Elbow Flashcards
carrying angle for men and women
11-14 degrees for men
13-16 degrees for women
what ligament holds the carrying angle?
MCL
closed packed position of humeroulnar joint elbow
extension and supination (anatomical position)
CPR of elbow
loss of flexion >extension
closed packed position of the humeroradial joint of elbow
flexed to 90 and supinated to 5 degrees
glide for flexion of humeroulnar joint
distal/anterior
glide for extension of humeroulnar joint
proximal/posterior
glide for flexion of humeroradial joint
anterior
glide for extension of humeroradial joint
posterior
glide for forearm varus
lateral
glide for forearm valgus
medial
CPP of proximal radioulnar joint
5 degrees supination
CPR prox. radioulnar joint
equal loss supination/pronation
what ligment covers apprx. 80% of the articular surface of the proximal radioulnar joint
annular ligament
to gain pronation, at prox. radioulnar joint, glide_______
dorsally, posteriorly
to gain supniation at prox. radioulnar joint, glide_____
anteriorly, volarly
glide and slide are in the _____ direction for the distal radioulnar joint?
same
to gain pronation at the distal radioulnar joint, glide______
volarly
to gain supination at distal radioulnar joing, glide_______
dorsally
symptom location at elbow: anterior
ant. capsule strain, biceps rupture, dislocation, pronator syndrome
symptom location at elbow: posterior
olecranon bursitis, olecranon process stress fx, triceps tendonitis
symptom location at elbow: medial
medial epicondylitis, MCL, ulnar neuritis, fx
symptom location at elbow: lateral
LCL, lateral epicondylitis, capitulum fx,ostochondral degeneration, osteochondritis dessicans, radial head fx
flexion ROM
150
extension ROM
0-10
supination ROM
90 degrees
pronation ROM
80-90
test for lateral epicondylitis
resisted middle finger extension, tests ECRB, mills and cozens tests also
Cozen’s test
resist wrist extension and radial dev. Tests ECRB and ECRL for lateral epicondylitis
Mill’s test
lateral epicondylitis test: passive stretch into pronation and flexion of wrist with extended elbow. pain?
medial epicondylitis test
passive stretch, supinate, extend wrist and extend elbow now radially deviate and palpate medial epicondyle
test for cubital tunnel syndrome
ulnar nerve tinnel’s tapping
other test for cubital tunnel syndrome (not tinnels)
sustained elbow flexion for up to 10 seconds.
what does a humeroulnar joint distraction help with? “the scoop”
flexion
how do u “release the olecranon” when performing glides at the elbow?
by placing a towel under the patient’s forearm in order to achieve 5 degrees of flexion
how much flexion is needed to perofrm a humeroradial distraction?
30-45 degrees
What is Panner’s disease?
avascular necrosis of the capitulum
who does panner’s disease most commonly affect?
boys, < 10 years old, affects their dominant arm
S&S of panner’s disease
dull ache at the lateral elbow, swelling, stiff, tender
can’t fully extend pronate or supinate
pain gets worse with activity and better with rest
tx for panner’s disease
reduce pain and inflammation, bone rebuilds on its own in 1-2 years
radial head fracture MOI
foosh with forearm pronated and elbow flexed, axial compression, valgus forces or forced supination
what is the radial head an important stabilizer of?
valgus stresses
what is the terrible triad?
elbow joint dislocation, radial head fracture and coronoid process fracture
S&S of radial head fx?
still elbow, cant fully flex or extend, pain with pronation and supination, pain over radial head
tx of radial head fx
may or may not have surgery, PT= no manual therapy, regain full wrist and elbow ROM, isometric elbow and wrist exercises, concentric wrist exercises in pain free range
types of radial head fx: I, II, III, IV
1= undisplaced 2= displaced >30% but <50% of the head 3= entire head comminuted 4= w/ elbow dislocation
Cubital tunnel syndrome
just like carpal tunnel but at the ulnar nerve in the cubital fossa of the elbow
S&S of cubital tunnel syndrome
waking up at night with numb fingers pain, swelling in elbow aching pain on inside of elbow difficulty manipulating objects weak grip claw hand n/t in the 4th and 5th digits, especially with a bent elbow mm wasting in hand if its chronic enough
special tests for cubital tunnel syndrome
tinel's sign elbow flexion test froment's sign upper limb tension test for ulnar N sensory exam for ulnar nerve distribution
tx of cubital tunnel syndrome
massage to flexor mm in forearm, neural mobs and glides
gentle ROM, strengthening
Grades of cubital tunnel syndrome: I, II, III
I- intermittent paresthesia, no motor loss
II- persistent symptoms, mild weakness
III- severe paresthesia, obvious loss of sensation, functional and motor impairment, atrophy of intrinsics, sign of benediction
medial epicondylitis (golfer’s elbow)
inflammation of medial epicondyle
S&S of golfer’s elbow
swelling, weakness, tightness, pain starting in medial elbow and radiating down, increased pain with twisting motions
tests for golfers elbow (med. epicondylitis)
resisted wrist flexion
resisted forearm pronation
tx for medial epincondylitis
friction massage, stretching, full and painless wrist and elbow ROM, start with isometrics then add resistance, then concentrics then eccentrics
little leaguer’s elbow
repetitive microtrauma to apophysis and ossification center of the medial epicondyle. constant medial traction pulls growth plate. in adults it stresses the UCL and leads to tommy john sx
little leaguer’s elbow MOI
overuse of large valgus stresses to the elbow and lateral compression of structures
S&S little leaguer’s elbow
medial elbow pain, tenderness, pain with throwing, decreased velocity with throwing, flexion contracture
tests for little leaguer’s elbow
moving valgus stress test milking maneuver (applying valgus stress) detailed history of throwing habits ulnar nerve and C8/T1 throwing mechanics?
tx of little leaguer’s elbow?
PRICE, pain free rom, active wrist and elbow motions, core and shoulder and scapular strengthening, eccentric exercises for elbow, low load high reps
lateral epicondylitis
tennis elbow: imflammation at the lateral epicondyle of elbow
what attatches to the lateral epicondylitis
extensors
s&S lateral epincondylitis
dull ache at rest
tenderness at lateral elbow over ECRB and ECRL
swelling
pain in lat. elbow during wrist extension and grasping
tests for lateral epicondylitis
cozen’s test
mill’s test
tx for lateral epicondylitis
stretching and isometrics in acute,
hand putty, PRICE
move to strengthening, focus on eccentric strengthening at the wrist, look at their tennis racket
what is the proper way to progress strengthening exercises
isometrics>AROM GE>AAROM with gravity>AROM against gravity>eccentrics> resisted eccentrics