ELBOW Flashcards
1
Q
ELBOW - ROM
A
- Flexion - 150
- Extension - 0 - 5
- Pronation - 90
- Supination - 90
2
Q
ELBOW - MYOTOMES
A
- Shoulder elevation - C4, XI
- Deltoid - C5, C6 - axillary
- Brachioradialis - C5, C6 - radial
- Biceps - C5, C6 - musculocutaneous
- Triceps - C6, C7, C8, T1 - radial
- Wrist extensors - C6, C7, C8 - radial
- Wrist flexors - C6, C7 - median/ulnar
- Finger flexors - C7, C8, T1 - ulnar/median
- Interossei - C7, C8, T1 - ulnar
3
Q
ELBOW - ORTHO TESTS - SCREENING
A
SCREENING - Valgus stress (0) - forearm supinated, Valgus stress (30), Varus stress (0) - forearm pronated, Varus stress (30)
4
Q
ELBOW - ORTHO TESTS - LATERAL EPICONDYLITIS
A
LATERAL EPICONDYLITIS - Cozen’s test, Mill’s test
5
Q
ELBOW - ORTHO TESTS - MEDIAL EPICONDYLITIS
A
MEDIAL EPICONDYLITIS - Reverse Cozen’s, Reverse Mill’s
6
Q
ELBOW - ORTHO TESTS - PRONATOR TERES/MEDIAN NERVE
A
PRONATOR TERES/MEDIAN NERVE - Tinel’s (wrist), Tinel’s (elbow), Pronator stretch test
7
Q
ELBOW - JOINT TYPE
A
- Hinge - humeroulnar & humeroradial
- Pivot - proximal radioulnar
8
Q
ELBOW - ARTICULAR SURFACES
A
- Humeroulnar - concave (trochlear notch of ulna) on convex (trochlea of humerus)
- Humeroradial - concave (radial head) on convex (capitilum of humerus)
- Proximal radioulnar - convex (radial head) on concave (radial notch of ulna)
9
Q
ELBOW - MAIN MUSCLE ACTIONS - FLEXION
A
FLEXION - brachial, biceps brachii, brachioradialis
10
Q
ELBOW - MAIN MUSCLE ACTIONS - EXTENSION
A
EXTENSION - triceps brachii, anconeus
11
Q
ELBOW - MAIN MUSCLE ACTIONS - PRONATION
A
PRONATION - pronator teres, pronator quadratus
12
Q
ELBOW MAIN MUSCLE ACTIONS - SUPINATION
A
SUPINATION - biceps brachii, supinator
13
Q
ELBOW - RESTING POSITION
A
Humeroulnar: flexion - 70
Humeroradial: full extension and supination
Proximal radioulnar: flexion - 70 supination - 35
14
Q
ELBOW - CLOSED PACKED POSITION
A
Humeroulnar: full extension
Humeroradial: flexion - 90 supination - 5
Proximal radioulnar: flexion - 90 supination - 5
15
Q
ELBOW - NORMAL END FEEL
A
FLEXION - soft tissue or bony approximation
EXTENSION - bony approximation
PRONATION - bony approximation or ligamentous
SUPINATION - ligamentous
16
Q
ELBOW - ABNORMAL END FEEL
A
Boggy - joint effusion
Early myospasm - acute injury
Late myospasm - instability
Springy block - loose body (osteochondritis dissicans)
17
Q
ELBOW - CONDITIONS - LATERAL EPICONDYLITIS
A
Hx - repetitive motions (gripping, hammering, tennis backhand, lifting)
S&S - tender to palpation over lateral epicondylitis/common extensor tendon; increased elbow pain with resisted wrist extension; +ve Mills, Cozen’s test
DDx - cervical radiculopathy, posterior interosseous nerve entrapment
18
Q
ELBOW - CONDITIONS - MEDIAL EPICONDYLITIS
A
Hx - repetitive motions (gripping, lifting, golfing)
S&S - tender to palpation over medial epicondylitis/common flexor tendon; increased elbow pain with resisted wrist flexion; +ve reverse Mill’s, reverse Cozen’s
DDx - cervical radiculopathy
19
Q
ELBOW - CONDITIONS - PULLED ELBOW
A
Hx - child (age 1-4) swung by arms or arm tugged
S&S - pain and apprehension, child is unwilling to straighten elbow
DDx - elbow or wrist fracture
20
Q
ELBOW - CONDITION - PRONATOR TERES SYNDROME
A
Hx - repetitive motions (gripping with pronation), tingling and weakness in hand
S&S - tender to palpation over mid pronator teres; increased hand symptoms with palpation of pronator teres, weakness in wrist flexion; +ve tinel’s
DDx - cervical radiculopathy, carpal tunnel syndrome
21
Q
ELBOW - CONDITION - UCL RUPTURE
A
Hx - prior elbow dislocation, throwing injury or chronic overload (throwing athlete)
S&S - tenderness to palpation of UCL; +ve valgus stress test
DDx - olecranon bursitis, osteochondritis dessicans, fracture
22
Q
ELBOW - ORTHO TEST - COZEN’S TEST
A
- Pt seated
- Elbow fully flexed, forearm pronated and wrist extended (waiter position)
- Stabilise the patients elbow eith one hand
- Examiner applies force in the direction of elbow extension and wrist flexion
23
Q
ELBOW - ORTHO TEST - COZEN’S TEST - POSITIVE
A
Lateral epicondylitis
- Pain or weakness
24
Q
ELBOW - ORTHO TEST - REVERSE COZEN’S TEST
A
- Pt seated
- Elbow flexed 120, forearm supinated and wrist slightly flexed and ulnar deviated
- Examiner applies pressure on pt palm with one hand
- Stabilise elbow and palpate medial epicondyle with the other hand
25
ELBOW - ORTHO TEST - REVERSE COZEN'S TEST - POSITIVE
**Medial epicondylitis**
- Localised pain at medial epicondyle or distal at common flexor tendon
26
ELBOW - ORTHO TEST - MILL'S TEST
- Pt seated
- Examiner extends and pronates pt elbow while flexing the wrist
- The test stretches the common extensor tenson
27
ELBOW - ORTHO TEST - MILL'S TEST - POSITIVE
**Lateral epicondylitis**
- Lateral elbow pain during test
28
ELBOW - ORTHO TEST - REVERSE MILL'S TEST
- Pt seated
- Examiner extends pt elbow, wrist and fingers to stretch common flexor tendon at medial epicondyle
29
ELBOW - ORTHO TEST - REVERSE MILL'S TEST - POSITIVE
**Medial epicondylitis**
- Localised pain at medial epicondyle or distal at common flexor tendon
30
ELBOW - ORTHO TEST - TINEL'S SIGN
- Pt seated
- Examiner gently taps 4-6 times over cubital tunnel (groove between the olecranon process and medial epicondyle) with fingertips
31
ELBOW - ORTHO TEST - TINEL'S SIGN - POSITIVE
**Ulnar compressive neuropathy**
- Shooting electrical pain along the medial side of the forearm to medial hand
32
ELBOW - ORTHO TEST - TINEL'S SIGN - SN & SP
**SN**: 70
**SP**: 98
33
ELBOW - ORTHO TEST - VALGUS STRESS TEST
- Pt seated
- Examiner applies valgus force with elbow fully extended
- Repeat while examiner applying valgus force with elbow flexed 30 and forearm supinated
34
ELBOW - ORTHO TEST - VALGUS STRESS TEST - POSITIVE
**Medial elbow sprain, Instability**
- Pain
- Excessive joint motion
35
ELBOW - ORTHO TEST - VARUS STRESS TEST
- Pt seated
- Examiner applies varus force with elbow fully extended
- Repeat while examiner applying varus force with elbow flexed 30 and forearm supinated
36
ELBOW - ORTHO TEST - VARUS STRESS TEST - POSITIVE
**Lateral elbow sprain, Instability**
- Pain
- Excessive joint motion
37
ELBOW - ELBOW DEFORMITIES
- Often occurs after some type of trauma (often a fracture) to the affected elbow
38
ELBOW - ELBOW DEFORMITIES - RISK FACTORS
- Congenital disorders
- Trauma
- Arthritis
39
ELBOW - ELBOW DEFORMITIES - POPULATION AFFECTED
- Older children/adults
40
ELBOW - ELBOW DEFORMITIES - CLINICAL PRESENTATION - CUBITUS VARUS
- **Cubitus varus**
- Most obvious when the elbows are extended, and the arms are elevated
41
ELBOW - ELBOW DEFORMITIES - CLINICAL PRESENTATION - CUBITUS VALGUS
- **Cubitus valgus**
- Most common cause is non-union of a fractured lateral condyle
- This may give gross deformity and a bony knob on the inner side of the joint
42
ELBOW - ELBOW DEFORMITIES - CLINICAL PRESENTATION - STIFF ELBOW
- **Stiff elbow**
- Can be a severe impediment
- Pt may be unable to reach out to or bring back from their environment
- Some pt may not be able to turn palm upwards to lift something
43
ELBOW - ELBOW DEFORMITIES - PROGNOSIS - CUBITUS VARUS
- **Cubitus varus**
- Deformity can be corrected by a wedge osteotomy of the lower humerus
44
ELBOW - ELBOW DEFORMITIES - PROGNOSIS - CUBITUS VALGUS
- **Cubitus valgus**
- Deformity itself needs no treatment
- For delayed ulnar palsy the nerve should be transported to the front of the elbow
45
ELBOW - ELBOW DEFORMITIES - PROGNOSIS - STIFF ELBOW
- **Stiff elbow**
- Physical therapy
- If physical therapy does not help, surgery is needed
46
ELBOW - TUBERCULOSIS
- Rare
- Accounts for 1-3% of all cases of osteoarticular TB
- Diagnosis is difficult because of the insidious onset, indolent process and mild and non-specific local or systemic symptoms
47
ELBOW - TUBERCULOSIS - RISK FACTORS
- Having HIV/AIDs
- Having diabetes mellitus
48
ELBOW - TUBERCULOSIS - POPULATION AFFECTED
- Middle age
49
ELBOW - TUBERCULOSIS - CLINICAL PRESENTATION
- Disease begins as synovitis or osteomyelitis
- Onset is insidious with a long history of aching and stiffness
- Most striking physical sign is marked wasting
- While the disease is active, the joint is:
- Held flexed
- Looks swollen
- Feels warm
- Diffusely tender
- Movement is considerably limited and accompanied by pain and spasm
50
ELBOW - TUBERCULOSIS - PROGNOSIS
- Antituberculosis drugs
- Elbow is rested
- First in a splint, Then by applying a collar and cuff
51
ELBOW - RHEUMATOID ARTHRITIS
- Elbow is involved in more than 50% of pt with rheumatoid arthritis
52
ELBOW - RHEUMATOID ARTHRITIS - RISK FACTORS
- Sex - Women more likely than men
- Age - Often begins at middle age
- Family history
- Smoking
- Excess weight
53
ELBOW - RHEUMATOID ARTHRITIS - POPULATION AFFECTED
- Usually 40 – 60 when it develops
54
ELBOW - RHEUMATOID ARTHRITIS - CLINICAL PRESENTATION
- Pain and tenderness especially around the head of the humerus
- Rheumatoid nodules can often be detected over the olecranon
- Eventually the whole elbow may become swollen and unstable
- Often both elbows are affected
55
ELBOW - RHEUMATOID ARTHRITIS - PROGNOSIS
- General RA treatment
56
ELBOW - OSTEOARTHRITIS
- Elbow is an uncommon site for osteoarthritis
- When it does occur it may be secondary to trauma
57
ELBOW - OSTEOARTHRITIS - RISK FACTORS
- Trauma
- Underlying disorders
58
ELBOW - OSTEOARTHRITIS - POPULATION AFFECTED
- 50 – 60 years
59
ELBOW - OSTEOARTHRITIS - CLINICAL PRESENTATION
- Pain
- Stiffness
- In late cases joint can become unstable
- Elbow may look and feel enlarged
- Movements are somewhat limited
60
ELBOW - OSTEOARTHRITIS - PROGNOSIS
- Rarely requires more than symptomatic treatment
- Loose bodies should be removed arthroscopically
61
ELBOW - LOOSE BODIES
- Commonest cause of a single loose body in the elbow is osteochondritis dissecans of the capitulum
- Multiple loose bodies may occur with osteoarthritis or synovial chondromatosis
62
ELBOW - LOOSE BODIES - RISK FACTORS
- Post traumatic arthritis
- Instability arthropathy
- Rheumatoid arthritis secondary to chronic inflammatory joint disease
- Septic arthritis following a joint infection
- Wear and tear
- Trauma
63
ELBOW - LOOSE BODIES - POPULATION AFFECTED
- Adolescents and young adults
64
ELBOW - LOOSE BODIES - CLINICAL PRESENTATION
- Cardinal feature is sudden locking of the elbow
- Pt can also experience - Clicking, Catching, Crepitus
- Most common complaint from pt is pain
65
ELBOW - LOOSE BODIES - PROGNOSIS
- Doesn’t really need treatment
- But if its troublesome, the loose bodies can be removed arthroscopically
66
ELBOW - OLECRANON BURSITIS
- Bursitis is a condition characterised by accumulation of fluid and cells within the bursal cavity
- Generally characterised as either septic or aseptic
- Aseptic are further subdivided into
- Idiopathic
- Traumatic
- Crystal induced
- 2/3 cases are non-septic (70%) and occur when repeated trauma or sports injuries lead to bleeding into the bursa or release of inflammatory mediators
- Occurs in both children and adults
67
ELBOW - OLECRANON BURSITIS - RISK FACTORS
- Repetitive pressure on the elbow
- Occupational risks
- Sex - Men affected more
- History of systemic disease - Chronic renal failure, Rheumatoid arthritis
68
ELBOW - OLECRANON BURSITIS - POPULATION AFFECTED
- 30 – 60 years (most common)
- Can also affect children
69
ELBOW - OLECRANON BURSITIS - CLINICAL PRESENTATION
- The olecranon bursa becomes enlarged as a result of pressure or friction
- Pts present with swelling and pain over the posterior elbow
- Pt with aseptic bursitis present with varying degrees of pain
- Rarely occurs bilaterally
- When it is also painful it is likely due to infection
- Gout
- Rheumatoid arthritis
70
ELBOW - OLECRANON BURSITIS - PROGNOSIS
- The underlying disorder must be treated
- Septic bursitis may need local drainage
- Aseptic bursitis is treated with initial aspiration followed by application of a compressive dressing and avoidance of aggravating activities
71
ELBOW - MEDIAL/LATERAL EPICONDYLITIS
- Affects 1% - 3% of adults each year
- Up to 50% of all recreational tennis players will experience symptoms of lateral epicondylitis at some point
- Most cases occur spontaneously as part of a natural degenerative process in the tendon aponeuroses attached to either the lateral or medial humeral epicondyle
72
ELBOW - MEDIAL/LATERAL EPICONDYLITIS - RISK FACTORS
- Certain sports
- Activities that involve strenuous wrist movements and forearm muscle contractions
- Age - Over 35
- High demand work or sport activities
- Poor general fitness levels
73
ELBOW - MEDIAL/LATERAL EPICONDYLITIS - POPULATION AFFECTED
- 35 – 55 years
74
ELBOW - MEDIAL/LATERAL EPICONDYLITIS - CLINICAL PRESENTATION - MEDIAL EPICONDYLITIS
- Diffuse medial elbow pain of insidious onset
- Pain is felt over the inner side of the elbow but in severe cases it may radiate widely it is initiated or aggravated by certain movements
- Repetitive tasks involving the wrist frequently make pain worse
- Pain may be related to activity or occur at rest
- The elbow looks normal and flexion and extension after fallen painless
- Tenderness is localised to a spot just in front of the medial epicondyle
- Pain is reproduced by getting the pt to extend the wrist against resistance
- Pain is reproduced by passive extension of the wrist in supination
75
ELBOW - MEDIAL/LATERAL EPICONDYLITIS - CLINICAL PRESENTATION - LATERAL EPICONDYLITIS
- Diffuse lateral elbow pain of insidious onset
- Pain is felt over the outer side of the elbow but in severe cases it may radiate widely it is initiated or aggravated by movements such as pouring out tea shaking hands were lifting the forearm pronated
- Repetitive tasks involving the wrist frequently make pain worse
- Pain may be related to activity or occur at rest
- The elbow looks normal and flexion and extension after fallen painless
- Tenderness is localised to a spot just in front of the lateral epicondyle
- Pain is reproduced by getting the pt to extend the wrist against resistance
76
ELBOW - MEDIAL/LATERAL EPICONDYLITIS - PROGNOSIS
- Rest or avoiding the precipitating activity
- If pain is severe, the area of maximum tenderness is injected with a mixture of corticosteroid and local anaesthetics
77
ELBOW - AROM - FLEXION - MUSCLES ACTIVATED
Brachialis
Biceps brachii
Brachioradialis
78
ELBOW - AROM - FLEXION - TISSUES STRETCHED
Triceps brachii
Posterior elbow joint capsule
Ulnar nerve
79
ELBOW - AROM - FLEXION - TISSUES COMPRESSED
Forearm flexors
Median nerve
Anterior joint capsule
80
ELBOW - AROM - EXTENSION - MUSCLES ACTIVATED
Triceps brachii
Anconeus
81
ELBOW - AROM - EXTENSION - TISSUES STRETCHED
Brachialis
Biceps brachii
Brachioradialis
Median nerve
82
ELBOW - AROM - EXTENSION - TISSUES COMPRESSED
Posterior joint capsule
83
ELBOW - AROM - SUPINATION - MUSCLES ACTIVATED
Biceps brachii
Supinator
84
ELBOW - AROM - SUPINATION - TISSUES STRETCHED
Pronator teres
Pronator quadratus
85
ELBOW - AROM - PRONATION - MUSCLES ACTIVATED
Pronator teres
Pronator quadratus
86
ELBOW - AROM - PRONATION - TISSUES STRETCHED
Biceps brachii
Supinator
Brachioradialis
87
BICEPS BRACHII - ORIGIN
**Long head** - supraglenoid tubercle and glenohumeral labrum
**Short head** - coracoid process of scapula
88
BICEPS BRACHII - INSERTION
Radial tuberosity
Bicipital aponeurosis
89
BICEPS BRACHII - ACTION
Flexion and supination of elbow
Flexion of shoulder
Abduction of shoulder (long head)
Adduction of shoulder (short head)
90
BICEPS BRACHII - INNERVATION
Musculocutaneous nerve (C5-C6)
91
BICEPS BRACHII - TRIGGER POINT REFERRAL
Trigger points usually found in distal part of muscle
Pain is generally referred upward over muscle and over anterior deltoid muscle
92
BICEPS BRACHII - STRETCH
Stand at doorway with shoulders extended, elbow straight, forearm pronated slowly flex knees and extend shoulders
93
BICEPS BRACHII - STRENGTHEN
Resisted elbow flexion with forearm supination
Curls with supination
Concentration curl with supination
94
BRACHIALIS - ORIGIN
Anterior distal 1/2 of humerus
95
BRACHIALIS - INSERTION
Ulnar tuberosity
Coricoid process of ulna
96
BRACHIALIS - ACTION
Flexion of elbow
97
BRACHIALIS - INNERVATION
Musculocutaneous and radial nerve (C5-C7)
98
BRACHIALIS - TRIGGER POINT REFERRAL
Trigger points most commonly occurs 1 inch above antecubital space
Pain referral is mainly down to the base of 1st digit and thenar region
99
BRACHIALIS - STRETCH
Extend elbow with shoulder flexed to 90 (this is a difficult muscle to stretch)
100
BRACHIALIS - STRENGTHEN
Resisted elbow flexion with forearm pronated
Reverse curl
Reverse preacher curl
101
TRICEPS BRACHII - ORIGIN
**Long head** - Infraglenoid tubercle of scapula
**Medial head** - posterior shaft of humerus
**Lateral head** - Upper half of posterior surface of shaft of humerus
102
TRICEPS BRACHII - INSERTION
Olecranon process of ulna
103
TRICEPS BRACHII - ACTION
Extension of elbow
Adduction and extension of the shoulder
104
TRICEPS BRACHII - INNERVATION
Radial nerve (C6-C8)
Axillary nerve (long head)
105
TRICEPS BRACHII - TRIGGER POINT REFERRAL
Commonly located in the long head and lateral head
Pain referral is usually to the posterior shoulder extending as far up as the angle of the neck, down the back and front of the arm and forearm
Lateral head may also send referral down as far as the posterior medial 2 digits (ring and little finger)
106
TRICEPS BRACHII - STRETCH
Flex elbow and plave behind head, keep neck in neutral position and apply pressure with opposite hand
107
TRICEPS BRACHII - STRENGTHEN
Resisted elbow extension
Triveps press
Triceps kick backs
Skull crusher
Dips
Close grip bench press
108
PRONATOR TERES - ORIGIN
**Humeral head** - medial epicondyle via common flexor tendon
**Ulnar head** - coronoid process of ulna
109
PRONATOR TERES - INSERTION
Lateral radius middle of shaft
110
PRONATOR TERES - ACTION
Pronation of forearm
111
PRONATOR TERES - INNERVATION
Median nerve (C6-C7)
112
PRONATOR TERES - TRIGGER POINT REFERRAL
Main referral is deep in the anterior radial region of the wrist also of the forearm and down to the base of the thumb
113
PRONATOR TERES - STRETCH
With elbow straight, use opposite hand to supinate forearm
114
PRONATOR TERES - STRENGTHEN
Resisted forearm pronation
Dumbell pronation
115
PRONATOR QUADRATUS - ORIGIN
Anterior distal ulna
116
PRONATOR QUADRATUS - INSERTION
Anterior distal radius
117
PRONATOR QUADRATUS - ACTION
Pronation of forearm
118
PRONATOR QUADRATUS - INNERVATION
Median nerve (C7-C8)
119
PRONATOR QUADRATUS - TRIGGER POINT REFERRAL
Middle and ulnar side of the muscle belly
Referral is local deep aching pain and tenderness over the anterior wrist in the local area
120
PRONATOR QUADRATUS - STRETCH
With elbow bent, use opposite hand to supinate forearm
121
PRONATOR QUADRATUS - STRENGTHEN
Resisted forearm pronation
Dumbell pronation
122
BRACHIORADIALIS - ORIGIN
Lateral supracondylar ridge of humerus
123
BRACHIORADIALIS - INSERTION
Styloid process of radius (lateral side)
124
BRACHIORADIALIS - ACTION
Flexion of elbow
Pronation of forearm when supinated
Supination of forearm when pronated
125
BRACHIORADIALIS - INNERVATION
Radial nerve (C5-C6)
126
BRACHIORADIALIS - TRIGGER POINT REFERRAL
Referral is over the wrist and base of thumb and in the web space between the thumb and index finger
127
BRACHIORADIALIS - STRETCH
Start with elbow straight and supinated, use opposite hand to stabilise origin of brachioradialis the fully pronate forearm
128
BRACHIORADIALIS - STRENGTHEN
Resisted elbow flexion with wrist in neutral
Hammer curls
Reverse curls
129
ANCONEUS - ORIGIN
Lateral epicondyle of humerus
130
ANCONEUS - INSERTION
Lateral posterior olecranon process
131
ANCONEUS - ACTION
Extension of elbow
Stabilises the lateral elbow joint
132
ANCONEUS - INNERVATION
Radial nerve (C6-C8)
133
SUPINATOR - ORIGIN
Lateral epicondyle of humerus
Supinator crest of lateral ulna
134
SUPINATOR - INSERTION
Proximal 1/3 of radius
135
SUPINATOR - ACTION
Supination of forearm
136
SUPINATOR - INNERVATION
Radial nerve (C6-C7)
137
SUPINATOR - TRIGGER POINT REFERRAL
referral is pain over the lateral epicondyle and posterior web of the thumb and index finger
138
SUPINATOR - STRETCH
Elbow straight, use opposite hand to apply pronation force over the distal forearm
139
SUPINATOR - STRENGTHEN
Resisted wrist supination
Wrist supination
