Lecture 6--Elbow Arthrology Flashcards
Is an outward angulation of a distal segment
Valgus
There are at least ____ muscles that cross the elbow, but only one acts exclusively at the elbow, this is _____.
15
Brachialis.
Is an inward angulation of a distal segment–distal segments go in.
Varies
Natural valgus angle, distal segment more lateral than proximal and the joint appears at an angle.
Carrying angle
Articulations of the elbow
Humeroulnar
Humeroradial
Proximal radioulnar
What are the ligaments of the elbow joint
Radial collateral ligament
Ulnar collateral ligament
Is a lateral strong fan shaped ligament. It goes from the lateral epicondyle of the humerus and blends distally with the annular ligament of the radius.
Radial collateral ligament
Reinforces the capsule and resists varus (medial to lateral) stress
Radial collateral ligament
Triangular shaped ligament with three different bands. It goes from the medial epicondyle of the humerus to the coronoid process and olecranon of the ulna.
Ulnar collateral ligament
What are the three different bands of the ulnar collateral ligament
Anterior cord is the strongest
Posterior is fan like and is the weakest
Oblique or transverse band exists to deepen the socket.
This ligament resists valgus stress at the elbow.
Ulnar collateral ligament
What happens if you have a constant valgus stress?
Tendinitis. The length changes and it gets looser, and you get inflammation markers which kicks off the healing process but you don’t get healing you get inflammation cycle. Eventually you can get fraying and possible rapture.
Describe tommy john surgery
Named for originating patient.
Performed by team physician frank Jobe in 1974
Transplant of long tendon from elsewhere in the body and woven in a figure 8 through drilled holes in the medial epicondyle and lateral aspect of the coronoid process. Full rehab is a year for pitchers and six months for other field players with no throwing motions. One third of active mlb players have had this surgery done.
What happens during pitching
There is a big lateral thrust against the wrist to the elbow and it causes a gap. There is valgus force while pitching.
Works to contain tendons and keep them from bowstringing
Extensor retinaculum
Anterior and distal thickening at the same level as the extensor retinaculum
Palmar carpal ligament
Thickening just distal and deep to the palmar carpal ligament. Forms the carpal tunnel
Flexor retinaculum
Is the interosseous membrane continuous with the antebrachial fascia?
Nope
Collagen fibers predominately pass from the radius to the ulna inferiority and obliquely
Interosseous membrane
What is the function of the interosseous membrane
Connects bones without hindering pronation/supination, transfers closed chain forces from the radius to the ulna, and provides attachment space for forearm musculature.
What are the contents of the anterior compartment of the forearm
Flexor/pronator muscles of the forearm
Most vascular and neural elements
Rule of the anterior compartment of the forearm
All of the flexors and pronators are Innervated by the median nerve except 1.5 by the ulnar nerve.
What’s in the posterior compartment of the forearm
Extensor/supinator muscles
Has less vascular and neural elements
All muscles in the posterior compartment of the forearm are Innervated by the
Radial nerve
What are the cubital fossa borders
Roof– subcutaneous tissue and deep fascia and bicipital aponeurosis
Superior– line connecting medial and lateral epicondyles of the humerus.
Medial– pronator teres
Lateral– brachioradialis
Floor– Brachialis and supinator
Contents of the cubital fossa
Veins (cephalic, basilic, median, and cubital), biceps brachii tendon, brachial artery, median nerve.
Describe the cubital tunnel
Enclosed by the medial epicondyle of the humerus, olecranon of the ulna, tendinous origin of the flexor Carpi ulnarks muscle, the floor includes elements of the joint capsule like the mcl and capsular fibers.
Contents if cubital tunnel
The ulnar nerve and it is very exposed. It is the funny bond
What is in guyon’s canal
Ulnar nerve and artery
What are the articulations of the carpus
Radio carpal
Intercarpal
Carpometacarpal
The radio carpal joint excludes what bone
The pisiform
What plane do abduction and adduction of the thumb happen in
Sagittal
Articulations of the metacarpus
Carpometacarpal
Intermetacarpal
Metacarpophalangeal
Describe boxers fracture
The fifth metacarpal has a fracture. 92% we’re males and over 60% were from intentional punches.
Articulations of the phalanges
Metacarpophalangeal
Interphalangeal
The median nerve passes between the two heads of what muscle as it enters the forearm?
Pronator teres
Radial artery lies lateral to what tendon
Flexor Carpi radialis tendon
Is the flexor Carpi radialis in the carpal tunnel
No, it passes within its own synovial sheath in a separate compartment formed by the flexor retinaculum on the lateral side of the wrist.
The palmaris longus is absent in
About 14% of people
What two muscles pass superficial instead of deep to the flexor retinaculum?
Palmaris longus and flexor carpi ulnaris
At the wrist the median nerve lies lateral to what tendon
Palmaris longus tendon
The ulnar nerve passes between the two proximal insertions of what muscle
Flexor Carpi ulnaris
At the wrist the ulnar nerve and artery pass laterally to what tendon
Flexor Carpi ulnaris tendon
Describe guyon’s canal
The medial border is the pisiform so the tendon insets on the pisiform and neural and vascular structures are just lateral to that. The ulnar nerve and artery are in here. Abductor pollicis longus and extensor pollicis brevis form the lateral border.
The median nerve and ulnar artery enter the forearm by passing between the humeroulnar and radial heads of what muscle
Flexor digitorum supeficialis
The anterior interosseous nerve and artery descend between what muscles
Flexor digitorum profundus and flexor pollicis longus
Flexor pollicis longus is ____ to the flexor digitorum profundus
Lateral
What is the only muscle that attaches only to the radius on one end and only to the ulna on the other
Pronator quadratus
Anterior interosseous artery pierces the interosseous membrane at the proximal border of what muscle
Pronator quadratus
Describe golfer’s elbow
If there is too much stress to the musculature, it can cause medial epicondyle tendinitis. From the top of the swing you throw your elbow down and create stress in the musculature.
What are the two branches of the ulnar artery that anastomose with branches of the brachial artery?
Anterior ulnar recurrent–> inferior ulnar collateral artery
Posterior ulnar recurrent–> superior ulnar collateral artery
