elbow Flashcards
ROM in degrees
flexion = 145-150deg
extension = 0 to -10 deg (0 is avg)
pronation = 90deg
supination = 90deg
goniometer helps measure
joints and mvmnts
flex/tension = humeroulnar and humeroradial joints
pro/supination = proximal radioulnar joint
ligaments of the elbow
UCL/ulnar collateral lig = collection of 3 bundles
- anterior bundle most injured
LCL/radial (lateral) collateral lig = from lateral epi to annular lig
annular lig = proximal radial head, surrounds head and neck…allows pro/supination
accessory lateral collateral ligament
muscles and actions
flexors = biceps, brachialis, brachioradialis
extensors = triceps, anconeus
pronation = pronator teres, pronator quadratus
supination = supinator, biceps
interosseous membrane
connects radius and ulna, site of muscle attachment and allows vessel passage
techniques to open membrane for inc mvnt after periods of immobilization
elbow nerves
musculocutaneous = c5-c7, supplies flexors
median = c5-t1, palmar hand
ulnar = c8-t4, 4th and 5th digits plus ulnar hand
- travels thru cubital tunnel
radial = c5-t1, largest branch…posterior forearm
brachial artery
blood supply to glexors
branches into ulnar and radial arteries
arm contusion
vulnerable bcs lack of padding
chronic blows –> dev ectopic bone
tackler’s exostosis: bone formation on bone…spur bcs of rep blows
myositis ossificans
periostitis/inflamed periosteum
fibrostitis/inflamed connective tissue and muscle
olecranon bursitis
septic: scraped when fall on elbow, obv from heat coming from joint
- also from cuts in other body parts where bacteria enters
- ASAP MEDICAL ATTENTION
- trace redness w marker to see spread
aseptic bursitis: assoc w rheumatoid and crystal-induced gout
MOI = fall on flexed elbow, can be chronic i.e. cont pressure
S/S = tender, swollen, rupture, goose egg
- cannot reach full flexion bcs tension over bursa
elbow sprain
MOI = FOOSH, valgus/varus force
- often bcs of repetitive forces that tear ligaments
S/S = pt tender, instability w stress tests
varus stress test
valgus stress test
tommy john
UCL reconstruction surgery using palmaris longus
anterior capsulitis
MOI = hyperextension, fall
S/S = diffuse, anterior elbow pain after traumatic episode, DEEP TENDERNESS w palpation
must rule out pronator teres strain and median nerve entrapment
proximal radial head dislocation
assoc w immature annular ligament
MOI = longitudinal traaction of extended and pronated upper arm
- swinging kid by arms
S/S = cannot pro/supinate w/o pain
immobilize w 3-6 wks in flexion
ulnar dislocation
peaks in teenage years
MOI = hyperextension, sudden and violent unidirectional valgus force
S/S = snap/crack, severe pain, rapid swelling, TOTAL FUNCTION LOSS w deformity
911 call bcs risk of shock and dec pulse
terrible triad
posterior elbow dislocation
coronoid process fracture
radial head fracture
biceps brachii rupture
MOI = sudden eccentric load
S/S = tender, distal tendon not palpable…bruising of antecubital fossa, weak flexion and supination
90%+ ruptures occur proximally
triceps brachii rupture
MOI = direct blow to posterior elbow, uncoordinated triceps contraction during fall
most occur distally at elbow jt
- 80% involve olecranon avulsion
S/S = palpable defect in tendon or step deformity off olecranon
- partial tear = weak extension
- full tear = no extension
compartment syndrome
swelling increases pressure w/in compartments, compresses vessels w/in
- bcs fascial sheets are inextensible
often a secondary condition
S/S = RAPID onset, swelling and bruising, absence of distal pulse
- sensory changes, paralysis
- PAIN AT REST, pain w inc stretching of muscles in compartment
- pain WORSENS OVER TIME, compared to fractures which improve
limb threatening
chronic exertion compartment syndrome
an overuse injury…inc BF and temporary symptoms i.e. tingling
symptoms resolve w rest as circulation normalizes, not medical emergency
medial epicondylitis
aka golfer’s elbow
- chronic
MOI = valgus force, repetition
medi epi is a common flexor origin
S/S = gradual onset, pain at med epi, inc pain when use forearm
- rarely swells
- dec extension, weak wrist flexors
tests:
resisted flexion, resisted pronation
passive elbow and wrist extension
treatment
- PIER = pressure, ice, elevate, rest
- inc ROM, inc musc flexion
- balance musc groups
lateral epicondylitis
aka tennis elbow, overuse
lateral epicondye = common extensor origin
MOI = eccentric loading of extensors during deceleration
S/S = pain at lat epi, dec extension and flexion
tests:
passive stretch of wrist extensors
resisted extension and radial deviation
little league elbow
growth plates at proximal radius head, lateral and medi epicondyles
compressive forces on lateral side, stretching/tensile forces on medial aspect
cubital tunnel syndrome
ulnar nerve entrapment
sensitive to press, stress, trauma
medial 1/2 arm, 5th and 1/2 4th digit
pronator syndrome
median nerve entrapment
compression via hypertrophy
i.e. pronator teres, aggravated by pronation
radial tunnel syndrome
radian nerve, innervation of posterior arm
acute i.e. humeral fracture, chronic i.e. trapped in cubital fossa
painful supination….tender supinator where nerve travels thru
pinch grip test
make o w index and thumb
abnormal pad to pad indicates median nerve entrapment
osteochondral injury
separation of articular cartilage from underlying bone
from repetition, jt overload
supracondylar fracture
common in kids, needs surgery
MOI = FOOSH
carrying angle
angle b/w long axis of humerus and ulna…avg adult = 10-15deg
cubitus varus = straighter than normal, less than 5-10deg
cubitus valgus = inc angle, greater than 20deg
is a sign of injury
osteochondritis dissecans
rep stress to immature elbow….cartilage and bone separate in jt
- adolescence 12-15y/o
MOI = lateral compressive forces or overhead throwing
cartilage fibres become loose body, impedes ROM
- swell/lock
- necrosis from dec blood supply
volkmann ischemic contracture
permanent, claw-like deformity
MOI = crushing, fracture, pressure from swelling
joint stiffens/shortens when injury doesn’t receive blood flow and never recovers
fracture testing
compression = good for long bones, start away from injury
distraction = makes it feel better, effective for long bones
percussion = tap test, vibration causes pain
tuning fork = must be placed on bone to work
