Cortex- Upper limb: Elbow Flashcards
what joints make up the elbow joint
humero-ulnar joint (flexion and extension)
radio-capitallar and proximal and distal radioulnar joint (supination/pronation)
where does the triceps muscle insert
onto the olecranon process
what powers elbow extension
triceps muscle
what powers elbow flexion
brachialis and biceps
where does the brachialis insert
coronoid process
what does the biceps insert
bicipital tuberosity of the radius
what muscles perform supination
biceps and supinator muscles
what muscles perform pronation
pronator teres muscle proximally
pronantor quadratus muscle distally
what does the common extensor tendon arise from
lateral epicondyle
where does the common flexor tendon arise from
medial epicondyle
what gives rise to the conditions of lateral and medial epicondylitis
enthesopathy- when enthesis (attachment) of the common extensor and flexor origins become painful
what is OA commonly secondary to in the elbow
trauma (intra-articular traumas)
what arthritis commonly affects the elbow
rheumatoid, OA can occur after trauma
what is tennis elbow
lateral epicondylitis
what causes lateral epicondylitis
repetitive strain injury (in tennis players) who regularly perform resisted extension at the wrist
can also be a degenerative enthesopathy
what is the pathology of tennis elbow
micro tears in the common extensor origin
what are the clinical features of tennis elbow
painful and tender lateral epicondyle and pain on resisted middle finger and wrist extension
what is the treatment for tennis elbow
self limiting, usually resolves
rest from activity that exacerbates pain, physio, NSAIDs, steriod injections, brace (elbow clasp)
surgery (division and excision of some fibres of common extensor origin) for refractory cases
what is golfers elbow
medial epicondylitis
what cause medial epicondylitis
repeated strain or degeneration of the common flexor origin
what is the treatment for medial epicondylitis
self limiting, physio, rest, NSAIDs
not injection as carries risk of injury to the ulnar nerve
what is the treatment for arthritic change at the radio-capitellar joint which has failed non-operative management
surgical excision of the radial head
what is the treatment for a humero-ulnar joint severely affected by RA or OA that hasn’t been treated by conservative managment
total elbow replacement (lifting restricted to 2.5kg postoperatively
what causes cubital tunnel syndrome
compression of the ulnar nerve at the elbow behind the medial epicondyle
what are the symptoms of cubital tunnel syndrome
paraesthesiae in the ulnar 1 1/2 fingers
tinels test over the cubital tunnel is usually positive
weakness of ulnar nerve innervated muscles may be present- 1st dorsal interosseous (abduction index finger) and adductor pollicis
what is tinel’s test
to detect irritated nerves- lightly tapping (percussing) over the nerve to elicit a sensation of tingling or “pins and needles” in the distribution of the nerve
what does froments test asses
adductor pollicis
what can compression of the ulnar nerve in cupital tunnel syndrome
a tight band of fascia forming the roof of the tunnel (osbornes fascia)
tightness at the intermuscular septum as the nerve passes through or between the two heads at the origin of flexor carpi ulnaris
what is the treatment for cubital tunnel syndrome
nerve conduction studies to confirm diagnosis, may need surgery to release tight structures
