elbow Flashcards
what non-muscular conditions can refer to the elbow?
acute MI, pancoasts tumor, esophageal motor disorders
what is the average carrying angle for women?
13-16
what is the average carrying angle for men?
11-14
what is considered optimal motion for supination and pronation?
supination - 90, pronation - 80
how many parts does the UCL have?
3 - anterior, posterior, transverse
when does the anterior band of the anterior portion of the UCL get taut?
full extension to 60 degrees of flexion
when does the posterior band of the anterior portion of the UCL get taut?
60 to 120 degrees of flexion
what is the greatest restraint to valgus stress at the elbow?
the anterior part of the UCL
what part of the RCL is involved in the posterolateral rotatory instability (PLRI)?
the ulnar portion
what innervates the biceps brachii and the brachialis?
musculocutaneous nerve
what innervates the brachioradialis?
branches of the radial nerve
what innervates the triceps and anconeus?
radial nerve
what innervates the wrist extensors?
the radial nerve
what nerve runs through the supinator?
radial
does supinator attach to lateral or medial epicondyle?
lateral
does pronator teres attach to the medial or lateral epicondyle?
medial
what nerve roots is radial nerve?
C5-T1
what nerve roots is the ulnar nerve?
C7-T1
what nerve roots is the median nerve?
C5-T1
what must you be aware of if someone comes in with acute onset of non-traumatic swelling in the elbow?
septic arthritis
what are two tests for lateral epicondylopathy?
Cozens (resisted extension) and Mill’s (stretching of the wrist extensors)
what are differential dx for lateral epicondylopathy?
nerve root compression C6-C7, radial tunnel syndrome, PLRI, compression of PIN
what intervention category has the highest recommendation for elbow tendonopathies?
manual therapy and mobilization.
when do you expect to see full ROM after a distal biceps tendon repair?
week 4
what should you be considering after someone has an elbow dislocation?
RCL instability
what is the preferred intervention for varus posteromedial rotatory instability?
surgery
how will someone with PLRI present to the clinic?
vague elbow discomfort, lateral elbow pain, clicking or clunking with supination, elbow giving out
how should PLRI be treated conservatively?
hinged brace in pronation for 4-6 weeks to protect structures. Avoid shoulder abduction and internal rotation
what is the mechanism of injury for PLRI?
axial compression, valgus stress, and supination forces
what are the 4 primary tests for PLRI?
lateral pivot shift of elbow, push up sign, chair sign, press up maneuver
Will someone with UCL insufficiency feel more unstable in supination or pronation?
pronation
what is the mechanism of injury for the valgus extension overload syndrome?
large forces into hyperextension, especially with UCL insufficiency
what is the most common MOI for elbow dislocation?
FOOSH
what is the terrible triad in the eblow
radial head fx, coronoid fx, elbow dislocation
what population does olecranon fx happen in most often?
elderly
what population most commonly experiences radial head fx’s?
females 20-60
How high is the incidence of HO after elbow dislocations and fx’s at 2 months post trauma?
56%
What the is the primary sign and symptoms of HO at the elbow?
Progressive loss of ROM
what is one way to differentiate arterial injury from compartment syndrome and neural injury?
it will have skin discoloration and decreased temperature
what is one way to differentiate compartment syndrome from arterial injury and neural injury?
increased compartment pressure
what is one way to differentiate neural from compartment syndrome and arterial injury?
You will have no pain with passive stretch of involved muscles.
how long does it take for neuropraxia to heal?
couple days to a couple weeks
how long does it take for axonotomesis to heal?
heals at 1mm/day can take many months
how long does it take for neurotmesis to heal?
trick question, it doesn’t
what is cubital tunnel syndrome?
it is irritation of the ulnar nerve as it passes through the medial side of the elbow
what is the success rate of conservative management of cubital tunnel syndrome?
50%
what is the common presentation for OCD of the elbow?
very active adolescent (12-17) male with insidious onset of vague lateral elbow pain and an extension ROM loss
What is Panners disease, how do you manage, and what are the outcomes?
very similar to OCD but occurs younger, treat with rest and bracing, great outcomes at three years
What should you do if you suspect acute forearm compartment syndrome?
send them to ER, it is a medical emergerncy
what nerve is involved in pronator teres syndrome?
median
how do you diagnose pronator teres syndrome?
pronator teres syndrome test (resisted forearm supination and elbow extension)
any muscle weakness with pronator teres syndrome?
yes, along median nerve distribution
Any sensory loss with pronator teres syndrome?
yes, along thumb and first two fingers
How does pronator teres syndrome present?
insidious onset of pain on radial side of forearm
Where does AIN entrapment occur.
b/w two heads of pronator teres
how does AIN present?
sudden, severe forearm pain
how do you test for AIN?
pinch grip test
any sensory loss with AIN?
no
any weakness with AIN
flexor pollicis longus
how does radial tunnel syndrome present?
pain over lateral epicondyle, poorly localized pain over lateral aspect of elbow and forearm
does radial tunnel syndrome have muscle weakness?
no typical pattern
does radial tunnel syndrome have sensory involvement?
radial distribution numbness
what is a test for radial tunnel syndrome?
middle finger extension
where does PIN get entraped
through supinator
how does PIN present?
functional wrist drop, difficulty extending fingers or thumb at MCP joint
does PIN have muscle weakness?
not unless chronic
how do you test for PIN?
index finer extension with rested hand palm down on table
does pin have sensory loss?
no
what nerve is involved in cubital tunnel syndrome?
ulnar
how does cubital tunnel syndrome present?
pain in 4th/5th digits, loss of grip power, greater pain or parasthesia at night
does cubital tunnel syndrome have muscle weakness?
atrophy/weakness of the ulnar intrinsics, clawing contracture of the 4th/5th digits when chronic
what is froments test?
hold paper between thumb and 1st finger and squeeze with finger flat, inability to do it is indicative of a ulnar neuropathy.
what is wartenbergs test?
patient has fingers passively pulled apart on a table and is then asked to squeeze them together. If they cannot pull the pinky in it is positive
what test do you use for cubital tunnel syndrome?
wartenbergs and froments
any sensory involvement with cubital tunnel syndrome?
ulnar nerve distribution
