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Ortho Tx 700 > Elbow > Flashcards

Elbow Flashcards

1
Q

Elbow flexion and extension adjusts for

A

Proper height and distance of hand

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2
Q

Supination and pronation allow for

A

Complex hand movements and mobility.

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3
Q

Biceps Brachii

A

Origin: (long head) supra glenoid tubercle
(Short head) corocoid process

Insertion: radial tuberosity, bicipital aponeurosis

Action: shoulder and elbow flexion. Supination.

Musculocutaneous nerve
Brachial artery

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4
Q

Brachialis

A

Origin: distal anterior shaft of the humerus

Insertion: ulnar tuberosity, coronoid process of the ulna

Action: elbow flexion (pronated)

Musculocutaneous nerve
Brachial artery

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5
Q

Brachioradialis

A

Origin: lateral supercondylar ridge

Insertion: styloid process of the radius

Action: flexes elbow in neutral; brings forearm to neutral from either supination or pronation

Radial nerve
Brachial and radial arteries

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6
Q

Triceps brachii

A

Origin: (long head) infra glenoid tubercle
(Lateral head) proximal 1/2 of humerus
(Medial head) distal 1/2 of humerus

Insertion: olecranon process of ulna

Action: elbow extension; GH extension

Radial nerve
Deep brachial artery

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7
Q

Anconeus

A

Origin: lateral epicondyle (CET)
Insertion: posterior proximal ulna (lateral to olecranon)

Action: elbow extension (last 15-20°)

Radial nerve
Deep brachial artery

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8
Q

Superficial layer of the posterior forearm:

A

CET (ECRB, extensor digitorum, ECU, EDMinimi)

ECRL

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9
Q

What inserts into the CET

A 
Anconeus 
ECU
ExtDig
ExtDigMini
ECRB
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10
Q

Extensor Carpi Radialis Longus

A

Origin: supercondylar ridge

Insertion:posterior base of MC #2

Action: wrist extension, radial deviation, (elbow flexion?)

Radial nerve
Brachial and radial artery

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11
Q

Extensor Carpi Radialis brevis

A

Origin: lateral epicondyle (CET)
Insertion: posterior base of MC #3

Wrist extension. Radial deviation. (Elbow flexion?)

Radial nerve
Brachial and radial artery

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12
Q

Extensor digitorum

A

Origin: lateral epicondyle (CET)

Insertion: middle and distal phalanges #2-5 (via DDE)

Wrist extension. MCP, DID and PIP extension (2-5). (Elbow extension)

Radial nerve
Posterior interosseus artery

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13
Q

Extensor Digiti Minimi

A

Origin: lateral epicondyle (CET)
Insertion: middle and distal phalanges #5 (DDE)

Wrist extension, MCP/PIP/DIP #5 extension. (Elbow extension)

Radial nerve
Posterior interosseus membrane

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14
Q

Extensor Carpi ulnaris

A

Origins: lateral epicondyle (CET), posterior 1/3 ulna

Insertion: posterior base of MC #5

Wrist extension. Ulnar deviation. (Elbow extension)

Radial nerve
Posterior interosseus artery

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15
Q

Muscles of the deep posterior forearm

A 
ABductor pollicis 
Extensor Poll Brev
Extensor Poll long 
Extensor indices
Supinator
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16
Q

Supinator

A

Origin: 1) lateral epicondyle; 2) supination crest of ulna

Insertion: proximal 1/3 radius

Supination of forearm.

Radial nerve
Radial and posterior interosseus artery

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17
Q

Abductor Pollicis Longus

A

Origin: 1) middle 1/3 posterior ulna; 2) interosseus membrane

Insertion: posterior base MC 1

Abducts thumb at CMC jt.

Radial nerve
Posterior interosseus artery

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18
Q

Extensor pollicis brevis

A

Origin: 1) posterior distal 1/3 radius; 2) distal 1/3 interosseus membrane

Insertion: posterior base proximal phalanx #1

Extends thumb at CMC and MCP

Radial nerve
Posterior interosseus artery

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19
Q

Extensor pollicis longus

A

Origin: 1) posterior middle 1/3 ulna; 2) middle 1/3 interosseus membrane

Insertion: posterior base of distal phalanx #1 (DDE)

Extends thumb at CMC, MCP, IP

Radial nerve
Posterior interosseus artery

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20
Q

Extensor indices

A

Origin: 1)posterior distal 1/3 ulna; 2) interosseus membrane

Insertion: posterior side of middle and distal phalanges #2 (DDE)

Extends index finger at MCP, PIP, DIP
Extends wrist

Radial nerve
Posterior interosseus artery

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21
Q

Superficial muscles of the anterior forearm

A

CFT (pronator teres, FCR, Palm Long, FCU)

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22
Q

Pronator Teres

A

Origin: (humeral) medial epicondyle via CFT
(Ulnar) coronoid process

Insertion: lateral radius (distal to supinator insertion); middle 1/3 interosseus membrane

Pronation. Elbow flexion

Median nerve
Ulnar and radial arteries

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23
Q

Flexor Carpi Radialis

A

Origin: medial epicondyle (CFT)

Insertion: base of 2nd and 3rd metacarpals

Wrist flexion. Radial deviation. (Elbow flexion)

Median nerve
Ulnar and radial arteries.

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24
Q

Palmaris Longus

A

Origin: medial epicondyle (CFT)

Insertion: palmar aponeurosis and flexor retinaculum

Wrist (and elbow) flexion.

Median nerve
Ulnar artery

(Not present in everyone)

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25
Q

Flexor Carpi ulnaris

A

Origin: medial epicondyle (CFT); proximal ulna

Insertion: pisiform, hook of hamate, 5th MC

Wrist flexion. Ulnar deviation (elbow flexion)

Ulnar nerve
Ulnar artery

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26
Q

Intermediate muscles of the anterior forearm

A

Flexor digitorum superficialis

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27
Q

Flexor digitorum

Superficialis

A

Origin: (humeral ulnar head) medial epicondyle (CFT), coronoid process
(Radial head). Proximal 1/3 radius

Insertion:palmar surface of middle
Phalanges 2-5

Median nerve
Ulnar and radial arteries.

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28
Q

Deep Muscles of the anterior forearm

A

Flexor digitorum profundus

Flexor pollicis Longus

Pronator quadratus

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29
Q

Flexor digitorum profundus

A

Origin: median/anterior ulnar; interosseus membrane

Insertion: palmar surfaces of distal phalanges 2-5

MCP/DIP 2-5 flexion. (Wrist and PIP flexion)

Median AND ulnar nerves
Radial, ulnar and anterior interosseus arteries.

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30
Q

Flexor pollicis longus

A

Origin: anterior radius and interosseus membrane

Insertion: distal thumb

Thumb flexion (CMC, MCP, IP).
Wrist flexion.
(?elbow flexion?)

Median nerve
Radial and anterior interosseus arteries.

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31
Q

Pronator quadratus

A

Origin: anterior distal ulna

Insertion: anterior distal radius

Pronation

Median nerve
Anterior interosseus artery.

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32
Q

Main function of elbow

A

Serve hand movement

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33
Q

MMT Biceps Brachii

A

Bicep curl position. Elbow flexed to 90°. Apply pressure toward extension

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34
Q

MMT Brachioradialis

A

Elbow flexed to 90°. Cushion under elbow.
Forearm neutral between pronation and supination.
Apply pressure toward extension

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35
Q

MMT Brachialis

A

Elbow flexed to 90°

Forearm pronated.

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36
Q

What happens to the FCU after the pisiform?

A

It’s tendons splay out and become a ligament.

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37
Q

Olecranon bursa

A

Lies between the olecranon and subcutaneous fascia.

Becomes very swollen when inflamed.

Irritated by weighty bearing or trauma.

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38
Q

Radial nerve

A

C5-T1

As Posterior Interosseus passes between heads of triceps
Crosses elbow anterior to lateral epicondyle
Passes under ECRL, pierces supinator (Arcade of Frohse)
Runs posterior along interosseus membrane

Wrist extensors

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39
Q

Median Nerve

A

C5-T1

As Anterior Interosseus branch, travels medial to biceps and along cubital fossa

Passes between heads of pronator teres

Runs through carpal tunnel.

Intrinsic hand muscles

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40
Q

Ulnar Nerve

A

C8-T1

In upper arm travels with brachial artery and median nerve

Passes behind median epicondyle in ulnar groove, through cubital tunnel.
In forearm runs deep to FCU

Innervates FCU, half of FDP

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41
Q

Cubital Tunnel

A

Formed by arcuate ligament

crossing ulnar groove

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42
Q

Brachial artery

A

Major blood vessel of upper arm.

Ventral arm to cubital fossa, then bifurcates to radial and ulnar

Closely related to median nerve

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43
Q

Functions of interosseus membrane

A
  1. Muscle attachment
  2. Stabilizes proximal, medial and distal radial-ulnar joints.
    * 3. Transmits force from radius to ulna

Also divided forearm into anterior and posterior compartments.

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44
Q

Path of brachial artery (before and after)

A 
Subclavian (spine)
Axillary (axilla)
Brachial (upper arms)
-bifurcates at cubital fossa-
Radial and Ulnar Arteries
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45
Q

HumeroUlnar joint

A

Synovial hinge

One degree of freedom (flex/ext)

Trochlea of humerus with trochlear notch of ulna

OK strength.

Resting: 70° flexion, 10° supination
Closed pack: full extension and supination
Capsular pattern: flex > extension

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46
Q

HumeroRadial joint

A

Synovial
Ellipsiod/gliding (or modified ball and socket)

2 degrees of freedom: flex/ext, sup/pro

Capitulum of humerus (convex) with head of radius (concave)

OK strength

Resting: full extension and supination
Closed pack: 90° flexion and 5° supination

Capsular pattern: flex>ext; sup/pro affected only if severe.

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47
Q

Carrying Angle

A

Abdication of forearm on full extension. The angle measured from midline of ulna to midline of humerus.

Greater in women (10-15°) than men (5-10°)

Caused because the trochlea of humerus is asymmetrical, creating an oblique axis of motion

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48
Q

Axis of motion associated with carrying angle

A

Sup-Lat to Inf-Med

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49
Q

The asymmetrical/oblique axis of motion along the trochlear groove causes what accessory movements?

A
  1. Slight screw action (ulna supinates during flexion; pronates during extension)

2 Abduction, adduction and gliding of radial head on both ulna and humerus

50
Q

On full extension what occurs with the olecranon?

A

Medial olecranon is not in contact with trochlea –> medial gap.

51
Q

On full flexion what occurs with the olecranon?

A

The lateral part of the olecranon is not in contact with the trochlea –> lateral gap

52
Q

Middle Radioulnar Articulation

A

Not a true joint.

Radius + ulna + interosseus membrane.

53
Q

Proximal Radio-Ulnar Joint

A

Synovial pivot

Head of radius (convex) on radial notch of ulna (concave)

Weak capsule

1 degree of freedom (supination/pronation)

Resting: 70º flexion, 35º supination
Closed pack: 5º supination and full extennsion
Capsular pattern: supination=pronation

54
Q

Elbow ROM/end feel

A

Flexion: 150º soft (HU, HR)
Extention: 5º hard (HU, HR)

Supination: 90º firm (HR, PRU)
Pronation: 70-90º firm/hard (HR, PRU)

55
Q

How many joint capsules in the elbow?

A

one

56
Q

Ulnar Collateral Ligament

A

Resists Valgum stress and checks medial-inferior displacement

Stabilizes humeroulnar joint
Triangular shape; three bands

Anterior: medial epicondyle –> edge of coronoid process
Posterior: holds medial epicondyle and olecrenon process together
Transverse: stabilizes the distal attachment of anterior and posterior UCL

57
Q

Radial Collateral Ligament

A

Resists Varum stress and checks lateral-inferior displacement

Part of HR joint

V-shaped
Underside of lateral epicondyle –> annular ligament and radial notch

58
Q

Annular Ligament

A

Part of Prox RadioUlnar joint

Prevents inferior distraction of radius

Anchors head of radius to radial notch

59
Q

Quadrate Ligament

A

Inferior thickening running inferior to annular ligment
From inferior radial notch on ulna to neck of radius.

Posterior fibres taut with pronation
Anterior fibres taut with supination
=> no matter what the movement, some fibres are always under movement

60
Q

Oblique Cord

A

Radial notch on ulna –> medial surface of neck of the radius (ulnar tuberosity on radius)

Prevents inferior displacement of radius on ulna during pulling movement

Runs at right angle to interosseus membrane

61
Q

Ligament of struthers

A

Only in 1% of population. Can be congenital or acquired

Supracondylar process –> medial epicondyle

Median nerve and brachial artery pass under and can be compressed there

62
Q

To increase pronation

A

Posterior glide at prox RadUl

63
Q

To increase supination

A

Anterior glide at prox RadUl

64
Q

When is the interosseus membrane most taut?

A

Halfway between supination and pronation

65
Q

What happens to the interosseus membrane and the oblique cord during pronation?

A

Both go slack

66
Q

How does the interosseus membrane transmit force?

A

During a push movement, force is transmitted up through the radius.

Interosseus membrane checks superior/proximal displacement of the radius on the ulna, and transmits the force to the ulna (which then travels upwards and onwards)

67
Q

What movement does the oblique cord check?

A

Distal/inferior displacement of the radius on the ulna, during a pulling movement

68
Q

What sort of lever is the elbow?

A

3rd Order Lever

middle of kinetic chain between hand and upper limb

69
Q

How is weight amplified between hand and elbow?

A

Tenfold (ie a 5lb weight in the hand = 50 lbs of force at the elbow)

70
Q

Cubitus valgus

A

Greater than normal elbow carrying angle

More evident on full extension

71
Q

Cubitus varus

A

Less than normal elbow carrying angle

72
Q

Gun Stock Deformity

A

The anti-carrying angle (marked cubitus varus)
Results from fracture or epiphyseal injury to distal humerus

Seen on full extension

73
Q

Elbow joint effusion is most evident in

A

The triangular space between the radial head, tip of the olecranon and lateral epicondyle

74
Q

Most activities are performed between

A

30-130º flexion/extension

50º supination/pronation

75
Q

C6 Dermatome

A

Lateral arm.

Dorsal surface of the proximal phalanx of the thumb.

76
Q

C7 Dermatome

A

On the dorsal surface of the proximal phalanx of the middle finger.

77
Q

T1 Dermatome

A

On the medial (ulnar) side of the antecubital fossa, just proximally to the medial epicondyle of the humerus.

78
Q

C6 Myotome

A

Waiters tray carry

elbow flexion, wrist extension

79
Q

C7 Myotome

A

Elbow extension wrist flexion

80
Q

C8 Myotome

A

Finger flexion

81
Q

T1 Myotome

A

Finger abduction

82
Q

C8 Dermatome

A

Dorsal surface little finger

83
Q

C5 Reflex Test

A

Biceps

84
Q

C6 Reflex Test

A

Brachioradialis

85
Q

C7 Reflex Test

A

Triceps

86
Q

MMT Triceps & anconeus

A

Prone, arm abducted 90º (T) or supine, arm flexed 90º.

Elbow extended. Apply pressure towards flexion

  • when prone, abducted arm means long head less effective, so triceps not as strong
87
Q

MMT Supinator

A

Supine, elbow flexed to 90º (+ biceps)
Seated, shoulder and elbow extended (biceps elongated)
Supine, elbow fully flexed (biceps shortened)

Apply pressure toward pronation

88
Q

MMT Pronator Teres (+ quadratus)

A

Supine, elbow partially flexed. Forearm pronated.

Hold elbow in place to avoid abduction

Apply pressure towards supination.

89
Q

MMT Pronator Quadratus

A

Supine, elbow fully flexed

Stabilize elbow and hold arm in flexion to avoid abduction.

Apply pressure towards supination

90
Q

Lateral Epicondylitis

A

Tennis Elbow

Occurs at CET
Most common elbow injury (7% sports injuries; most common 40-50 yo)

Repetition injury of Extension and Supination

Repeated tensile loads in pronation/elbow extension/wrist flexion
Vibration (they terminate in lateral epicondyle)

91
Q

What muscle is primarily affected in lateral epicondylitis

A

Extensor Carpi Radialis Brevis

sometimes also ECRL and rarely ECU

92
Q

Why is the ECRB so susceptible to injury?

A

Tendon runs just over the radial head, gets abraded easily with (hyper)pronation, elbow extension, and elbow flexion (ie bad backhand)

93
Q

Lateral Epicondylitis: Sx

A

Pain over tendon, which can progress to lateral epicondyle and later supracondylar ridge

Pain referring into posterior forearm, digits 2-4 (similar to C7 dermatome pattern)

94
Q

Medial Epicondylitis

A

Golfers Elbow

Caused by medial tendon overload from repeated microtrauma to the flexor-pronator musculature

May involve compression neuropraxia of ulnar groove

95
Q

What muscles are primarily involved in medial epicondylitis?

A

Pronator Teres and FCR

Occasionally palmaris longus, FCU, FDS.

96
Q

Medial Epicondylitis: Sx

A

Pain
Weak grip
Possible ulnar nerve involvement

97
Q

Triceps Tendinitis

A

AKA posterior tendon injury, posterior tennis elbow

Rare

Involves insertion of triceps at tendinous junction

Typically involves sudden strain to triceps tendon as the arm is fully extended

98
Q

Triceps Tendinitis: Sx

A

Pain at resisted elbow extension

Perception of snapping over posteromedial elbow

99
Q

Tendinitis: Presentation

A
  1. local sharp (twinging) pain to tendon
  2. associated aching pain to muscle belly
  3. history of repetitive use (gradual onset)
100
Q

Tendinitis Grading

A
  1. pain after activity
  2. pain at the beginning and after activity
  3. pain at the beginning, during, and after activity
  4. pain with ADL and continues to get worse
101
Q

Tests for Lateral Epicondylitis

A

Cozen’s Test (RROM)
Mill’s Test (PROM)
Method 3 (ECRB)

102
Q

Test for Medial Epicondylitis

A

Medial Epicondylitis Test

103
Q

Olecranon Bursitis

A

Inflammation caused by repetitive weight bearing or trauma

Sx: obvious swelling, heat, redness, inflammation

104
Q

Simple Fracture

A

Skin unbroken

105
Q

Comminuted Fracture

A

Bone splintered into pieces

106
Q

Impacted Fracture

A

One section is wedged into the interior of another

107
Q

Incomplete Fracture

A

Does not include entire cross section of bone

108
Q

Greenstick Fracture

A

Partially broken and partially bent. In children (bones still soft), esp with Rickets, Vit D deficiency

109
Q

Epiphyseal Fracture

A

In children; between shaft and epiphysis

110
Q

Colles Fracture

A

Distal radius, just proximal to wrist
Fragments rotate and are displaced dorsally
“Dinner Fork”
FOOSH

111
Q

Galeazzi Fracture

A

Fracture of radius with dislocation of distal radioulnar joint.

112
Q

Transverse Fracture of Distal Humerus

A

From one supracondylar ridge to the other

113
Q

Most common elbow fracture in adults

A

Radial head

FOOSH

114
Q

Most common elbow fracture in children and seniors

A

Displaced Supracondylar Fracture

Caused by displaced humerus which affects neighbouring arteries and nerves –> pain , often medical emergency

115
Q

Special tests after fracture

A

Capillary refill
Tinells
Girth measurement

116
Q

Nursemaids Elbow

A

Dislocation of radial head from annular ligament

Presents with elbow flexion and pronation

117
Q

Elbow relevant ulnar nerve impingement

A
  1. cubital tunnel

2. under the FCU

118
Q

Elbow relevant median nerve impingement

A
  1. pronator teres

2. supracondylar spur/ligament of Struthers

119
Q

Elbow relevant radial nerve impingement

A
  1. fracture at shaft of humerus

2. supinator (Arcade of Frohse)

120
Q

Frictioning tendinitis

A

Subacute, chronic

Poor vascularity –> spontaneous resolution unlikely , fibrosis formation probably

Ortho Tx 700 (12 decks)

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