Final - Elbow Flashcards
lat humeral epi
extensor attachment
med humeral epi
flexor attachment
capitulum of humerus -
radiohumeral jt
trochlea of humerus
humeroulnar jt
head of radius
proximal, disc shaped, round and flat at sup end articulates with capitulum of humerus to form radio humeral jt
radial tuberosity
distal radioulnar jt and has a radial styloid process
proximal ulna
humeroulnar / trochlear jt - bw trochlea of humerus and trochlear notch of ulna
distal ulna
distal radioulnar jt with radius and has ulnar styloid process
normal ROM of elbow
touch your shoulder and extend
mechanics of humeroulnar jt
hinge - only movement in one plane
radiohumeral jt
uniaxial hinge jt for flexion and extension
proximal radioulnar
mechanics
synovial pivot
head of radius and ulna surrounded by annular lig
pronation and supination of forearm
mechanics of the radioulnar
spinning of either direction - in our elbow
fracture of the radius would limit motion at
elbow and the wrist
distal radioulnar articulation
synovial pivot
between head of ulna and ulnar notch of radius
articular/triangular fibrocarlage disc unite them
supination pronation radial moves around ulna
stability of elbow - 3
bony architecture of humerus and ulna
strong ulnar and radial collateral ligs
muscles that surround the jt
UCL
bands
ulnar/medial collateral lig - valgus test and used in throwing/overhead sports - esp poor mechanics
ant band - med epi to coronoid process of ulna - tight in extension
pos band - med humeral condyle of humerus to olecranon process - resist valgus in flex position
oblique/transverse - from olecranon process to coronoid process and resists valgus force
radio collateral lig
lat humeral epi to ulna, some fibres blend with annular, prevent distraction of radius and resis varus
annular
coronoid process around radial to coronoid process - free rotary movement
interosseous membrane
fibrous sheet between ulna and radius - syndesmosis jt of forearm
site for muscle attachment and transfer forces between radius ulna and humerus
shin splits
3 flexion muclses
biceps - supinated grip
brachialis - pronated grip
brachioradialis - neutral grip
2 pronation muscles
pronator teres and pronator quadratus
2 supinators
supinor, bieps (sup, flex, should flex) - wine uncorking muscle
3 main nerves at the brachial plexus
under collarbone and in then out of the first ribs - travel down the arm for sensation and muscular innervation - end in hands and give feelings to extremities and moves the hand
median - ant compartment (flexor/pronator), affected in carpal tunnel
ulnar - ant compartment - funny bone
radial - pos compartment (extensor/supinator)
thoracic outlet syndrome
poor posture and lots of pec workouts
observation of elbow injuries
carrying angle and swelling
movement of the elbow
flextion extension
supination pronation
test all movements - shoulder and wrist
middle finger test
lateral epicondylosis - fully extended arm with flexed wrist and outstretched middle finger, light downward pressure
pos - weakness and pain over lat epi
exercise for tennis elbow
eccentric movements of elbow extension
cozens test
lat epi
flexed/fully extended arm, resisted wrist extension
pos - pain
medial eipcondylitis
golfers elbow
supination - resisted wrist flexion
pos - pain and weakness
valgus stress test
UCL
extended and supported at the elbow and wrist - valgus force pronated, supinate for LCL
pos - laxity and pain
vaurs stress test
RCL
slightly flexed, supported at elbow and wrist - varus force
pos - laxity and pain
tinels sign
impingement of ulnar nerve
tap ulnar notch - zaps down
pos - tingling along forearm, hand and fingers
tennis elbow
MOI
S&S
Management
overuse of forearm/wrist extensors for pain at lat elbow
backhand athletes
microtearing because of eccentric loading of extensor
insidious pain, numbness/tingling, pain with movement and passive movement, localized tenderness over lap epi
PIER, NSAID, brace, eccentric strengthening exercises, mechanics
At what weight can you repeat an exercise forever?
15% weight of 1RM
correct person for a job?
physical demands - what forces can they generate
3 ways to prevent work place injuries
change yourself - strength
change the task
change administrative - relief positions and reduce exposure, or switch your hands
racquet material
graphite composites - best in torsion and vibration controil
head size of racquet
midsize (95-110 square inches), oversize susceptible to arm injuries with increased torque effects of shots hit off centre
string tension of racquet
lower end of recommendation - higher control but more torque and vibration
stringing material of racquet
synthetic nylon every 6 m
grip size of racquet
too large/small lessen control and promote excessive wrist movement - from mid palm to tip of fingers
golfers elbow
MOI
s&s
management
medial epicondylitis
forceful/cont flexion and pronation - raquet sports, golf, piano for common flexor tendon
micro tears due to eccentric loading and poor blood supply
pain, pain with resisted forearm flexion, decreased grip strength, tight with stretching elbow and wrist flexors, may spread down forearm
PIER, NSAIDS, brace, address mechanics, stretch flexor, brace for new insertion pt of muslce
olecranon bursitis
S&S
management
students elbow
inflammation of bursa
localized swelling, TOP for acute and septic, no TOP for bursa, pain
PIER, mechanics for chronic, pad
3 types of bursitis
acute - direct trauma
chronic - most common due to repetitive trauma
septic - infection
UCL sprain
management
sprain or tear, overuse in throwing
pain, instability, dysfunction, swelling, tingling/numbness - lack of full extension
PIER, compression base, strengthen when cleared to play
cubital tunnel syndrome
S&S
compression, traction or irritation of ulnar nerve as it passes the cubital tunnel of medial elbow
sublux nerve over medial epi, muscular compression of triceps, UCL instability, overuse in flexion or extension
pain, paresthesia of 4th and 5th fingers, weak grip, snapping/popping of medial elbow, TOP esp with hyperflexion
no PIER due to neurological symptoms, stretch and strengthen, MD for cortisone which reduce inflammation but makes everything lax - 3 shots/site increase chance of rupture
rest and immob for 2 wks, NSAIDS, splinting,
dislocation of the elbow
MOI
S&S
management
FOOSH with elbow hyperextended, twist with elbow in flexed position, olecranon extends pos
deformity, swelling, pain, loss of function, lig and muscle restraining mechanism, severe pain and hemarthosis, injury to median and radial nerves and blood vessels
immobilize in position found - PIER
dont reduce, sling after reduction at MD
restore strength and ROM when cleared - have to push
why elbow is often injured
nature of sport
bony architecture
broad ROM
exposure to soft tissue damage
contusion
MOI
contact
swell
PIER, xray to r/o #
strains
MOI
S&S
management
hyperextension - wrist flexors and biceps
pain with AROM, point tenderness
PIER, sling
MCL sprain
MOI
S&S
management
hyperextension of elbow and valgus force
pain, inability to throw or grasp, TOP MCL, flexor tendon injury
PIER, tape to prevent hyperextension, limit motion
grip strength related to
whole body strength
Taping for elbow hyperextension
slightly flex
2 anchors above biceps
2 anchors around forearm
make a fan, fill the fan and leave cubital fossa open
elbow osteochondritis dissecans
MOI
S&S
management
uk, impairment of blood supply - fragmentation of articular surface - loose bodies within the jt, repetitive microtrauma or rotation extension and valgus force - radial head compression
sudden pain, locking, crepitus
rest, PIER, NSAIDS, cast, surgery
little league elbow
MOI
S&S
Management
repetitive microtrauma from throwing, disorder of growth plate, accelerated apophyseal growth region, traction apophysitis with fragmentation of medial epicondylar apophysis - avulsion of radial head, non-union stress fracture of olecranon epiphysis
flexion contracture, tightness of ant jt capsule and weakness of tricep, locking and catching, decreased ROM for pronation and supination
PIER, stretch flexors and extensors, correct faulty mechanics and limit pitches
what body part to use in javeline
shoulders
pitching mechanics
finite number of throws - retrospective - injury induced by muscular fatigue
6 steps of pitches
wind up - initiate to rotated and striding leg is elevated and flexed
stride - till when lead foot contacts ground
arm cocking - begins at stride and ends at max shoulder external rotation
arm acceleration - follow arm cocking and end at ball release
arm decel - ball release to max shoulder internal rotation
follow through - arm completes movement
elbow fracture
MOI
S&S
management
foosh
deformity, hemorrhage, swelling, muscle spasm, pain
splint, PIER, ER
volkmann’s contracture
MOI
S&S
Management
serious elbow injury -> brachial/radial pulse monitored periodically - cause muscle spasm, swelling, bone pressure, inhibit blood circulation to forearm, wrist and hand
permanent? greater pain in forearm when fingers are passively extended
pain followed by cessation of brachial/radial pulses
removing elastic tensors, casts, and elevation - MD
