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5 Ortho > L9 Elbow Exam > Flashcards

L9 Elbow Exam Flashcards

1
Q

Radiocapitellar Line

A

when a line is drawn through the proximal radial shaft AND neck, and extended through the joint, it should pass through to the articulating capitellum

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2
Q

Anterior humeral line

A

on lateral view, when a line is drawn along the anterior surface of the ulnar cortex and extended, it should pass through the middle third of the capitellum

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3
Q

Immobilization causes individuals to lose

A

extension within a few weeks

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4
Q

Annular ligament

A

limits distraction and dislocation of radial head

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5
Q

Radial collateral ligament (LCL or RCL)

A

primary lateral stabilzer followed by capsule and common extensor group

taught through flexion and extension, tension increases in supination

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6
Q

Interosseous membrane

A

prevents proximal displacement of radius on ulna

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7
Q

Ulnar/medial Collateral Ligament Complex

A

has three different bands; anterior, posterior, and oblique

the anterior portion of UCL is the strongest, provides greatest restrain to valgus stress

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8
Q

Ant band of UCL

A

Ant portion: taut 0-60° flexion
Post portion: taught 60-120° flexion

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9
Q

Post band of UCL

A

taut at 90°

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10
Q

Oblique band of UCL

A

can be absent, blends with capsule

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11
Q

When the UCL is impaired

A

lateral structures can become overstressed

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12
Q

Arcade of Frohse

A

semicircular arch at the proximal edge of supinator muscle, about 2 cm distal to radiohumeral joint

deep radial nerve travels under the AOF

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13
Q

Common sites of r. nerve entrapment

A
  1. tendinous margin, origin ECRB
  2. arcade of frohse
  3. distal border of supinator

s/s: finger drop and radial wrist deviation on extension

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14
Q

Radial head dislocation

A

children 3-6
elbow pain and lacking supination
also known as nursemaid’s elbow

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15
Q

Osteochondriditis dissecans

A

12-20 yo
pain usually lateral, insidious onset, may have click or catch, loss of extension

MOI: repetitive stress. localized fragmentation of bone and cartilage

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16
Q

Distal Biceps Rupture MOI/RF

A

MOI: rapid eccentric contraction of biceps
load takes elbow from flexion into extension in supinated position

factors that could dispose you to it are degenerative changes, spurring of bicipital tuberosity, use of steroids, smoking

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17
Q

Distal Biceps Rupture population + S/S

A

males 4th to 6th decade of life OR young weightlifters and bodybuilders, manual labor

complains of painful pop at front of elbow, loss of supination, positive hook test, deformity, bruising

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18
Q

pain in multiple joints?

A

most likely RA

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19
Q

Joint pathology is relieved by

A

holding elbow into side and supporting wrist, it takes load off extensor group

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20
Q

Clicking or locking indicate

A

loose bodies
chondral injury
osteophytes
instability

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21
Q

Compression ulnar nerve locations

A

above elbow in region of intermuscular septum
medial epicondylar region
ulnar groove
region of cubital tunnel
where ulnar nerve exits from FCU

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22
Q

Observation of elbow

A

Swelling
Soft tissue contours
carrying angle
anterior view
posterior view
deformities
guarding

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23
Q

Swelling at elbow

A

olecranon bursitis

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24
Q

Tennis players age 55 and over may

A

have a loss of 10° of extension

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25
Q

Carrying angle

A

males: 5 to 10°
females: 10 to 15°

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26
Q

Anterior view of elbow

A

proximal rupture
distal rupture
erb’s palsy

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27
Q

Proximal rupture of biceps

A

popeye’s sign
muscle belly springs down

28
Q

Distal rupture of biceps

A

muscle belly springs up

29
Q

Erb’s palsy

A

C5 C6, (musculotaneous and axillary nerve)

elbow is extended, pronated. Shoulder is IR and adducted. Wrist is flexed (waiter’s tip)

30
Q

What radigraphic guide should you use for a posterior dislocation of elbow?

A

radio-capetellar

31
Q

Techniques for reducing nursemaid’s elbow

A
  1. Elbow ext, supination, traction, flexion
  2. elbow extension, hyperpronation
32
Q

When should you exam the C-spine?

A

over 30 yrs old
1. no hx of trauma
2. radicular signs
3. trauma with radicular signs
4. altered sensation

33
Q

Would you clear the c-spine as part of your standard elbow exam?

A

no the joint is above the shoulder

34
Q

Capsular pattern for elbow

A

flexion more limited than extension

35
Q

Biceps length test

A
  1. supine w/shoulder at edge of table
  2. passively extend shoulder to end range, then extend elbow

normal: elbow extension passively is the same range as AROM –>overpressure can’t go past bone to bone

36
Q

Triceps length test

A
  1. sitting passively forward flex arm to full elevation with elbow in extension
  2. passively flex elbow

normal: elbow flexion is passively and actively in same range

37
Q

Cubital fossa contains

A

coronoid process
head of radius
biceps and brachialis

38
Q

Palpation of Radial tunnel

A

forearm is in neutral, palpate in line anterior to radiohumeral jt to the midpoint between the radius and ulna on posterior aspect of forearm, ECRB.

tunnel is about 4 fingertips wide

tenderness should be expected over radial tunnel, not lateral epicondyle. should perform special tests if both are painful

39
Q

Joint play movements of elbow

A

radial deviation of the ulna and radius on humerus

ulnar deviation of the ulna and radius on humerus

distraction of olecranon from humerus in 90° flexion

anteroposterior glide of the radius on humerus

40
Q

Biceps referral pattern

A

bicipital groove to anterior elbow

41
Q

Brachialis referral pattern

A

anterior arm, elbow to lateral thenar eminence

42
Q

Triceps referral pattern

A

posterior shoulder, arm, elbow, forearm to medial epicondyle

43
Q

Brachioradialis referral pain

A

lateral epicondyle, lateral forearm to posterior web space BT thumb and index finger

44
Q

Anconeus referral pain

A

lateral epicondyle area

45
Q

Supinator referral pain

A

lateral epicondyle, post web space, BT thumb, index finger

46
Q

ECRB referral pain

A

posterior forearm to posterior wrist

47
Q

FCR pain referral

A

anteromedial wrist

48
Q

FDS pain referral

A

palm to appropriate digit

49
Q

Diagnostic imaging

A

should be used in conjunction with a physical exam to determine diagnosis
should not be used as sole method of diagnosisS

50
Q

Supracondylar fracture

A
51
Q

Cozen’s test

A

patient is asked to move the wrist to dorsal flexion and the therapist provides resistance to this movement

positive is pain in lateral epicondyle

testing for lateral epicondylitis

52
Q

Mill’s test

A

clinician palpates the patient’s lateral epicondyle with one hand while pronating the patient’s forearm, fully flexing the wrist, the elbow extended

positive is pain over lateral epicondyle

testing for lateral epicondylitis

53
Q

Tests for Lateral Epicondylitis

A

Cozen’s
Mill’s
Tennis Elbow

54
Q

Golfer’s Elbow Test

A

palpate medial epicondyle
passively supinate forearm, extend elbow and wrist

positive is indicate by pain over medial epicondyle of humerus

55
Q

Hook Test

A

patient actively flexes elbow to 90° and fully supinates

therapist uses index finger to approach lateral side, attempts to hook finger under lateral edege of biceps tendon

positive is no biceps tendon to hook

56
Q

Tinel’s sign at the elbow

A

tap the ulnar nerve in the groove between the olecranon process and medial epicondyle

positive sign is indicated by tingling sensation in the ulnar distribution of forearm and hand distal to the point of compression of the nerve

57
Q

Testing for TFCC injury

A

Impingement: elbow on table, palpate TFCC, then UD rotate forearm. Positive is clicking

Compression: as above, load as wrist is UD

58
Q

Watson’s test

A

Thumb of one hand holds palmar aspect of scpahoid and index finger on radial tubercle dorsally.

maintaining firm pressure, push the pt into radial deviation

proximal pole will jump over the dorsal lip of radius with a clunk if positive

59
Q

Grind Test for OA

A

hold patient thumb between your thumb and index finger and place your opposite hand over CMC joint. Apply axial compression and rotation to the mc base on trapezium

palpate for instability or crepitus, which is a positive for this test

60
Q

Froment’s sign

A

as paper is pulled away by the examiner, thumb will either IP joint flex or not. Positive would be IP joint flexion

tests for ulnar nerve

61
Q

Wartenberg’s sign

A

passively place all of pts fingers in abducted position and then ask to bring fingers together while keeping them flat on the table

positive if little finger remains in abduction

watch for other fingers moving towards little finger to compensate

62
Q

Phalen’s test

A

place dorsum of hands together and lower elbows to create bilateral wrist flexion dorsum of hands are pressed together for 1 minute. Positive if patient reports pain in median nerve distribution

testing carpal tunnel

63
Q

Reverse Phalen’s test

A

place palmar surface of hands together and raise elbows to create bilateral wrist flexion, pressed together for a minute

positive if pain in median nerve distribution

64
Q

Tinel’s median test

A

tap over carpal tunnel at median nerve for 10s. Positive if pt reports pain in median nerve distribution

65
Q

Testing of FDP and FDS

A

FDP: hold distal IP joint and flick with other hand. Should be tense

FDS: hold all fingers down except for affected. Flick finger into extension, should be flaccid

66
Q

Elson Test

A

testing rupture of central slip, not boutonniere deformity

passively flex PIP to 90 over edge of a table and asks pt to extend the PIP while examiner resists. Positive would be no extension power and extension at DIP

67
Q
A

5 Ortho (14 decks)

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