Elbow Flashcards
Humeroulnar joint type
hinge
Humeroulnar joint - open chain vs. closed chain (roll/glide)
roll/glide in SAME direction = open chain
roll/glide OPP = closed chain
Humeroulnar joint - closed packed
full extension and supination
Humeroradial joint - type
Ball and shallow socket
Humeroradial joint - close packed
90 flex and supination
Active ROM
135-145 with supination
Carrying angle
Arm in full ext, lat deviation of ulnar with respect to humerus
Usually 10-15 degrees
Capsule
Loose
Humeroulnar
Humeroradial
Proximal radioulnar
Medial collateral ligament - taut in ___, resists ___
Taut in ext ant
Taut in flex post
Resists valgus deviation and IR/ER
Lateral collateral ligament - resists ____
Resists varus deviation and IR/ER
Annular ligament - resists
lateral and distal subluxation of radius
Is very strong
Proximal radioulnar close packed
full ext and 5 supination
Distal radioulnar close packed
5 supination
Dislocation is typically
posterior
humerus moves forward into forced hyperextension
FOOSH
Second degree damage with elbow dislocation
Clips coronoid proccess at brachialis attachment
could fracture
would be painful with resisted flex
often associated MCL injury or radial head fracture
Complete elbow disloation
Anterior capsule is disrupted
brachialis is torn or significantly stretched
humerus sits in front of coronaoid process
Partial elbow dislocation
Perched
Less capsular/ligamentous injury
humerus sits on top of coronoid process
Nursemaids elbow
Often in kids
sublux or dislocate radioulnar joint
head of humerus slips out of the ligament
Valgus stress test
MCL
Elbow in 20-30 flex and full forearm supination
gap jt at elbow
Varus stress test
LCL
elbow in 20-30 flex and full supination
gap jt at elbow
Hyperextension test
pos if 10 degrees of hyperextension
Medial collateral ligament reconstruction - elbow dislocation from
forceful valgus stress repetitive trauma (baseball throwing)
Medial collateral ligament reconstruction - graft from
Palmaris longus
extensor hallicus longus
Radial head fracture - type 1
non displaced
Radial head fracture - type II
displaced, require ORIF, brief immobilzation
Radial head fracture - TYpe III
Displaced, require ORIF, need stabiliztion of elbow and excision of fragments
full ROM rarely returns
Lateral epicondylitis/algia
Algia - until have diagnosis of itis
pain at lateral elbow - could be from radial head fracture or entrapment of radal nerve
At elbow - where does radial nerve get trapped
Between supinator and extensor carpi radialis brevis
Lateral epicondylitis is usually from what muscle
extensor carpi radialis brevis
Lateral epicondylitis - tests
Will have pain with resisted wrist extnesion, tendernes at extenors
pos coffe cup sign (grip, ext, rad dev)
Mills test
Palpate lateral epicondyle while simultaneously pronating pt forearm
flex pt wrist fully with ulnar deviation and extend their elbow
(+) if pain over lateral epicondyle
Maudleys test
Resist pt extension of middle finger distal to PIP, stressing extensor digitorum
(+) if pain reroduced
(Lateral epicondylitis)
Medial epicondylitis
Inflammation of wrist felxors
Pain with resisted wrist flex and pronation
Medial epicondylitis test
Palpate medial epcondyle while supinating pt forearm, extending elbow, and extending wrist fully with radial deviation
(+) if pain reproduced
Median nerve compression = where
At elbow - pronator teres and interosseous region (flexor pollicis longus)
Carpal tunnel at wrist
Median nerve compression - paresthesias where
Thumb and 2nd and 3rd fingers
Radial nerve compression - where
At elbo w- posterior interosseous region (supinaotr, extensor radialis brevis)
Radial nerve compression - paresthesias where
post aspect fo hand, esp middle finger
Ulnar nerve compression - where
At cubital tunnel and Guyons tunnel (hook of hamate and pisiform)
Ulnar nerve compression - paresthesias
Ulnar aspect of hand and ring finger
Tinels sign
ulnar n - tap at cubital tunnel
Wartenbergs sign
Ulnar
Passively spread fingers and ask pt to bring fingers together
Pos if unable to adduct 5th finger back to others
Elbow flexion test
Ulnar n traction in cubital tunnel
Completely flex elboes and hold for 5 min
POs if tingle in ulnar distribution (can also be median though)
Pronator teres test
Median
Sit with elbow flexed 90
PT try to supinate and exten pt elbow as pt resists (tries to flex elbow and pronate)
Pos if tingle in median nerve distribtuon
Pinch grip test
Anterior interosseous n (innervated quadratus, FPL, FDP)
Pt tries to pinch tups of thumb and 2nd finger togehter
Pos if unable to touch fingers together - they will bring pads together insterad
If unable to flex IP of 2nd digit suspect median nerve involvement
