Elbow Flashcards
What observations should you consider when assessing the elbow?
carrying angle– cubitus valgus versus cubitus varus.
is there hyperextension
with the elbow at 90 is there an isosceles triangle with the olecranon and epicondyles
What are the ROM for elbow assessments?
flexion, extension, pronation and supination
what are the special tests for the elbow?
circulatory pulses @ brachial artery and radial artery
tinels sign- tap on ulnar nerve 4-6 times between olecranon process and medial epicondyles
capsular injury- support arm in passive end ROM, if extends past 0 degrees with pain, indication of injury to capsule
what bones make up the elbow?
humerus, ulna, and radius
What are the joints of the elbow?
ulnar-humeral(flexion/ extension)
radio-humeral (flexion/extension)
radio-ulnar(pronation/supination)
What are the main structures of the elbow?
ligaments, musculature, bursa
What are the ligaments of the elbow?
MCL(ulnar collateral ligament), LCL (radial collateral ligament), annular
What musculature makes up the elbow?
biceps brachii, triceps brachii, brachialis, brachioradialis, common extensor and flexors, pronators and supinators.
What is the bursa of the elbow?
olecranon bursa
What muscle acting on the elbow joint causes flexion, forearm supination, and shoulder flexion?
biceps brachii
What muscles acting on the elbow joint cause elbow flexion?
brachialis and brachioradialis
which muscle acting on the elbow joint causes elbow extension and shoulder extension?
triceps brachii
what muscle acting on the elbow joint causes forearm pronation?
pronator teres
which muscle acting on the elbow joint causes elbow extension?
anconeus
What is the ROM for flexion of the elbow?
135 degrees
what is the ROM for pronation-supination of the elbow?
70-90 degrees
what is the ROM for hyperextension?
5 degrees
What protects the elbow from overuse and traumatic injuries?
bony limitations, ligamentous support and muscular stability.
the elbow is a critical link in the kinetic chain in upper extremity
What are carrying angles of the elbow in males and females?
males- 5 degrees
females 10-15
What are acute injuries to the elbow?
contusions, olecranon bursitis, sprains, strains, dislocations, fractures.
What are chronic injuries of the elbow?
tennis elbow, golfers elbow and olecranon bursitis
What is tennis elbow?
lateral epicondylitis
What is golfers elbow?
medial epicondylitis
What are MOI for contusions of the elbow?
direct blow most often involving olecranon bursa
What are S&S of contusions of the elbow?
very painful, localized pain;
rapid swelling if bursa involved
bruising, limited ROM
ulnar neuropraxia with paresthesia into 4/5 phalanges
What is treatment for contusions of the elbow?
PIER, sling and support severe pain suggests xray modalities as necessary pad support for return to play rule out an infection
What are MOI for sprains of the elbow?
FOOSH, hyperextension of elbow or repetitive stresses
what are S&S for elbow sprains?
joint tenderness, pain with AROM & PROM, joint laxity, swelling and limited motion.
how do you manage elbow sprains?
PIER, NSAIDs, & protect with taping/bracing/slinging
What are MOI for strains of the elbow?
movement beyond normal ROM or sudden eccentric loading
S&S of strains of the elbow:
point tenderness, pain with AROM, weakness, swelling, bruising, possible deformity(gr. 3).
How do you manage strains of the elbow?
PIER, NSAIDS, & protect/rest with sling. xray to rule out fracture.
Where can fractures of the elbow occur?
distal humerus, proximal radius, and proximal ulna.
What are MOI for fractures of the elbow?
FOOSH, direct impact, falling on flexed elbow.
What are S&S of fractures of the elbow?
vast amounts of swelling that often occlude injury
extensive pain in elbow joints
associated muscle spasm of surrounding musculature
how do you treat fractures of elbow?
always assess distal PMS (pulse, motor, sensory)
splint and support joints above and below injury in comfortable position
arrange for transport to hospital
What is Colle’s fracture?
involves distal end of radius or ulnar or both.
What is the MOI for Colle’s fracture? How do you treat it?
impact force going through extended or flexed wrist forcing the distal radius and ulna up and back.
sign= drop down of hand from forearm.
splint and transport to medical care
What is epicondylitis?
describes an inflammation at the elbow involving the attachment of the common flexor or extensor tendons of the forearm.
What are MOI for epicondylitis?
direct trauma or overuse/ improper mechanics involving wrist movements with repeated eccentric loads.
what is the etiology of lateral epicondylitis?
eccentric loading of extensors during deceleration phase of throwing or tennis stroke;
poor technique backhand stroke;
racquet size inappropriate/string tension too high/grip too large-weak grip or small- tight grip;
missing the “sweet spot”
age of participant ~30-50yrs
What are S&S of lateral epicondylitis?
pain anterior or just distal to epicondyle; may radiate into forearm extensors during activity
repetition produces pain that becomes more severe and increased with resisted wrist extension
positive tennis elbow test
What is management for lateral epicondylitis?
ICE, NSAIDS adn rest
support for return to activity
What is the etiology of medial epicondylitis?
repeated valgus forces during acceleration phase of throwing;
excessive eccentric wrist flexion
What are s&s of medial epicondylitis?
swelling, ecchymosis, point tenderness at humeroulnar joint over flexor/pronator origin.
severe pain
aggravated by resisted wrist flexion/pronation, valgus stress applied at 15-20 degrees of elbow flexion
ulnar nerve involved
How do you manage medial epicondylitis?
ICE, NSAIDS
immobilize in sling with slight wrist flexion for 2-3 weeks
activity should not be resumed until functional testing can be completed without pain
functional brace for RTP
How do you measure for grip size?
measure proximal crease of palm to tip of ring finger, if between sizes choose smaller size.
where do dislocations occur in the elbow?
proximal radial head;
ulnar dislocation: occurs in <20yrs
- caused by hyperextension; sudden, violent unidirectional valgus force drives ulna posteriolateral
What are S&S for an elbow dislocation?
snapping or cracking sensations;
severe pain, rapid swelling;
total loss of function;
obvious deformity;
arm held in flexion, with forearm appearing shortened;
olecranon and radial head palpable posteriorly;
slight indentation in triceps visible proximal to olecranon;
nerve palsy
management of elbow dislocation:
immediate immobilization;
activate EMS and transport to hostpital
How does olecranon bursitis occur?
acute: fall on flexed elbow
chronic: constant leaning on elbow or repetitive pressure and friction
What are S&S of olecranon bursitis?
tender, swollen, relatively painless
rupture- goose egg visible
50% history of abrupt onset; 50% insidious onset over a few weeks
motion limited at extreme of flexion- tension increases over the bursa
