Elbow Pathology Flashcards
What are the concave/convex components of the HumeroUlnar Joint?
Concave: trochlear notch of the ulna
Convex: trochlea of humerus
Which joint has a carrying angle + norms?
The HU joint: 11-14 men, 13-16 women
What is the resting position of the HU joint?
70 degrees elbow flexion, 10 degrees of supination
What is the closed pack position of the HU joint?
full elbow extension and supination
What is the capsular pattern of the HU joint?
flexion, extension
What are the concave/convex partners of the HumeroRadial joint?
Concave: head of the radius
Convex: Capitulum of the humerus
What is the resting position of the HR joint?
full elbow extension and supination
What is the closed pack position of the HR joint
Elbow flexed to 90 deg and supinated to 5 deg
What are the concave/convex partners of the proximal radioulnar joint
Concave: ulna
Convex: head of the radius
What is the resting position of the proximal RU jont
70 deg flexion 35 deg supination
What is the closed pack position of the proximal RU joint
5 deg supination
What is the capsular pattern of the prox. RU joint
pronation and supination equally limited
What are the medial ligaments of the elbow?
Ulnar Collateral Ligament w/anterior, transverse, and posterior bundle
Which bundle of the UCL is the primary restraint against valgus stress?
Anterior bundle
What are the lateral ligaments of the elbow?
Annular ligament
Lateral Radial Collateral Ligament
Lateral Ulnar Collateral ligament
Which lateral ligament wraps around the radial head?
Annular ligament
Which lateral ligament is associated w/ECRB and supinator
Lateral Radial collateral ligament
What are the primary flexors of the elbow?
Biceps, bracialis, bracioradialis
What are the weak flexors of the elbow?
PT
FCR
FCU
ECRL
What are the extensors of the elbow?
Triceps and anconeus
Where is the common extensor/supinator insertion?
Lateral epicondyle
Where is the common flexor/pronator insertion?
Medial epicondyle
List some pathologies that can occur at the lateral elbow
Lateral epicondylitis
Posterior interosseous nerve syndrome
Radial Tunnel Syndrome
Osteochondritis dissecans
panners disease
Osteochondral degenerative changes
Lateral collateral ligament injury
Synovitis & bursitis
Capitellum fracture
Radial head fracture
Cervical origin (C6-7)
What is the mechanism of injury for Lateral Epicondylitis
Overuse/insidious onset from manual labor actiities (could be due to a repetitive microtrauma)
What would you hear in the history to make you think Lateral Epicondalgia
Pain over lateral epicondyle
Pain with gripping
Occasional night pain or neck and shoulder pain
What are the special tests for lateral epicondalgia
Cozens, Mills and Middle Digit Extension Test
What are the examination findings that would indicate lateral epicondalgia
Full PROM of the elbow, limited wrist flexion - especially with pronation and elbow extension
Pain with resisted extension & RD, weak and painful grip strength
Tenderness at lateral epicondyle
What PT Interventions should be used for lateral epicondalgia?
Education
PREs (for chronic tendonosis not tendonitis)
Prox. forearm strap
Addressing proximal mm strength
manual therapy
What condition should you be mindful of when examining for lateral epicondalgia?
Radial tunnel syndrome
What are the possible areas of compression for Radial Tunnel Syndrome?
1 - Fibrous bands connecting brachialis to brachioradialis
2 - Vascular leash of henry (BV at radial neck)
3 - Medial leading edge of teh ECRB
4 - Fibrous bands at proximal and distal edge of supinator
What is the clinical presentation of Radial Tunnel Syndrome
- Diffuse aching in forearm
- Aggravated by repetitive pronation & supination
- Pain with resisted supination
- No sensory/motor changes
- tenderness over radial tunnel
- worsened w/forearm strap
What are the special tests for Radial Tunnel Syndrome
Pain w/resisted middle finger extension
What Interventions should be used for Radial Tunnel Syndrome?
- Conservative: immobilizations, NSAIDs, PT, and activitiy modification
- Sx (wide success range 10-95%): to decompress radial nerve
What is the clinical presentation of Posterior Interosseus Nerve Syndrome
- Lateral forearm/elbow pain
- Weakness of finger extension
- Thumb extension causes lateral epicondyle pain
- No sensation loss
- Motor symptoms (Impaced mm: EDM, ECU, ED, ECRb, EI, EPL, EPb, APL, Supinator - SPARED MM: Triceps, anconeus, brachiorad & ECRL)
What is capitellar osteochondritis dissecans (OCD)
Separation of a localized area of articular cartilage and subchondral bone
What are the signs and symptoms of capitellar osteochondritis dissecans
- Difficulty extending elbow - often 5-23 degree flexion contracture
- tenderness over lateral epicondyle
- lateral/antereior elbow/forearm pain
- Pain w/Weight bearing
What are the special tests for Osteochondritis Dissecans
Active compression test (Extended elbow w/pronation and supination)
Treatment of OCD
Depends on severity & compliance
- early: conservative 4-6 months
- Late/if needed: Sx (remove loose bodies, microfractures, OATs)
What is Panners disease
Focal osteonecrosis of the entire capitellum
A. OCD vs B. Panners
1. Age
2. History/onset
3. Locking and catching?
4. Duration of symptoms
1A. 10-21 yo vs B. 7-12 yo
2. Repetitive trauma overuse vs B. insidious
3A. locking and catching present vs B. not
4A. 5-6 mo, B. 2-24 mo
MOI for RCL sprain
Trauma, FOOSH, or axial compression w/ER and force
What does radiohumeral bursitis present similarly to?
Lateral epicondylitis
What are possible pathologies of the medial elbow?
Medial epicondylitis
Flexor/pronator strain
UCL sprain
Ulnar neuritis
Coronoid Fracture
CFCS
What two muscles are most affected with medial epicondyalgia
FCR and PT
MOI for medial epicondyalgia
Insidious onset or overuse (more common in golfers, tennis players, and overhead throwers)
Which decade of life is common onset for medial epicondyalgia
4th to 6th
What other condition should you be mindful of if you are thinking medial epicondyalgia?
UCL pathology in OH athletes or an ulnar nerve pathology
What population is a UCL sprain common in?
Baseball pitchers and gymnasts
What is MOI of UCL sprain?
Cummulative microtrauma from valgus + ER at HU jt or FOOSH