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K&B Test 1 > Elbow And Forearm > Flashcards

Elbow And Forearm Flashcards

0
Q

Articulations at the humeroulnar joint

A

Humerus–> trochlea

Ulna–> trochlea fossa

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1
Q

What are the articulations of the elbow

A

Humeroulnar

Humeroradial

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2
Q

What are the articulations at the humeroradial joint

A

Humerus–> capitulum

Radius–> head

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3
Q

What is the function of the elbow and forearm

A

Add mobility of the hand in space by:
Shortening and or lengthening the arm
Rotating the forearm
Combination of both

Provide control and stability
Skilled hand motions
Forceful upper extremity motions

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4
Q

What are the articulations at the forearm

A

Proximal or superior radioulnar

Distal or inferior radioulnar

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5
Q

_____ is made up of two joints that function together

A

Elbow

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6
Q

What kind of joint is the elbow and why

A

Modified hinge. There is a few degrees of axial rotation at the extremes of flexion and extension.

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7
Q

The _____ is more distal then the _____ in terms of elbow arthrology

A

Trochlea

Capitulum

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8
Q

What is the axis of the elbow joint

A

Transverse (medial-lateral) for flexion/extension

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9
Q

What is the carrying angle formed by

A

Longitudinal axis of the humerus

Longitudinal axis of the forearm

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10
Q

_____ is lateral deviation of a distal segment with respect to a proximal segment

A

Valgus

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11
Q

What is the normal cubital valgus for males and females

A

Females–20-25 degrees

Males: 10-15 degrees

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12
Q

______ medial deviation of a limb segment with respect to the proximal segment

A

Varus

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13
Q

The joint capsule of the elbow encloses what?

A

Humeroulnar joint
Humeroradial joint
Proximal radioulnar joint

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14
Q

The elbow is reinforced by what structures

A

Collateral ligaments

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15
Q

What would you see if you had a strained ligament at the elbow

A

Extremes in valgus

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16
Q

_____ stabilizes the medial elbow joint and prevents forearm abduction

A

Medial collateral ligament

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17
Q

Where does the anterior band of the mcl attach

A

Medial epicondyle

Side of the coronoid process

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18
Q

______ reinforces the humerulnar joint against valgus/abduction stress

A

Anterior band of mcl

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19
Q

_____ Attaches to the epicondyle and the olecranon

A

Posterior band of the mcl

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20
Q

When is the posterior band of the mcl taut

A

With valgus and extremes of elbow flexion

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21
Q

______ attaches to the olecranon and the coronoid process

A

Transverse or oblique band of the mcl

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22
Q

______ stabilizes the lateral elbow joint and prevents forearm adduction (varus stress)

A

Lateral collateral ligament

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23
Q

______ goes from the lateral epicondyle and blends with the annular ligament and some forearm muscles. It protects the lateral joint and stabilizes against varus stresses.

A

Lcl

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24
Q

What are the components of the lcl

A

Radial–blends with the annular ligament

Ulnar–lateral

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25
Q

Flexion of the humeroulnar joint is limited by what

A

Soft tissue

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26
Q

Ranges for humeroulnar joint flexion

A

135-150

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27
Q

What are the values of humeroulnar joint extension

A

0-5 degrees of hyperextension

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28
Q

Humeroulnar king extension is a ______ position

A

Closed packed position

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29
Q

Most ADL’s are done in ______-______ humeroulnar joint extension or flexion

A

30-130

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30
Q

In _____ the rim of the radius slides in the capitular-trochlear groove

A

Humeroradial joint flexion

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31
Q

In full ____ the radius reaches the radial fossa of the humerus

A

Humeroradial joint flexion

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32
Q

Describe extension at the humeroradial joint

A

There is NO contact between the capitulum and the radial head

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33
Q

What is the axis at the humeroulnar joint

A

The medial-lateral axis is through the center of the trochlea

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34
Q

What are the arthrokinematics of the humeroulnar joint in extension

A

Inferior sliding, some rolling at extremes of flexion and extension

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35
Q

What are the arthrokinematics of the humeroulnar joint in flexion

A

Concave trochlea (ulna) rolls and slides superiorly on the coves trochlea (humerus)

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36
Q

Where is the medial lateral axis of the humeroradial joint

A

Center of the capitulum

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37
Q

What are the arthrokinematics of the humeroradial joint in extension

A

There is no contact between the capitulum and the radial head

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38
Q

What are the arthrokinematics of the humeroradial joint in flexion

A

Active–muscle contraction pulls the radial fovea to the capitulum

The fovea of the radius rolls and slide superiorly on the capitulum

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39
Q

What are the fibers oriented like in the interosseous membrane

A

Oblique medial and distal–away from the radius

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40
Q

What is the function of the interosseous membrane

A

Bind radius to ulna
Attachment for some extrinsic hand muscles
Force transmission through the upper limb

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41
Q

_____ is for resisting traction or distraction

A

Oblique cord and annular ligament

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42
Q

In upper extremity weight bearing ____ of the compression force is transferred through the radius

A

80%

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43
Q

How does the force transmission of the interosseous membrane work

A

Compression force on radius stretches the interosseous membrane. The fiber orientation of it transfers some force to the ulna and limits the force of the humeroradial joint.

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44
Q

The interosseous membrane transfers components of ______ from the radius and the ulna because major elbow flexors, pronators and supinator a have distal attachment to the radius

A

Muscle force

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45
Q

IM does not resist force in the _____ direction

A

Distal

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46
Q

Why does the IM have no resistance to distraction

A

The distal pull on the radius slackens the IM. The oblique cord and annular ligament accept the load and brachioradialis contracts.

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47
Q

Pronation and supination are ______ movements

A

Open kinematic chain

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48
Q

What bone rotates in supination and pronation

A

Radius

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49
Q

What happens at the proximal an distal radioulnar joints with pronation and supination

A

Proximal: radial head rotation
Distal: rotational displacement

50
Q

What is the function of the proximal and distal radioulnar joints

A

Independent rotation of the hand

51
Q

______ binds the radial head to the radial notch on the ulna and encircles the head and neck of the radius

A

Annular ligament

52
Q

_____ is lined with articular cartilage and synovial to decrease friction during radial head rotation

A

Annular ligament

53
Q

What are the ligaments of the proximal radioulnar joint

A

Annular and quad rate

54
Q

_____ connects to the border of the radial notch to the neck of the radius

A

Quadrate ligaments

55
Q

_____ reinforces inferior joint capsule and helps keep the apposition between radial head and radial notch

A

Quadrate ligament

56
Q

______ limits the spin of radial head with pronation and supination

A

Quadrate ligament

57
Q

What injury normally happens in the proximal radioulnar joint

A

Dislocation, called pulled elbow syndrome

58
Q

What is pulled elbow syndrome

A

2-4 years is the average age. It’s a pull on the extended primates arm causing a tensile force at the elbow. The radial head is pulled from the annular ligament. As children get older the annular ligament gets thicker and resists tearing, making this injury less likely.

59
Q

What kind of joints are the radioulnar joints

A

They are unisxial pivot joints

60
Q

What is the axis for the radioulnar joints for pronation and supination

A

A longitudinal axis passes through the head of the radius and the center of the distal ulna.

61
Q

What are normal ranges for pronation and supination

A

Zero reference position–thumb up– midway between pronation and supination.

Pronation: 75-90
Supination: 85-90

62
Q

When the elbow is in extension what is pronation limited by

A

The passive tension on the biceps

63
Q

When the elbow is in extension what is supination limited by

A

Passive tension on the interosseous membrane

64
Q

Functional activities are in the ranges of _____ in regards to pronation and supination

A

50-50 pronation/supination

65
Q

Arthrokinematics of supination for the distal radioulnar joint

A

Concave ulnar notch of the radius rolls and slides in the same direction as the radial head. The loser end of the radius rotates around the head of the ulna

66
Q

Arthrokinematics of supination for the proximal radioulnar joint

A

The radial head rotates within the annular ligament and the radial notch. Fovea is slightly concave and articulates with the capitulum of the humerus.

67
Q

Arthrokinematics of pronation for the distal radioulnar joint

A

Concave ulnar notch of the radius rolls and slides in the same direction as the radial head

68
Q

Arthrokinematics of pronation for the proximal radioulnar joint

A

The convex radius rotates with in the annular ligament on the concave radial notch of the ulna.

69
Q

Arthrokinematics of the humeroradial joint for active pronation

A

The fovea of the radial head spins against the rounded capitulum of the humerus.

Pronator teres contraction causes the radius to migrate proximally and compress the capitulum.

This is the screw home mechanism of the elbow.

70
Q

Osteokinematics of closed kinetic chain for pronation

A

External rotation of the humerus and ulna

71
Q

Osteokinematics of closed kinetic chain for supination

A

Internal rotation of the humerus and ulna

72
Q

Arthrokinematics for pronation supination closed kinetic chain for proximal radio ulnar joint

A

Annular ligament and radial notch (ulna) rotate around a fixed radial head.

73
Q

Arthrokinematics for pronation supination closed kinetic chain for distal radio ulnar joint

A

Convex ulnar head rolls and slides in opposite directions on the concave ulnar notch of the radius.

74
Q

What is the muscle function of the distal attachment–ulna

A

Flex or extend

Cannot primate or supinate

75
Q

What is the muscle function of the distal attachment–radius

A

Flex or extend, pronate or supinate

76
Q

Elbow flexors muscle action line is _____ to the joint axis

A

Anterior

77
Q

What are the elbow flexors

A

Biceps
Brachialis
Brachioradialis
Secondary flexor is pronator teres

78
Q

What are the actions of biceps brachii

A

Simultaneous elbow flexion and forearm supination
Shoulder flexion
GH joint stabilization

79
Q

______ weakness would be decreased strength in elbow flexion and forearm supination and decreased GH stability with orator cuff pathology

A

Biceps brachii

80
Q

_______ tightness would be decreased range of motion in elbow extension and forearm pronation

A

Biceps brachii

81
Q

Action of Brachialis

A

Primary elbow flexor

82
Q

Is the Brachialis affected by radial head rotation

A

No

83
Q

What elbow flexor has the largest pcsa

A

Brachialis

84
Q

Where does the Brachialis have its greatest torque

A

100 degrees

85
Q

_____ weakness would lead to decreased elbow flexion in all positions

A

Brachialis

86
Q

_____ tightness would lead to decreased elbow extension in all positions

A

Brachialis

87
Q

What is the action of brachioradialis

A

Elbow flexion with forearm rotation to neutral (midway between pronation and supination)

88
Q

What is an example of an eccentric action with the brachioradialis

A

Hammering

89
Q

_____ weakness is decreased elbow flexion with neutral forearm

A

Brachioradialis

90
Q

______ tightness would cause decreased elbow extension with a neutral forearm

A

Brachioradialis

91
Q

What is a spurt muscle. What are examples

A

Moves quickly through a large range of motion

Biceps and Brachialis

92
Q

Characteristics of a spurt muscle

A

Proximal attachment is for from the joint axis
Distal attachment is close to the joint axis
There is a large rotatory component
Small compression component

93
Q

What is a shunt muscle and what are examples

A

They are for joint stability and the brachioradialis is an example.

94
Q

Characteristics of a shunt muscle

A

Proximal attachment is close to the joint axis
Distal attachment is far from the joint axis
Large compression component
Small rotatory component

95
Q

_____ is the perpendicular distance from the point of rotation (joint axis) to the line of pull (muscle action line)

A

Muscle moment arm (MA)

96
Q

What are the MA longest to shortest for the elbow flexors

A

Brachioradialis
Biceps
Brachialis
Pronator teres

97
Q

Elbow flexion torque is ______ than extension torque

A

70% greater

98
Q

Elbow flexion torque is 20-25% greater in _____ than _____

A

Supination

Pronation

Because biceps comes in and is stronger than brachioradialis

99
Q

Where is the Highest amount of elbow flexion torque

A

@ 90 degrees. This is the optimal length tension relationship and internal MA

100
Q

Explain elbow flexion and shoulder extension

A

Biceps generate a slow flexion torque

Posterior deltoid does GH extension. It is a synergist and enhances the biceps force.

101
Q

explain pulling

A

There is an elongation at the GH, shortening at the elbow which gives a slower contraction velocity but a greater torque generated

102
Q

For the elbow extensors the muscle action line is passing _____ to the joint axis

A

Posterior

103
Q

What are the elbow flexors

A

Tricpeps

Anconeous

104
Q

Action of triceps brachii

A

Primary elbow extender

Medial head is active through all rom

105
Q

Which head of the triceps has the largest pcsa

A

Lateral

106
Q

What would happen if someone had weak triceps

A

Almost complete loss of elbow extension strength

107
Q

What would be seen if someone had tight triceps

A

Limitations in elbow flexion and shoulder elevation rom

Also could see functional impairments like feeding and hygiene

108
Q

What are the actions of the anconeous

A

Contributes to extension

Anterolateral stability

109
Q

_____ pulls the capsule away and prevents anterior impingement during flexion

A

Anconeous

110
Q

________ weakness may lead to impingement of the posterior capsule and decreased ability to pronate the forearm with a fixed hand

A

Anconeous

111
Q

Where is the most torque produced for elbow extension

A

At 90

112
Q

Where is the longest internal moment arm for elbow extension

A

Near full extension

113
Q

For Elbow extension _____ not ______ determines torque

A

Muscle length

Leverage

114
Q

_____ provide static stability to the elbow

A

Elbow extension

115
Q

______ stabilize a flexed elbow

A

Elbow extensors

116
Q

Explain elbow extension with shoulder flexion

A

Anterior deltoid flexes the GH–synergistically to the triceps

117
Q

What movements do we use elbow extension and shoulder flexion

A

Pushing a door and throwing a ball

118
Q

What are the supinators

A

Primary mover are the supinator and biceps

Secondary mover is radial wrist extensors, extensor pollicis longus, extensor indicis, brachioradialis

119
Q

What are the prime movers for pronators

A

Pronator quadratus is the prime mover and so is the pronator teres and this is also a secondary flexor.

120
Q

______ is the most active consistently used pronator regardless of elbow position

A

Pronator quadratus

121
Q

_____ is the stabilizer of the distal radioulnar joint

A

Pronator quadratus

122
Q

_____ is at its greatest with high power like pitching and overhead light bulb

A

Pronator teres

K&B Test 1 (4 decks)

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