Elbow Flashcards
Patients with what usually have a history of neck pain? No history?
Radiculopathy
Neuropathy
Leaning away may help those with?
Radiculopathy
What is worse with valsalva
Radiculopathy
May have pain/sensory/motor findings
Neuropathy
Tests for radiculopathy/findings
Weakness in muscles supplied by same spinal NR. Ex: c6: biceps, brachioradialis, wrist extensors
Tests for NR involvement: foraminal compression, Jackson compression etc.
Neck pain and radiating arm pain
Radiculopathy
No neck pain or radiation arm pain. Rather pain present in forearm or hand
Neuropathy
Sensory deficits in one peripheral nerve
Neuropathy
Tests/findings for neuropathy
Sensory deficit in peripheral nerve distribution
Orthos for peripheral nerve involvement: tinels, phalens
NR in median N
C5-T1
Main trunk passes through 2 heads of pronator teres
Median N
Anterior interosseous nerve branches from where and has what supply
Median
NO SENSORY
Flexor digitorum profundus
Flexor pollicis longus
Pronator quadratus
Sensory to palmar surfaces of thumb, index, middle finger, and radial half of ring finger
Dorsal: middle and distal phalanges of index, middle and lateral half of ring
Median nerve distribution
Pronator teres syndrome
Anterior interosseous nerve entrapped between heads to pronator teres
May affect main trunk and or anterior interosseous (no sensory issues if not ant. Inter.
S/s of pronator teres syndrome
Pain in proximal forearm
- tenderness of pronator muscles
- hard to flex distal thumb and index
- if main trunk affected have sensory loss over median nerve distribution
Ligament of struthers may cause entrapment of what nerve
Median
Hand signs seen with median nerve entrapment
Ape hand
Simian hand
Monkey paw
TheNar atrophy and thumb resting in adduction
Thenar atrophy with thumb resting in adduction . Sign and nerve?
Ape hand/simian hand/monkey paw
Median nerve
NR with ulnar nerve
C7-T1
Ulnar nerve Passes through _____ and into upper arm. Then descends in posterior compartment of arm and enters ______ groove. Runs between humeral and ulnar heads of ___ _____ ____ muscle and descends along ulnar aspect of forearm to ___ and ____
Axilla
Retroepicondylar (ulnar)
Flexor carpi ulnaris
Wrist and hand
Ulnar nerve entrapment aka
Cubital tunnel syndrome
Cubital tunnel is small and smaller with what action
Elbow flexion
Repetitive elbow flexion may cause entrapment of what nerve
Ulnar
S/s of ulnar nerve entrapment/cubital tunnel syndrome
Intermittent numbness/tingling in ulnar distribution
Weakness of grasp/pinch and loss of dexterity
- weakness of adductor pollicis
- loss of control of small finger-wartenbergs sign
- claw deformity
- benediction hand
Loss of control of small finder. Name and nerve
Wartenberg’s sign
Ulnar nerve—cubital tunnel syndrome
Hand signs seen with cubital tunnel syndrome
Wartenberg’s sign (loss control of small finger—stuck in abduction)
- claw deformity
- benediction hand
Claw deformity, and benediction hand associated with what and what nerve
Cubital tunnel syndrome
Ulnar nerve
Wartenberg’s sign
Loss of control of small finger—gets caught in pocket because stuck in abducted posture
Unoppposed extensor tone at 4/5th MCP joints and unopposed flexor tone at IP joint
Claw deformity
NR for radial nerve
C5-T1
Radial nerve exits through where
Axilla
Descends posterior medial arm while giving off cutaneous and muscular branches
Radial
Radial nerve splits into what
Superficial radial sensory nerve
-posterior interosseous nerve (wrist and finger extensors, supinator, abductor pollicis longus)
Wrist drop seen with what nerve entrapment
Radial
Crutch palsy
Saturday night palsy
Bride-groom honeymoon
Radial nerve entrapment
Lateral epicondylitis
Musculotendinous lesion at lateral epicondylitis
Mc: extensors carpi radialis brevis
Lesion Mc where in lateral epicondylitis
ECRB
Ext. carpi radialis brevis
S/s of lateral epicondylitis
Grip impaired due to pain
Tenderness over area
Localized pain
Aka for lateral epicondylitis
Tennis elbow
Aka for medial epicondulitis
Golfers elbow/baseball elbow
Medial epicondylitis
Micro tearing of tendon
Damage/stress to wrist flexors
Excessive force to flex wrist may lead/cause what
Medial epicondylitis/golfers elbow
Elbow ROM
Flex: 140-150
Ext: 0-10
Sup: 90
Pron: 80-90
Tingling with tinel sign indicates
Regeneration of nerves
Tingling and pain with tinsel sign at elbow indicates what
Injury/degeneration
What muscles does the main branch of median nerve supply
Abductor pollicis brevis
Opponents pollicis
Lat head of flexor pollicis brevis
1/2 lumbricles
What type of loss is causes if main trunk of median nerve is entrapped
Motor and sensory
What type of loss is causes if anterior interosseous nerve is entrapped
Motor only —has no sensory function
Motor: flex digitorum profundus, flex pollicis longus, pronator quadratus
Difficulty flexing distal thumb and index what nerve may be entrapped
Median nerve
Treatment for lateral epicondylitis
Anti-inflammatory drugs Corticosteroid injection Ultrasonography Brace-counterforce brace distal to epicondylitis Resistance exercises Oral NSAIDs Mobilization Acupuncture Surgery
What does medial epicondylitis damage/stress
Wrist flexors
Pinch grip tests what nerve
Anterior interosseous nerve for entrapment/syndrome (median branch)
Elbow flexion test tests what and for what
Ulnar nerve for cubital tunnel syndrome
Froment paper sign tests what and tests for what
Ulnar nerve for paralysis
Mills test tests what and for what
Lateral epicondylitis for epicondylitis/tennis elbow
Cozen test tests what and for what
Lateral epicondyle for epicondylitis or radiohumeral bursitis
Golfer elbow test: what and for?
Medial epicondyle for epicondylitis
Lift test: what and for?
Lateral/medial epicondyle: epicondylitis
Ligamentous instability test: what and for?
Ligaments
Sprain
Ligamentous instability test testing what with varus/valgus test
Varus: lateral collateral ligament
Valgus: medial collateral ligament
