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BR 3rd Ed > Ch 4 - MSK: Elbow > Flashcards

Ch 4 - MSK: Elbow Flashcards

1
Q

Describe elbow ROM.

A
  • Elbow flexion: 135°
  • Elbow extension: 0° to 5°
  • Forearm supination: 90°
  • Forearm pronation: 90°
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2
Q

Describe muscles and innervation involved with elbow flexion.

A

– Brachialis (musculocutaneous n, lateral cord: C5, C6, C7)
– Biceps brachii (musculocutaneous n, lateral cord: C5, C6)
– Brachioradialis (radial n, posterior cord: C5, C6, C7)
– Pronator teres (median n, lateral cord: C6, C7)

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3
Q

Describe muscles and innervation involved with Elbow extension.

A

– Triceps (radial n, posterior cord: C6, C7, C8)

– Anconeus (radial n, posterior cord: C7, C8, T1)

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4
Q

Describe muscles and innervation involved with forearm supination.

A

– Supinator (PIN, posterior cord: C5, C6)

– Biceps brachii (musculocutaneous n, lateral cord: C5, C6)

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5
Q

Describe muscles and innervation involved with forearm pronation.

A

– Pronator quadratus (AIN: C7, C8, T1)
– Pronator teres (median n, lateral cord: C6, C7)
– Flexor carpi radialis (median n, lateral cord: C6, C7)

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6
Q

What does the annular ligament do?

A

Holds the radial head in proper position

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7
Q

What is the normal carrying angle?

A

– Males: 5° of valgus
– Females: 10° to 15° of valgus
– >20° is abnormal

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8
Q

What are indications for elbow arthrodesis?

A

– Arthritis

– Failed surgical procedure

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9
Q

Describe the fusion position of elbow arthrodesis.

A

– Unilateral: Flexion—90°

– Bilateral: Flexion—110° in one arm and 65° for the other

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10
Q

What causes medial epicondylitis?

A

Repetitive valgus stress to the elbow

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11
Q

Who is typically affected by medial epicondylitis?

A

Baseball pitchers

Golfers

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12
Q

What phase of throwing causes medial epicondylitis?

A

Late cocking and acceleration phase

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13
Q

What phase of a golf swing causes medial epicondylitis?

A

Backswing and downward follow-through swing just prior to ball impact

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14
Q

What is Little Leaguer’s elbow?

A

Hypertrophy of the medial epicondyle leading to microtearing and fragmentation of the medial epicondylar apophysis

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15
Q

What can Little Leaguer’s elbow lead to?

A

Osteochondritis dissecans of the capitellum

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16
Q

What reproduces symptoms of medial epicondylitis on exam?

A

Resisted wrist flexion and pronation

TTP over common flexor tendon origin

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17
Q

What is the MOI of lateral epicondylitis?

A

Activities that require repetitive wrist extension and/or forearm supinatio

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18
Q

What types of poor technique with racquet sports can lead to lateral epicondylitis?

A

– Improper technique for backhand swings
– Inappropriate string tension
– Inappropriate grip size

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19
Q

What tendon is inolved in lateral epicondylitis?

A

Extensor carpi radialis brevis (ECR-B)

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20
Q

Describe Cozen’s test.

A

Pain in the lateral epicondyle with making a fist, pronating forearm, radially deviating and extending the wrist against resistance

21
Q

Describe Mill’s test.

A

Passive extension of the elbow with forced flexion of the wrist with radial deviation may precipitate pain at the lateral epicondyle

22
Q

Describe posttreatment RTP for lateral epicondylitis.

A

– Dec string tension to <55 lb

– Inc grip size

23
Q

What is the mechanism of olecranon bursitis?

A 
Repetitive trauma
Inflammatory  disorder  (gout, pseudogout, RA)
24
Q

Who is typically affected by elbow dislocation?

A

2nd MC dislocation in children and adults

25-30 yo most affected and sports activities account for almost 50% of injuries

25
Q

What is the MOI of elbow dislocation?

A

FOOSH

26
Q

What is the MC direction of elbow dislocation?

A

98% posterior

27
Q

What are associated injuries of elbow dislocation?

A

Radial head fx
Brachial artery
Median nerve

28
Q

What are treatments of elbow dislocation?

A
  • Reduce dislocation as soon as possible after injury
  • Splint for 10 days
  • ROM exercises
  • NSAIDs
29
Q

What is the cause of distal biceps tendonitis?

A

Repetitive elbow flexion and supination or resisted elbow extension

30
Q

What is the cause of distal triceps tendonitis?

A

Overuse syndrome secondary to repetitive elbow extension

31
Q

What is the cause of distal triceps avulsion?

A

Decelerating counterforce during active elbow extension

32
Q

What is valgus extension overload (VEO) syndrome?

A

Overuse elbow injuries in baseball players caused by repetitive valgus forces during the throwing motion, esp cocking and acceleration phases

33
Q

What is the cause of valgus extension overload (VEO) syndrome?

A

Valgus forces cause tensile stress in the medial elbow and lateral shear stress in the posterior aspect of the elbow (posteromedial olecranon)

34
Q

Describe the VEO test.

A

Flex elbow to 30° and repeatedly extend the elbow fully while applying a valgus stress

35
Q

What indicates a (+) VEO test?

A

Pain elicited at the last 5° to 10° of extension

36
Q

Why should a valgus stress test be done in VEO syndrome?

A

Performed >90° to rule out MCL injury

37
Q

What is the cause of MCL/UCL sprain?

A

A repetitive valgus stress occurring across the elbow most prominently during the acceleration phase of throwing

38
Q

What indicates a torn UCL on exam?

A

Medial pain or instability on valgus stress with the elbow, flexed 20° to 30°

39
Q

What indicates UCL on injury on x-ray?

A

Valgus stress radiographs demonstrate a 2-mm joint space

40
Q

What is the cause of a LCL/RCL sprain?

A

Elbow dislocation from a traumatic event

41
Q

What indicates a torn LCL on exam?

A

Lateral pain or instability on varus stress with the elbow flexed 20° to 30°

42
Q

What indicates LCL on injury on x-ray?

A

Varus stress radiographs demonstrating a 2-mm joint space

43
Q

What is pronator teres syndrome?

A

Median nerve compression at the elbow by:
– Ligament of Struthers or supracondylar spur
– Lacertus fibrosus
– Pronator teres muscle
– B/W 2 heads of the FDS

44
Q

What causes ulnar entrapment in cubital tunnel syndrome?

A

– Arcade of Struthers
– Hypermobility of the ulnar nerve
– Excessive valgus force at the elbow
– Impingement from osteophytes or loose bodies

45
Q

What is Panner’s disease?

A

Osteochondrosis of the elbow

Epiphysial aseptic necrosis of the capitellum

46
Q

What is the cause of Panner’s disease?

A

Interference in blood supply to epiphysis> resorption of the ossification center> repair/replacement

47
Q

Which elbow is typically affected by Panner’s disease?

A

Dominant elbow of young boys

48
Q

What is the clinical presentation of Panner’s disease?

A
  • Sx relieved by rest and aggravated by activity
  • Tender/ swelling of lateral elbow
  • Limited extension
49
Q

What is seen on radiographs of Panner’s disease?

A

Sclerosis, patchy areas of lucency with fragmentation

BR 3rd Ed (92 decks)

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