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Elbow Eval & Treat Flashcards

1
Q

Humero-Ulnar Joint

A

-FLX/EXT: 5-145 Normal; 30-130 Functional
-SUP/PRO: 75-85 Normal; 50 Functional
-Uniaxial hinge
-OPP: 70 deg FLX and 10 deg SUP
-CPP: full EXT; full SUP
-Convex medial lip of trochlea on Humerus and concave ulnar notch
-FLX/EXT

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2
Q

Humero-Radial Joint

A

-FLX/EXT: 5-145 Normal; 30-130 Functional
-SUP/PRO: 75-85 Normal; 50 Functional
-OPP: full ext; full sup
-CPP: 90 FLX; 5 SUP
-flx/ext/spin
-Capsular Pattern: equal sup and pro
-Concave radial head and convex capitulum of humerus
-Radial head: resists valgus stress

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3
Q

Proximal Radio-Ulnar Joint

A

-FLX/EXT: 5-145 Normal; 30-130 Functional
-SUP/PRO: 75-85 Normal; 50 Functional
-70 PRO; 80 SUP
-OPP: 70 deg FLX; 35 def SUP
-Radial head, annular ligament, radial fossa of ulna
-interosseous membrane

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4
Q

Functional Motion of Elbow

A

Flx: 130
Ext: 30
Sup/Pro: 50

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5
Q

Carrying Angle

A

-valgus angulation at elbow

Males: 11-14
Females: 13-16

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6
Q

Elbow Joint Capsule

A

-thin but strong
-greatest extensibility 70-90 flx
-do not respond well to injury

Anterior:
-taut in full ext
-38% valgus force resistance
-32% varus force resistance

Posterior:
-taught in full flx

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7
Q

Medial Ligament Complex

A

-Ulnar Collateral Ligament/UCL
-fan shaped
-resists valgus stess, especially 20-130 deg flx

Anterior: strongest and stiffest
Oblique/Transverse: little stability
Posterior: taut btwn 60-90 flx

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8
Q

Lateral Ligament Complex

A

Lateral Collateral Ligament
-varus stabiliy
-primary restrain to posterio-lateral instability
-taut in full SUP

2 Parts:
-Lateral UCL: Humerus + Ulna
-RCL: Humerus + Radius

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9
Q

Annular Ligament

A

-encircles radial head
-maintains proximal RUJ
-very strong , reinforced by LCL
-lined w/ cartilage inside

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10
Q

Interosseous Membrane

A

-collagen that binds ulna and radius
-finbers directed away from radius
-assists in force transfer from radius to ulna

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11
Q

Anterior Elbow Muscles

A

-flexors
-Musculocutaneous Nerve

-Biceps Brachii
-Brachialis
-Brachioradialis (Radial N.)

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12
Q

Posterior Elbow Muscles

A

-extensors
-Radial Nerve

-Ticeps
-Anconeus

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13
Q

Anterior Forearm Muscles

A

-flexor/pronators
-Median and Ulnar Nerve

-pronator teres
-pronator quadratus (AIN)
-FCR, FCU (Ulnar), FDS, FDP (AIN), PL

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14
Q

Posterior Forearm Muscles

A

-Extensor/supinators
-radial nerve

-Supinator (PIN)
-ECRL (radial), ECRB, ED, EI, ECU, APL (PIN)

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15
Q

Cubial Tunnel

A

-fibro-osseous canal of ulnar nerve
-INC canal volume: ext
-DEC canal volume: flx, space occupying lesion, OA/RA, trauma

Floor: UCL
Roof: Aponeurosis
POS: Medial head of triceps
ANT: medial epi
Lateral: olecranon

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16
Q

Cubital fossa

A

Lateral border: brachioradialis
Medial border: pronator teres
Floor: brachialis

Contents:
-TAN
Biceps brachii tendon
Brachial artery
Median/radial nerve

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17
Q

Extensor compartments

A
  1. Apple peanut butter.
    Abductor pollicis longus, and extensor pollicis brevis
  2. Tennis elbow. Extensor carpi radialis longus, and brevis.
  3. Listers tubercle. Extensor pollicis longus
  4. Extensor digitorum and extensor indicis.
  5. Tea with the queen. Extensor digiti minimi
  6. Extensor carpi ulnaris
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18
Q

Median Nerve

A

-Medial and Lateral Cords of BP
-C5-T1

Anterior Interosseous N. (AIN)
-C8-T1
-Median after cubital tunnel
-FDP (2-3), FPL, PQ

-Superficial layer of anterior forearm (except FCU) , intermediate layer of anterior forearm, Deep layer of flexors (AIN), thenar muscles (recurrent branch), lumbricals (digital Branch)

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19
Q

Musculocutaneous Nerve

A

-Lateral Cord of Brachial Plexus
-C5-C7

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20
Q

Radial Nerve muscles

A

-Posterior Cord of BP
-C5-T1

Posterior Interosseous Nerve
-deep branch
-ECRB/ECU/ED/EU/EDM/APL/supinator

-Brachialis, triceps brachii, Anconeus, brachioradialis, superficial layer of posterior forearm, outcropping of the deep layer of posterior forearm (PIN),

21
Q

Ulnar Nerve muscles

A

-Medial Card of brachial Plexus
-C8-T1

-Medial part of FDP (regular), FCU
hypothenar muscles, adductor pollicis, Palmsr interossei, dorsal interossei, 4th and 5th lumbricals (deep branch)

22
Q

Common Elbow Injuries: Fx

A

-w/ or w/o dislocations

23
Q

Common Elbow Injuries: Ligament

A

-UCL Sprain
-LCL Sprain

24
Q

Common Elbow Injuries: Tendinopathies

A

-Lat/Med Epicondylitis
-Distal Biceps Tendon Rupture

25
Common Elbow Injuries: Nerve Entrapment
-Cubital tunnel -Radial tunnel -Pronator Teres syndrome -AIN Syndrome
26
Common Elbow Injuries: Others
-Valgus Ext Overload -Panner's -Osteochondritis Dissecans -Little League Elbow -Olecranon Bursitis
27
Supracondylar Fx
-fall on hyperextended or flexed elbow -MC in kids -ofter has Gunstock Deformity
28
Gunstock Deformity
-heals shorter -varus -dec ext
29
Olecranon Fx
-Fall onto elbow OR power triceps (steroids)
30
Coronoid Fx
-seen with high energy fx -seen with posterior elbow displacements
31
Radial Head Fx
-FOOSH; forces head into capitulum
32
Elbow Dislocation: HUJ
-humero-ulnar joint -MC posterior or postero-lateral -FOOSH -inc likelihood of coronoid fx
33
Elbow Dislocation: PRUJ
-proximal radio-ulnar joint -Nursemaid's Elbow: radial head dislocation secondary to distraction force
34
Elbow Dislocations
-extensive soft tissue damage (muscles, ligaments, capsule) Associated Fx: -Radial head fx -Coronoid -olecranon -Capitulum (least common)
35
UCL Sprain
Hx: -pop or acute pain over medial elbow -progressive pain w/ throwing MOI: -acute valgus stress to flexed elbow (acceleration phase MC) Imaging: -bone spurs -epipheseal separation -loose bodies -leaking dye from torn capsule (arthrogram) -complete rupture (MRI)
36
LCL/RCL Sprain
-results in posterio-lateral rotary instability at elbow -MC recurrent instability at elbow -Conservative Tx not often effective Hx: -clicking of radial head slipping -Lateral Elbow pain MOI: -Compression + Shouler ER + valgus -LAtrrogenic: agressive debridement
37
Lateral Elbow Tendinopathy
-tennis elbow Hx: -35-50 yrs -pain at lat elbow -TTP 1cm disal to lat epi -pain w/ passive flx, gripping, resisted ext MOI: -repetitive strain -high physical work DDx: -Radial Nerve entrapment -Instability
38
Medial Elbow Tendinopathy
-golfer's elbow Hx: -dull aching pain -pain at med elbow -pain w/, weak gripping, resisted flex MOI: -repetitive strain -high physical work DDx: -Ulnar Nerve entrapment
39
Disal Biceps Tendon Rupture
-must have surgery (5-6m recovery) S/s: -popping sensation w/ swelling -visible/palpable defect -dec grip sttrength -dec ability to feel MOI: -single traumatic event w/ resistance against arm in 90 flx
40
Cubital Tunnel Syndrome
-2nd MC nerve entrapment -inflammaion of ulnar nerve S/s: -ulnar nerve s/s MOI: -traction -valgus deformity -sustained flexion posture (bicyclists) DDx: -Cervical Radic -TOS
41
Radial Tunnel Syndrome
-compressuon of PIN from radial nerve as it passes btwn supinator -NO sensory involvement Test: -use extensor indicis or EPL to test for weakness S/s: -pain distal to lateral epicondyle; at supinator
42
Pronator Teres Syndrome
-compression of median nerve btwn pronator teres -rare Test: -pain w/ resisted pronation DDx: -Carpal tunnel -Palmar sensory changes -FDS weakness -cervival root compression
43
Anterior Interosseous Nerve Syndrome
-motor only -FPL, pronator quadratus, FDP of 2-3 Hx: -difficulty gripping -issue buttoning shirt -difficultty making fist Test: -difficulty making ok sign -weakness -Positive Pinch Grip Test
44
Valgus Extension Overload Syndrome
MOI: repeated extension Test: -TTP around olecranon -pain with forced ext -Increased valgus laxity
45
Panner's Disease/Osteochondrosis
-osteochondrosis of capitulum (lateral side) -children only 7-10 (peak at 9) S/s: -sudden lateral elbow pain (dull, aching) -worse after movement -no mechanical symptoms MOI: -repetitive valgus stress causeing compression to lateral/radio-capitellar joint -capitulum suseptible due to dec blood supply
46
Osteochondritis Dissecans
-inflammation and separation of subchondral bone of capitulum -Children 12-17 (throwers and gymnasts) -doesn't get better on it's own MOI: -reipetitive valgus steess causes compression -repeteat ext and forceful pronation S/s: -gradual lat elbow pain -dull aching, worsened by motion -locking and catching -crepitus -swelling -limied extension 5-20 deg Imaging: -crescent shaped region -loose bodies
47
Little League Elbow
-spectrum of pathologies related to growth plate stess while throwing
48
Olecranon Bursitis
MOI: -trauma Test: -swelling over olecranon -full ROM except extreem FLX DDx: -ceellulitis -seeptic arthritis -elbow sprain

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