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Musculoskeletal 1 > elbow Examination (general trauma and hypomobility) > Flashcards

elbow Examination (general trauma and hypomobility) Flashcards

1
Q

What are the ligaments of the elbow

A
  • capsule
  • LCL
  • Annular ligament
  • oblique cord
  • MCL
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2
Q

carrying angle normal and variations

A
  • normal valgus 5-15
  • excessive cubitus valgus = >15
  • cubitus varus = -5 varus
  • gunstock deformity varus = -15 (varus)
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3
Q

Gunstock deformit varus casues

A
  • can result from fracture or injury to epiphyseal plate
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4
Q

Elbow flexion/extension osteokinematics/arthrokinematics

A
  • flexion 0-145: roll and glide anterior with varus tilt
  • extension: 145-0: roll and glide posterior valgus tilt
    *possible hyperextension
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5
Q

Pronation and supination pivot joint osteokinematics/arthrokinematics (proximal R/U joint)

A
  • supination 0-90: spin
  • pronation 0-90: spin
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6
Q

Pronation and supination pivot joint osteokinematics/arthrokinematics (distal R/U joint)

A
  • supination 0-90: roll and glide in same direction
  • pronation 0-90: roll and glide in same direction
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7
Q

Medial collateral ligaments

A
  • resists valgus
  • anterior fibers: also taut in extension
  • posterior fibers: taut in flexion
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8
Q

Common trauma to MCL or common injury with valgus forces at the elbow

A
  • MCL sprain/tear from falling on hand and a valgus forces gets applied
  • avulsion fx common in throwers
  • compression of radius and capitulum: fracture, avascular necrosis, loose bodies
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9
Q

Valgus force injury clinical test

A
  • while maintaing valgus stress, preform flexion and extension of elbow
  • (+) test = pain
    (medial elbow pain due to tensile stress on MCL and lateral elbow pain from compression)
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10
Q

Tommy John UCL reconstruction

A
  • UCL reconstruction
  • tunnels drilled into ulna and humerus
  • new tendon in place
  • can be tendon esp. palmaris longus or donor tendon
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11
Q

LCL

A
  • resists varus forces
  • radial collateral ligament
  • lateral ulnar ligaments: also taut in end range flexion and extension
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12
Q

Annular ligament

A
  • resists distraction of radius
  • pulled elbow
  • radial head displaced inferiorly through annular ligament
  • forearm typically held in extension and pronation
  • reduce by axial compression, elbow flexion and supination
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13
Q

Olecranon fracture and how it is treated?

A
  • fall on olecranon
  • nondisplaced: splint 45-90 degress
  • displaced = ORIF plates, screws, wires
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14
Q

Radial head fracture
- mechanism
- treatment

A
  • FOOSH: valgus force
  • nondisplaed: splint
  • displaced/comminuted = ORIF or RH replacement
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15
Q

Alvusion fractureat the elbow

A
  • trauma
  • ligament pulled during muscle contraction
  • medial or lateral epicondyle
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16
Q

Fracture/elbow dislocation

A
  • ulna and radius go posterior
  • humerus goes anterior
  • fracture epicondyle/coronoid
  • can damage a lot of other tissues think cubital fossa
17
Q

intercondylar fracture is caused by

A
  • impact Though the hand or elbow–> humerus splits condyles
18
Q

humeral shaft fracture

A
  • radial nerve injures
  • drop wrist
  • decreased grasp due to active insufficiency of finger flexors
19
Q

distal humeral fracture in ulnar groove at elbow

A
  • ulnar nerve injured
  • diminished key grip
  • diminished power grip (gripping hammer)
  • wrist deviates radially during wrist flexion and extension
20
Q

bone/articular cartilage piece in joint “loose body”

A
  • avulsion fracture, osteochondrosis
  • bony block end feel in shortened range
21
Q

Volkmans Ischemic Contracture

A
  • elbow fracture = blood and transudate into forearm
  • rapid increase in pressure
  • compression can cause nerve damage if its not relieved quickly
  • muscle ischemia –> necrosis
22
Q

olecranon bursistis

A

“students elbow”

  • bursa fills with fluid
  • chronic problematic
  • may need it drained or excised
23
Q

Tendiopathies at the elbow

A
  • epicondylagia (pain at elbow)
  • tendinitis
  • tendinosis
  • tennis elbow (lateral epicondyle)
  • golfers elbow (medial epicondyle)
24
Q

Steps (general) to the elbow exam

A
  1. history interview systems review
  2. observation
  3. functional assessment/limitations
  4. elbow examination
  5. joint play
  6. resisted isometrics
  7. sensation testing (if indicated)
  8. special tests
  9. palpation
25
Q

What to look at/ask in the history/interview for an elbow patient

A
  • symptom type, location, severity
  • MOI - trauma, overuse, onset, acute vs chronic
  • what makes it feel better or worse
  • functional limitations: dominate hand?
  • occupation, leisure activities, sports
  • diagnostic tests, Xrays, MRI
  • previous treatment
  • patient goals
26
Q

what to observe at the elbow

A
  • protection
  • willingness to move
  • alignment of elbow
  • edema: typically around the epicondyles within the triangle
  • olecranon bursitis
27
Q

Funcation requirements of the elbow ROM

A
  • 30-130 for flexion and extension
  • 50 supination
  • 50 pronation
28
Q

Once you rule out CS and shoulder what do you do at the elbow

A
  • AROM/PROM: is there a capsular pattern (flexion> extension)
  • elbow: normal end feels vs abnormal end feels
29
Q

Normal end feels at the elbow

A
  • flexion = soft tissue aprox.
  • extension: bony
  • pronation/supination: tissue stretch
30
Q

elbow abnormal end feels

A
  • limited capsular = stiff with no creep
  • limited boddy/squishy = swelling
  • hard end feel that limits = bone cartilage, loose body
  • empty = pain limits
31
Q

elbow/forearm open pack

A
  • UH = 70-90 flexion and 35 supination
  • distal RU = 10 supination
32
Q

Closed pack position for elbow/forearm

A
  • UH = full extension
  • RU = full supination or full pronation
33
Q

Joint play at the elbow/forearm

A
  • ulnar distraction: of olcranon process on the humerus in 70-90 flexion
  • medial varus/lateral varus tilt: of radius and ulna on humerus in slight flexion
  • proximal R/U joint = anterior posterior glide of radial head
  • Distraction radioulnar joint = anterior glide radius on ulna
34
Q

resisted isometrics

A
  • elbow, forearm wrist and hand
  • extrinsics
35
Q

Sensation testing

A
  • if indicated
  • dermatomal
  • peripheral nerve
  • specialized = 2 point discrimination/monofilaments

Musculoskeletal 1 (42 decks)

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