MSK Elbow Flashcards
Name the normal elbow ranges of motion: Flexion: Extension: Supination: Pronation:
F: 135
E 0-5
Sup 90
Pron 90
Name the 3 elbow joint articulations
humeroulnar joint
humeroradial joint
proximal radioulnar joint
Name the 4 elbow flexors
- Brachialis (musculocutaneous nerve - LC, C5-C7)
- Biceps brachii (musculocutaneous nerve - LC C5-C6)
- Brachioradialis (radial nerve, PC C5-7)
- Pronator teres (median nerve, LC C6/7)
Name the two elbow extensors
- Triceps (radial nerve, PC C6-8)
2. Anconeus (radial nerve, PC C7-T1)
Name the 2 forearm supinators
1 supinator (PIN - radial nerve, PC C5/6) 2. Biceps brachii (musculocutaneous nerve, LC C5/6)
Name the 3 forearm pronators
- Pronator quadratus (AIN, Median n, C7-T1)
- Pronator teres (median n, LC; C6/7)
- FCR (median n, LC C6/7)
Name the three elbow ligaments
which is key stabilizer?
- medial (ulnar) collateral ligament - MCL
- key stabilizer of elbow joint (anterior band) - Lateral (radial) collateral ligament - LCL
- Annular ligament
- holds radial head in proper position
Name the 6 muscles originating at the medial epicondyle of the humerus
FCR FDS FDP palmaris longus pronator teres FCU
name the 6 muscles originating at the lateral epicondyle of the humerus
ECR-Longus ECR-Brevis ECU EDS Supinator Anconeus
The ____ is the anatomic valgus angulation between the upper arm and forearm when the arm is fully extended
carrying angle
Normal carrying angle:
Male:
Female:
Angle > _____ is abnormal
Males: 5 degrees of valgus
Females: 10-15 degrees of valgus
>20 degrees is abnormal
Indications for elbow arthrodesis? - 2
Fusion positions?
- arthritis
- failed surgical procedure
- unilateral - flexion 90 degrees
- bilateral - flexion 110 in one arm and 65 for the other.
_____ also known as golfers elbow, little leaguer’s elbow (children) or pitchers elbow
medial epicondylitis
Medial epicondylitis is caused by _____
repetitive valgus stress on theelbow.
medial epicondylitis is seen in pitchers during______ phases and golfers during _____
Pitchers
- late cocking and acceleration phase
Golfers
- swing- back swing and downward follow-through swing just prior to ball contact.
Name the 4 phases of pitcher’s throw
- early cocking phase
- late cocking phase
- acceleration phase
- follow-through
Little leaguer’s elbow can lead to (3) and could result in _______ which cannot be overlooked
- medial epicondylitis
- medial epicondyle apophysitis
- traction apophysitis - as a result of microtrauma
can have hypertrophy of the medial epicondyle leading to microtearing and fragmentation of the medial epicondylar apophysis.
***may lead to osteochondritis dissecans of the capitellum
Pathology?
- tenderness just distal to the medial epicondyle over the common flexor tendon origin
- may be reproduced with resisted wrist flexion and pronation
- Ulnar neuropathy symptoms may occur secondary to valgus stretch of the nerve
Medial epicondylitis
_____ is also known as tennis elbow
lateral epicondylitis
What is mechanism of injury for lateral epicondylitis?
activities that require repetitive wrist extension and or forearm supination.
What three poor techniques can preceed lateral epicondylitis in racquet sports?
- improper technique for backhand swings
- inappropriate string tension
- inappropriate grip size.
Lateral epicondylitis is due to chronic microtearing of which muscle tendon?
ECR-Brevis
What pathology?
tenderness just distal to the lateral epicondyle at the extensor tendon origin
pain and weakness in grip strength
lateral epicondylitis
What are the two provocative tests for lateral epicondylitis
- Cozens test - examiner stabilizes the elbow with the thumb over the extensor tendon origin just distal to the lateral epicondyle. Pain in the lateral epicondyle is seen with the patient making a fist, pronating the forearm, and radially deviating and extending the wrist against resistance by the examiner. (the test may be more sensitive when done in full extension at the elbow)
- Mill’s Test - passive extension of the elbow with forced flexion of the wrist with radial deviation may precipitate pain at the lateral epicondyle
What is the surgical procedure for lateral epicondylitis
ECRB debridement
Lateral epicondylitis - post treatment return to play, the player should (2)
- increase grip size
2. decrease string tension to <55lbs
_____ is also known as draftsmans elbow, students elbow, or miners elbow
olecranon bursitis
Mechanism of injury for olecranon bursitis
repetitive trauma, inflammatory disorder (gout, pseudogout, RA)
_____ is the most common type of dislocation in children and 2nd most common type in adults (second to shoulder)
dislocation of the elbow
dislocation of the elbow
Adults _____ yoa are most affected
sports activities account for almost ____% of these injuries
25-30
50%
elbow dislocation
_____ direction is most common, occuring 98% of the time
posterior
Associated injuries with elbow dislocation include 3
1 fracture of radial head
- injury to brachial artery
- median nerve
4 potential adverse outcomes after elbow dislocation
- loss of ROM, especially extension
- ectopic bone formation
- neurovascular injury
- Arthritis of the elbow
____ is caused by overloading of the biceps tendon, commonly due to repetitive elbow flexion and supination or resisted elbow extension
distal biceps tendonitis
_____ is an overuse syndrome secondary to repetitive elbow extension
triceps tendonitis
____ is due to decelerating counterforce during active elbow extension
triceps avulsion
____ is a spectrum of overuse elbow injuries in baseball players caused by repetitive valgus forces during the throwing motion, especially in cocking and accelleration phase of throwing.
Valgus extension overload (VEO) syndrome of the elbow
In valgus extension overload (VEO) syndrome, valgus force causes tensile stress in the _____ elbow and lateral shear stress in the _____ aspect of the elbow
medial elbow Posterior aspect (posteromedial olecranon)
What is the provacative test for valgus extension overload (VEO) syndrome?
VEO test: flex elbow to 30 degrees and repeatedly extend the elbow fully while applying valgus stress. Pain may be elicited, particularly at the last 5-10 degrees of extension. Valgus stress test should also be performed at greater than 90 degrees to rule out MCL injury
______ occurs with repetitive valgus stress occurring across the elbow most prominently during the acceleration phase of throwing
medial ulnar collateral ligament sprain (MCL)
In elbow MCL injury, there is inflammation of ______ band of ulnar collateral ligament which is the segment that provides the majority of valgus stability
anterior bandd
in MCL sprain ____ will occur on testing if UCL is torn
medial pain or instability on valgus stress with elbow flexed 20-30 degrees
valgus stress test is definitive test but should also perform VEO test to differentiate between UCL injury and VEO syndrome
Valgus stres radiographs demonstrate a ______ joint space suggestive of UCL injury
2mm
after elbow dislocation after a traumatic event, ____ ligament sprain can occur
lateral (radial) collateral ligament sprain
Pathology?
recurrent locking or clicking of the elbow with extension and supination. Lateral pain or instability with varus stress with the elbow flexed 20-30 degrees
Lateral (radial) collateral ligament sprain; will have instability on varus stress if RCL is torn
What are the two provocative tests for lateral (radial) collateral ligament (LCL) sprain?
- Varus stress test - tenderness over lateral aspect of elbow, which may be increased with a varus stress
- Lateral pivot-shift test - assesses the RCL for posterolateral instability
Pronator syndrome is a ____ compression at the elbow
median
what four structures may cause compression of the median nerve at the elbow in pronator syndrome
- ligament of struthers or supracondylar spur
- lacertus fibrosus
- pronator teres muscle
- beween two heads of FDS
Pathology?
- dull aching pain in proximal forearm just distal to the elbow
- numbness in median nerve distribution of the hand.
pronation syndrome - symptoms will be exacerbated by pronation
name the four structures that can compromise the ulnar nerve at the elbow
cubital tunnel syndrome:
- arcade of struthers
- hypermobility of the ulnar nerve
- excessive valgus force at the elbow
- impingement from osteophytes or loose bodies
pathology?
- medial forarm aching pain with parasthesias radiating distally to the fourth and fifth digits.
- weakness in the ulnar innervated hand intrinsic musculature: weak grip strength, muscle atrophy
- positive tinel’s at the elbow
- positive froment sign
cubital tunel syndrome
froments sign - pincer grip test - assesses flexor pollicis longus
____ is epiphysial aseptic necrosis of the capitellum
osteochondrosis of the elbow (Panners disease)
etiology of osteochondrosis of the elbow? panners disease
believed to be caused by interference in blood supply to epiphysis, leading to resorption of the ossification center initially followed by repair/replacement
osteochondrosis of the elbow (Panners disease)
- will have tenderness and swellingon ____ aspect of elbow
- usually seen in _____ elbow of ____(sex)
lateral
dominant elbow - boys
what is conservative treatment for humeral shaft fractures?
splint for 2 weeks
complication of concern in humeral shaft fractures?
radial nerve injury - 95% of patients will regain their nerve function within 6 months
five complications of distal humerus fractures
- neurovascular injury
- nonunion
- malunion
- elbow contracture
- poor ROM
dislocations of the elbow are commonlyassociated with ____
radial head fractures
typically occurs after fall on outstretched arm.
Name the 3 types of radial head fractures and treatment for each`
Type I nondisplaced - shrot period of immobilization (3-5 days) followed by early ROM
Type II Marginal radial head fracture, minimal displacement - surgical fixation for fracture greater than 2mm displacement or 30% radial head involvement
Type III comminuted fracture - surgical fixation
____ nerve might be involved in olecrenon fractures
ulnar nerve
