Elbow Flashcards
What Structures absorb the forces in elbow distraction
Extension - 90% anterior capsule, 10% MCL and LCL
90 flexion - MCL provides most support
What Structures absorb a valgus force at the elbow
Extension - MCL, anterior capsule, joint articulation equally
90 flexion - 50% MCL, 50% capsule and bony articulation
What Structures absorb a varus force at the elbow
Extension - 50% LCL, anterior capsule, 50% joint articulation
90 flexion - 80% joint articulation, 20% soft tissues
Briefly describe Lateral elbow tendinopathy
Tendon degeneration and pain at the lateral aspect of the elbow
What structures present with imaging abnormalities with LET
ECRB
LCL
Anular ligament
What activities are associated with LET
Smokers Tennis players Manual workers Basketball Javelin Golf Squash Racquet ball Swimming Weight lifting
What motion of the arm could lead to LET
Repetitive grasping with the wrist in extension
What is the clinical presentation of LET
Pain with extension and grasping activities
Achiness and morning stiffness
Where is the tenderness located with LET
Max tenderness over lateral epicondyle
ECRL
ECRB
What AROM and PROM finding will present with LET
AROM - pain with wrist flexion when combined with elbow extension
PROM - Pain with wrist flexion when the forearm is pronated and elbow extended
What are some special tests for LET
Chair test Cozens test Mills test Maudsley Pain free grip test
How do you determine if LET pain is remote
Symptoms will change with various positions of the neck and shoulders
What is the intervention strategy for LET
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
What is the PTREE
Valid, reliable and sensitive measurement for LET
MCID = 11
What is the MOI for MCL sprains
Chronic resistance of valgus and ER forces
FOOSH
What activities are associated with MCL sprains
Tennis
Baseball
Describe the presentation of MCL sprain
Medial elbow pain
May have osteophyte formation and degeneration of the bone
What are some general intervention strategies for MCL sprain
2-4 weeks of rest and activity modification
ROM exercises, modalities, NSAID’s
What are the goals in the acute phase of MCL sprain treatment
Manage pain and inflammation
Increase ROM
Promote MCL healing
Prevent muscle atrophy
What are the goals in the subacute phase of MCL sprain treatment
Strengthening and stretching of the FCU and FDS
Strengthen secondary stabilizers
Strengthen elbow and shoulder muscles
What are the goals in the chronic phase of MCL sprain treatment
Improve strength
What is the criteria to return to throwing for MCL sprains
Full and nonpainful ROM
No increase in laxity
Isokinetic tests fulfill criteria
Briefly describe medial elbow tendinopathy
Tendinopathy of common flexor origin
Specifically the FCR and humeral head of pronator Teres
Describe the MOI for MET
Repetitive wrist flexion activities
Direct trauma
What are some more detailed MOIs for MET
Fatigue of flexor and pronator muscles
Sudden change in level of stress
MCL fails to stabilize
How does MET begin
As a micro tear between pronator teres and FCR origins
How does MET present
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
How do you treat triceps tendinopathy
Closed chain extension exercises
Shoulder strengthening
Scapular stabilization
Describe the MOI of olecranon bursitis
Direct trauma
Repetitive stress
Describe the presentation of Olecranon bursitis
Swelling over the olecranon
Decreased ROM
Inability to don long shirt
How do you determine if the bursa is infected and what do you do if it is
Exquisite tenderness = infection or trauma
Redness and heat = inflammation
Infected bursa need prompt medical attention
Briefly describe the fat pad at the elbow
Moves posterior in elbow extension as it is pulled by the triceps and anconeus
Describe the MOI of an irritated fat pad at the elbow
Poor mobility
Trauma
Describe the presentation of an irritated fat pad at the elbow
Will become irritated
If adhered, hypomobility and spring rebound end feel
Describe some fat pad interventions
Management of inflammation
Elbow joint mobilizations - distraction may relieve pain
STM
Submax triceps isometrics
What is a common MOI for biceps rupture
Contraction of biceps against significant load in 90 degrees flexion
Occurs after 50
What should make you suspect brachialis involvement
Pain with elbow flexion and forearm pronation
What is the Common age of children with nursemaid’s elbow
Preschool age
What is the MOI of nursemaids elbow
Longitudinal traction force on the pronated wrist and extended elbow
How does nursemaid’s elbow present
No swelling or deformity
Child unwilling to use the arm
What intervention do you use for nursemaid’s elbow
Supination and downward pressure on the radius with extended elbow
Click indicates success
What nerve is affected the most at the elbow
Ulnar nerve
What is the MOI for cubital tunnel syndrome
Repetitive motion
Prolonged elbow flexion
Medial elbow instability
What is cubital tunnel syndrome presentation
Pain in ulnar distribution
Weakness in ulnar distribution
Both worse at night
What are some intervention strategies for cubital tunnel syndrome
Activity modification and protection
Surgery for people 3-4 months in
Briefly describe Median nerve entrapment and name the 2 types
Relatively rare
Often misdiagnosed as CTS
Pronator syndrome
Anterior interosseous syndrome
Name the locations of entrapment in PS
Bicipital aponeuroses
Pronator teres
FDS
Describe the presentation of PS
Insidious onset
Pain on anterior elbow, radial palm, lateral 3 1/2 digits
“Heaviness of forearm”
What does not present with PS
Tinnel’s sign at carpal tunnel
Nocturnal symptoms
What are some interventions for PS
Rest
NSAID’s
Ice
Restore wrist strength and flexibility
Where is the nerve entrapped in AIS
Part of FPL - gantzer’s muscle
FCR
Describe the presentation of AIS
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
What are the clinical differences between CTS, PS, AIS
CTS - paresthesia in lateral 3 1/2 digits
PA - Paresthesia in lateral 3 1/2 digits and radial palm
AIS - no paresthesia
What are the 4 types of radial nerve entrapment
High radial nerve compression
Posterior interosseous nerve syndrome
Radial tunnel syndrome
Radial sensory nerve entrapment
Describe the presentation of high radial nerve compression
Loss of wrist, finger and thumb extension
Decreased sensation to dorsal webspace
Describe the MOI of high radial nerve compression
Humeral fracture or triceps compression
Describe the presentation of posterior interosseous nerve syndrome
tender 3-4cm distal to lateral epicondyle
Lateral elbow pain radiating into distal forearm
Pain with repetitive pronation and supination
Describe the presentation of radial tunnel syndrome
Poorly localized pain on lateral elbow
Describe the presentation of radial sensory nerve entrapment
burning pain along the posterior-radial forearm, wrist and thumb
Pain with flexion and ulnar deviation
In radial sensory nerve entrapment what muscles are indicated
Brachioradialis
ECRL
Describe the valgus stress test
Tests anterior band of MCL
Describe the moving valgus test
90 90 arm and shoulder
Tests for chronic MCL tear
Describe the milking maneuver
Tests the posterior band of MCL
Describe the elbow flexion test for cubital tunnel
Tests for ulnar compression at the cubital tunnel Depress both shoulders Supinate the forearms Flex both elbows Extend both wrists 3-5 minutes
Describe this special test
Popeye sign
Indicates rupture of the long head of the biceps
