Elbow Flashcards by Ilexa Flagstad

What ligament is responsible for posterolateral rotatory instability and a positive pivot shift test in the elbow?

Lateral Ulnar Collateral Ligament

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What does the microhistopathology of lateral epicondylitis reveal?

angiofibroblastic hyperplasia, disorganized collagen, and lacks inflammatory cells

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During what phase of throwing is valgus load on the elbow the highest?

Late cocking, early acceleration

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What are the two bands of the anterior oblique ligament of the MUCL? And what are their function?

anterior band - primary restraint to valgus stress; isometric strain throughout elbow ROM
posterior band - increasing strain during elbow flexion

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What are the three components of the MUCL? And which is the primary restraint to valgus stress?

Anterior oblique ligament; posterior ligament, transverse ligament; the anterior oblique band (specifically the anterior band) is the primary restraint to valgus stress

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What is the origin and the insertion of the anterior oblique ligament of the MUCL?

O: anteroinferior ridge on medial epicondyle
I: sublime tubercle

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During what degrees of elbow ROM is the UCL the primary restraint to valgus stress?

30 to 120 degrees

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What are the risk factors for little league elbow?

> 85 mph pitching speed, more than 8 months of pitching per year, >80 pitches per game, continued pitching despite arm fatigue and pain, participating in showcases

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What is the orientation of the distal insertion of the long head and short head of the biceps tendon?

The long head of the biceps inserts more proximally while the short head inserts distally at the tuberosity.

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Where does the anterior oblique bundle of the ulnar collateral ligament insert?

sublime tubercle

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Which muscle is thought to be the instigator of lateral epicondylitis?

ECRB

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Where does ECRL originate?

lateral supracondylar ridge

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What muscles originate on the lateral epicondyle?

extensor carpi radialis brevis, extensor carpi ulnaris, extensor digitorum, extensor digiti minimi, anconeus (shares same attachment site as ECRB)

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What is the origin and the insertion of ECRB?

anterior aspect of the lateral epicondyle and inserts on the third metacarpal

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A patient develops posterolateral rotatory instability after arthroscopic debridement for lateral epicondylitis, which structure was injured?

lateral ulnar collateral ligament

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What is the origin and the insertion of the lateral ulnar collateral ligament?

originates on the lateral epicondyle of the humerus and inserts upon the supinator crest of the ulna.

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What is the survival rate of total elbow arthroplasty in patients with rheumatoid arthritis at 15 years?

upwards of 90% survival rate at 15 years

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What is the most common mode of failure of the lateral ulnar collateral ligament associated with an elbow dislocation?

Avulsion off the humeral origin (lateral epicondyle)

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What is the origin of the LUCL?

lateral epicondyle

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What are the primary static stabilizers of the elbow joint?

ulnohumeral joint, anterior bundle of the MCL, LCL complex (including the LUCL)

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What are the secondary static stabilizers of the elbow joint?

radiocapitellar joint, the capsule, origins of the common flexor and extensor tendons

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What are the dynamic stabilizers of the elbow?

muscles that cross the joint - brachialis, anconeus, triceps

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In extension and axial loading, how much weight is carried through the ulnohumeral joint? and the radiocapitellar joint, respectively?

40% through ulnohumeral joint; 60% through radiohumeral joint

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Where does the anterior bundle of the medial ulnar collateral ligament attach distally?

Sublime tubercle on the ulna

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Microtrauma from repetitive valgus stress leads to rupture of the [...] band of the medial UCL

Baseball pitchers place significant valgus stress on the elbow in the [...] and [...] phase of throwing

late cocking; early acceleration

The UCL primary restraint to elbow valgus stress from [...] degrees of flexion

30 to 120

In elbow UCL anterior band reconstructions, [...] technique is associated with better patient outcomes and lower complication rate compared to figure-of-8 fixation

humeral docking

The [...] autograft most common graft used for UCL reconstruction surgery.

palmaris longus

What is the blood supply to palmaris longus?

posterior ulnar recurrent artery

What is the innervation of palmaris longus?

median nerve

Patients undergoing UCL reconstruction should avoid valgus stress until [...] months post op

What is the most common complication following elbow UCL reconstruction?

ulnar n. neuropraxia

Lateral collateral ligament complex of the elbow most commonly fails at [...]

humeral origin (lateral epicondyle)

[...] is the primary stabilizer to varus & ER stress at the elbow

LUCL

What is the insertion of the LUCL?

the tubercle of the supinator crest of the ulna

During flexion of the elbow on the lateral pivot shift test the [...] reduces the radial head

triceps tension

What is the intermuscular plane of the Kocher approach to the elbow?

ECU and anconeus

During the Kocher approach to the elbow, the forearm should be kept in [...] to avoid injury to the PIN

pronation

During the Kocher approach to the elbow, the PIN is not in danger as long as dissection remains proximal to [...].

annular ligament

What is the inter-nervous plane in the Kocher approach to the elbow?

Radial n (anconeus); PIN (ECU)

After reconstruction of the LUCL complex, it is important to keep forearm in full [...] during ROM until after 6 weeks

pronation

Partial distal biceps tendon tears occur primarily on the [...] side of the tuberosity footprint.

radial

What is the most medial structure in the antecubital fossa?

median nerve

What is the most lateral structure in the antecubital fossa?

radial nerve

In the antecubital fossa, the [...] vessels lie superficial to biceps tendon.

radial recurrent

The short head of the distal biceps attaches [...] and [...] on the radial tuberosity.

distal; anterior

The long head of the distal biceps attaches [...] and [...] on the radial tuberosity.

proximal; posterior

Which is a better supinator, the long head or short head of the biceps?

Long head

The lacertus fibrosis originates from the distal [...] head of the biceps tendon

short

In a distal biceps rupture, is more supination or flexion strength lost?

supination (note: 50% loss in sustained supination; 40% loss in supination; only 30% flexion strength lost)

In an anterior single incision technique for distal biceps repair, the intermuscular interval is between the [...] and [...].

Brachioradialis (radial n) and pronator teres (median n)

In a single incision approach to a distal biceps repair, the lateral antebrachial cutaneous nerve (LABCN) is identified as it exits between the [...] and [...] muscles at antecubital fossa.

biceps; brachialis

The lateral antebrachial cutaneous nerve (LABCN) originates from [...] cord of brachial plexus

lateral

The lateral antebrachial cutaneous nerve (LABCN) is the terminal branch of [...] nerve.

musculocutaneous

In a single incision distal biceps repair, protect PIN by limiting forceful lateral retraction and maintaining forearm [...].

Supination

What is the most common complication following a single-incision distal biceps repair?

Injury to LABCN

There is a higher rate of LABCN injury in the [...]-incision distal biceps repair technique.

single (most retraction)

In a dual-incision distal biceps repair, the posterior interval is between [...] and [...]

ECU; EDC

What is the most common complication following a dual-incision distal biceps repair?

LABCN injury

What is the overall most common complication to a distal biceps repair?

LABCN injury (higher in single incision technique)

What is the 2nd most common cutaneous nerve injured in distal biceps repair?

superficial radial nerve

Bone tunnels [...] to the radial tuberosity can increase the risk of proximal radius fracture following a distal biceps tendon repair.

proximal

Which muscles shares same attachment site as ECRB?

Anconeus

What is Maudsley's test?

resisted extension of the 3rd digit of the hand leads to pain over the lateral epicondyle

ECRB located [...] and [...] to ECRL

deep; posterior

What is the most frequent site of PIN entrapment?

tendinous edge of the supinator (arcade of Frohse)

What vessels can cause PIN entrapment?

radial recurrent vessels (Leash of Henry)

The PIN passes over [...] muscle origin to reach interosseous membrane

abductor pollicis longus

Longest survivorship of TEA is seen when performed for [...] compared to other indications

rheumatoid arthritis

[...] designs TEA requires competent collateral ligaments

Unconstrained (unlinked)

What is the most common complication of unconstrained (unlinked) TEA?

instability

Semiconstrained or linked TEA [...] stress on bone-cement interface, which [...] incidence of component loosening

reduces; reduces

Which TEA design has the best results?

Semi-constrained

Which TEA design has the highest rates of loosening?

Constrained

In elbow arthroscopy, the [...] portal usually avoided due to proximity to ulnar nerve

posterior medial

What is the most common nerve palsy seen after elbow arthroscopy?

transient ulnar nerve palsy

The radial nerve is at risk during placement of which elbow arthroscopy portal?

proximal anterolateral

In elbow arthroscopy, the [...] muscle provides protective layer between anterior capsule and radial nerve proximal to the radial neck

brachialis

In elbow arthroscopy, the medial antebrachial cutaneous nerve is at risk from [...] portal

anteromedial

In elbow arthroscopy, the median nerve is at risk from the [...] portal

anteromedial

In elbow arthroscopy, the PIN is at risk with the [...] portal

distal anterolateral

What is a known complication from intra-articular steroid injection at the time of elbow arthroscopy?

infection

What is the MOA of penicillin?

Binds to the transpeptidase enzyme and inhibits cell wall synthesis

The medial UCL is subjected to near-failure tensile stresses during the [...] phase of throwing.

late cocking/early acceleration

Which structure is the most important static stabilizer to valgus forces at the elbow in a throwing athlete?

anterior band of the anterior bundle of the UCL

TEA for rheumatoid arthritis has been shown to have very positive survival analysis up to [...] years, with studies showing rates of survival rates of over 90%.

What is the origin of ECRL?

Lateral supracondylar ridge

What is the origin of ECRB?

Anterior aspect of lateral epicondyle (note: same origin as anconeus)

Varus posteromedial instability of the elbow is characterized by injury to the [...] and fracture of the [...] facet of the coronoid

LCL; anteromedial

What is an Essex-Lopresti injury?

radial head fracture, DRUJ injury, interosseous membrane injury

The annular ligament originates and inserts on the anterior and posterior aspects of the [...]

lesser sigmoid notch

PIN crosses the proximal radius from anterior to posterior within the supinator muscle [...] cm distal to radial head

In both Kocher and Kaplan approaches, the forearm should be [...] to protect PIN

pronated

In a Kocher approach to the elbow, pronation pulls the PIN [...] and away from the surgical field

Pronation of the forearm places the PIN [...]

volar/anterior

What is the innervation of ECRB?

Deep branch of the radial nerve

What is the interval for a Kaplan approach to the elbow?

EDC (PIN) and ECRB (radial n)

In a lateral approach to the elbow, dissection distal to the bicipital tuberosity places the [...] at risk.

The lateral ulnar collateral ligament (LUCL) is often injured with elbow dislocations, and is most commonly injured at the [...]

proximal origin (ligament avulsion off humerus)

What is the treatment for a Mason Type I radial head fracture (minimally displaced, no mechanical block, intra-articular displacement <2mm)?

Sling immobilization for 2 days followed by active mobilization is recommended.

Radial head articular fractures with greater than [...] fragments do better with radial head replacement

What is the Kaplan intermusclar interval?

EDC (PIN) and ECRB (radial n)

If both the MCL and LCL are repaired in a terrible triad, passive elbow motion should occur with the forearm in [...].

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