Cortex- Upper limb: Elbow

Question 1

what joints make up the elbow joint

Answer 1

humero-ulnar joint (flexion and extension)

radio-capitallar and proximal and distal radioulnar joint (supination/pronation)

Question 2

where does the triceps muscle insert

Answer 2

onto the olecranon process

Question 3

what powers elbow extension

Answer 3

triceps muscle

Question 4

what powers elbow flexion

Answer 4

brachialis and biceps

Question 5

where does the brachialis insert

Answer 5

coronoid process

Question 6

what does the biceps insert

Answer 6

bicipital tuberosity of the radius

Question 7

what muscles perform supination

Answer 7

biceps and supinator muscles

Question 8

what muscles perform pronation

Answer 8

pronator teres muscle proximally

pronantor quadratus muscle distally

Question 9

what does the common extensor tendon arise from

Answer 9

lateral epicondyle

Question 10

where does the common flexor tendon arise from

Answer 10

medial epicondyle

Question 11

what gives rise to the conditions of lateral and medial epicondylitis

Answer 11

enthesopathy- when enthesis (attachment) of the common extensor and flexor origins become painful

Question 12

what is OA commonly secondary to in the elbow

Answer 12

trauma (intra-articular traumas)

Question 13

what arthritis commonly affects the elbow

Answer 13

rheumatoid, OA can occur after trauma

Question 14

what is tennis elbow

Answer 14

lateral epicondylitis

Question 15

what causes lateral epicondylitis

Answer 15

repetitive strain injury (in tennis players) who regularly perform resisted extension at the wrist

can also be a degenerative enthesopathy

Question 16

what is the pathology of tennis elbow

Answer 16

micro tears in the common extensor origin

Question 17

what are the clinical features of tennis elbow

Answer 17

painful and tender lateral epicondyle and pain on resisted middle finger and wrist extension

Question 18

what is the treatment for tennis elbow

Answer 18

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

Question 19

what is golfers elbow

Answer 19

medial epicondylitis

Question 20

what cause medial epicondylitis

Answer 20

repeated strain or degeneration of the common flexor origin

Question 21

what is the treatment for medial epicondylitis

Answer 21

self limiting, physio, rest, NSAIDs

not injection as carries risk of injury to the ulnar nerve

Question 22

what is the treatment for arthritic change at the radio-capitellar joint which has failed non-operative management

Answer 22

surgical excision of the radial head

Question 23

what is the treatment for a humero-ulnar joint severely affected by RA or OA that hasn’t been treated by conservative managment

Answer 23

total elbow replacement (lifting restricted to 2.5kg postoperatively

Question 24

what causes cubital tunnel syndrome

Answer 24

compression of the ulnar nerve at the elbow behind the medial epicondyle

Question 25

what are the symptoms of cubital tunnel syndrome

Answer 25

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

Question 26

what is tinel’s test

Answer 26

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

Question 27

what does froments test asses

Answer 27

adductor pollicis

Question 28

what can compression of the ulnar nerve in cupital tunnel syndrome

Answer 28

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

Question 29

what is the treatment for cubital tunnel syndrome

Answer 29

nerve conduction studies to confirm diagnosis, may need surgery to release tight structures