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Ortho UE > Elbow Lecture > Flashcards

Elbow Lecture Flashcards

1
Q

what is the opened pack position of the humeroulnar joint

A

70 degrees flexion and 10 degrees supination

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2
Q

what is the closed pack position of the humeroulnar joint

A

full extension and full supination

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3
Q

what is the action of the humeroulnar joint

A

elbow flexion and extension

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4
Q

what is the open packed position of the humeroradial joint

A

full extension and supination

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5
Q

what is the closed back position of the humeroradial joint

A

90 degrees flexion and 5 degrees supination

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6
Q

how many degrees of freedom does the humeroradial joint have

A

3

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7
Q

what is the open packed position of the proximal humeroradial joint

A

70 degrees flexion and 35 degrees supination

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8
Q

what is the closed packed position of the proximal humeroradial joint

A

5 degrees supination

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9
Q

what is the normal carrying angle of the elbow

A

10-15 degrees

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10
Q

cubitus varus

A

larger carrying angle (elbows in palms out)

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11
Q

cubitus valgus

A

smaller carrying angle (straight hands)

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12
Q

what are the 2 bands of the UCL

A

anterior and posterior

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13
Q

that does the anterior band of the UCL resist

A

valgus stress from 0-70 degrees (commonly stressed in OH throwers)

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14
Q

what does the posterior band of the UCL resist

A

valgus stress from 60-120 degrees

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15
Q

what does the annular ligament do

A

supports the radial head

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16
Q

where does the lateral stability come from

A

50-70% from boney structures
30-50% from the lateral collateral ligament

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17
Q

what dx are you going to rule in or out for lateral elbow pain

A

lateral epicondyalgia

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18
Q

what dx are you going to rule in or out for medial elbow pain

A
  • tendoinopathy at the site of attachment of the flexor wad and pronator teres muscle (golfers elbow)
  • MCL sprain
  • ulnar nerve compression
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19
Q

what dx are you going to rule in or out for posterior elbow pain

A
  • olcranon bursitis
  • triceps tendinosis
  • valgus extension overload (VEO)
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20
Q

what dx are you going to rule in or out for cubital fossa pain

A
  • tear of the brachialis muscle at the musculotendinous junctions
  • biceps brachii lesion
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21
Q

what is the description for arthritis of the elbow

A
  • condition from numerous conditions such as RA, crystalline diseases, infection, and OA
  • common in males 40-60 with hx of strenuous work, throwing sports, or trauma
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22
Q

what is the subjective for RA at the elbow

A

pain and swelling

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23
Q

what is the subjective for non-RA inflammatory arthritis at the elbow

A

acute pain, swelling, effusion, loss of ROM, and warmth

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24
Q

what is the subjective for OA at the elbow

A

stiffness, mechanical locking, and occasionally deformity

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25
Q

what is the subjective for septic arthritis

A

acute and severe pain, stiffness, warmth, swelling, effusion, and fever/chills/malaise

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26
Q

what are the objective findings of RA at the elbow

A

joint swelling, rheumatoid nodules over the olecranon and extensor surface of the forearm, tenderness, joint instability (advanced)

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27
Q

that is the objective findings for non-RA or septic arthritis

A

severely painful and restricted ROM in the presence of significant effusion and warmth

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28
Q

what is the objective findings for OA at the elbow

A

minimal effusion and joint line tenderness

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29
Q

what are the special tests that should be done for arthritis of the elbow

A

valgus and varus instability to rule in/ out joint instability

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30
Q

what is the intervention for OA of the elbow

A

conservative: POLICE
Invasive: arthroscopic debridement

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31
Q

what is the intervention for RA of the elbow

A

conservative: cortisteriod injection, gental PT, static hinged sprints
invasive (early stage): synovectomy with or without radial head excision providing pain relief
invasive (late stage with serious limitations): total elbow

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32
Q

what is the mechanism of a fx of the radial head or neck

A

result from trauma typically FOOSH

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33
Q

what is a type 1 Mason Johnson classification for fx of the radial head/neck

A

non displaced fx

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34
Q

what is a type 2 Mason Johnson classification for fx of the radial head/neck

A

minimally displaced greater then 2 mm at articular surface or angulated neck

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35
Q

what is a type 3 Mason Johnson classification for fx of the radial head/neck

A

severely comminuted fx

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36
Q

what is a type 4 Mason Johnson classification for fx of the radial head/neck

A

ulnohumeral dislocation

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37
Q

what is the subjective of a fx of the radial head or neck

A
  • pain and swelling over the lateral aspect of the elbow
  • loss of ROM due to pain or mechanical block
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38
Q

what are the objective findings of a tx of the radial head or neck

A
  • palpate carefully and feel for deformity at the radial head
  • assess neurovasular function down the rest of the arm
  • tender over the lateral aspect of the elbow
  • PROM limited in pronation and supination
  • AROM and PROM of flexion and extension might also be limited
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39
Q

what is the intervention for type 1 radial head or neck fx

A
  • initally: sling or splint, early AROM as pain allows
  • 3 weeks: isometric
  • 5-6 weeks: concentric
  • 8 weeks: heavy resistance
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40
Q

what is the intervention for type 2 radial head or neck fx

A

use the rules of 3 to determine if surgery is needed
- nonsurgical if less then 1/3 of the articular process is involved, less then 30 degrees of angulation, and displacement less than 3 mm

41
Q

intervention of type 3 radial head or neck fx

A

early excision of the bone fragments through internal fixation

42
Q

how long does rehab post internal fixation of a elbow last

A

12 weeks

43
Q

what is the first thing initiated after immobilization for internal fixation of the elbow

A

active and passive ROM into flexion and extension

44
Q

when are isometrics exercises incorporated for post internal fixation of the elbow

A

within the first week post immobilization

45
Q

what is the goal at week 2 post internal fixation

A

15-105 ROM

46
Q

when can joint mobs into flexion and extension start post internal fixation of the elbow

A

week 2

47
Q

when can the patient post internal fixation of the elbow be preforming lightweight concentric movement in the elbow sagittal plane

A

week 3

48
Q

when do AAROM into pronation and supination occur post internal fixation of the elbow

A

week 6

49
Q

when are eccentric and UE plyo incorporated in post internal fixation rehab

A

week 7

50
Q

what is the mechanism of olecranon bursitis

A
  • falling and striking elbow on hard surfaces
  • more common in students and wrestlers
  • easily bruised through direct trauma or irritated through repetitive wt bearing
51
Q

what is the subjective of olecranon bursitis

A
  • complaints of pain and swelling that is gradual or sudden
  • increased ROM especially into extension or inability to don a long sleeved shirt
52
Q

treatment for olecranon bursitis

A
  • simple posttraumatic bursitis are treated with police
  • infected bursa needs prompt medial attention
  • bursitis that recurs despite 3+ aspirations or infection that does not respond to antibiotics requires evaluation for surgical excision
52
Q

what is the objective of olecranon bursitis

A
  • swelling over olecranon process
  • redness and heat is usually a sign of infection
53
Q

what is the mechanism of a bicep tendon rupture

A
  • sudden contracture of the biceps against a significant load with the elbow in 90 degrees of flexion
  • more common in muscular males over the age of 50
54
Q

what is the subjective of a bicep tendon rupture

A
  • sharp tearing pain concurrent with an acute injury
  • loss of strength in activites involving elbow flexion and supination
55
Q

what is the objective of a bicep tendon rupture

A
  • ecchymosis in antecubial fossa
  • visible deformity
  • loss of strength in elbow flexion, grip strength and supination
56
Q

how will ROM be lost if someone does not get surgery for biceps tendon rupture

A

88% loss of elbow flexion and 74% loss of supination strength

57
Q

how long should the elbow be protected post op biceps tendon rupture

A

6-8 weeks

58
Q

when is return to unrestricted activity post biceps tendon rupture

A

6 months

59
Q

what is the mechanism for a triceps tendon rupture

A

deceleration force occurs during elbow extension or with an uncoordinated contraction between the triceps and the elbow flexors

60
Q

what is the objective for a triceps tendon rupture

A

loss of elbow extension strength, and inability to extend overhead against gravity

61
Q

treatment of a triceps tendon rupture

A

partial: conservative treatment with immobilization for 3 weeks that progression of ROM and strength
complete rupture: surgical repair required

62
Q

triceps tendon repair PT goals stage 1 0-3 weeks

A
  • sling all the time except for PT ex
  • short arc gental PROM and pendulum
63
Q

triceps tendon repair PT stage 2 goals 3-6 weeks

A
  • no active elbow extension
  • hinge brace
  • isometrics biceps
64
Q

triceps tendon repair PT goals stage 3 6-12 weeks

A
  • discontinue elbow hinge brace at 8 weeks
  • progress to full AROM at 8 weeks
  • biceps AROM at 6 weeks
  • triceps strengthening at 9 weeks
65
Q

triceps tendon repair PT goals stage 4 12+ weeks

A
  • progress to full lifting and carrying
  • return to work in 12 weeks
  • return to heavy lifting job in 16 weeks
  • return to sport in 6 months
66
Q

what is the most common age range for lateral epicodyalgia

A

35-50

67
Q

what is the mechanism of lateral epicodyalgia

A

repetitive grasping or other activities that involve repetitive wrist extension and radial deviation

68
Q

where does the extensor carpi radialis originate

A

the supracondylar ridge

69
Q

what is the most common extensor tendon to become injured

A

the extensor carpi radialis brevis

70
Q

what is stage 1 of repetitive microtrauma for lateral epicondyalgia

A

inflammatory injury but not associated with pathologic alterations

71
Q

what is stage 2 of repetitive microtrauma for lateral epicondyalgia

A

injury with pathologic alterations such as tendinosis or angiofibroblastic degeneration - most commonly related to sports related injury

72
Q

what is stage 3 of repetitive micro trauma for lateral epicondyalgia

A

pathologic changes and complete structural failure (partial tears) - autologous cell therapy

73
Q

what is stage 4 of repetitive micro trauma for the lateral epicondyalgia

A

macroscopic tears; associated with changes such as fibrosis, matrix calcification, and hard osseous calcification - need surgery

74
Q

what are the subjective findings for lateral epicondylitis

A
  • complaints of diffuse achiness and morning stiffness of the elbow
  • reports of localized tenderness over the lateral aspect of the elbow
75
Q

what are the objective findings of lateral epicondyalgia

A
  • tenderness to palpation usually over the extensor carpi radialis brevis and extensor carpi radialis longus
  • Pain with resisted or AROM wrist extension and radial deviation
  • pain with PROM wrist flexion and forearm pronation
  • positive lateral epi special tests
76
Q

lateral epi palpation type 1

A

lesion in the muscle of the ECRL (supracondular ridge)

77
Q

lateral epi palpation type 2

A

insertion tendiopathy of the ECRB (most common)

78
Q

lateral epi palpation type 3

A

pain at the radial head - from a oval shaped radial head going into pronation and supination

79
Q

lateral epi palpation type 4

A

ECRB muscle belly strain

80
Q

lateral epi palpation type 5

A

inflammation at the origin of the extensor digitorum

81
Q

description of medial epicondyalgia

A
  • tendinopathy at the attachment of the flexor/ pronator muscle at their origin
  • mechanism related to over use
  • overuse results in a strain on the common tendon at the medial epicondyle
82
Q

what muscles attach at the medial epi

A

1) pronator teres
2) flexor carpi radialis
3) palmaris longus
4) flexor digitorum superficialis
5) flexor carpi ulnaris

83
Q

subjective findings of medial epicondylitis

A
  • pain along the medial elbow
  • hx of needing a tight grip
  • increased pain with active wrist flexion and forearm pronation
84
Q

what are the objective findings for medial epicondylitis

A
  • tender to palpation 5 mm distal to the midpoint of the medial epicondyle
  • pain on resisted wrist flexion and pronation
  • pain with PROM wrist extension, supination, and radial deviation???? (says ulnar in slides but radial would stretch more??)
85
Q

what is the mechanism of damage of the medial collateral ligament

A

chronic valgus and ER forces from Oh sports or FOOSH

86
Q

what are the 3 parts of the MCL/UCL

A

anterior, posterior, and transverse

87
Q

what is the nerve that can be damages with an injury to the MCL/UCL

A

the ulnar nerve

88
Q

what is the subjective of a MCL/UCL tear

A
  • medial elbow pain along the site of the ligament
  • if pain at the ligament’s origin or at the insertion site there is a potential for an acute avulsion this will also have a a lot of swelling that is associated with it.
89
Q

what is the objective findings of the MCL/UCL

A
  • tenderness with palpation along the course of the of the MCL
  • tenderness over the ulnar nerve and a potential positive tinel sign
  • Possible loss of terminal elbow extension
  • positive valgus stress test
90
Q

what should the treatment be for early symptoms of MCL/UCL injury in a throwing athlete

A

rest and activity modification for 2-4 weeks

91
Q

what should be a focus of rehab treatment in UCL/MCL tear

A

isometric ex of the forearm flexors, unlar deviators, and pronators to enhance their role as secondary stabilizers

92
Q

what is the mechanism of little league elbow

A
  • young (8-15) athletes usually throwers
  • repetitive trauma of valgus stress that occurs at the medial elbow during cocking and acceleration phase of pitching
  • shearing force posterior with compression along the lateral elbow
93
Q

what is the subjective for little league elbow

A
  • medial elbow pain
  • medial swelling
  • decreased throwing effectiveness or distance
  • occational flextion contractors
  • pain with throwing
94
Q

what is the objective for little league elbow

A

similar to medial epicondyalgia
- pain with palpation
- pain with active wrist flexion and supination
- pain with passive wrist extension and pronation
- refer pt out to make sure it is not apophysitis or osteochondritis dissecans of the capitelium

95
Q

what is pronatory syndrome often misdiagnosised as

A

carpel tunnel

96
Q

mechanism of pronator syndrome

A

insidious pain felt on the anterior aspect of the elbow, radial side of the palm, and the palmar side of the 1st, 2nd, 3rd, and half of the 4th digit

97
Q

subjective of pronator syndrome

A
  • associated heaviness of the forearm
  • numbness and tingling into the hands
98
Q

what is the objective of median nerve entrapment/ pronator syndrome

A
  • pressure over the pronator teres
  • pain with resisted supination and resisted finger flexors
  • pain with PROM pronation, elbow flexion, and wrist flexion

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