Elbow Flashcards
What are the three joints of the elbow?
Ulnohumeral
Radiohumeral
Radioulnar
What are the ROM patterns of the elbow joint in degrees?
Flexion = 160
Extension = 5
Supination = 90
Pronation = 90
What type of joint is the proximal radioulnar joint?
Pivot (trochoid)
What joints does flexion and extension of the elbow occur at?
Ulnohumeral and radiohumeral
What joints does supination and pronation of the elbow occur at?
Radiohumeral and proximal radioulnar
During pronation the radius ______________________________?
Crosses over the ulna
What is the most common elbow fracture in adults?
Radial head
What is the primary mechanism of a radial head fracture?
FOOSH with arm supinated
The radius is longer than the ulna especially in the ____________________ position?
Supinated
What is a radial head dislocation commonly known as?
Nursemaid’s elbow
What age group does a radial head dislocation or nursemaid’s elbow occur in?
2-4 y.o.
What is the MOI for a radial head dislocation?
Sudden long axis traction to the arm causing the radial head to slip out of the annular ligament
What is the function of the annular ligament?
Holds the radial head in place during pronation
How is a radial head dislocation diagnosed?
Based on history and exam (NO IMAGING NEEDED)
How is a radial head dislocation or nursemaid’s elbow treated?
Reduction with flexion and supination
What characterizes olecranon bursitis?
Posterior elbow swelling and tenderness with a palpable, large bursa
What causes an aseptic olecranon bursitis?
Acute trauma or chronic repeated trauma
Aseptic olecranon bursitis is most commonly caused by (Acute/Repetitive Chronic) trauma?
Repetitive Chronic
What causes a septic olecranon bursitis?
Infection from hematogenous spread or direct inoculation
What pathology besides infection can cause olecranon bursitis?
Gout
If a patient has stiffness at the lateral elbow what joint(s) is/are likely affected?
Radiohumeral joint
If a patient has stiffness at the medial elbow what joint(s) is/are likely affected?
Ulnohumeral joint
If a patient has stiffness at the anterior elbow what joint(s) is/are likely affected?
Radiohumeral and ulnohumeral joints
If a patient has stiffness during supination and pronation of the elbow what joint(s) is/are likely affected?
Proximal radioulnar joint
What motions does the proximal radioulnar joint assist with at the elbow?
Pronation and supination
What motions do the radiohumeral and ulnohumeral joints assist with at the elbow?
Flexion and extension
What muscle tendon is most commonly affected in lateral epicondylitis?
Extensor carpi radialis brevis
What is the MOI of lateral epicondylitis?
Repetitive wrist extension or repetitive power grip with hand
What will be evident on physical examination with a patient who has lateral epicondylitis?
Tenderness on palpation at the lateral epicondyle
What two orthopedic tests are positive for lateral epicondylitis?
Cozen’s and Mills
Where is the insertion of the common flexor tendon in the arm?
Medial epicondyle of the humerus
Where is the insertion of the common extensor tendon in the arm?
Lateral epicondyle of the humerus
Medial epicondylitis involves the (Flexor/Extensor) compartment in the arm?
Flexor
Lateral epicondylitis involves the (Flexor/Extensor) compartment in the arm?
Extensor
What two muscles are most commonly involved in medial epicondylitis?
Flexor carpi ulnaris and pronator teres
What orthopedic test is used to test for medial epicondylitis?
Golfer’s elbow test
What is the second most common entrapment neuropathy?
Ulnar neuropathy at the elbow
Where is the ulnar nerve vulnerable to compression?
Ulnar groove
Cubital tunnel
Canal of Guyon
What nerve runs in the cubital fossa?
Median nerve
What nerve runs in the cubital tunnel?
Ulnar nerve
What forms the roof of the cubital tunnel?
Aponeurosis arch of FCU
What forms the floor of the cubital tunnel?
Medial elbow ligament
What forms the sides of the cubital tunnel?
Two heads of FCU
What is the most common cause of ulnar neuropathy at the elbow?
Idiopathic
A patient has numbness in the anterior and posterior aspects of the fifth and medial half of the fourth digits. What is the likely diagnosis?
Ulnar neuropathy at the ulnar groove or cubital tunnel
What is the distribution of the ulnar nerve in the hand?
Anterior medial palm, dorsomedial hand, anterior and posterior aspects of the fifth digit and medial half of the fourth digit
A patient with ulnar neuropathy on just the anterior side of the hand likely has compression where?
Canal of Guyon
A patient with ulnar neuropathy on the anterior and posterior side of the hand likely has compression where?
Cubital tunnel
What movement may aggravate ulnar neuropathy compression in the elbow?
Elbow flexion
What action may be clumsy or weak in a patient with ulnar neuropathy compression in the elbow?
Power grip
What muscles will be atrophied in a patient with long-standing ulnar neuropathy?
Interossei and hypothenar muscles
What interossei muscle is most commonly atrophied in a patient with long-standing ulnar neuropathy?
First dorsal interosseous (dorsal thumb web)
What muscles in the hand are innervated by the median nerve?
Lateral lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis longus
LOAF
What causes an ulnar claw hand deformity?
Weakness of the interossei and lumbricals at the 4th/5th digits
What nerve innervates the medial two lumbricals?
Ulnar nerve
What nerve innervates the lateral two lumbricals?
Median nerve
Most of your differential diagnoses come from the patient __________________?
History
What muscles in the forearm and hand are innervated by the ulnar nerve?
Flexor carpi ulnaris
Flexor digitorum profundus for the 4th/5th digits
Dorsal and palmar interossei
Adductor pollicis
Abductor digiti minimi
Flexor carpi ulnaris and flexor digitorum profundus (4/5th) are only affected in severe cases of ulnar neuropathy (TRUE/FALSE)?
t
What nerve root may be affected if the medial hand is experiencing numbness?
C8
What orthopedic tests can be used to test for ulnar neuropathy at the elbow?
Tinel tap
Ulnar flexion maneuver
What is a positive result for a Tinel tap test for the ulnar nerve at the elbow?
Sustained paresthesia in the sensory distribution of the ulnar nerve
What is a positive result for an ulnar flexion maneuver at the elbow?
Sustained paresthesia in the sensory distribution of the ulnar nerve
What is the dermatomal distribution for a C8 MRS?
4th and 5th digit and medial hand/forearm
What nerve innervates the pronator teres, flexor carpi radialis, and palmaris longus in the hand?
Median nerve
What is the primary reflex for a C8 MRS?
NONE
What is the secondary reflex for a C8 MRS?
Brachioradialis
Repetitive wrist flexion results in (Medial/Lateral) epicondylitis?
Medial
What is the muscle group tested for a C8 MRS?
Finger flexors 2-5th digits
What is the dermatomal sensory distribution for a T1 MRS?
Medial arm
What is the reflex for a T1 MRS?
NONE
What is the muscle group tested for a T1 MRS?
Interossei
What orthopedic tests are used to test for cervical radiculopathy?
Cervical foraminal compression
Cervical distraction
Shoulder depression test
What is a positive result for a cervical foraminal compression test?
Cervical radiculopathy
What is the interpretation of a positive cervical distraction test if the patient receives relief of pain during the test?
Cervical radiculopathy
What is the interpretation of a positive cervical distraction test if the patient has increased pain during a test?
Nerve root adhesion
What is the interpretation of a cervical distraction test if the patient has increased localized pain in the neck?
Negative with capsular inflammation
What is a positive result for a shoulder distraction test?
Cervical radiculopathy
What diagnostic test can be performed for radiculopathy if diagnosis is uncertain?
Electrodiagnostic testing
What is the most common entrapment neuropathy?
Median nerve at the carpal tunnel
What imaging can be performed to rule out other conditions besides radiculopathy?
Radiograph or MRI
