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Muscloskeletal Ultrasound > Elbow > Flashcards

Elbow Flashcards

0
Q

Name the tendons that comprise the CFTO

A

Flexor Carpi Radialis, Flexor Carpi Ulnaris, Flexor Digitorum Superficialis, , Pronator Teres

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1
Q

Name the tendons within the CETO

A

Extensor Carpi Radialis Brevis, Extensor Digitorum, Extensor Digitorum minimi, Extensor Carpi Ulnaris

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2
Q

Name the origin, insertion and action of the Extensor Carpi Ulnaris

A 
O- CETO
I- Dorsal surface of base of 5 th MC
A- extends hand, assists in addiction of hand with FCU
Crosses over fore-arm
N- Radial N
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3
Q

Name the origin, insertion and action of the Extensor Digiti Minimi

A 
O- CEO
I- dorsal surface base of proximal phalanx of 5th finger
A- extends 5th finger
Runs along posterior arm
N- Radial N
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4
Q

Name origin, insertion and action of the Extensor Digitorum

A

O- CEO
I- lateral and dorsal surfaces of all the phalanges of the four fingers
A- extends fingers and wrist
N- Deep branch of radial N

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5
Q

Name the origin, insertion and action of the Extensor Indices

A

O- distal posterior ulna and IOM
I- Proximal phalanx of index finger
A- extends index finger
N- Radial N

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6
Q

Name the origin, insertion and action of the extensorPollicis Longus

A

O- Dorsal surface of ulna and IOM
I- base of distal phalanx of thumb
A - extends thumb
N- Radial N

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7
Q

Name the origin,insertion and action of the Extensor Carpi Radialis Brevis

A

I- CEO
O- dorsal base of 3rd MC
A-extends hand, aids in abduction of hand with FCR
N- radial

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8
Q

Name the origin, insertion and action of the Extensor Carpi Radialis Longus

A

O- distal third of lateral supracondylar ridge of humerus
I- dorsal surface of base of 2nd MC
A- extends hand , aids in abduction of hand with FCR
N- Radial N

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9
Q

Name the origin, insertion and action of the Extensor Pollicis Brevis

A

O- dorsal surface of radius part of IOM
I- base of proximal phalanx of thumb
A- extends thumb, abducts hand
N-Radial N

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10
Q

Name the origin, insertion and action of the Abductor Pollicis Longus

A

O- dorsal shaft of radius, ulna and IOM
I- dorsal surface of base of base of first MC
A- abducts, laterally rotates, extends thumb. Abducts wrist
Often has an accessory tendon
N- Radial N

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11
Q

Name the origin insertion and action of the Flexor Carpi Radialis

A

O- CFO
I- anterior aspect of bases of 2nd and 3rd MC
A- flexes hand, aids in abduction with ECRL and ECRB
N- median

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12
Q

Name the origin, insertion and action of the Flexor Carpi Ulnaris

A

O- CFO
I- Pisiform, hook of hamate, base of 5th MC
A- flexes hand, assists in addiction of hand with ECU
N- Ulna N

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13
Q

Name the origin, insertion and action of the Flexor Digitorum Superficialis

A

O- CFO
I- 4 tendons divide into 2 slips each, slips insert into the sides of the anterior surface of the middle phalanx of all 4 fingers
A- flexes middle phalanges of fingers
N-Median N

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14
Q

Name the origin, insertion and action of the Flexor Digitorum Profundus

A

O- upper 3/4 of the anterior and medial shaft of ulna, medial side of coronoid process and IOM
I- anterior base of the 4 distal phalanges
A- finger flexes
Called perforating muscles as it splits through the FDS tendons
N- Ulna N little to ring fingers
Median N- supplies lateral half, index and middle fingers

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15
Q

Name the origin, insertion and action of the Flexor Pollicis Longus

A

O- middle of the anterior surface of the shaft of the radius, IOM, medial epicondyle of humerus
I- palmar aspect of base of the distal phalanx of thumb
A- flexes thumb
N- Median N

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16
Q

What is the Osbourne retinaculum?

A

The Osborn retinaculum bridges the cubital tunnel. If absent the ulna N can dislocate over the medial epicondyle

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17
Q

What is pronator syndrome ?

A

When the median N is trapped between the 2 heads of the pronator Teres muscles.
Watch for constricted movement of the Nerve as you pronate and supinate.

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18
Q

Radial N Tunnel Syndrome

A

Entrapment of PIN by a build up of fibrous tissue as it dives through the supinatior muscle at the Arcade of Froshe.
Look for neurofibroma / schwannoma.
Pain on restricted supination of forearm

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19
Q

Cubital Tunnel Syndrome

A

Compression or entrapment of the Ulna N proximal, at or distal to groove, caused by osteophytes, muscle hypertrophy, tendon or ligament thickening, an accessory muscle, effusion, ganglia, synovial hypertrophy or secondary to triceps tendon tear.
Subluxation of N ( anteriorly and medially to medial epicondyle), this can be asymptomatic and bilateral
- localised hypertrophy - fusiform swelling of the nerve
- Neuromas

20
Q

Supinatior

A

O-lateral epicondyle of humerus, RCL of elbow, annular lig, supinatior crest of ulna
I- dorsal and lateral surfaces of upper third of radius
A-Supinates forearm
N-radial n

21
Q

Name the muscles which make up the thenar eminence

A

The Abductor pollicis Brevis, flexor pollicis Brevis,and opponens pollicis form the thenar eminence at the base of the thumb.

22
Q

Brachioradialis

A

O- distal humerus
I- styloid process of radius
A- flexes forearm
N- radial n

23
Q

Pronator Quadratus

A 
O- anterior distal ulna
I- distal anterior radius
A- pronates forearm
N- median nerve
Deepest forearm muscle
24
Q

Pronator Teres

A

O-CFO medial epicondyle of humerus
I-middle of lateral shaft of the radius
A-Pronates and weakly flexes forearm
N- median

25
Q

Acute injuries of elbow

A
  • Fracture
  • Dislocation
  • Ligament or tendon ruptures - UCL after dislocation - biceps-weight lifting - triceps, fall or direct blow
26
Q

Lateral Elbow -chronic pain

A

Tennis elbow- CEO tendinosis.
Overuse from excessive wrist extension causing degeneration of tendon which can lead to microscopic tears of tendon
-resisted extension of middle finger produces ache over epicondyle
-Mills test- resisted wrist extension with wrist probated and radially deviated
- pain with palpating over lateral epicondyle
-hurts to open a jar, shake hands and carry a bag

  • less commonly: -synovitis of radio-capitellar joint
  • radio humeral bursitis
  • entrapment of posterior interosseous nerve as it passes through the supinatior muscle
  • May exist by themselves or in association with extensor tendinosis
27
Q

Medial elbow pain causes

A

Golfer elbow - CFO tendinosis. Pain from excessive activity of wrist flexors, eg repetitive throwing

  • UCL strain
  • pain on resisted wrist flexion and resisted forearm pronation
  • pain at or on medial epicondyle
  • less commonly
  • ulna nerve compression
  • avulsion fracture of medial condyle
  • apophysitis
  • Referred Pain
28
Q

Posterior Elbow pain causes

A
  • Olecranon bursitis with swelling over posterior elbow
  • triceps tendonopathy
  • posterior impingement
  • Gout
29
Q

Patient Symptoms

A
  • look, listen, palmate, compare, move
  • Insidious onset - tendinosis
  • sudden onset - tear
  • if pain is persistent, unpredictable or related to posture think referred pain from cervical spine or from increased neural tension
  • if pain radiates into lateral aspect of forearm think PIN entrapment
30
Q

PIN entrapment symptoms

A

Pain on resisted supination of forearm

31
Q

Ulna nerve compression symptoms

A
  • sensory symptoms along ulnar border of forearm and 5 th and medial half of 4th fingers
  • May be tender behind medial epicondyle
  • tapping over nerve may produce symptoms
32
Q

Distal biceps pathology

A

Be aware that biceps tendon has two heads

  • Tendinopathy- changes in echogenicity and thickness of the tendon MUST compare with contralateral side
  • Partial tears- hypoechoic or anechoic defect in the tendon, usually towards radial side of tendon. Compare with other side
  • Complete tear- avulsion of tendon from its insertion on the radial tuberosity with tendon retraction proximally to the cubital fossa
  • Cubital bursa
  • Bursitis -trauma and inflammation can lead to an increase In size of the bursa as it fills with haematoma and debris
33
Q

Brachialis pathology

A
  • muscle tears

- atrophy

34
Q

Median Nerve pathology

A
  • pronator syndrome -entrapment of median nerve between the 2 heads of the pronator Teres muscle. Watch for constricted movement of nerve as you pronate and supinate the forearm
  • impingement of nerve may occur in association with rupture of the biceps insertion and cubital bursitis
35
Q

Anterior joint and anular recess pathology

A
  • joint effusion- elevation of joint capsule from the articular cartilage by an anechoic fluid collection
  • elevation of hyperechoic fat pad by synovial pannus as in rheumatoid arthritis
  • Ganglia
  • Loose bodies
36
Q

Radial Nerve Pathology

A
  • radial tunnel syndrome ( can also be looked at laterally) - entrapment of PIN by a build up of fibrous tissue as it dives through the supinatior muscle
  • neurofibroma/schwannoma
37
Q

CETO pathology

A

-lateral epicondylitis , Tennis elbow, CERO Tendinopathy/tendinosis
Degeneration of the ECRB with 1-2cm of its attachment on the lateral epicondyle, hypoechoic thickened tendon.
Compare with measurements to contralateral side, colour Doppler for hyperaemia of the tendon. Use gentle pressure and relax arm. Normal tendons demonstrate little or no flow .

-partial and intrasubstance tears can be seen as anechoic areas.
Pronate and supinate the wrist to spread the fibres of the tear
-complete rupture
-calcification in the tendon can be from previous steroid injections

38
Q

Radial collateral ligament pathology

A
  • hypertrophy/ strain
  • partial tear
  • complete rupture
39
Q

Common flexor tendon pathology

A

Golfers elbow, medial epicondylitis, CFTO tendinosis - thickened tendon origin with point tenderness. This is a very short tendinous insertion onto the medial epicondyle, not to be confused with the ulna collateral ligament which lies across the joint. Compare with measurements to contralateral side.

40
Q

Ulnar collateral ligament pathology

A
  • hypertrophy / strain
  • partial tears
  • complete rupture
41
Q

Epitrochlear lymphadenitis

A

Cat scratch syndrome - a reactive subcutaneous tissues lymph node close to the medial epicondyle in response to a viral infection

42
Q

Olecranon bursa pathology

A

-bursitis / students elbow -fluid in subcutaneous tissues-usually quite obvious clinically as a large swelling over the posterior elbow

43
Q

Triceps pathology

A
  • Tendinopathy
  • partial tears
  • complete avulsion may be associated with fracture
  • musculotendinous junction tear
44
Q

Posterior elbow joint pathology

A
  • effusion

- loose bodies

45
Q

Ulna nerve pathology

A
  • compression or entrapment of ulnar nerve proximal, at or distal to groove, caused by osteophytes , muscle hypertrophy, tendon or ligament thickening, an accessory muscle, effusion, ganglia, synovial hypertrophy or secondary to distal triceps tendon tear
  • subluxation of nerve anteriorly and medially to medial epicondyle. This can be asymptomatic and bilateral
  • localised hypertrophy-fusiform swelling of the nerve
  • Neuromas
46
Q

Extra posterior pathology

A

Muscle tears/atrophy
Lipomas
Myositis ossificans

47
Q

Other tests?

A

X-ray’s helpful for fractures, arthritis
MRI- subchondral bone, hyaline and fibrous cartilage and periarticular fluid
Arthroscopy- intra-articular structures
Histology-assess the collagen and architecture
CT-if MRI is not available

Muscloskeletal Ultrasound (13 decks)

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