Elbow Flashcards
Elbow consists of complex set of joints that make up ____ articulations
What are these joints?
Elbow consists of complex set of joints that make up cubital articulations
Ulnohumeral (trochlear) 8major stabilizer
Radio humeral
Superior radioulnar
What is the primary role of the elbow?
Elbow’s primary role is to help position the hand in the appropriate location to perform its function
RADIOHUMERAL JOINT capsular pattern
Flexion, extension, supination, pronation
Type of joint: which is correct?
Ulnohumeral ; Uniaxial hinge
Radio humeral ; Uniaxial pivot
Superior radioulnar ; uniaxial hinge
Ulnohumeral ; Uniaxial hinge
Radio humeral ; Uniaxial hinge
Superior radioulnar ; uniaxial pivot
RADIOHUMERAL JOINT closed packed position
Elbow flexed to 90 degrees, forearm supinated to 5 degrees
ULNOHUMERAL (TROCHLEAR) JOINT Resting position
70 degrees elbow flexion, 10 degree supination
ULNOHUMERAL (TROCHLEAR) JOINT Capsular pattern
Flexion, extension
SUPERIOR RADIOULNAR JOINT Resting position
35 degrees supination, 70 degrees elbow flexion
Repetitive movement of extension, flexion, and Pronation/Supination (each) can lead to what condition?
Extension = Tennis Elbow
Flexion = Golfer’s Elbow
Pronate/Supinate = Pronator Teres syndrome
Radioulnar joint rotates during flexion, how many degrees?
5 deg. IR in EARLY flexion,
5 deg ER in LATE flexion
SUPERIOR RADIOULNAR JOINT closed packed position
5 degrees supination
SUPERIOR RADIOULNAR JOINT capsular pattern
Equal limitation of supination and pronation
What ligament is the Major stabilizer of proximal radioulnar connection?
MOI Tear: ______ in the forearm
Oblique Ligament
ULNOHUMERAL (TROCHLEAR) JOINT closed packed position
Extension with supination
What does the Quadrate Ligament limit?
Limits spinning of the radial head during pronation and supination
RADIOHUMERAL JOINT Resting position
Full extension and full supination
SSX: (+) popping, pain & Swelling
Ligament sprain
What is the Most common instability of the elbow and Most common direction of dislocation?
PosteroLateral
What ligament Prevent dislocation of proximal radioulnar joint,
Wraps around the head of radius?
What is a possible condition if damaged?
Annular Ligament
Nurse maid’s elbow
SSX: (+) popping, weakness of elbow flexors
Distal biceps rupture
What are the age demographics of the Tennis Elbow ( lateral epicondylitis), Nursemaid’s elbow (radial dislocation) and Osteochondritis Dissicans?
Tennis Elbow = > 35 y.o.
Radial Dislocation = < 5 y.o.
OD = 15 - 20
If the patient had experience Valgus force what is the injured ligament?
MCL = Valgus
*LCL = Vaarus
SSX: (+) pain, discomfort, “lock”, “click”, “snap”, “slip”
Posterolateral rotary instability
*MOI: twisting of elbow
SSX: (+) Aching pain over lateral epicondyle
*aching is not local
Tennis Elbow
*radiating is not always nerve, ECRB is the mm most affected
What are the normal value of the carrying angle?
10-15 degrees for females (13-16 by magee)
5-10 degrees for males (11-14 by magee)
Define:
Excessive Cubitus Valgus
Cubitus Varus
More than the normal value = Excessive Cubitus Valgus
Less than the normal value = Cubitus Varus
Carrying angle that is Beyond -5 degrees is considered a deformity called?
Gun stock deformity
Normal carrying angle of Male and female
10-15 degrees for females (13-16 by magee)
5-10 degrees for males (11-14 by magee)
The triangle sign that consist of ME, LE, and OP is normally present, if it is absent what is the indication?
Has a condition, can be fx, dc, degeneration
In observation what should you observe?
Observe P.t when entering the examination room
Patient suitably undressed
Observe movements
Observe facial expressions during movements
Your pt. has visible bruising (black na) arounds the elbow what could be the possible condition?
Dislocation
Your pt. upon OI present with inflammation of the posterior aspect of the elbow, what is the possible condition?
Olecranon bursitis (minner’s elbow, Student’s elbow, etc.,)
*(+) swelling on (R) elbow
Pt. present with C5-C6 cervical lesion where would you tap the neurohammer? what muscle is affected?
MM: Biceps
tap in cubital fossa area
Things to observe (4)
Observe P.t when entering the examination room
Patient suitably undressed
Observe movements (ROM)
Observe facial expressions during movements
ROM of Elbow flexion & Extension
Flexion: 140 deg -150 deg, Firm
Extension: 10deg -15 deg, Firm
Elbow movement that is 1st to disappear after an injury
Elbow Hyper Extension
*also the movement 1st to recover in healing
What is the difference b/w Colles fx and Smith fx in MOI?
Colles = FOOSH
Smith fx = FOBH
What is the nerve reflex being tested for:
Biceps
Brachioradialis
Triceps
Biceps (C5-C6)
Brachioradialis (C5-C6)
Triceps (C7-C8)
T or F
Colles fx = Silver fork
Smithfx = Garden spade
TRUE
An injury to the biceps brachii especially the tendon
Indicates that the tendon of the biceps is torn resulting the muscle to be dislodged
POPEYE SIGN
What nerve passes through the cubital tunnel
Ulnar nerve
* Cubbital tunnel syndrome - 2nd most common nerve impingement (1st is CTS)
CUTANEOUS DISTRIBUTION
Assess dermatomes around the elbow and cutaneous distribution of various nerves
Be aware of variability in distribution patterns
Sometimes there are manifestations wherein pain is referrred to UE
Pain may be referred to the elbow from neck, shoulder, or wrist
note
Position of the biceps when using 2x strength and 4x strength (each)
Extended = 2x
Flexed 90 deg + supinated = 4x
Pt is in sitting position, they bring their hand to their mouth (elbow flexion) the weight they are holding is 2.7 kg . What is the outcome measure (functionality)?
Functional (Lift 2.3 kg - 2.7 kg)
*Lift 1.4 kg - 1.8 kg: Functionally Fair
* Lift 0.5 - 0.9 kg: Non functional
Pt is performing wall push ups (elbow extension), they are only able to do 3 repetitions. What is the outcome measure (functionality) ?
Functionally Fair (3 - 4 Repetitions)
*5 - 6 Repetitions: Functional
*1 - 2 Repetitions: Functionally Poor
*0 Repetitions: Nonfunctional
*SAME VALUES AS SUPINATIONAND PRONATION
You are to consider an injury to your musculocutaneous, (if you are to assess the sensation of the patient, you need to know specifically where you will elicit a stimulus), where will you pinprick and cotton the patient?
The area of the lateral forearm
T or F
In all pronator teres syndrome, the Pronator teres is the Muscle involved
FALSE
Pronator Teres is actually NOT affected, it remains unaffected
WHY? The median nerve is impinged in between the heads, the two heads are actually the reason why the nerve is impinged
*aka Grocery bag syndrome
Injury by impingement between two heads of Pronator teres
AIN SYNDROME or Kiloh-Nevin syndrome or sign
Monteggia fracture is an fx of what structure?
Forearm
T or F
the anterior interosseous nerve is damaged, the pt will have ssx of paresthesia
FALSE
AIN is a mainly a motor nerve, so NO sensory loss will be felt
How to asses Kiloh-Nevin sign?
🔖 To assess for the Kiloh-Nevin sign, ask the pt. To perform an okay sign (seen at ss), the assessment is positive if the tips of the thumb and the long finger does not touch (palmar aspect of the fingertips touch a.k.a. Palm-to-palm touch)
The loss of the hypothenar muscles and flattening of the palmar metacarpal arch
Possible depressed ang hypothenar area
MASSE’S SIGN
*signs under ulnar nerve
Inability to flex the DIP joints of the 4th and 5th digits (i.e, loss of FDP)
Can be an indication of weakness
POLLOCK’S SIGN
*under ulnar nerve signs
In Saturday night palsy what nerve is affected?
Radial nerve
*aka crutch palsy
