test

A

evaluate ligaments of the medial elbow

26
Q

lateral elbow pain ddx

A 
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
Q

lateral epicondylitis history

A

lateral elbow pain with radiation to forearm

28
Q

exams for lateral epicondylitis

A

Cozens
long finger
pain with resisted wrist extension

29
Q

diagnosis of refractory lateral epicondylitis

A

MRI or EMG

30
Q

treatment of lateral epicondylitis

A

NSAIDs
RICE
physical therapy
injection (steroids vs PRP)

31
Q

PIN syndrome history

A

insidious onset of forearm pain +/- finger weakness

32
Q

exam for PIN syndrome

A

pain with resisted supination

finger extensor / wrist extensor weakness

33
Q

diagnosis of PIN syndrome

A

EMG/NCS

all dorsal extensors except ECRL, anconeus and brachioradialis (innervated above PIN)

34
Q

medial elbow pain ddx

A 
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
Q

medial epicondylitis history

A

insidious medial elbow pain which radiates into the proximal forearm

36
Q

exams for medial epicondylitis

A

pain with resisted flexion / pronation

37
Q

diagnostics for medial epicondylitis

A

not indicated

radiographs to rule out fracture

38
Q

treatment of medial epicondylitis

A

NSAIDs
RICE
therapy
biomechanical correction

39
Q

refractory treatment of medial epicondylitis

A

operative debridement of the degenerative proximal portion of the pronator teres and FCR

40
Q

medial epicondyle stress lesion history

A

medial elbow pain with throwing
loss of throwing speed
diminished throwing effectiveness

41
Q

exams for medial epicondyle stress lesion

A

point tenderness
pain with valgus stressing
milking test +

42
Q

diagnostics of medial epicondyle stress lesion

A

Xray can show widening of apophyseal line

43
Q

treatment of medial epicondyle stress lesion

A

6 weeks cessation of throwing
ice
NSAIDs

44
Q

UCL injury history

A

insidious medial elbow pain

provoked by valgus stresses and relieved by rest

45
Q

exams for UCL injury

A

swelling, pain, tenderness 2 cm distal to medial epicondyle

milking test _

46
Q

diagnostics of UCL injury

A

radiographs can show avulsion fracture, MCL ossification, or > 2mm gapping with valgus stress view
MRI useful for tear evaluation

47
Q

treatment of UCL injury

A 
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
Q

throwing mechanics

A

80% prep & cocking
2% acceleration
18% deceleration / follow through

49
Q

preparation / wind up phase of throwing

A

establishes the rhythm

rotates the body so the hip and shoulders are at 90 deg to the target

50
Q

cocking phase of throwing

A

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
Q

acceleration phase of throwing

A

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
Q

deceleration / follow through phase of throwing

A

high forces pull forward on glenohumeral joint following ball release

53
Q

pitching errors

A

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
Q

anterior elbow pain ddx

A 
tendinopathy
-biceps tendinopathy
muscle strain
-biceps brachii, brachialis
bursitis
-bicipital bursitis
bones
-fracture
mononeuropathy
-median 
radiculopathy
-C5
55
Q

posterior elbow pain ddx

A 
tendinopathy
-triceps tendinopathy
muscle strain
-triceps
bursitis
-olecranon bursitis
bones
-olecranon fracture
mononeuropathy
-radial
radiculopathy
-C7
56
Q

olecranon bursitis history

A

pain and swelling at olecranon

associated with frequent irritation or trauma

57
Q

exam of olecranon bursitis

A

swelling over olecranon

58
Q

diagnostics of olecranon bursitis

A

radiographs demonstrate fluid collection

59
Q

treatment of olecranon bursitis

A 
NSAIDs
RICE
elbow pads
compression
aspiration
60
Q

muscle attachment most likely involved in lateral epicondylitis

A

extensor carpi radialis brevis

MM Test 4 (20 decks)

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