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PHTH 710- Musculoskeletal II (Upper Extremity) > Elbow > Flashcards

Elbow Flashcards

1
Q

elbow functional assessment

A

Most ADL performed between 30 and 130 deg of flexion and between 50 deg of pronation and 50 deg of supination

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2
Q

reflexes

A

biceps (C5-C6)

brachioradialis (C5-C6)

Triceps (C7-C8)

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3
Q

peripheral nerves

A
  1. lower lateral cutaneous nerve of arm (radial)
  2. medial cutaneous nerve of forearm
  3. medial cutaneous nerve of forearm
  4. lateral cutaneous nerve of forearm (musculocutaneous)
  5. posterior cutaneous nerve of forearm (radial)
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4
Q

peripheral nerve injuries about the elbow

A

median nerve (C6-C8, T1)- ant interosseous syndrome, pronator syndrome, ligament of struthers

Ulnar nerve (C7-C8, T1)- cubital tunnel

Radial nerve (C5-C8, T1)- canal of Frohse

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5
Q

Lateral epicondylitis sy/sx

A

PROM-full wrist flex with ulnar deviation, full pronation, and elbow ext

resisted wrist ext with elbow extended

joint play-WNL and not painful

palpation over lateral epicondyle or muscle substance

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6
Q

Lateral epicondylitis tests

A

grip strength

cozen test

mills test

third finger resistance test

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7
Q

Lateral epicondylitis DDX

A

C5 nerve root px

radial nerve entrapment

radial head involvement/annular ligament sprain

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8
Q

Lateral epicondylitis

A

Most commonly involved ECRB

Attach to the lateral collateral lig, annular lig, and epicodyle, Runs over radial head in ext/pro

ECRL and brachioradialis attach above the epicondyle-papate above condyle for tenderness

Due to fatigue and micro-trauma

More tendinosis than tendinitis

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9
Q

Medial epicondylitis

A

tendinitis vs tendinosis

wrist flx and pronation mechanism (golf, throwing)

involved pronator teres and flexor carpi radialis. Occasionally FCU and FD superficialis

Ulnar nerve compression in ulnar groove-can produce similar symptoms

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10
Q

Medial instability

A

response to excessive valgus force

can be acute of chronic

overhead throwing a common mechanism

presents with medial elbow pain

tenderness distal to medial epicondye of humerus

Valgus stress test (straight and at 70 deg)

bracing.surgical repair

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11
Q

Medial tension overload

A

medial tendinosis, instability, tension (traction), lateral elbow compression

symptoms medial initially and eventually can be lateral as well

ligament, muscle/tendon, bone/epiphyseal pate, nerve

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12
Q

Myositis ossificans

A

result of fracture, dislocation, direct bow, also seen in individuals with neurologic px

ectopic bone growth. calcium deposits in muscle

may be palpated, seen on xray

noted as stiffness, pain, and firm mass on palpation

do not use heat

no resistance exercises involving muscle

typically, brachialis

can develop while in cast over 3-6 weeks

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13
Q

Nerve entrapment

A

r/o cervical spine and brachial plexus

ulnar, median, ant interosseus, and radial and post interosseus nerve

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14
Q

ulnar nerve

A

damaged with supracondylar and epicondylar fractures, fracture callus

behind med epicodyle usceptile to trauma and direct injury

friction syndromein ulnar groove or intermuscular septum. Can sublux in groove

can become involved with medial instability

fromet’s sign: adductor pollicus (can’t hold aper between thumb and first finger)

wartenburgs sign: weakness of 5th finger ADD

sensory changes along inervation of ulnar hand (little finger and lateral hand)

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15
Q

Triceps tendinitis

A

sudden snapping of the elbow towards extension

pain with resisted elbow EXT

Differentiate from post impingement (synovial capsule/tissue pinched between olecranon fossa)

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16
Q

Radial head fractures

A

type I- undisplaced ( no immobilization or little 2-3 wks, can be full rom if no pain)

type II-displaced. Usually single fragment displaced more than 3 cm

type III- comminuted. Radial head in multiple frag. (II and III-ORIF, brief immob, 30 deg rom lost)

type IV- with dislocation of elbow (usually involve capsule, lig, and capitulum. Usually will not regain full EXT-need to prevent myositis ossificans)

17
Q

Olecranon fractures

A

direct blow or hyper-extension which leads to dislocation

soft tissue sweling posteriorly

can have avulsion of olecranon/triceps tendon

18
Q

distal humerus fracture

A

common to children

50-60% of all elbow fx in children

98% with arm-wrist EXT

Must be reduced, traction

check neurovascular

malunion common, with varus deformity (lose carrying angle)

19
Q

Capsular tightness

A

mobilization

prolonged positioning

Ice after ROM is common

AROM before PROM

strengthening

surgical intervention

20
Q

Median nerve

A

injured with post dislocation

can be involved with callus formation

can be entrapped under lig of struthers

usually presents as neurpraxia

dx with EMG, NVC

21
Q

Anterior interosseus nerve

A

branch of median nerve

between two heads of pronator teres, fracture, or fracture callus

can cause “pronator teres syndrome”

deficit purely motor (no pain)-FPL, FDP, PQ

surgical release is common tx

22
Q

radial

A

mid shaft fractures at spiral groove

direct trauma to brachioradialis, extensor carpi radialis

motor nerve

enters the supinator muscle (arcade of Frohse) between two heads

ECRB and fibrous edge of supinator

radial tunnel syndrome

23
Q

Posterior interosseus

A

motor nerve

enters te supinator muscle (arcade of Frohse) between two heads

ECRB and fibrous edge of supinator

radial tunnel syndrome

mimics lateral epicondylitis

doe not resolve with standard tx

weakness and pain on resist wrist ad finger EXT/ esp middle

pain on passive stretch

tender over radial nerve

24
Q

Bursitis

A

trauma

inflamm dis/gout

repet micro trauma

infection/cellulitis

sometimes can see capsular pattern

tx-injection, padding, rest

25
Q

Lateral ligament injury

A

radial collateral lig is primary restrain to varus forces

common extensor tendon, pot capsule, capsule/annular lig are secondary restraints

PLRI has been noted to develop following steroid injection in the lateral elbow

physical exam may appear normal, except post lat instab test (pivot shift). symptoms vague

push sign can provoke-push up with forearms supinated

apprehension is a positive finding

26
Q

Lateral ligament injury mechanisms of injury

A

elbow dislocation

varus elbow stress

iatrogenic (related to tx uch as a fracture)

27
Q

Lateral ligament injury rehab

A

no evidence favoring particular program

rehab should include protection and reloading of the injured muscles

hinged elbow brace with forearm in pronation for 4-6 weeks

avoidance of shoulder abduction/IR with elbow exercise

following surgery, jt is immobilized for 1-2 weeks, with ROM gradually introduced

protect healing structures with post surgical rehab

28
Q

Posterior elbow dislocation

A

if fracture or unstable before 60 deg FLX= surgical mobilization

reduction and immobilization (90 deg with a post splint) for 4 days

days 4-2 weeks hinged elbow brace

by 6 weeks, should have full FLX

can begin low-load prolonged stretching for EXT at 6 weeks

29
Q

Radial head dislocation

A

FOOSH, MVA, direct blow, pulling on arm

posterior dislocation most common. can have recurrent dislocations.

divergent-adius seperate from ulna and humerus

rx: neurovascular, alignment, stability

if uncomplicated-excellent results

PHTH 710- Musculoskeletal II (Upper Extremity) (20 decks)

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