conditions of the elbow and forearm

Question 1

what mvts does the humeroulnar joint do

Answer 1

flexion (biceps, brachioradialis) and extension (triceps)

Question 2

what mvts does the prox/distal radioulnar joint do

Answer 2

supination (supinator) and pronation (pronator teres)

Question 3

what are the three main n. of the arm and where do they pass

Answer 3

median (pierces thru pronator teres)
ulnar (comes out of brachial plexus)
radial (pierces thru supinator m.)

Question 4

what is an ulnar collateral lig sprain caused by and what band is more commonly injured

Answer 4

valgus loading of the HU joint, foosh
anterior band (elbow flex past 60° can injure post band too)

Question 5

what is the carrying angle and how does it affect the risk of a sprain

Answer 5

angle btw humerus and ulna w a straight arm

increased risk of sprain if angle is bigger

Question 6

UCL sprain is more common in what athletes and in what mvt

Answer 6

in overhead athletes with cocking and acceleration phases = most stress on UCL (pull baseball players out of game bc of overhead mvt but can keep rugby and hockey players in if just medium pain)

Question 7

s/s UCL sprain

Answer 7

• pain w mvt (swelling pressure will cause pain too, flex=post, extension=ant capsule)
• feeling of potential instability
• pronation and wrist flexors weak
• swelling can be noted- medial and post aspects
• ecchymosis
• ulnar n. involvement (numbness, tingling, burning all the way down to the pinky)

Question 8

valgus extension overload is a collection of what kinds of forces

Answer 8

tensile (on UCL, ulnar n.)
compressive/shear (radial head and post medial olecranon process)
all caused by UCL laxity

Question 9

s/s valgus extension overload and what structures will rub if the other side of the joint closes

Answer 9

pain on medial side and radial head
posteromedial and lateral elbow pain
nerve paresthesia

radial head and humerus will rub b. on b. which can also cause a chip of b. to come off and stay stuck in the joint which will lock that jnt

Question 10

what is a RCL sprain, what is it caused by and is it common

Answer 10

pain and laxity
weakness during pronation, supination (bc RCL attaches to the radial head)
weakness of wrist extensors (all pull on lateral epi; where the RCL is)

more rare bc most positions are shielded from varus stress

Question 11

what is affected in an anterior capsular ligament sprain, what moi can be seen, where can pain be felt

Answer 11

• can be seen in foosh (hyperextension of the elbow will cause pain)
• pain in cubital fossa w palpation, pain w passive elbow extension at end ROM
• elbow flexors may also be affected (bicep, brachialis and brachioradialis bc they run over that area)

Question 12

what is medial epicondylitis, what is it caused by and what is another name for it

Answer 12

its an irritation to medial epicondyle, where all of the wrist flexor m. originate (eccentric mvt will pull on epi even more)

caused by:

• repeated, medial tension/lateral compression (valgus forces)
• swift, powerful snapping of the wrist and pronation of the forearm

golfer’s elbow: ecc cnt of wrist flexors by that quick mvt of snapping of wrist

Question 13

s/s of medial epicondylitis

Answer 13

• swelling, ecchymosis
• tenderness on origin of common flexor tendon (just distal to medial epi; 1-2 cm below along FCR and PT m.)
• pain w flexion and pronation of wrist
• grip decreased (gripping smt will cause pain on medial epi)
• may have n. involvement; ulnar n. (if m. is too tight = will pinch it)
• valgus stress test may cause pain at 20-30°

Question 14

which one is more micro/macrotrauma out of lat and medial epicondylitis

Answer 14

lat: macro
medial: micro

Question 15

what is a little league elbow

what becomes vulnerable and what can be done to prevent it

Answer 15

avulsion of the common flexor tendon (attached to it) from medial epicondyle due to tension build up, it’s a bone that can’t keep up with the strength of all the other structures
growth plate becomes vulnerable (inj to that area can stunt growth)
restrict the number of pitches/week (<200, 3-4 innings/game)

Question 16

what is lateral epicondylitis and what is the other name for it

Answer 16

inflammation or repetitive stresses at the lateral epicondyle (irritates the common origin of the wrist extensor m., extensor carpi radialis brevis=most affected)
repetitive eccentric forces
will cause pain with a reduced strength

tennis elbow bc wrist pushed into flexion and extensors will contract eccentrically

Question 17

s/s lateral epicondylitis

Answer 17

• pain over lat epi
• decreased grip strength, pain w gripping
• may see swelling, point tenderness over lat epi w palpation
• pain w resisted wrist extension, elbow extension and forearm supination
• possible entrapment of the radial n. (if m. are tight, will find during palpation)

Question 18

how can you RTP an athlete that has med/lat epicondylitis

Answer 18

adding a foam pad that will change the point of origin of that m.

Question 19

what is ulnar n. pathology and what are the possible moi

Answer 19

superficial therefore predisposing it to concussive forces
nerves supporting structures are unstable (irritation that can come from many diff areas; pinched at thoracic outlet for example)

moi: may chronically sublux as forearm is flexed (sublux from behind medial epi), subject to traction forces when throwing (valgus), inflammed structures can decrease cubital tunnel leading to compression of the ulnar n.

Question 20

s/s ulnar n. pathology

Answer 20

• ulnar n. is stretched w elbow flexion and wrist extension
• may complain of decreased sensory and motor function (any m. that the ulnar n. innervates)
• complain of increased symptoms w elbow flexed for extended periods of time (night pain- if elbow flexed)
• burning to medial forearm, pinky/ring finger (elbow flex and wrist ext)
• decreased strength of finger flexors, thumb abductors and the FCU
• numbness on dorsal side; indicates ulnar neuropathy coming from the elbow
• numbness on the palmar side; indicates entrapment in the tunnel of guyon (pinched btw pisiform and hook of hamate)

Question 21

what are the common places for ulnar n. entrapment

Answer 21

btw the two heads of the FCU

behind the medial epicondyle

Question 22

musculoskeletal injuries heal __ times ___ than n. injuries

Answer 22

3 times faster

Question 23

radial n. pathology is most commonly injured with what

Answer 23

deep lacerations of the elbow or secondary to fx of the humerus or radius

Question 24

what is radial tunnel syndrome (what is it, where is it, s/s)

Answer 24

entrapment of the radial n.
located more distally than lateral epicondylitis
s/s: reproduced w resisted supination, extension of the middle finger

Question 25

path of the radial n.

Answer 25

lateral arm; thumb, first and second digit

Question 26

median n. pathology, where is it typically injured

Answer 26

at the distal forearm; pressure as the n. crosses the cubital fossa can put pressure on the median n.

Question 27

what is the pronator teres syndrome

Answer 27

median n. compressed by the pronator teres, inability to pinch the tip of the thumb and index fingers together

Question 28

what is the forearm compartment syndrome; what is it caused by and what does it increase the risks of compromising

Answer 28

increased pressure in the palmar, dorsal components of the forearm (bc lots of m., vessels, n. in that small space)
cause by hypertrophy m., hemorrhage (lots of swelling and bleeding will increase pressure), fx to the mid forearm or distal radius , supracondylar area

increases the risk of compromising the circulation (check PMSC) and neurological function (some will cut the skin to release some pressure)

Question 29

s/s forearm compartment syndrome

Answer 29

• complains of pressure in the forearm
• sensory disruption in the hand/fingers
• decreased muscular strength
• pain during stretching of the m. (more than normal stretch discomfort)
• prolonged/increased intensity, absence of radial or ulnar pulses can lead to; volkmann’s ischemic contracture (tissues start to die bc of lack of nutrients/blood supply)

Question 30

where can bicep strains occur

Answer 30

midbelly of muscle or distal end of tendon (m. tendon jnt)

Question 31

bicep ruptures are more common at what age

Answer 31

males 40 and more

tendon degrades w time

Question 32

moi and s/s of bicep ruptures and strains

Answer 32

eccentric loading of the biceps brachii when elbow is flexed to 90°

• loss of strength of elbow flexion and supination
• chief complaints: immediate pain, pop, loss of elbow flexion
• swelling or ecchymosis
• palpable defect possible

Question 33

moi and s/s of tricep strains

Answer 33

usually caused by eccentric load of triceps (cte elbow forced into flexion)
possible swelling, ecchymosis, palpable defect
chief complaints: pain w elbow extension, loss of strength

Question 34

what is the moi for an elbow dislocation

Answer 34

large traumatic force (foosh, increased valgus force): axial load through the forearm w elbow slightly flexed

Question 35

what is the incidence for a posterior dislocation of the elbow

Answer 35

90%; forearm is displaced posterior or posterolateral to the humerus; olecranon pushed post to humerus (looses groove in elbow)

Question 36

s/s of elbow dislocated and what needs to be done immediately

Answer 36

onset of rapid swelling, deformity
compromised blood vessels and n.
reduction ASAP (by trained professional)

Question 37

what is osteochondritis dissicans of the capitellum (how does it develop and what are the chief complaints)

Answer 37

develops from increased valgus loading compressing the radial head and capitulum w overhead throwing
(gets caught in elbow and blocks ROM like a doorstop)

lat elbow pain that increases w activity
flexion contracture
locking of the elbow (loose body)

Question 38

what are the two types of olecranon bursitis and what is the diff btw them

Answer 38

subcutaneous bursa; located btw olecranon and skin, typically injured from a traumatic force to the elbow

subtendinous bursa; located btw tricep tendon and olecranon, inflamed due to repetitive stresses applied to a jnt

Question 39

what are the two possible moi for olecranon bursitis

Answer 39

acute or chronic : fall on flexed elbow, constantly leaning on elbow-repetitive pressure

Question 40

s/s of olecranon bursitis

and what needs to be done first

Answer 40

• immediate, tender swollen area (golf ball)
• redness
• pain w mvt of the elbow
• rebound pain (when youb let go of the area, the pressure will go up)

compression wrap first always with a pad on the area too