Elbow Flashcards
Humeroulnar responsible for?
15* carrying angle
Open pack Humeroulnar
70* flexion and 10* supination
Closed pack Humeroulnar
Max flexion
Humeroradial open pack
Extension and supination
Humeroradial closed pack
90* flexion and 5* supination
Radioulnar open pack
70* flexion and 35* supination
Radioulnar closed pack
5* supination
UCL stability against ____ forces between ______ & ______ degrees flexion
Valgus between 20-130 degrees
Anterior bundle of UCL stability at what angles of elbow flexion?
30, 60, 90 degrees
Posterior oblique bundle of UCL is taught when?
After 60* of flexion
Lateral ligament complex general function
Maintains stability of humeral joints when in supination
RCL function
Stabilizes varus forces from extension thru 90* flexion
Ulnar nerve tension test (ULTT 3 - 6 actions) & nerve roots
Shoulder girdle depression, shoulder abduction, shoulder external rotation, wrist and finger extension, elbow flexion, wrist pronation
C8-T1
Median nerve tension test (ULTT 1 - 7 actions) & nerve roots
C5-T1
Shoulder girdle depression, shoulder abduction, shoulder ER, supination, wrist and finger extension, elbow extension, cervical lateral flexion
Median nerve passes thru what muscle?
Pronator teres
Radial Nerve tension test (ULTT 2 - 7 actions) & nerve roots
C5-T1
Shoulder girdle depression, elbow extension, shoulder IR, pronation, wrist and finger flexion
Radial nerve branches into what 3 nerves?
Posterior interosseous nerve, deep and superficial branches of radial N.
What muscles originate at the common flexor tendon?
Flexor carpi radialis
Flexor carpi ulnaris
Palmaris longus
Flexor digitorum superficialis
What muscles originate at the common extensor tendon?
Extensor carpi radialis longus and brevis
Extensor digitorum
Extensor carp ulnaris
Extensor digiti minimi
How to test Brachialis
In pronation
How to test biceps
Supinated
Hope to test Brachioradialis
Neural hand/forearm position
Normal flexion ROM
140-150*
Normal extension ROM
0*
Normal supination ROM
85*
Normal supination ROM
85*
Normal supination ROM
85*
Normal pronation ROM
75*
Tests for lateral epicondylopathy
Cozen’s (forearm pronated, resisted radial deviation and wrist extension)
Mill’s (forearm pronated, passively move wrist into flexion and elbow into extension)
Maudsley (resisted extension of 3rd digit/middle finger)
Medial epicondylopathy - aka
Golfer’s elbow
lateral epicondylopathy - aka
Tennis elbow
Medial epicondylopathy tests
Golfer’s elbow test - while palpating medial epicondyle, possibly move elbow, wrist, and fingers into full extension
**active test is resisting elbow and wrist flexion
UCL/MCL sprain/tear is common in?
Overhead throwing athletes - esp. during late cocking phase/early throwing phase (shoulder abducted and moving into ext. rot creating VALGUS force)
What band of UCL/MCL is typically injured?
Anterior band (strongest one?!)
Special tests for UCL/MCL sprain
Valgus stress test - supinated forearm, elbow at 30*, apply Valgus force
Moving Valgus stress test - shoulder in 90* abduction, 100-120* elbow flexion, elbow quickly extended (fully)
LCL complex sprain mechanism
Typically due to trauma and forceful varus
Mechanism of injury for Olecranon bursitis
High repetition activities/overuse, direct trauma, or constant weight bearing through elbows
Osteochrondritis dissecans capitellum description and MOI
Inflammatory condition causing fragmentation or necrosis of cartilage and bone of capitellum
Frequent compressive forces at radiohumeral joint
Special tests for osteochrondritis dissecans capitellum
Valgus overload test - Valgus stress while moving into extension (no particular elbow flexion degree/ROM listed)
Radiohumeral compressive test - full ext of elbow. W/ pronation and supination compressive force
Special tests for osteochrondritis dissecans capitellum
Valgus overload test - Valgus stress while moving elbow into extension (no specific range mentioned for elbow flexion)
Radiohumeral compressive test - full extension of elbow w/ pronation and supination compressive force
What can cause median nerve neuropathy? (4 dx)
Anterior interosseous syndrome, Pronator teres syndrome, carpal tunnel syndrome
Ligament of Struthers - runs from supracondylar process to head of Pronator teres, Median nerve passes underneath
Median nerve compression can lead to the motor loss of what? (9)
1)Pronator teres,
2)flexor carpi radialis,
3)flexor digitorum superficialis,
4)flexor pollicis longus
5)Lateral half of flexor digitorum profundus
6)Pronator quadratus,
7)Palmaris longus
8)lateral 2 lumbricals
9)thenar eminence
Sensory loss accompanied by medial nerve compression
Palmar aspect of lateral hand
Dorsal aspect of distal ring finger
Middle and index fingers
Functional loss accompanied by medial nerve compression (7)
Pronation
Wrist flexion
Radial deviation
Opposition of thumb
Thumb adduction
Weak overall grip
No pinch grip
Functional loss associated w/ medial nerve compression
Pronation
Radial deviation
Wrist flexion
Thumb adduction AND opposition
Weak overall grip
No pinch grip
Anterior interosseous syndrome - signs/tests
OK sign - unable to flex distal phalanx of index and thumb
Sign of benediction - unable to flex 1st 3 digits
(T/F) There is both sensory and motor loss w/ Anterior interosseous syndrome
False - only motor loss in:
flexor pollicis longus,
lateral half of flexor digitorum profundus,
Pronator quadratus,
thenar eminence,
lateral 2 lumbricals
Pronator teres syndrome - how to differentiate from anterior interosseous syndrome
There IS sensory loss w/ Pronator teres syndrome
Also - forearm heaviness and potential weakness
Pain production and one other test for Pronator teres syndrome
Resist:
Pronation, elbow flexion, and wrist flexion at the same time
Supination
Finger flexion
Handshake test - resisted pronation @ 90* of elbow flexion
4 possible dx for Radial nerve neuropathy
High radial nerve palsy
Posterior interosseous syndrome
Radial tunnel syndrome
Superficial radial nerve palsy
Potential motor loss w/ radial neuropathy (11)
Anconeous
Brachioradialis
Extensor carpi radialis longus + brevis
Extensor digitorum
Extensor pollicis longus + brevis
Abductor pollicis longus
Extensor carpi ulnaris
Extensor indicis
Extensor digit minimi
Motor loss associated with radial neuropathy
Extensor pollicis longus + brevis
Extensor indicis
Extensor carpi radialis (longus and brevis) and ulnaris
Extensor digitorum
Anconeous
Brachioradialis
Abductor pollicis longus and brevis
Extensor digiti minimi
Radial nerve sensory distribution
Lateral 2/3 of dorsal hand (full length of thumb, up to head of proximal phalanx of digits 2 & 3)
High radial nerve compression typically due to? Loss of?
Compression at lateral head of triceps due to humerus fx at spiral groove
Accompanied by loss of wrist and finger extension as well as potential weakness at triceps
Posterior interosseous syndrome accompanied by what motor loss? (Think functional) What is spared and why? Pain?
Inability to extend digits at MCP and IP, loss of abduction at thumb
Wrist extension spared due to innervation of ECRL and ECRB before entrance to radial tunnel
Lateral elbow pain w/ resisted pronation and supination
