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TRI 3 - MSK 2 > Elbow > Flashcards

Elbow Flashcards

1
Q

What Structures absorb the forces in elbow distraction

A

Extension - 90% anterior capsule, 10% MCL and LCL

90 flexion - MCL provides most support

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2
Q

What Structures absorb a valgus force at the elbow

A

Extension - MCL, anterior capsule, joint articulation equally
90 flexion - 50% MCL, 50% capsule and bony articulation

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3
Q

What Structures absorb a varus force at the elbow

A

Extension - 50% LCL, anterior capsule, 50% joint articulation
90 flexion - 80% joint articulation, 20% soft tissues

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4
Q

Briefly describe Lateral elbow tendinopathy

A

Tendon degeneration and pain at the lateral aspect of the elbow

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5
Q

What structures present with imaging abnormalities with LET

A

ECRB
LCL
Anular ligament

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6
Q

What activities are associated with LET

A 
Smokers
Tennis players
Manual workers
Basketball
Javelin
Golf
Squash
Racquet ball
Swimming
Weight lifting
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7
Q

What motion of the arm could lead to LET

A

Repetitive grasping with the wrist in extension

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8
Q

What is the clinical presentation of LET

A

Pain with extension and grasping activities

Achiness and morning stiffness

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9
Q

Where is the tenderness located with LET

A

Max tenderness over lateral epicondyle
ECRL
ECRB

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10
Q

What AROM and PROM finding will present with LET

A

AROM - pain with wrist flexion when combined with elbow extension
PROM - Pain with wrist flexion when the forearm is pronated and elbow extended

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11
Q

What are some special tests for LET

A 
Chair test
Cozens test
Mills test
Maudsley
Pain free grip test
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12
Q

How do you determine if LET pain is remote

A

Symptoms will change with various positions of the neck and shoulders

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13
Q

What is the intervention strategy for LET

A 
Ideal remedy not yet found
Acute
 - Decrease pain, inflammation
 - Promote tissue healing
 - Increase flexibility
 - Prevent atrophy
 - Subacute 
 - Continue to improve strength and flexibility
Chronic
 - Continue to improve strength and flexibility
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14
Q

What is the PTREE

A

Valid, reliable and sensitive measurement for LET

MCID = 11

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15
Q

What is the MOI for MCL sprains

A

Chronic resistance of valgus and ER forces

FOOSH

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16
Q

What activities are associated with MCL sprains

A

Tennis

Baseball

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17
Q

Describe the presentation of MCL sprain

A

Medial elbow pain

May have osteophyte formation and degeneration of the bone

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18
Q

What are some general intervention strategies for MCL sprain

A

2-4 weeks of rest and activity modification

ROM exercises, modalities, NSAID’s

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19
Q

What are the goals in the acute phase of MCL sprain treatment

A

Manage pain and inflammation
Increase ROM
Promote MCL healing
Prevent muscle atrophy

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20
Q

What are the goals in the subacute phase of MCL sprain treatment

A

Strengthening and stretching of the FCU and FDS
Strengthen secondary stabilizers
Strengthen elbow and shoulder muscles

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21
Q

What are the goals in the chronic phase of MCL sprain treatment

A

Improve strength

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22
Q

What is the criteria to return to throwing for MCL sprains

A

Full and nonpainful ROM
No increase in laxity
Isokinetic tests fulfill criteria

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23
Q

Briefly describe medial elbow tendinopathy

A

Tendinopathy of common flexor origin

Specifically the FCR and humeral head of pronator Teres

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24
Q

Describe the MOI for MET

A

Repetitive wrist flexion activities

Direct trauma

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25
Q

What are some more detailed MOIs for MET

A

Fatigue of flexor and pronator muscles
Sudden change in level of stress
MCL fails to stabilize

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26
Q

How does MET begin

A

As a micro tear between pronator teres and FCR origins

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27
Q

How does MET present

A

Pain on flexor pronator origin, slightly distal and anterior to the medial epicondyle
Pain with resisted flexion and pronation
Pain with passive extension and supination

28
Q

How do you treat triceps tendinopathy

A

Closed chain extension exercises
Shoulder strengthening
Scapular stabilization

29
Q

Describe the MOI of olecranon bursitis

A

Direct trauma

Repetitive stress

30
Q

Describe the presentation of Olecranon bursitis

A

Swelling over the olecranon
Decreased ROM
Inability to don long shirt

31
Q

How do you determine if the bursa is infected and what do you do if it is

A

Exquisite tenderness = infection or trauma
Redness and heat = inflammation
Infected bursa need prompt medical attention

32
Q

Briefly describe the fat pad at the elbow

A

Moves posterior in elbow extension as it is pulled by the triceps and anconeus

33
Q

Describe the MOI of an irritated fat pad at the elbow

A

Poor mobility

Trauma

34
Q

Describe the presentation of an irritated fat pad at the elbow

A

Will become irritated

If adhered, hypomobility and spring rebound end feel

35
Q

Describe some fat pad interventions

A

Management of inflammation
Elbow joint mobilizations - distraction may relieve pain
STM
Submax triceps isometrics

36
Q

What is a common MOI for biceps rupture

A

Contraction of biceps against significant load in 90 degrees flexion
Occurs after 50

37
Q

What should make you suspect brachialis involvement

A

Pain with elbow flexion and forearm pronation

38
Q

What is the Common age of children with nursemaid’s elbow

A

Preschool age

39
Q

What is the MOI of nursemaids elbow

A

Longitudinal traction force on the pronated wrist and extended elbow

40
Q

How does nursemaid’s elbow present

A

No swelling or deformity

Child unwilling to use the arm

41
Q

What intervention do you use for nursemaid’s elbow

A

Supination and downward pressure on the radius with extended elbow
Click indicates success

42
Q

What nerve is affected the most at the elbow

A

Ulnar nerve

43
Q

What is the MOI for cubital tunnel syndrome

A

Repetitive motion
Prolonged elbow flexion
Medial elbow instability

44
Q

What is cubital tunnel syndrome presentation

A

Pain in ulnar distribution
Weakness in ulnar distribution
Both worse at night

45
Q

What are some intervention strategies for cubital tunnel syndrome

A

Activity modification and protection

Surgery for people 3-4 months in

46
Q

Briefly describe Median nerve entrapment and name the 2 types

A

Relatively rare
Often misdiagnosed as CTS
Pronator syndrome
Anterior interosseous syndrome

47
Q

Name the locations of entrapment in PS

A

Bicipital aponeuroses
Pronator teres
FDS

48
Q

Describe the presentation of PS

A

Insidious onset
Pain on anterior elbow, radial palm, lateral 3 1/2 digits
“Heaviness of forearm”

49
Q

What does not present with PS

A

Tinnel’s sign at carpal tunnel

Nocturnal symptoms

50
Q

What are some interventions for PS

A

Rest
NSAID’s
Ice
Restore wrist strength and flexibility

51
Q

Where is the nerve entrapped in AIS

A

Part of FPL - gantzer’s muscle

FCR

52
Q

Describe the presentation of AIS

A

Motor loss of FPL, pronator quadratus, half of FDP
Unable to perform ok sign
Pain and weakness with flexion of IP of thumb and DIP of index

53
Q

What are the clinical differences between CTS, PS, AIS

A

CTS - paresthesia in lateral 3 1/2 digits
PA - Paresthesia in lateral 3 1/2 digits and radial palm
AIS - no paresthesia

54
Q

What are the 4 types of radial nerve entrapment

A

High radial nerve compression
Posterior interosseous nerve syndrome
Radial tunnel syndrome
Radial sensory nerve entrapment

55
Q

Describe the presentation of high radial nerve compression

A

Loss of wrist, finger and thumb extension

Decreased sensation to dorsal webspace

56
Q

Describe the MOI of high radial nerve compression

A

Humeral fracture or triceps compression

57
Q

Describe the presentation of posterior interosseous nerve syndrome

A

tender 3-4cm distal to lateral epicondyle
Lateral elbow pain radiating into distal forearm
Pain with repetitive pronation and supination

58
Q

Describe the presentation of radial tunnel syndrome

A

Poorly localized pain on lateral elbow

59
Q

Describe the presentation of radial sensory nerve entrapment

A

burning pain along the posterior-radial forearm, wrist and thumb
Pain with flexion and ulnar deviation

60
Q

In radial sensory nerve entrapment what muscles are indicated

A

Brachioradialis

ECRL

61
Q

Describe the valgus stress test

A

Tests anterior band of MCL

62
Q

Describe the moving valgus test

A

90 90 arm and shoulder

Tests for chronic MCL tear

63
Q

Describe the milking maneuver

A

Tests the posterior band of MCL

64
Q

Describe the elbow flexion test for cubital tunnel

A 
Tests for ulnar compression at the cubital tunnel
Depress both shoulders
Supinate the forearms
Flex both elbows
Extend both wrists
3-5 minutes
65
Q

Describe this special test

A

Popeye sign

Indicates rupture of the long head of the biceps

TRI 3 - MSK 2 (7 decks)

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