lecture 12: conditions of the elbow and forearm Flashcards
what are the 2 joints assocatied with the elbow/forearm
humeroulnar joint
proximal/distal radioulnar joint
what is the function of the humeroulnar joint
flexion and extensionn
what is the function of the prox and distal radioulnar joint
supination and pronatior
what is the most commonly injuried ligament of the elbow
anterior bands of MCL
what are some ligaments of the elbow
MCL
LCL
annular ligament
what is the function of the annular ligament
keeps the radial head in place
what are the muscles that help with elvow and wrist movement
triceps, biceps wrist extensions and flexors
what are the 3 nerves of the arm
1) median nerve
2) ulnar nerve
3) radial nerve
where does the median nerve pass thru
goes thru pronator quadratus
where does the ulnar nerve pass thry
goes thru flexor carpi ulnaris
where does the radial nerve paSS THROUGH
through supinatory (dorsal side)
what nerve more commonly gets injured iwth valgus stretch
ulnar nerve
what is another name for MCL
ulnar collateral ligament
what is a MCL sprain caused by
valgus loading of the humeroulnar
joint
• FOOSH
what is the problem with a larger carrying angle
since there is more stress put on the medial side they are most likely to injure the MCL
MCL is typically injured in what types of athletes
overhead atheltes
what movements causes the most stress on MCL
cocking and acceleration pahses
what band of the MCL is most commonly injured
anterior band
what motion can injure the posterior band of the MCL
elbow flexion past 60 degrees (most strecthed in full flexion)
ehat are the SS of MCL sprain
Pain with movement • Feeling of potential instability • Pronation and wrist flexors weak • Swelling can be noted- medial and posterior aspects • Ecchymosis • Ulnar nerve involvement
what movement will be weak with MCL
pronation and wrist flexors
true or false: there is usually ulnar nerve involvement in MCL
true
what is valgus extension overload
Collection of tensile, shear and compressive forces caused by UCL laxity
where is there a lot of tension of valgus extension overlead
on MCL and ulnar nerve
and are the SS of valgus extension overlead
posteromedial and lateral elbow pain, nerve paresthesia
what strucutes will be compressed in valvus extrensionn overload
radial head and posterior medial olecrannon process
is LCL sprain rare and why
yes because most positions are shielded from varus stress
what are the SS of LCL sprain
pain, laxity
weakness during pronation and supination of wrist extensors
anterior capsular ligament sprain can be seen in what MOI
FOOSh (because of hyperextension of tehe elbow)
where will there be pain with an anterior capsular ligament sprain
Pain in cubital fossa with palpation • Pain with passive elbow extension at EROM • Elbow flexors may also be affected
true or false:
• Elbow flexors may also be
affected in anterior capsular ligament sprain
true
what is anothre name for medial epicondylitis
golfers eblow
what is medial epicondylitis caused by
Repeated, medial tension/lateral
compression (valgus forces)
• Swift, powerful snapping of the
wrist and pronation of the forearm
what are the SS of medial epicondylistis
Swelling, ecchymosis
- Tenderness on origin of common flexor tendon (just distal to the medial epicondyle)
- 1-2cm below along FCR and PT muscle
- Pain with wrist flexion and pronation
- Grip decreased
- May have nerve involvement- ulnar nerve
- Valgus stress test may cause pain at 20-30°
where will there be tendernesss for medial epicondylitis
Tenderness on origin of common flexor tendon (just distal to the medial epicondyle)
• 1-2cm below along FCR and PT muscle
can medial epicondylitis have any nerve involvement ?
yes ulnar
what is little league elbow
Little league elbow”- avulsion of the common flexor tendon from
medial epicondyle due to tension build up
what is vulnerable in litlte league elbow
growth plate
how can you avoid little league elbow
restrict # of pitches/week
less than 200, 3-4 innings/game
what is another name for lateral epicondylitis
tennis elbow
what is lateral epicondylistis
Inflammation or repetitive
stresses at the lateral epicondyle which Irritates the common origin of the wrist extensor muscles
what are the most common muscle affected by latetral epicondylitis
extensior carpi radialis brevis
true or false: lateral epicondilytis can be caused by repetive concentric forces
false, eccentric
what are the SS of lateral epicondylitis
Pain over the lateral epicondyle
- Decreased grip strength, pain with gripping
- May see swelling, point tenderness over lateral epicondyle with palpation
• Pain with resisted wrist extension, elbow extension, and forearm
supination
• Possible entrapment of the radial nerve
where will there is point tenderness in lateral epicondylitis
main over lataral epicondylitis
is there any nerve enrtapment involved with latteral epicondylitis
yes possible enttrapment of radial nerve
what motions will be painful for lateral epicondylitis
pain w reistance wrist extension, elbow extension and foream supinationn
what nevre is superficial
ulnar nevre
what is the problem with ulnar nerve being superficial
it predisposes is to concussive forces
what is the MOI of ulnar nerve pathology
May chronically sublux as forearm is flexed
(Sublux from behind medial epicondyle)
• Subject to traction forces when
throwing (valgus)
• Inflammed structures can decrease cubital tunnel leading to compression of the ulnar nerve
inflammed structures can dexrease cubital tunnel which leads to what
compression of the ulnar nerve
what are the SS assocatied with ulnar nerve pathology
• May complain of decreased sensory and motor function
- Complain of increased symptoms with elbow flexed for extended periods of time
- Night pain- if elbow flexed
- Burning to medial forearm, pinky/ring finger
- Decreased strength of finger flexors, thumb abductors and FCU
• Numbness on dorsal side- indicates ulnar neuropathy coming from the
elbow
• Numbness on the palmar side- indicates entrapment in the tunnel of guyon
Ulnar nerve is stretched with what movements
elbow flexion and wrist extension
where will there be burning for ulnar nerve pathology
burning to medial forearm, pink/ring finger
where will there be decreased strengtth witth ulnar nervre pathology
decreased strength of finger flexiors, thumb abductors and FCU
wha are the 2 cmomon places for ulnar nerve entrapment
1) between two heads of the FCU
2) behind medial epicondyle
how is radial nerve pathology most comoonly injured
Most commonly injured with deep lacerations of the elbow or
secondary to fractures of the humerus or radius
what is radial tunnel syndrome and where is it locatied
Entrapment of the radial nerve
• Located more distally then lateral epicondylitis
what are the SS of radial nerve patholy
• S/S reproduced with resisted supination, extension of the middle finger
where is median nerve pathology usually injured
at distal foream
explain how the median nerve patholgy is injured
Pressure as the nerve crosses the
cubital fossa can put pressure on the
median nerve
median nerve compresses by the BLANK muscle
pronator teres
what is pronnator teres synndrome
Inability to pinch the tips of the
thumb and index finger together
where does increase pressure happen in forearm compartment syndrome
incrased pressure in the palmar, dorsal components of the forearm
what is forearm compartmennt syndrome caused by
hypertrophy muscles
• Hemorrhage
• Fractures to the mid forearm or distal radius, supracondylar area
forearm comparement sybdrome icnrnases the risk of compromising what things
1) circulationn
2) neurological function
ehat are the SS of forearm compartment syndrome
Complains of pressure in the
forearm
• sensory disruption in the
hand/fingers
• decreased muscular strength
• pain during stretching of the
muscles
• Prolonged/increased intensity,
absence of radial or ulnar pulses
can lead to Volkmann’s ischemic contracture
Prolonged/increased intensity,
absence of radial or ulnar pulses can lead to what
Volkmann’s ischemic contracture
biceps stran can occur where
occur midbelly of muscle of distal end of tendon
biceps rubptures are most common in what age and gender and why
in males 40 and plus
=tendonn degrades with time
what is the MOI of biceps strain/rupture
eccentric loading of the biceps brachii when elbow is flexed to 90 degrees
where is there loss of strength in a biceps strain/rupture
elbow flexion and supination
what are the chief complaints of biceps strain/rupture
immediate pain, “pop”, loss of elbow flexion
is there any swelling with biceps
yes swelling and ecchymossi
true or false: there is no palpable defect fo biceps straign
false there is palpable defect possible
what is triceps strain usually cause by
eccentric loading of the tricpe s
what are the chief complants of triceps strain
pain with elbow extension, loss of strength
true or false: there is possible swelling with triceps straign
true, and ecchymosis and palpable defect
elbow dislocations are usually caused by
large trauamatic force
=axial load through the forearm with elbow slightly flexed
posterior dislocation of the elbow is approximately BLANK percent of the cases
90%
what is the position of the elbow in posterior discolationns
forearm is displaced posterior or posterolateral to the humerus
elbow dislocations dont swell alot?
FALSE THEY RAPIDLY SWELL AND HAVE DEFORRMITY
what is the problem with elbow dislocations
it compromises blood vessels and nerves therefore reduction needs to be doneASAp
how does osteochondritis dissicans of the capitellum develop from
Develops from increased valgus loading compressing the radial head and capitulum with overhead throwing
what are the chief explain of osteochondritis dissicans of the capitellum (3)
Lateral elbow pain that increases with activity
- A flexion contracture
- Locking of the elbow (loose body)
what can lead to osteochondritis dissifcacans of the capitellum
LCL sprain and valgus extension overload
true or false: olecrannon bursitis can only be acute
false also chronic
explain the MOI for olecranon bursitis
Fall on flexed elbow
• Constantly leaning on elbow- repetitive pressure
where is the subcuteanous bursa located
betweent he olecranon process and the skin
how is subcuteanous bursa typically injured
from a traumatic force to the elbow
where is the subtendinous bursa located
located b/w triceps tendon and olecranonn process
how does the subtendinous get inflammed
due to repetitive streeses applied to a joint
what are the SS of olecreanon bursitis
Immediate, tender swollen area (golf ball)
• redness
• Pain with movement of the elbow
• Rebound pain
what is assocaited with rebound pain
olecranon bursistis
