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Elbow Flashcards

1
Q

In general, who has a larger carrying angle, men v. women?

A

Women

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2
Q

Which epicondyle is more prominent?

A

Medial

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3
Q

What 3 main anatomical attachments occur at the medial epicondyle?

A

Flexors, ulnar collateral ligament, pronator teres

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4
Q

What 3 main anatomical attachments occur at the lateral epicondyle?

A

Extensors, radial collateral ligament, supinator

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5
Q

What is the attachment site for the biceps brachii?

A

Radial tuberosity

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6
Q

The radius articulates with what aspect of the humerus?

A

Capitellum

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7
Q

The ulna articulates with what aspects of the humerus?

A

Coronoid fossa - olecranon fossa

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8
Q

In what motion does the UCL become taut?

A

Flexion - higher the deg of flexion, the more taut the ligament

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9
Q

In what motion is the RCL taut?

A

RCL is taut throughout flexion and extension - increases even more in supination

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10
Q

Name the flexors of the elbow (3) and their nerve innervations:
Flexor of shoulder additionally (1)

A

Biceps - musculocutaneous
Brachialis - musculocutaneous
Brachioradialis - radial
Coracobrachialis - musculocutaneous

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11
Q

Name the extensor of the elbow (2) and their nerve innervations:

A

Triceps - radial

Anconeus - radial

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12
Q

In general, the extensor muscles (5) are innervated by what peripheral nerve?

A

Radial nerve - ECRL, ECRB, extensor digitorum, extensor digiti minimi, extnesor carpi ulnaris

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13
Q

Supinator muscle is innervated and pierced by what peripheral nerve?

A

Radial nerve

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14
Q

When the radial nerve exits supinator muscle, what does it become?

A

Posterior interosseous nerve

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15
Q

Which muscle is the primary supinator of the elbow/forearm?

A

Biceps - supinator assists

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16
Q

Which nerve innervates pronator teres?

A

Median nerve

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17
Q

Flexor muscle group is innervated by both median and ulnar nerves - distinguish between FCR / FCU / Flexor digitorum superficialis / Flexor digitorum profundus ->

A

FCR - median
FCU - ulnar
Flexor digitorum superificialis - median
Flexor digitorum profundus - digits 2 and 3 median // digits 4 and 5 ulnar

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18
Q

Posterior interosseous nerve innervates 4 thumb/index finger muscles:

A

1) abductor pollicis
2) extensor pollicis longus
3) extensor pollicis brevis
4) extensor indicis

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19
Q

After median nerve passes through pronator teres, it becomes what peripheral nerve?

A

Anterior interosseous nerve

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20
Q

Anterior interosseous nerve innervates two important muscles in making the OK sign: they are ->

A

Flexor pollicis longus

FDProfundus (digits 2/3 - branch of median nerve)

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21
Q

Which gender is more affected with lateral tendinoapthy?

A

Women

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22
Q

Does medial tendinopathy affect the dominant or non-dominant elbow?

A

Dominant > non-dominant

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23
Q

What age group and gender is most prevalent for distal biceps rupture?

A

Men, age 40-60 - also younger men powerlifting/body building

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24
Q

What are the Biceps squeeze test and Hook test?

A

Assessment of integrity of distal biceps tendon

25
Is posterolateral rotatory instability a dislocation of the radial head or humeroulnar/humeroradial joints?
ER of the ulnar away from trochlea with subluxing humeroulnar & radial joints
26
Define the lateral pivot shift test for the elbow:
Axillary compression down forearm shaft, starting in extension -> moving into flexion and applying vaglus force with supination to produce clunk between 40-70 deg of flexion
27
Who is at inc risk for UCL injury?
Overhead throwing athlete - esp younger with open physis
28
In Little Leaguer's Elbow, what puts the athlete at inc risk for developing UCL injury?
Higher pitch count
29
With Tommy John Surgery, what is time frame for return to sport?
9-12 months - return to progressive throwing at 4 months
30
What loss of ROM appears to be linked with length of time immobilized after elbow dislocation?
Extension
31
Three sub/objective signs indicating fracture in the elbow:
1) Hx of trauma 2) presence of fat pad sign (effusion over posterior elbow) 3) inability to fully extend elbow
32
Cardinal signs of olecranon fracture: (3)
Loss of extension Triceps weakness/disruption Fragment on radiograph
33
Can the radial head be excised if the UCL is not intact?
NO! If UCL is intact, pronator/flexor mass can compensate
34
Define Monteggia fracture:
Fx of proximal third of ulan with dislocation of radial head
35
Define Essex-Lopresti fracture:
Fx of radial head with concurrent dislocation of distal RUJ, disruption of IOM
36
What nerve is affected with severe elbow flexion contracture?
Ulnar - can develop ulnar neruritis
37
What can develop for up to 2 months after soft tissue injury? Hallmark sign is pain with progressive loss of motion
Heterotropic ossificans
38
What nerve injury is the transient physiological block caused by ischemia (pressure/stretch) without Wallerian degeneration - nerve structure intact?
Neurapraxia - no positive Tinel without Wallerian degeneration
39
What nerve injury occurs when the axons of the nerve are badly damaged, but the architecture of the nerve remains intact - Wallerian degeneration occurs?
Axonotmesis - positive Tinels
40
What nerve injury occurs when the structure of the nerve is destroyed by cutting, scarring, or prolong severe compression - Wallerian degeneration occurs?
Neurotmesis - positive Tinels
41
What is the expected recovery of neurapraxia?
Will resolve - days to weeks
42
What is the expected recovery for axonotmesis?
Recovery at 1mm/day - >18 months of recovery = poorer prognosis
43
What is expected recovery for neurontmesis?
Incomplete recovery, surgical intervention usually required
44
What nerve disorder are overhead throwers most likely to develop?
Cubital tunnel syndrome; traction with extreme valgus stress on medial arm
45
Define Wartenburgs sign:
Place hand flat on table, passively abduct digits - inability to adduct 5th digit; indication of ulnar nerve palsy
46
Define Froments sign:
Attempts to remove piece of paper between thumb and index finger will result in inability to hold paper or hyperflexion of IP of thumb; indicates ulnar nerve palsy
47
What is the hallmark sign for Anterior Interosseous Nerve entrapment?
Inability to make OK sign - decreased motor function of flexor pollicis longus/flexor digitorum profundus (2/3)
48
What is a distinguishing feature between AIN entrapment and pronator teres syndrome?
In AIN syndrome, there are no sensory sxs in the fingers - pronator teres may have sensory component like CTS
49
What are distinguishing tests for pronator teres syndrome versus CTS?
Tinels and prolong wrist flexion - do no reproduce sxs in pronator teres syndrome
50
What nerves are seen commonly affected in Parsonage Turner Syndrome?
Commonly affects axillary nerve, upper trunk of brachial plexus (suprascapular and long thoracic nerve)
51
Does Posterior Interosseous Nerve syndrome have sensation loss?
No
52
PIN syndrome causes weakness in what muscle group?
Finger extensors
53
What diagnosis causes pain with resisted supination, repetitive wrist flexion but has no motor or sensory loss?
Radial tunnel syndrome
54
What population is more greatly affected by Osteochondritis Dissecans?
Adolescents - male 12-17 y.o. - esp pitchers
55
What disease consists of epicondyle apophysitis in children 7-10 y.o. with non-traumatic development?
Panner's disease
56
Which arthritis has best outcomes for Total elbow arthroplasty?
RA > OA (traumatic)
57
What is the MCID for the DASH?
10-17
58
What is the MCID for the quickDASH?
19

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