Elbow/forearm Flashcards
humeroulnar joint
convex trochlea of humerus and concave trochlear notch of ulna
ulna moves lat during ext due to articular groove and distal med aspect
carrying angle
men-5-15
women 15-20
medial collateral ligament
UCL
resists valgus force
ant band- taut flex/ext
post-aut flex
HU resting position
70 degrees flex, 10 degrees supination
HU closed
full ext and full supination
HU capsular pattern
much more limitation in flex than ext
HR resting
full ext and forearm sup
HR closed
90 elbow flex and 5 degrees of supination
HR capsular pattern
flex> ext, equal limitation of pronation and supination is observed
proximal RU joint
resting- 70 degrees flex, 35 supination
closed- 5 degrees supination
capsular pattern- pronation=supination, minimal to no loss of motion with pain at the end ranges of pro and sup
distal RU
closed- 5 sup
loose- 10 sup
capsular pattern- pronation=supination, full range with pain at end ranges
ulnar ? occurs with ? and ?
ulnar abduction occurs with pronation and ext
ulnar adduction occurs with supination and flexion
functional arc of motion
30-130 degrees
Ulnar N
goes through flexors and pronators
medial epicondyle goes through cubital tunnel
sensation to 4th and 5th finger and medial arm
median N
carpal tunnel pain
ant to elbow
FDS,FDP, pronator
palmar part 1,2,3 and fingernails of dorsal
entrapped in forearm leads to pronator teres problems
radial N
most frequently injured N associated with fractures of humerus
lateral arm- ext and sup
can be misdiagnosis as lateral epi
numbness and tingling
motor and sensory loss
pain with resisted finger
tender lateral epi
radial tunnel- closer to radial head, SENSATION loss
Post interosseus- MOTOR loss, MCP or thumb ext, compressed at arcade of Frohse (supinator)
cubitus valgus
excessive angulation of carrying angle >25
can irritate ulnar N
cubitus varus
decreased carrying angle
lateral epi
tennis elbow 4-7 times more common than medial epic often ED,ECRB involved repetitive wrist ext or grasp dull ache at rest, sharp pain at lateral epic with lifting resisted wrist ext causes PAIN rule out C spine radial head mobility soft tissue mob deep friction massage
medial epi
golfers elbow
tendinitis of wrist flexors
often FCR and pronator teres
wrist FLEX and PRONATION
little leaguers elbow
epiphysis of medial epicondyle gradual onset forceful pronation (throwing) loss of full ext pain with resisted flex
panners disease
affects growth, ossification centers necrosis of capitulum of humerus laterally followed by regeneration and reclassification 7-12 yo self limiting nontraumatic no locking/catching loss of 5-20 ext may take up to 3 years
osteochondritis dissecans
arterial injury with subsequent bone necrosis resulting from increased radiohumeral LAT compression forces
causes-ischemia, trauma, predisposition
high risk- boy baseball pitchers and girl gymnastics
limited AROM and PROM ext
CLICKING/LOCKING
pain with sup/pro
6 months
arthritis
most common arthritis in elbow is RA
lab tests differentiate from bursitis
want to work on strength and ROM
biceps tendon rupture
most common distal rupture quick forceful biceps contraction usually occurs in males 50 yo weak elbow flex strength and supination ecchymosis in antecubital fossa
cubital tunnel syndrome
ulnar N compression distal to med epirepetitive motion increases inflammation and traction forces caused by elbow flex causes compression looks like med epic parathesias 4th and 5th dorsally worse at night weak pinch grasp claw hand
pronator teres syndrome
median N compression
parasthesia in thumb, index finger, middle finger aggravated with activity
pain volar aspect of forearm
NOT NOCTURNAL
possible dislocation
weakness in forearm muscles
neg phalanes test
pain with resistance pronation, elbow flex and wrist flex
splint 90/slight forearm pronation/wrist flex
subluxation/dislocation
subluxation of radial head- PULLED elbow (kids) annular lig is torn when arm ext and pronated
torn surface slips into radiohumeral joint and gets trapped
posterior dislocation- ulna and radius are displaced post to the humerus
caused by fall on outstretched hand with elbow extended
rapid edema
N injury common
MCL instability
post trauma FOOSH overuse forceful elbow ext , valgus stress, pronation overhead athletes and pitchers medial pain pop at time of injury tender gradual onset aggravated by throwing hypermobile want to immobilize and modify activity surgical-tommy johns (12 months)
extension valgus overload syndrome
compression of the olecranon of the ulna against the humerus with a values stress
flexion contracture and painful active ext
post pain with passive elbow pronation, values, ext
rest, NSAIDS, correct mechanics, eccentric strengthening
radial head fracture
MOST common elbow injury in adults
typically from fall
start active motion 7-10 days since immobilization can lead to perm loss of motion
olecranon fx
usually avulsion
FOOSH
ORIF
supracondylar fx
MOST common elbow fx in children
hyperext or fall on flexed elbow
