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Musculo > Elbow Examination > Flashcards

Elbow Examination Flashcards

1
Q

Elbow examination parts (9)

A
  1. History
  2. Observation
  3. AROM
  4. Repeated movements
  5. PROM
  6. Passive accessory motion
  7. Muscle performance testing
  8. Special tests and neuroscreen
  9. Palpation
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2
Q

How does an elbow instability and subluxation and dislocation present (4)

A
  1. FOOSH
  2. May have deformity
  3. May have neural involvement
  4. May have vascular involvement
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3
Q

How does an elbow fracture present (3)

A
  1. Trauma
  2. Presence of fat pad sign
  3. Inability to fully extend elbow
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4
Q

What are the 4 common elbow fractures

A
  1. Medial and lateral epicondyle
  2. Olecranon
  3. Radial head
  4. Coronoid process
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5
Q

What are complications of elbow trauma (5)

A
  1. Stiffness
  2. Loss of extension
  3. Mild to moderate pain
  4. Popping or locking
  5. Ulnar neuritis
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6
Q

What is the power nerve of the hand

A

Ulnar nerve

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7
Q

What innervates the hand and finger extensors

A

Radial nerve

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8
Q

What is the fine motor skills of the hand and fingers

A

Median nerve

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9
Q

What does heterotrophic ossificans present with (3)

A
  1. Pain with progressing loss of ROM
  2. May have hyperemia, swelling, warmth
  3. May show increased serum alkaline phosphatase, sedimentation rate, and WBC count
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10
Q

Who is more likely to get complex regional pain syndrome

A

Women 40 years of age

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11
Q

What is complex regional pain syndrome

A

Severe pain disproportionate to the injury

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12
Q

How does posterolateral rotatory instability present (5)

A
  1. Vague elbow discomfort
  2. Lateral elbow pain
  3. Clicking, snapping, or clunking worse with supination
  4. Something is not right
  5. Elbow giving out with loading flexed elbow
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13
Q

How does valgus instability occur acute and insidious

A

Acute: FOOSH
Insidious: Overuse in excessive valgus

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14
Q

How does valgus instability present (3)

A
  1. Medial elbow pain
  2. Pop at time of injury
  3. Tenderness at UCL
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15
Q

How does lateral tendinitis present (4)

A
  1. Point tenderness to distal humerus
  2. Difficulty gripping
  3. Pain with wrist flexion
  4. Pain with active wrist/finger extension
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16
Q

Who most commonly get lateral tendinitis

A

Women age 35-50

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17
Q

How does medial tendonitis present

A

Pain with flexion and pronation of wrist

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18
Q

Who is more likely to get medial tendinitis

A

Men and women are the same

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19
Q

What percent of medial tendinitis occurs in the dominant hand

A

75%

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20
Q

What is the incidence of biceps tendon rupture

A

1.2/100000

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21
Q

Who is most likely to rupture biceps tendon

A

Males 40-60

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22
Q

How does biceps tendon rupture present (3)

A
  1. Pop
  2. Acute weakness
  3. May have deformity
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23
Q

What is another name for the cubital tunnel

A

Ulnar tunnel

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24
Q

The cubital tunnel is the sight of what common nerve entrapment in UE

A

2nd most common

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25
Q

How does cubital tunnel syndrome present (3)

A
  1. Paresthesia along ulnar distribution
  2. Clumsiness or loss of coordination of hand
  3. Popping or snapping during flexion/extension
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26
Q

What nerve is involved in cubital tunnel syndrome

A

Ulnar nerve

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27
Q

What nerve is involved in pronator syndrome

A

Median nerve

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28
Q

How does pronator syndrome present (6)

A
  1. Anterior elbow pain
  2. Usually lack of specific injury
  3. Pain volar proximal forearm
  4. Sensory changes palmer surface of digits 2-4
  5. Weakness of digits 1-3
  6. Positive compression at pronator border
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29
Q

What nerve is involved in anterior interosseous syndrome

A

Median nerve

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30
Q

How does anterior interosseous syndrome present (6)

A
  1. Pain volar proximal forearm
  2. No sensory symptoms in fingers
  3. Weak FPL, lateral FDP, thenar sparing
  4. Negative compression at pronator border
  5. Inability to make ok sign
  6. Motor loss
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31
Q

What nerve is involved in radial tunnel syndrome

A

Radial nerve

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32
Q

How does radial tunnel syndrome present (5)

A
  1. Deep ache distal to lateral epicondyle
  2. Pain at belly of brachioradialis
  3. Pain with resisted supination
  4. Pain with repetitive wrist flexion, and/or pronation
  5. No motor over sensory loss
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33
Q

What nerve is involved in posterior interosseous syndrome

A

Radial nerve

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34
Q

how does posterior interosseous syndrome present (5)

A
  1. Lateral forearm or elbow pain
  2. Weak wrist extension with radial deviation
  3. Weakness of digital extensors
  4. Thumb extension produces pain at lateral epicondyle
  5. Motor loss
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35
Q

Who is most likely to get osteoarthritis

A

Males 40-60

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36
Q

How does OA present (5)

A
  1. Repetitive use of UE
  2. Insidious onset
  3. Loss of terminal extension
  4. Pain at end of flex/ext
  5. Ulnar neuropathy
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37
Q

What percent of OA have ulnar neuropathy

A

26-55%

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38
Q

Who is most likely to have acute forearm compartment syndrome

A

Males under 30

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39
Q

How does acute forearm compartment syndrome present (3)

A
  1. Supracondylar Fx in children
  2. Distal radial fracture
  3. 5 Ps
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40
Q

What are the 5 Ps

A
  1. Pain
  2. Pallor
  3. Pain with passive stretch of muscle
  4. Parathesia
  5. Pulselessness
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41
Q

Do you have to have all 5 Ps at once

A

Nope

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42
Q

How does chronic forearm compartment syndrome present (3)

A
  1. Increase in forearm pressure due to muscle activity
  2. Forearm pain of gradual onset
  3. Weakness, numbness, clumsiness, and pain
43
Q

What is olecranon bursitis

A

Inflammation of bursal sac covering olecranon

44
Q

What is the rate of septic olecranon bursitis

A

0.6/1.2-1000

45
Q

How long does it take aseptic bursitis to heal

A

Very quick

46
Q

How long does it take septic bursitis to heal

A

Up to 40 days

47
Q

Diagnose: Pain over lateral elbow during gripping activities (2)

A
  1. Lateral epicondylitis

2. Radial tunnel syndrome

48
Q

Diagnose: Pain over medial elbow with wrist flexion and pronation (1)

A
  1. Medial epicondylitis
49
Q

Diagnose: Numbness and tingling along ulnar nerve distribution distal to elbow (1)

A
  1. Cubital tunnel syndrome
50
Q

Diagnose: Pain in anterior elbow and forearm worsened with wrist flexion combined with elbow flexion and forearm pronation (1)

A
  1. Pronator syndrome
51
Q

Diagnose: Pain with elbow movement with sensation of catching or instability (1)

A
  1. Rotatory instability
52
Q

Diagnose: Posterior elbow pain with elbow hyperextension

A

Valgus extension overload syndrome

53
Q

What is the normal carrying angle for males and females

A

Males: 5-10
Females: 10-15

54
Q

What is the carrying angle for cubital valgus

A

30

55
Q

What is the carrying angle for cubital varus

A

-5

56
Q

What is the carrying angle for gunstock deformity

A

-15

57
Q

What does the carrying angle allow for

A

Us to clear hip joint with forearms

58
Q

How are the epicondyles and olecranon orientated during extension

A

Straight line

59
Q

How are the epicondyles and olecranon orientated during flexion

A

Equilateral triangle

60
Q

What ligaments prevent varus

A

Lateral collateral ligaments

61
Q

What ligaments prevent valgus

A

Medial collateral ligaments

62
Q

When are the median and radial nerve tension loaded

A

Extension

63
Q

When is the ulnar nerve tension loaded

A

Flexion

64
Q

What is the motion at the humeroulnar articulation

A

Slide of ulnar trochlear ridge on humeral trochlear groove

65
Q

What is the motion during extension at the humeroulnar joint

A

Olecranon process of ulna in olecranon fossa of humerus

66
Q

What is the motion during flexion at the humeroulnar joint

A

Coronoid process of ulna in coronoid fossa of humerus

67
Q

what is the motion at the humeroradial articulation

A

Concave radial head slides on convex capitulum of the humerus and tubercle/groove on lateral lip of trochlea

68
Q

What is the motion during extension at the humeroradial joint

A

No contact is made between the radius and humerus

69
Q

What is the motion during flexion at the humeroradial joint

A

Rim of radial head slides in capitulotrochlear groove into radial fossa

70
Q

What holds the radial head in place

A

Annular ligament

71
Q

What is normal flexion of elbow

A

150

72
Q

What is normal extension of elbow

A

0

73
Q

What is normal supination of elbow

A

90

74
Q

What is normal pronation of elbow

A

80

75
Q

What is functional ROM of the elbow

A

30-130

76
Q

What is the roll and glide of forearm varus

A

Roll: Medial
Glide: Lateral

77
Q

What is the roll and glide of forearm valgus

A

Roll: Lateral
Glide: Medial

78
Q

True or False:

Forearm varus/valgus configuration is convex on concave

A

True

79
Q

True or False:

The proximal radioulnar joint configuration is convex on concave

A

True

80
Q

True or False:

The distal radioulnar joint configuration is concave on convex

A

True

81
Q

What is the resting position of the humeroulnar joint

A

70 elbow flexion and 10 supination

82
Q

What is the closed pack position of the humeroulnar joint

A

Extension with supination

83
Q

What is the capsular pattern of the humeroulnar joint

A

Flexion then extension

84
Q

What is the resting position of the humeroradial joint

A

Full extension and full supination

85
Q

What is the closed pack position of the humeroradial joint

A

Elbow flexed 90 and forearm supinated 5

86
Q

What is the capsular pattern of the humeroradial joint

A

Flexion, extension, supination, pronation

87
Q

What is the resting position of the superior radioulnar joint

A

Supination 35 and elbow flexion 70

88
Q

What is the closed pack position of the superior radioulnar joint

A

5 supination

89
Q

What is the capsular pattern of the superior radioulnar joint

A

Equal limitations of supination and pronation

90
Q

How much valgus stress do the UCL, anterior capsule, and bony articulation resist at 0 elbow extension

A

UCL: 31%
Ant Cap: 38%
Bone: 31%

91
Q

How much valgus stress do the UCL, anterior capsule, and bony articulation resist at 90 elbow extension

A

UCL: 54%
Ant Cap: 10%
Bone: 36%

92
Q

How much varus stress do the RCL, anterior capsule, and bony articulation resist at 0 elbow extension

A

RCL: 14%
Ant Cap: 32%
Bone: 55%

93
Q

How much varus stress do the RCL, anterior capsule, and bony articulation resist at 90 elbow extension

A

RCL: 9%
Ant Cap: 13%
Bone: 75%

94
Q

How much distraction do the UCL and anterior capsule resist at 0 elbow extension

A

UCL: 5%

Ant Cap: 70%

95
Q

How much distraction do the UCL and anterior capsule resist at 90 elbow extension

A

UCL: Primary resistance

Ant Cap: Minimal resistance

96
Q

What are the passive accessory motions of the elbow (10)

A
  1. Passive elbow flexion/extension
  2. Passive elbow flexion/extension with overpressure
  3. Passive elbow flexion/extension with varus
  4. Passive elbow flexion/extension with valgus
  5. PA of humeroulnar joint
  6. PA of humeroradial joint
  7. AP of humeroulnar joint
  8. AP of humeroradial joint
  9. PA of radioulnar joint
  10. AP of radioulnar joint
97
Q

What are the resisted isometrics of the elbow (6)

A
  1. Elbow flexion
  2. Elbow extension
  3. Forearm supination
  4. Forearm pronation
  5. Wrist flexion
  6. Wrist extension
98
Q

When we extend our elbow we have a valgus or varus

A

Valgus

99
Q

When we flex our elbow we have a valgus or varus

A

Varus

100
Q

When is the biceps brachii isolated

A

Forearm supination

101
Q

When is the brachioradialis isolated

A

Neutral forearm

102
Q

When is the brachialis isolted

A

Forearm pronation

103
Q

Motivation

A

Why stop now you can see the end

Musculo (18 decks)

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