Elbow Flashcards
What motion (flex/ext) increases tension on UCL at elbow?
Flexion
What portion of UCL is strongest?
anterior
At what ROM is the posterior portion of the UCL most taut?
90 degrees of flexion
Which elbow flexor has the longest moment arm for flexion?
Brachioradialis
What is the primary supinator muscle?
biceps
What is the radial nerve called after leaving the supinator?
posterior interosseous nerve
What muscle does the ulnar nerve pierce?
FCU
Which forearm muscle is innervated by both median and ulnar nerves?
FDP
Which nerve roots does the radial nerve originate from
C5-8 (posterior cord)
Which nerve roots does the ulnar nerve originate from
C8, T1. medial cord
Which muscle does the median nerve run through in the forearm?
pronator teres
What motion (supination/pronation) occurs during initiation of flexion?
pronation
Which joint at the elbow transmits the majority of the weight through the forearm
radiocapitellar
What condition may lead to the radial head being required for stabilization of valgus stress?
UCL insufficiency
Following simple dislocation, when should functional mobility begin?
As soon as joint stability is achieved
Greater than ___ days immobilization following elbow dislocation increases risk of stiffness
14
What is long term outlook of simple elbow dislocation
95% return to previous occupation
Following olecranon fracture surgical intervention, which has higher rate of complication, ORIF or excision of bone fragment?
ORIF.
Similar ROM, strength, and stability
Is immobilization frequently used with simple, nondisplaced radial head fractures?
no
If splinting is used for radial head fx, which position has better outcomes?
full extension
What are potential indications for total elbow arthroplasty?
advanced age low physical demand chronic instability advanced RA post-traumatic OA ankylosis of elbow
What ROM is expected following TEA
15-130 degrees
What are lifting restrictions post TEA?
very light
1kg repeated, 5kg max
What are the most common locations of heterotropic ossificans following elbow injury?
1) b/w brachialis and anterior capsule
2) between triceps and posterior capsule
How common is heterotropic ossificans following significant elbow trauma?
Fairly common, up to 56% of fracture/dislocation.
Peak incidence is 2 months following injury
What is the hallmark symptom of CRPS?
intraceable pain in nonperipheral nerve distribution. Evidence of edema with sensory and motor changes also present
Allodynia and hyperalgesia also common
What may lead to chronic insufficiency of radial collateral ligament (3 items)
1) postural deformity-potentially following childhood fx
2) overuse of varus stress during weight bearing. (ex: crutch usage)
3) iatrogenic: lateral tendionpathy surgery
What is typical mechanism of acute UCL tear
FOOSH
Which phases of throwing most stress UCL?
cocking/late cocking-> acceleration
Which portion of UCL most susceptible to injury?
anterior
Which motion at elbow decreases UCL stress during throwing?
elbow flexion
Which has a higher success rate for return to sport following UCL surgery, reconstruction or repair
reconstruction
How far out of UCL surgery is throwing typically allowed?
4 months
What is little leaguer’s elbow?
apophysitis/avulsion fracture of medial elbow
What shoulder motion is typically found to be limited in throwers with UCL injury?
GHJ IR.
When should eccentrics be introduced in patients with medial elbow tendinosis?
early in treatment, and should be sufficient load to elicit discomfort
What patients may be candidates for medial elbow tendinosis surgery
- failed PT
- failed steroid injections
- longer than 1 year symptoms
- intra-articular symptoms
What benefits for coritcosteroid use are there with elbow tendinopathy?
short term benefits, but worse than PT medium and long term
What forms the cubital tunnel?
walls: medial condyle and olecranon
roof: aponeurosis
floor: UCL, joint capsule, olecranon
What is success rate does non-operative management have with low level cubital tunnel syndrome?
50%
What position is important to limit with cubital tunnel syndrome
excessive flexion- night splint at 30-45 degrees often utilized
What motions/activities should be limited with cubital tunnel syndrome
flexion beyond 90 degrees
wrist and finger flexion
valgus stress
With cubital tunnel syndrome, at what stage should aggressive STM be added to treatment?
later in rehab
What hand symptoms are indicative of anterior interosseous nerve syndrome?
inability to make “ok” with hand.
Indicative of decreased FDP of index finger and FPL function
Which is more likely to have motor symptoms, posterior interosseous or radial tunnel syndrome?
posterior interosseus. Radial tunnel is pain dominant
If forearm band for lateral tendinopathy increases symptoms/weakness, what should be considered?
radial nerve involvement
What differentiates PIN syndrome and radial tunnel syndrome?
RTS lacks motor involvement
What populations are at risk for osteochondritis dissecans at elbow?
young female gymnasts and adolescent male baseball pitchers
Healing time frame for osteochondritis dissecans?
return to activities at 3 mo, full activity at 6 mo
What is likely to be primary sign of RA of elbow?
loss of extension
Is there loss of joint space in elbow OA?
not typically, more common is presence of osteophytes and joint capsule contracture
Elbow mwm cpg
Age under 49, strong on opposite grip, low pain free on involved side
