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Anatomy UE > elbow > Flashcards

elbow Flashcards

1
Q

what (basic) account for the eblows stability

A

bony articulation and soft-tissue stabilizers

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2
Q

what kind of joint is the elbow

A

Hinge joint

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3
Q

what are the 2 component of the elbow joint

A

Humero-radial
Humero-ulnar

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4
Q

what bones make up the basic elbow joint

A

the distal humerus, proximal radius and proximal ulna

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5
Q

what make up the Humeroulnar articulation

A

between the trochlea and the trochlear notch

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6
Q

what is the movement seen at the Humeroulnar articulation

A

flexion and extension

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7
Q

what makes up the Humeroradial articulation

A

between the capitulum and the head of the radius

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8
Q

what action is seen at the Humeroradial articulation

A

pronation/supination, flex/ext

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9
Q

what makes up the Proximal radioulnar joint

A

between the head of the radius and the radial notch of the ulna

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10
Q

what movement is seen at the Proximal radioulnar joint

A

pron/sup

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11
Q

what movement do we see at the distal radial ulnar joint

A

pron/sup

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12
Q

what makes up the distal RU joint

A

Articulation between the lateral side of head of ulna with ulnar notch of distal radius

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13
Q

what separates joint cavity of distal RU joint from wrist joint

A

an Articular disc

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14
Q

how much joint stability is provided by the bony architecture

A

50%

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15
Q

how Congruous is the elbow joint

A

One of the most congruous joints

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16
Q

how much joint stability is provided by the soft tissues of the elbow joint

A

50%

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17
Q

how many degrees of freedom in a hindge joint

A

2 DF

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18
Q

what movement is allowed at the elbow joint - high joint

A

flexion and extension

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19
Q

Proximal and distal RU are what kind of joint

A

pivot joints (trochoid) and allow axial rotation or pivoting.

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20
Q

how many joints are in the elbow

A

Anatomically there is 1 joint, the cubital complex (elbow), and 1 capsule

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21
Q

what kind of movement is allowed at all of the elbow structures - all together now

A

Physiologically, the elbow movements are flexion/extension & pronation/supination

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22
Q

Fibrous capsule

A

Completely encloses joints and blends with annular ligament and collateral ligament on each side

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23
Q

Annular ligament

A

holds the radial head in place in radial notch

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24
Q

what are the static soft tissue stabilizers of the elbow

A

Anterior capsule and collateral ligaments

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25
Q

Synovial capsule of the elbow jt

A

inner layer

Lines the deep surface of the annular ligament

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26
Q

synovial capsule and the proximal radio-ulnar joint

A

the SC Continuous with the synovial membrane of the proximal radio-ulnar joint

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27
Q

radius in the synovial membrane

A

Radius is able to rotate in here without tearing

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28
Q

role of the Medial and lateral ligament complexes

A

primary elbow stabilizers, and are thickenings of the fibrous capsule

Restrict – varus and valgus stress

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29
Q

valgus stresses cause the

A

Most instability

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30
Q

which is stronger the medial or lateral collateral ligament complex

A

medial

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31
Q

how many fat pads does the elbow have

A

3 fats pads - between the fibrous capsule and synovial membrane

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32
Q

3 elbow fat pads locations

A

Olecranon fossa – post
Coronoid fossa – ant
Radial fossa – ant

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33
Q

what is the bursa role in the elbow

A

Bursa role is to reduce friction of surface that are moving in each other

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34
Q

Subcutaneous olecranon bursa

A

between skin and olecranon process

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35
Q

Subtendinous olecranon bursa

A

between tendon of triceps and olecranon process

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36
Q

Bicipitoradial bursa

A

between biceps tendon and radial tuberosity

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37
Q

Radioulnar bursa:

A

between extensor digitorum, radiohumeral joint, and supinator

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38
Q

Olecranon bursitis

A

Inflammation of the subcutaneous olecranon bursa – olecranon bursitis or “student’s elbow”.

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39
Q

what causes Olecranon bursitis

A

Caused by repeated friction and pressure of the bursa.

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40
Q

Distal RU fibrous capsule- weakness.

A

encloses the joint – It has weak anterior and posterior bands

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41
Q

Distal RU synovial capsule

A

capsule lines the fibrous capsule and the proximal surface of the disc.

Sacciform recess is the proximal extension of the synovial capsule and it accommodates twisting during pron/sup

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42
Q

what makes up the medial complex

A

Formed by the Medial Collateral Ligament (MCL) or ulnar collateral ligament (UCL)

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43
Q

role of the medial complex

A

resist valgus stress

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44
Q

where is the medial complex coming from

A

Originates on the central part of anteroinferior medial epicondyle, just posterior to the axis of rotation for flexion/ext

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45
Q

3 bundles of the medial complex

A

anterior, posterior, and transverse

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46
Q

Anterior bundle of the medial complex characteristics

A

strongest and stiffest - most important component of ligamentous complex,

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47
Q

when does the ant bundle of the medial complex stabilize the elbow

A

primarily stabilizes elbow from 30° to 120°

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48
Q

portions of the anterior bundle of the medial complex

A

anterior band
posterior band
deep middle portion

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49
Q

anterior band of the ant bundle of the medial complex is taut when

A

taut close to extension
(stabilizes from ± 30 to 60°)

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50
Q

Deep middle portion of the anterior bundle of the medial complex

A

isometric during movement - positioned along the ulnohumeral joint axis

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51
Q

Posterior band of the anterior bundle of the medial complex

A

taut in flexion (stabilizes from 60° to 120° flexion)

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52
Q

Posterior bundle - the medial bundle

A

less defined thickening of capsule – functions as a corestraint with anterior bundle, taut at terminal elbow flexion

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53
Q

Transverse bundle runs from

A

from the tip of the olecranon to just distal to the coronoid (variably present, little role in elbow stability)

  • not seen in everyone
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54
Q

Radial head role in support

A

Radial head is a secondary ulnohumeral joint stabilizer to valgus loads

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55
Q

Flexor and pronator muscles - as support

A

originate at the medial epicondyle and provide additional support on the medial side of the elbow

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56
Q

most common Medial complex injuries

A

Chronic attenuation and Posttraumatic

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57
Q

what type of people is chronic attenuation often seen in

A

throwing players

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58
Q

what is chrontic attenuation

A

combination of valgus and external rotation force, stretching over time

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59
Q

what is Posttraumatic

A

usually after a fall onto an outstretched hand (FOOSH) - associated injuries include fractures of radial head, olecranon, or medial epicondyle

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60
Q

the Lateral Collateral Ligament (LCL) is composed of which ligamnets

A

composed of radial collateral ligament, lateral ulnar collateral ligament, annular ligament, and accessory lateral collateral ligament

y shaped

61
Q

lateral ulnar collateral ligament is a key stablizer for what

A

is key stabilizer for varus stress and posterolateral stability

62
Q

where does the radial collateral​ ligament run

A

lateral humerus at the elbow axis of rotation and courses distally inserting into annular ligament

63
Q

where does the lateral ulnar collateral ligament run too

A

lateral epicondyle to ulna (proximal)

64
Q

what muscle does the RCl give rise too

A

origin for the supinator muscle

65
Q

LCL is the primary restraint to

A

maintain ulnohumeral and radiocapitellar joints in a reduced position when elbow is loaded in supination

66
Q

what is is called when there is an insuffiency in the LCL

A

posterolateral rotatory instability (PLRI),

67
Q

what is posterolateral rotatory instability (PLRI),

A

commonly posttraumatic and is a combination of axial compression, external rotation, and valgus force

68
Q

what are the 2ndary restraints​ of the elbow

A

the extensor muscles

69
Q

posterolateral elbow rotatory instability requires insufficiency of

A

ligaments and muscular origins about the lateral elbow

70
Q

Annular ligament runs from

A

from anterior margin of radial notch of ulna around the radial head to the posterior margin of radial notch (covered with hyaline cartilage)

71
Q

Quadrate ligament runs from

A

from neck of radius to the inferior surface of radial notch of ulna

72
Q

when does the qaurate ligament get taut

A

Anterior fibers = forearm supination
posterior fibers= during pronation

73
Q

Shafts of radius and ulna are connected by

A

interosseous membrane (IM) (syndesmosis) and oblique cord (OC)

74
Q

what muscles interest into the IO

A

FDP, FPL, APL, EPB, EPL, EI

75
Q

what joint does the IO provide support too

A

RUJ

76
Q

IM resists what kind of displacement

A

IM resists proximal displacement of radius on ulna during pushing movements

77
Q

what kind of displacement​ does the oblique cord resist

A

OC resists distal displacement of radius during pulling movements

78
Q

Distal RU joint - ligaments

A

Anterior radioulnar ligament
Posterior radioulnar ligament
triangular fibrocartilage complex (TFCC),

79
Q

Anterior and posterior radioulnar ligament properties

A

both are weak - therefore we need support for other areas (triangluar)

80
Q

triangular fibrocartilage complex (TFCC) is made up of what

A

extensor carpi ulnaris, interosseous ligament, pronator quadratus, and associated forearm muscles

81
Q

Blood for Cubital Complex

A

elbow anastomosis via collateral branches from brachial artery and recurrent branches from radial and ulnar arteries

82
Q

Blood for DRUJ

A

anterior and posterior interosseous arteries

83
Q

Nerve Supply for Cubital Complex

A

articular branches primarily from musculocutaneous, median, and radial nerves

84
Q

Nerve Supply for DRUJ

A

articular branches of anterior and posterior interosseous nerves

85
Q

Elbow movement

A

flexion and extension
sup and pro

86
Q

what joints do pronation and supination

A

in radio-capitellar and proximal and distal RU joints.

87
Q

what jts do Flexion/extension

A

ulnohumeral and radio-capitellar joint.

88
Q

Flexion/extension axis

A

Axis of rotation passes through the capitellum in line with the bottom of the trochlear sulcus (red line)

89
Q

Supination/pronation axis

A

Axis passes through the center of the radial head and extends through the radial border of the distal ulna

90
Q

Extension degress

A

0
5-10 hyperextension

91
Q

what limits extension

A

Limited by bony contact and tension of anterior muscles and ligaments

92
Q

how much active flexion can we get

A

145

93
Q

how much passive flexion can we get

A

160

94
Q

what is passive flexion limited by

A

limited by bony contact and posterior soft tissue tension

95
Q

what is active tension lmited ​by

A

limited by apposition of contracting anterior muscles

96
Q

is the distal humerous concave or convex

A

convex
trochlea & capitulum

97
Q

Proximal ulna has concave feature

A

trochlear notch

98
Q

Proximal radius has concave feature

A

radial head

99
Q

flexion artho

A

anterior (volar) roll and glide of ulna and radius on humerus
- look at the fist

100
Q

extension artho

A

posterior (dorsal) roll and glide of ulna and radius on humerus

101
Q

Movements of proximal RUJ

A

pronation and supination

102
Q

movement seen in the cubital complex during pronation and supination

A

Rotation (spin) of the head of radius about its axis in the osseofibrous ring (i.e., on the capitulum)

103
Q

what does volar mean

A

anterior

104
Q

range of supination and pronation

A

90-degrees

105
Q

supination is restricted​ by

A

Limited by tension in interosseous membrane and volar capsule of the distal RU joint

106
Q

what do the radius and ulna look like in supination

A

parallel

107
Q

in pronation what do the radius and ulna look like

A

the cross each other

108
Q

what restricts pronation

A

bony contact of the radius and the ulna ring(capitulm) and tension in dorsal band of distal RU joint

109
Q

what is moving in pronation and supination at the proximal RUJ

A

convex radial head on the concave radial notch of the ulna

110
Q

pronation at proximal​ RUJ

A

anterior roll and posterior glide of radial head on proximal ulna

111
Q

supination at the proximal RUJ

A

posterior roll and anterior glide of radial head on proximal ulna

112
Q

Distal RUJ cave and vex

A

Medial aspect of radius is concave AP (ulnar notch); radial aspect of distal ulna is convex AP

113
Q

Distal RUJ pronation

A

anterior roll and glide of distal radius on ulnar head

114
Q

Distal RUJ supination

A

posterior roll and glide of distal radius on ulnar head

115
Q

do we do joint mobilzation and play in open or closed packed ppositions​

A

open

116
Q

Open-packed position Humeroulnar joint

A

70° of elbow flexion, 10° supination

117
Q

Open-packed position Humeroradial joint

A

full extension and supination

118
Q

Open-packed position Radioulnar joints

A

proximal- 35° of supination, 70° elbow flexion
distal - 10° supination

119
Q

Close-packed position Humeroulnar joint

A

full elbow extension

120
Q

Close-packed position Humeroradial joint

A

90° of flexion, 5° of supination

121
Q

Close-packed position Radioulnar joints

A

5° of supination

122
Q

during extension what do the olecranon and epis form

A

a stright line

123
Q

during flexion what do the olecranon and epis form

A

isosceles triangle

124
Q

Elbow flexion contractures develop when

A

rapidly when elbow is immobilized for extended period of time (6 weeks)

125
Q

traumatic compressive forces what is most likely​ to fracture

A

Radial head and coronoid process are liable to fracture

126
Q

is the elbow often dislocated

A

2nd most common joint dislocated
Dislocations may be simple (not fracture) or complex (with fractures)

127
Q

what is more common Posterior or anterior dislocation

A

post

128
Q

Posterior dislocation what direction does the ulna and humerus​ move

A

posterior - ulna
anterior - humerous

129
Q

what normally causes a Posterior dislocation

A

due to fracture of coronoid process or humeral condyles (compressive force with extended elbow)

130
Q

Associated fractures with elbow dislocations are more common in what population

A

children (bone fusion occurs ~ 14 to 17)
elderly due to fragile bones

131
Q

In children where do we see associated fractures

A

fracture-separation of proximal radial epiphysis, or fracture dislocation of the humeral condyles

132
Q

carrying angle - created by what

A

formed by the orientation of the trochlear groove

the distal projection of the medial edge of the trochlear compared to the lateral edge

the lateral orentation of the ulnar shaft

133
Q

what is the average carrying angle

A

14

larger in females

134
Q

is carrying angle present in fleexion and extension

A

not flexion just extesnion

135
Q

where is the supinator crest

A

distal to the trochlear groove

136
Q

what attaches at the supinator creast

A

laterasl portion of the UCL and supinator muscle

137
Q

is the radial head concave or convex

A

concave

138
Q

how many joints does the triceps cross

A

2

139
Q

what are stronger elbow flexors​ or extensors

A

Elbow extensors are weaker than the elbow flexors by around 30%, and the dominant side is around 5-10% stronger than the non-dominant side.

140
Q

Common Extensor Tendon comes from what side of the humerou​s

A

lateral epicondyle

141
Q

what is in the common extensor tendon

A

Extensor carpi radialis brevis (Deep radial n.)
Extensor digitorum (PIN)
Extensor digiti minimi (PIN)
Extensor carpi ulnaris (PIN)

142
Q

Lateral epicondylitis

A

Principally ECRB
May involve radioulnar bursa

143
Q

Radial Nerve Entrapments

A

Posterior interosseous n. (comes off deep branch of radial n.) runs between 2 heads of supinator muscle through the Arcade of Frohse (present in 30% of population), which is a possible site of entrapment

144
Q

Intermediate layer of the forearm

A

Flexor digitorum superficialis

145
Q

Common Flexor Tendon comes from what part of the humerous

A

medial epicondyle

146
Q

Common Flexor Tendon- muscles

A

Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
Flexor digitorum superficialis

147
Q

Medial Epicondylitis

A

Inflammation of medial epicondyle and common wrist flexor tendon

148
Q

Median Nerve Entrapment

A

Median and anterior interosseous nerves pass through the 2 heads of pronator teres

The 2 heads are joined by the tendinous arch of the FDS, and nerve can be entrapped there

149
Q

Ulnar Nerve Entrapment

A

In tunnel entrance - space formed by medial intermuscular septum and covering layer of fascia (arcade of Struthers), pink

In tunnel exit: between two origins of flexor carpi ulnaris (Osborne’s lig), blue

Anatomy UE (11 decks)

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