Elbow Flashcards
humeroulnar open pack
70 flexion, 10 supination
humeroulnar capsular pattern
flexion more limited than extension
humeroulnar closed pack
full extension and supination
humeroradial open pack
full extension and supination
humeroradial closed pack
90 flexion, 5 supination
radioulnar open pack
70 flexion flexion, 35 supination
radioulnar closed pack
5 supination
normal carrying angle
10-15 degrees
ligaments of the elbow
UCL
LCL
annular ligament
UCL movement restraint
UCL resists valgus stress
anterior: 0-70 elbow flexoin
posterior: 60-120 elbow flexion
LCL movement restriction
provides 30-50% stability against varus
bony structures provide other 50-70%
annular ligament function
supports radial head as part of the capsule
lateral elbow pain indicates:
epicondylitis
medial elbow pain indicates:
tendinopathy
MCL sprain
ulnar nerve compression
posterior elbow pain indicates:
olecranon bursitis
triceps tendinosis
valgus extension overload
cubital fossa pain indicates
brachialis tear
biceps tear
elbow arthritis: causes
trauma
RA
gout
infecction
OA
age 40-60
strenuous work/throwing
elbow arthritis subjective
pain
swelling
stiffness
mechanical locking
deformity
septic arthritis: fever/chills/malaise
elbow arthritis objective
RA: joint swelling, nodules, tenderness, joint instability
Septic arthritis: severe pain, ROM restriction
OA: minor effusion, joint line tenderness
interventions for elbow arthritis
OA: rest, NSAIDs, gentle stretch, modify activity
RA: corticosteroids into joint, splinting, gentle PT to avoid degradation of tissue
surgical intervention for arthritis
arthroscopic debridement
synovectomy
total elbow arthroplasty
fracture of radial head/neck: cause
trauma: FOOSH
classifications of radial Fxs
type 1: nondisplaced
type 2: displaced 2 mm at articular surface/neck Fx creating articular discongruency
type 3: severely crushed Fx of radial head and neck
type 4: ulnohumeral dislocation
subjective of radial Fx
pain and swelling over lateral elbow
decreased elbow motion: block, pain inhibition, joint effusion
objective of radial Fx
radial head deformity
neurovascular function can be impaired
lateral elbow tenderness
limited passive supination/pronation & flexion/ext
radial Fx interventions
type 1: nondisplaced - sling/splint, early AROM
strengthening: iso at 3 weeks, concentric at 5-6 weeks, heavy resistance after 8
type 2: rules of 3s - non surgical if less than 1/3rd of articular surface, less than 30 angulation, less than 3 mm displacement
type 3: excise bone fragments, rehab 12 weeks after fixation
get ROM back first in week 2
olecranon bursitis
inflammation of bursa
pain with motion due to compression of tissue while moving
olecranon bursitis subjective
pain
swelling
decreased ROM
olecranon bursitis subjective/objective
swelling up to 6 cm
but redness and heat indicate infection
biceps tendon rupture: cause
sudden contraction against significant load
90 degrees flexion
biceps tendon rupture subjectiv
sharp tear with acute injury
loss of strength in elbow flexion activities/supination
biceps tendon rupture objective
eccymosis
visible deformity
loss of strength in elbow flexion/supination
biceps tendon rupture intervention
surgery
protect 6-8 weeks after surgery, then unrestricted ROM
triceps tendon rupture: cause
deceleration force in elbow extension
uncoordinated contraction of triceps against flexing elbow
more likely if pt has triceps tendinopathy
triceps tendon rupture: subjective/objective
loss of elbow extension strength
unable to extend arm overhead against gravity
triceps tendon rupture: intervention
primary repair
partial tear treat w PT,
lateral epicondylitis
wrist extensor tendons at origin, pathology/inflammation/degeneration becoming chronic
35-50 y/o
caused by repetitive grasping/sports/overuse causing microtrauma
grades of lateral epicondylitis
1: inflammaotyr, acute
2: pathological alteration of tissue like tendinosis, overuse injury
3: partial tear due to pathological changes and structural failure
4: large tear with fibrosis, matrix calcification, osseous calcification
lateral epiconylalgia: subjective/objective
diffuse achiness
morning stiffness
localized tenderness over extensors
pain w wrist flexion + elbow extension
PROM painful
resisted tests painful
types of tendon lesions based on pain w palpation
1: ECRL origin
2: insertion tendinopathy, ECRB (most common)
3: pain at radial head
4: ECRB muscle belly
5: inflam at extensor digitorum origin
lateral epicondylalgia special tests
Cozen
Mills
medial epicondylalgia
tendinopathy at flexor/pronator attachment
overuse
medial epicondylalgia: subjective/objective
medial elbow pain
overuse/lifting/gripping
pain w wrist flexion/pronation
PTP distal to medial epicondyle
pain w passive wrist extension and forearm supination
MCL tear elbow
s/s
medial elbow pain at ligament site
tender to palpation
ulnar nerve TTP
+ tinel’s at ulnar
loss of terminal elbow extension
+ valgus stress test
MCL tear elbow treatment
rest
activity modification
ROM
modalities
NSAIDs
stretch and strengthen flexors to support medial elbow
little league elbow
pain w throwing or palpation due to overuse in 8-15 year olds
valgus stress in cocking/acceleration of pitching
limit max pitches per day
median nerve entrapment: pronator syndrome
insidious pain
median nerve distribution pain
PTP w pronator teres, resisted supination, long finger flexors
treat median nerve entrapment
activity modification to avoid aggravating actions
NSAIDs/modalities
stretch wrist flexors/pronators
manual techniques
