H&P Elbow

Question 1

What type of joint is the (ulno-humeral) elbow?

Answer 1

Hinge joint

Question 2

Hinge joints provide what kind of movement?

Answer 2

Flexion and Extension

Question 3

Ligament that supports the radial head.

Answer 3

Annular ligament

Question 4

Attach humerus to ulna and provide majority of stability

Answer 4

Ulnar collateral ligament

Radial collateral ligament

Question 5

Forearm flexors attach to:

Answer 5

Medial epicondyle

Question 6

Forearm flexors innervated by:

Answer 6

Median nerve

Question 7

Forearm extensors attach to:

Answer 7

Lateral epicondyle

Question 8

Forearm extensors innervated by:

Answer 8

Radial nerve

Question 9

Arterial supply to the elbow and forearm

Answer 9

Brachial artery which divides into the radial/ulnar arteries

Question 10

Provide sensory and motor control of forearm

Answer 10

Median, ulnar and radial nerves

Question 11

Elbow and forearm are composed of articulation between what 3 bones

Answer 11

Humerus
Radius
Ulna

Question 12

The pivot joint of the forearm provides what movement

Answer 12

Pronation/Supination

Question 13

ROM/Strength Testing

Answer 13

Assess the elbow in flexion and extension as well as pronation and supination; Perform ROM bilaterally and assess for asymmetry; Assess strength in flexion, extension and pronation/supination

Question 14

Radial head fractures usually occur from what MOI

Answer 14

A fall backwards on an outstreched hand

Question 15

Supracondylar fractures occur by

Answer 15

Falling on an extended arm

Question 16

Pathomneumonic for elbow fracture on Xray

Answer 16

Anterior and posterior fat pad sign or sail sign

Question 17

Elbow strains involve what ligaments

Answer 17

Medial and lateral collateral ligaments

Question 18

Elbow strains are due to what type of injury

Answer 18

Valgus or varus stress

Question 19

Elbow dislocations usually result from what MOI

Answer 19

Falling backwards on an incompletely extended arm

Question 20

Most elbow dislocations are

Answer 20

Posterior

Question 21

Common MOI for a radial head fx

Answer 21

FOOSH

Question 22

Patient may complain of what with a radial head fx

Answer 22

Increased pain w/pronation and supination

Question 23

Full extension is usually painful with what kind of fx

Answer 23

Radial head fx

Question 24

Xray may show anterior and posterior fat pad sign or sail sign with what kind of elbow fracture

Answer 24

Radial head fx

Question 25

MOI for a supracondylar fx

Answer 25

FOOSH; likely to occur w/a partially extended elbow

Question 26

Displacement and angulation w/supracondylar fx is almost always

Answer 26

Posterior

Question 27

What are the assoc. injuries w/supracondylar fx?

Answer 27

Injuries to the brachial artery and nerve are common

Question 28

Supracondylar fxs are common in

Answer 28

Kids w/open physes

Question 29

Tx of supracondylar fxs

Answer 29

Emergent referal to ortho w/surgical management; Nonsurgical management is freq unsucessful

Question 30

Radial Head Subluxation (Nursemaid’s Elbow) MOI

Answer 30

Children 2-3yrs old from being pulled by the arm (Hyperextension and supination)

Question 31

Tx of Radial Head Subluxation

Answer 31

1. Supinate arm

2. Flex arm at elbow

Question 32

Bursitis of the elbow

Answer 32

Olecranon, usually a result of direct trauma (Pt. may not remember and does not need to be significant trauma)

Question 33

Medial epicondylitis (“Golfer’s Elbow”)

Answer 33

Overuse of flexor tendons

Question 34

Lateral epicondylitis (“Tennis Elbow”)

Answer 34

Overuse of extensor tendons

Question 35

Common MOI of elbow sprains

Answer 35

Overhead throwing motion; medial column is most commonly injured (In young athletes, suspect assoc Salter Harris injuries to the medial epicondyle) “Thrower’s Elbow”

Question 36

Nursemaid’s Elbow

Answer 36

Common in kids 2-4; Kids will usually hold the arm in slight flexion and pronation; accurate hx of MOI is key in dx; always get pre and post reduction images; assess for other injuries, assess for recurrance of condition

Question 37

Lateral Epicondylitis

Answer 37

“Tennis Elbow”; in young athletes it may be due to overuse or repetitive activitiy; in 40+ may be degenerative in origin; assess radial nerve function in those who have self-treated with a tennis elbow band

Question 38

Elbow Dislocation

Answer 38

Common MOI is a FOOSH w/elbow incompletely extended; high energy injury; think of assoc injuries to the wrist and shoulder; be concerned about potential injury to brachial artery or nerve; not a primary care problem-emergent ortho referral is appropriate

Question 39

Olecranon Bursitis

Answer 39

Fairly common and usually concerning to patient; MOI is usually a direct trauma to the bursa; if patient is febrile or ill consider septic bursitis; allow specialist to aspirate if indicated

Question 40

Medial Epicondylitis

Answer 40

“Golfer’s Elbow”; less common than lateral epicondylitis; pain will localize to the medial epicondyle w/resisted wrist flexion and pronation; grip strenght may be affected; can aggravate latent cubital tunnel syndrome

Question 41

Inspection of Elbow

Answer 41

Are they using the involved limb; is the arm in an abnormal position; is the limb hanging limp; do the shoulders look symmetrical; do there appear to be any deformities-swelling, atrophy, bone deformity, skin color, bruising; skin temperature; any signs of trauma

Question 42

Palpation of Elbow

Answer 42

Imagine the underlying anatomy as you are palpating each structure; palpate each bony landmark and each ligament or bursa; assess for crepitus, tenderness, swelling, excess warmth, abnormal mass

Question 43

Elbow Hx: MOI

Answer 43

What was the mechanism of injury-describe or demonstrate; what were you doing when the injury occurred-was it the result of throwing or swinging; was there a direct blow to the elbow; what was angle of impact; what was the position of the arm at impact; did it involve the neck or shoulder-is there any pain in the shoulder or neck; was the wrist forced beyond its normal ROM-in which direction; did you hear or feel anything at the time of injury

Question 44

Elbow Hx: Occupational/Recreational Hx

Answer 44

How do you use your arms at work; Dominant arm; what hobbies and activities do you participate in/ how will this affect your daily activities

Question 45

Elbow Hx: Signs and Sxs

Answer 45

Describe the sxs; was it gradual or sudden onset; is it sharp or dull; localized or diffuse; is the pain radiating down your arm (might indicate neurogenic origin); rate the pain; demonstrate what causes pain; do you feel any numbness, tingling, burning; do you feel any weakness; does the arm feel tight or locked

Question 46

Elbow Hx: Previous Injury

Answer 46

Have you had a previous injury (radial head fx can cause OA); did you see a clinician; what was the dx; were you fully recovered