EXAM #3 Flashcards
Bones of the elbow joint complex
- Distal humerus (anterior & posterior)
- Proximal ulna
- Proximal radius
- Olecranon process
Elbow important for:
- dressing
- throwing
- grooming
- feeding
Elbow joint
- Humeroulnar joint, also humeroradial joint
- superior radioulnar joint
Elbow joint is…
- synovial
- compound joint
- single capsule
- hinge joint for flexion and extension
Proximal radioulnar joint:
- part of _ _ _ - not needed for flexion/extension
- radial notch of ulna (+) radial head (+) annular ligament
- allows _ and _
- elbow joint complex
- pronation, supination
Elbow movements
- flexion
- extension
- pronation
- supination
Elbow movements:
Flexion ROM = _
150 degrees
Elbow movements:
Extension ROM = _
0 degrees or beyond
Elbow movements:
Pronation & supination ROM = _
0-90 degrees
Elbow ligaments
- ulnar collateral ligament
- radial collateral ligament
- annular ligament of radius
Elbow ligaments:
Provides protection against valgus stresses to the elbow
medial (ulnar) collateral ligament
Elbow ligaments:
provides protection against varus stresses to the elbow
lateral (radial) collateral ligament
Elbow ligaments:
Holds radial head in place
annular ligament
Proximal elbow joint complex is a _, compound joint comprising three articular surfaces ( _, _, _ ) surrounded by a single _ _
- synovial
- distal humerus, proximal radius, proximal ulna
- articular capsule
Elbow muscles
- Biceps brachii
- Brachialis
- Brachioradialis
- Triceps brachii
- Anconeus
- Pronator teres
- supinator
Elbow muscles:
Biceps Brachii
- Origin: long head - _
- Origin: short head - _
- O: long head - glenoid & labrum
- O: short head - coracoid process
Elbow muscles:
Biceps Brachii
- Insertion: _
I: proximal radius
Elbow muscles:
Biceps Brachii
- Action: _
A: shoulder flexion, elbow flexion, wrist supination
Elbow muscles:
Brachialis
- Origin: _
humerus
Elbow muscles:
Brachialis
- Insertion: _
Ulna
Elbow muscles:
Brachialis
- Action: _
elbow flexion
Elbow muscles:
Brachioradialis
- Origin: _
humerus
Elbow muscles:
Brachioradialis
- Insertion: _
distal radius
Elbow muscles:
Brachioradialis
- Action: _
elbow flexion
Elbow muscles:
Triceps brachii
- Origin: long head - _
- Origin: lateral head - _
- Origin: medial head - _
- O: long head - glenoid
- O: lateral head - upper part of posterior humerus
- O: medial head - middle part of posterior humerus
Elbow muscles:
Triceps brachii
- Insertion: _
olecranon process of ulna
Elbow muscles:
Triceps brachii
- Action: _
elbow extension
Elbow muscles:
Anconeus
- Origin: _
lateral humerus
Elbow muscles:
Anconeus
- Insertion: _
olecranon and ulna
Elbow muscles:
Anconeus
- Action: _
elbow extension
Elbow muscles:
Pronator teres
- Origin: _
medial epicondyle of humerus
Elbow muscles:
Pronator teres
- Insertion: _
middle radius
Elbow muscles:
Pronator teres
- Action: _
wrist pronation, elbow flexion
Elbow muscles:
Supinator
- Origin: _
lateral epicondyle of humerus and lateral ulna
Elbow muscles:
Supinator
- Insertion: _
radius
Elbow muscles:
Supinator
- Action: _
supination of elbow
Elbow injuries
- Elbow Bursitis
- Elbow Dislocation
- Elbow Fracture
- Ulnar Collateral Ligament Rupture
- Distal Biceps Tendon Rupture
- Elbow Arthritis
- Elbow Replacement
Elbow injuries:
Bursa Sac of Fluid to Protect the Olecranon Process
- Allows skin to move freely
- Can get injured:
▪ Trauma
▪ Prolonged Pressure
▪ Infection
elbow bursitis
Elbow injuries:
Humerus and Ulna become Disarticulated
- Extreme Trauma
▪ Fall at High Speed
▪ MVA
elbow dislocation
Elbow injuries:
- Can be open or closed
- May sever artery or nerve
- Reduction may be painful
- May or may not require surgery
- May not regain full motion
elbow dislocation
Elbow injuries:
- Unable to Regain Full ROM
- Loss of Elbow Extension
- May Be Permanent
elbow arthrofibrosis
Elbow injuries:
- Due to trauma
- May or may not require surgery
- depends on alignment
elbow fracture
Elbow injuries:
- Stressed with valgus force at the elbow
▪ Pitchers, Throwers
▪ May rupture
▪ May require surgery
Ulnar collateral ligament rupture
Elbow injuries:
- Sharp Pain in Arm
- Black and Blue
- “Popeye” Sign
- Usually does not require surgery
Distal biceps tendon rupture
Elbow injuries:
Disruption of the Articular Cartilage of the Humerus or Ulna
- May or May Not Have Pain
elbow arthritis
Elbow injuries:
- End Stage Operation
- For Pain Relief
- Hard to Regain Full Motion
elbow joint replacement
Elbow injuries:
- End Stage Operation
- For Pain Relief
- Hard to Regain Full Motion
elbow joint replacement
6 phases of the throwing cycle
- wind-up
- early cocking
- late cocking
- acceleration
- deceleration
- follow-through
Throwing cycle phases:
- Shoulder in slight internal rotation (IR)
- Minimal abduction
- Phase with minimal shoulder stress
Wind-Up
Throwing cycle phases:
- Contralateral Hip to 90 degrees Hip Flexion
- Shoulder in Neutral Rotation – 0 Internal and 0 External Rotation
- End of phase: increased activity of the rotator cuff
– Supraspinatus
– Infraspinatus
– Teres Minor
Early cocking
Throwing cycle phases:
- Begins with planting of the striding leg
- Scapular retraction
- Abduction to 90 degrees
- Torso starts to rotate forward
- 400 N shear force on anterior shoulder
- Increase in supraspinatus, infraspinatus, and
teres minor activitycompressive force of 650 N
- Maximal ER (up to 180 degrees)
- Shoulder Capsule is Tight
Late cocking
Throwing:
- Bony twist about the long axis of the humerus
- Results in more external ROM
humeral torsion
Throwing cycle phases:
- Beginning of forward movement of the arm
- Arm internally rotates
- Increased activity of :
– Pec major
– Lats
– Serratus anterior
- Shoulder rotates at speeds >700 degrees/ sec
- Elbow moves from flexion to extension
– Early triceps activity
- Capsule unwinds
Acceleration
Throwing cycle phases:
- Begins when object (ball) is released
- Violent eccentric contraction of all muscle groups
– Rotator Cuff
- Maximal load on joints (posterior shear
forces of 400 N, inferior shear forces of
300 N, and compressive force of 1,000 N)
Deceleration
Throwing cycle phases:
- Body moves forward with arm until motion stops
follow-through
Throwing cycle phase with maximal external rotation
late cocking
Shoulder injuries
- Laxity and Instability
- Superior Labrum Anterior-Posterior (SLAP) lesion
- Rotator Cuff Tears
- Impingement
- Glenohumeral Internal Rotation Deficit (GIRD)
- Scapular dyskinesia
The thrower’s shoulder must be lax enough to allow excessive external rotation but stable enough to prevent symptomatic humeral head subluxations and functional stability
“Thrower’s Paradox”
Throwing:
Result of repetitive stresses during the cocking and acceleration phases
– May make the shoulder loose – _
– Or too loose – _
- laxity (normal)
- instability (abnormal, pathologic)
Shoulder injuries:
- Caused by extreme ER
- “Peel back mechanism” (Burkhart and Morgan, 1998)
- Pain in late cocking phase and loss of velocity of the pitch
Shoulder labrum lesions
Shoulder injuries:
- Compression of rotator cuff between acromial arch and humeral head
- Superior migration of the humeral head due to fatigue of RC
Shoulder impingement
Shoulder injuries:
- Posterior shift in total arc of motion
- Increase in length of anterior capsule –> excessive ER
- Loss of IR motion
GIRD (Glenohumeral Internal Rotation Deficit)
Shoulder injuries:
- Imbalance of scapular muscles secondary to fatigue, direct trauma, or nerve injury
- Can lead to:
– impingement during late cocking phase
– anterior instability
Scapular Dyskinesia
Elbow injuries
Ulnar Collateral Ligament
* Ulnar neuritis
* Medial epicondylitis
* Valgus extension overload syndrome with
posterior olecranon impingement
Elbow injuries:
- During late cocking phase MCL experiences forces reaching its tensile limit
- Leads to microtrauma, ligament attenuation, and eventual rupture
Ulnar collateral ligament (UCL) injury
Elbow injuries:
- pediatric injuries
- GIRD
- Medial epicondyle apophysitis (“Little leaguer’s Elbow)
Elbow injuries:
- fatigue fracture, widened epiphyseal line, stress
- displaced medial epicondyle fracture
- entrapment of epicondyle in joint
Little Leaguer’s Elbow
Bones of the hand (fingers to wrist)
- Distal phalanges
- Intermediate phalanges
- proximal phalanges
- metacarpals
- carpals
Distal phalanges
Intermediate phalanges
proximal phalanges
metacarpals
Phalanges:
Numbered:
1 = _
5 = _
- thumb
- pinky finger
5 joints of the wrist & hand
- Carpometacarpal (CMC)
- Metacarpophalangeal (MCP)
- Proximal Interphalangeal (PIP)
- Distal Interphalangeal (DIP)
- Interphalangeal Joint (IP) (Thumb)
All joints of the hand are _ _ with joint capsules
synovial joints
Wrist & hand joints:
Distal Carpals and Metacarpals
- Function: Helps Cup the Hand – Palmar Cupping
- Conforms to Shape of an Object
- Maximizes Surface Contact
- Increases Sensory Feedback
- Enhances Stability
Carpometacarpal (CMC)
Wrist & hand joints:
- CMC 1 - Digit 1 (Thumb) to Trapezium is unique
- Called a Saddle Joint
- Trapezuim looks like a saddle
- Allows Many Motions
- CMC 2-5 are Different than CMC 1
Carpometacarpal (CMC)
Wrist & hand joints:
- Metacarpals to the Phalanges
- Convex Metacarpal Head and Concave Base of Proximal Phalanx
- Gripping
Metacarpophalangeal (MCP)
Wrist & hand joints:
- Proximal Phalanx with Middle Phalanx
- Gripping
- Proximal Phalanx (PP) is convex
- Middle Phalanx (MP) is concave
Proximal Interphalangeal (PIP)
Wrist & hand joints:
- Middle Phalanx with Distal Phalanx
- Fine Motor Control
- Pinching
- Threading
- Writing
Distal Interphalangeal (DIP)
Wrist & hand movements:
Digit 1 = thumb
- CMC 1 moves in many directions
- Flexion
- Extension
- Adduction
- Abduction
- Circumduction
- Opposition
Wrist & hand movements:
CMC 2-4
almost no motion
Wrist & hand movements:
CMC 5
20 degrees of flexion and abduction
Wrist & hand movements:
MCP
- Flexion
- Extension
- Abduction
- Adduction
Wrist & hand movements:
MCP flexion/extension motion _ _
increases ulnarly
Wrist & hand movements:
MCP unable to abduct nor adduct with MCP _ _
maximal flexion
Wrist & hand movements:
PIP
only flexion & extension ( motion increases ulnarly)
Wrist & hand movements:
DIP
only flexion & extension ( motion increases ulnarly)
Ulnar grip:
With more motion ulnarly at MCP, PIP, and DIP:
- Tighter Grip
- Greater Closure
- Some objects are wider at digit 2 and narrower at digit 5
Wrist & hand ligaments:
Radiocarpal joint
- Radial collateral ligament limits _ _
ulnar deviation
Wrist & hand ligaments:
Radiocarpal joint
- Ulnar collateral ligament limits _ _
radial deviation
Wrist & hand ligaments:
Radiocarpal joint
- Palmar radiocarpal and ulnocarpal ligaments limits _
extension
Wrist & hand ligaments:
Radiocarpal joint
- Dorsal radiocarpal ligament limits _
flexion
Wrist & hand ligaments:
Carpometacarpal joints (CMC)
intermetacarpal ligaments