Lab - Elbow Flashcards
Bones?
Humerus - med (trochlea)and lateral (capitulum) condyle
Radius - Head articulates w/ capitulum
Ulna - has a semilunar notch that trochlea fits into. Has the olecranon - ulna is bigger than radius and elbow but radius is bigger than ulna at wrist
In supination - radius and ulna are parallel to each other
In pronation - radius pivots over ulna to switch sides
Joints?
Humeroulnar – distal humerus medially & proximal ulna
Radiohumeral (or humeroradial) – distal humerus laterally & proximal radius
- In flexion => IN contact
- In extension => NOT in contact
Superior radioulnar (or Proximal RU) – radial notch of ulna & radial head
- A pivot joint
- Important in supination and pronation
Ligaments and Support Structure?
Joint capsule – relatively thin; covered by brachialis muscle in front & triceps in back
Radiocollateral or lateral collateral ligament (LCL) – provides varus elbow stability
Ulnocollateral or medial collateral ligament (MCL) – provides valgus elbow stability (Tommy John - baseball)
Annular ligament – encircles the head and neck of the radius
- stabilizes the radius rotating on the ulna during supination/ pronation
Elbow Flexors?
Biceps brachii (long & short heads) – insertion at common tendon at the radial tuberosity
Brachioradialis – inserts on lateral styloid process of distal radius
Brachialis - inserts on coronoid process of ulna
Common flexor Origin – (CFO), originate at medial epicondyle - just below
Elbow Extensors?
Triceps brachii (long, medial, & lateral heads) – insertion at common tendon at olecranon process
Anconeus – assists triceps; stabilizes elbow joint. Weak elbow extensor
Common extensor Origin – (CEO), originate at lateral epicondyle - just below
Pronators – pronator teres, pronator quadratus
Supinators – biceps brachii, supinator
Bursae?
Bicipital – lies in the anterior aspect of biceps tuberosity
Olecranon – lies between olecranon process and skin
“Student’s elbow” - Chronic
Nerves?
Musculocutaneous – coracobrachialis, biceps, brachialis
Radial – triceps, anconeus, supinator, brachioradialis, common extensors
“Saturday night palsy”
- Palsy = compression or traction of the nerve
- Digging pressure on triceps belly = compression and destruction of radial n. = Wrist drop.
Ulnar – (some of) common flexors, (most of) small hand muscles - funny bone
Median – pronator teres, (most of) common flexors, (some of) hand muscles (Carpal Tunnel Syndrome)
Arteries?
Brachial artery – branches into radial and ulnar arteries
Normal Elbow ROM?
Flex = 140-150
Ext = 0
Pronation = 80-90
Pronation = 80-90
Functional Anatomy?
Carrying angle – to allow clearance of arms while walking, exists because of the more distal projection of the humerus medially
Normal = 10-15 degrees for females, 5-10 degrees for males
Cubital valgus – greater than 15 degrees for females or greater than 10 degrees for males
Cubital varus – less than the 15 and 10 degrees respectively
“gunstock deformity - forearm angled inward
Cubitus recurvatum – hyperextending elbow
These abnormalities are usually from an elbow injury
Cubital = elbow
Palpation?
Medial and lateral epicondyles (attachment of common flexors and extensors respectively)
Olecranon process
Head of the radius
Tinel’s Tap?
Tap the (ulnar) nerve within the cubital tunnel (“funny bone”)
- For checking tunnel syndromes –> carpal tunnel, Cubital tunnel syndrome
+ test = nervy feeling pinkie/ ring finger
Finding Arteries?
Radial - easier to find
Ulnar
Ligament Sprains?
Medial and lateral ligament stress test (Varus ado Valgus)
Just like the knee
Look for pain and laxity
Golfers Elbow?
Medial Epicondylitis (chronic)
Elbow slightly bent, passively supinate, then extend the wrist, add elbow extension, while palpating the medial epicondyle
+ve if reproduces their elbow pain and is TOP over the medial epicondyle
Also known as Pitcher’s elbow, Racketball elbow, or Javelin-thrower’s elbow
Results from repeated forceful flexions of wrist and extreme valgus torques on the elbow
May be associated neuropathy of the ulnar nerve
Tennis Elbow?
Lateral Epicondylitis (Chronic)
Elbow slightly bent and perform resisted wrist extension
+ve if reproduces their elbow pain and is TOP over lateral epicondyle
Repetitive microtrauma with overuse of the extensor muscles
Use of tennis elbow brace may be helpful
Hyperextension (sprain or strain)?
If a person cannot fully extend their elbow and there is pain
Can tape
Contusions?
Elbow has lack of padding and general vulnerability
Best treated with POLICE; possible x-ray?
Bursitis?
Most frequently injured is olecranon bursa
Signs and symptoms include pain severe swelling, TOP
Ice, NSAIDs
Usually end ranges are painful
Sprains or Strains?
POLICE
Then Physio
Little League Elbow?
Occurs in 10-25% of young pitchers
Results from repetitive throwing microtrauma, not from type of pitch
Typically insidious onset
Good throwing guidance & technique essential to prevention
Repetitive valgus stress
Umbrella term for elbow pain related to baseball pitching
- can be stress#, growth plate, medial epicondylitis, MCL injuries
Elbow Osteochondritis Dissecans (OCD)?
Unknown cause
Loose bodies (fragments of articular cartilage and bone) within joint, due to impaired blood supply
Seen in young athletes (age 10-15) in throwing or racket sports
Cubital Tunnel Syndrome?
Compression of Ulnar n.
Dislocation/ #
MOI usually FOOSH, severe twist, or direct blow to elbow
Both can result in complications such as loss of ROM, neurovascular injury, myositis ossificans
Nursemaid’s Elbow
- Posterior elbow sublux in kids –> displaced annular lig.
- From arm being pulled/ lifted
Volmann’s Contracture?
Forearm ischemic contracture resulting from brachial artery injury, leads to ischemic degeneration of the muscle
Irreversible muscle necrosis occurs after 4-6 hrs;
it is therefore essential that brachial or radial pulses are closely monitored after serious elbow injury (eg. supracondylar humeral fracture)
