MSK Management of the Elbow and Forearm Flashcards
t/f: fx in the elbow are often difficult to regain full ROM in
true
the ulnar nerve goes through the ___ ____
ulnar groove
irritation of the ____ compounds medial epicondylalgia
UCL
t/f: there is a synovial lining in the radial collateral lig
true
what is a quicker and easier way to gather pt info than a regular DASH?
quickDASH
is the trochlea on the side of the ulna or radius?
ulna
is the capitulum on the side of the ulna or radius?
radius
what ligament wraps around the radial head?
the annular ligament
what information should we gather in the pt history?
demographics
PMH
MOI
HPI
limitations/impairments
pain profile
if a pt has medial elbow pain, what should we be thinking about?
wrist flexors, ulnar nerve, medial epicondylalgia
if a pt’s occupation requires for them to lifting objects with pronation, what may be stressed?
wrist extensors
what info should we gather from observation?
posture
symmetry
carrying angle
epicondyle and olecranon alignment (triangle)
what is the normal carrying angle?
15 deg
do men or women tend to have a larger carrying angle? why?
women bc they tend to have wider hips
t/f: the elbow moves mostly in the sagital plane, but there is some add/abd to get the hand to the face
true
if we have the time, should we use girth or volumetric measurements for better measurements of the wrist and elbow?
volumetric measurements
why should we check the LE with cervical signs?
bc it would sniff out cervical myelopathy (cord and nerve root compression >65 y/o)
what is the spinal level of the biceps?
C5
what is the spinal level of the brachioradialis?
C6
what is the spinal level of the triceps?
C7
what DTRs should we check?
biceps, brachioradialis, and triceps
what is normal elbow flexion?
150-160 deg
what is normal elbow extension?
5-10 deg (hyperextension)
what is normal elbow pro/sup?
80-90 deg
what is the concave surface of the humeroulnar jt?
trochlear notch of the ulna
what is the convex surface of the humeroulnar jt?
trochlea of the humerus
what is the roll and glide of the humeroulnar jt in flexion?
ulna rolls and glides ant on the humerus
what is the roll and glide of the humeroulnar jt in extension?
ulna rolls and glides post on the humerus
what is the concave surface of the humeroradial jt?
fovea of the radial head
what is the convex surface of the humeroradial jt?
capitulum of the humerus
what is the roll and glide of the humeroradial jt in flexion?
radius rolls and glides ant on the humerus
what is the roll and glide of the humeroradial jt in extension?
radius rolls and glides post on the humerus
what is the concave surface of the proximal radioulnar jt?
radial notch of the ulna
what is the convex surface of the proximal radioulnar jt?
radial head
what is the roll/spin/glide of the proximal radioulnar jt in pronation?
radius spins med on the ulna
radius glides ant
ulna glides post
what is the roll/spin/glide of the proximal radioulnar jt in supination?
radius spins lat on the ulna
radius glides post
ulna glides ant
what are the key points of consideration in the examination of muscle function?
active insufficiency
muscle’s angle of pull
each muscle’s fxn across primary and secondary jts
there is better elbow flexion with shoulder _____
extension
muscles have the most power _____
mid-range
what are the flexors at the elbow?
biceps
brachialis
brachioradialis
the elbow extensors are ___% strength of the flexors
60
most elbow flexors force is generated bw _______ deg of flexion w/supination (biceps and brachialis)
90-110
where are the biceps the strongest?
in supination
where is the brachialis the strongest?
in pronation
where is the brachioradialis the strongest?
in neutral
what are the extensors at the elbow?
triceps
anconeus
the triceps produce what motions?
shoulder ext
elbow ext
adduction
where is the peak torque of the triceps?
bw 70-90 deg of flexion
the long head of the triceps accounts for ___% of total torque of elbow extension
25
the anconeus contributes _____% of total torque of elbow extension
10-15
the pronators are _____% strength of supinators
85
the biceps contributes to supination primarily at ___ deg flexion
90
what is the first muscles to supinate and mostly active in extension?
the supinator
what muscle is an elbow flexor and pronator primarily w/resistance?
pronator teres
what should we be feeling with palpation?
the jt line just proximal to the wrist
ulnar and radial styloid processes
med/lat epicondyles
head of the radius
muscles
what are the wrist flexors?
pronator teres
flexor carpi radialis
palmaris longus
flexor carpi ulnaris
what are the wrist extensors?
extensor carpi radialis brevis and longus
extensor digitorum
extensor carpi ulnaris
how is the varus/valgus stress test performed?
elbow flexed to 20 deg
avoid full supination
valgus: stabilize the forearm medially and push the elbow in
varus: stabilize the forearm laterally and push the elbow out
what nerve may get irritated by the pronator teres if gripping the forearm too hard with the varus/valgus stress test?
median nerve
what is the varus/valgus stress test a test for?
ligaments in the elbow
how do we perform the moving valgus stress test?
apply a valgus force as you extend the elbow in 90 deg shoulder abduction
what is the sensitivity/specificity and (+)LR and (-)LR of the moving valgus stress test?
sn=100%
sp=75%
(+) LR=4.0
(-) LR=0
what is the moving valgus stress test for?
ligaments test
how do we perform the tinel/compression test?
flex the elbow and tap/compress the cubital tunnel for 60 sec
what is the tinel/compression test for at the elbow?
ulnar nerve test
what is a (+) tinel/compression test?
tingling into the ulnar nerve distribution along the lateral hand
is volar tingling a (+) tinel test?
nope
what is the sensitivity and specificity of the tinel/compression test?
sn=68-70%
sp=76-98%
what is the difference bw the pronator teres and carpel tunnel?
the pronator teres doesn’t produce nocturnal symptoms, while carpal tunnel does
what is the Cozen and Mill test for?
lateral epicondylalgia
how do we perform the Cozen sign?
flex the elbow at the side and resist wrist extension (may do various deg of wrist ext)
what other resistance may also be painful with tennis elbow (lateral epicondylalgia)?
supination
how do we perform the Mill test?
extend the elbow and flex the wrist to stretch the wrist extensors that attach to the lateral epicondyle