S2_L2: Elbow & Forearm Flashcards
What part of the humerus articulates to the ulna?
Trochlea
Source: Lecture Formative Quiz
What is the type of joint of the humero-ulnar articulation?
Modified hinge joint
Source: Lecture Formative Quiz
What ligament provides stabilizing action against varus
forces at the elbow?
Radial collateral ligament
Source: Lecture Formative Quiz
Among the elbow flexors, which one contracts actively always regardless of the position of the forearm?
Brachialis
Source: Lecture Formative Quiz
Among the elbow flexors, which one is most effective
between 80-100Β° of flexion?
Biceps brachii
Source: Lecture Formative Quiz
Where is the common origin of wrist flexor muscles?
Medial epicondyle
Source: Lecture Formative Quiz
What nerve provides sensory supply on the lateral side of the dorsum of wrist and hand and lateral 3 1β2 digits?
Radial nerve
Source: Lecture Formative Quiz
What nerve may be entrapped between the two heads of the flexor carpi ulnaris?
Ulnar nerve
Source: Lecture Formative Quiz
What is the endfeel for elbow flexion?
Soft
Source: Lecture Formative Quiz
What is the dermatome assigned at the level of the lateral epicondyle?
C5
Source: Lecture Formative Quiz
Regeneration rate of nerves when immobilized
1 mm per day (range 0.5-0.9mm)
Match the following techniques to the nerve it is associated with.
- ULTT 1
- ULTT 4
- ULTT 3
A. Radial nerve
B. Median nerve
C. Ulnar nerve
- B
- C
- A
This condition is known as the Little Leagueβs Elbow
Medial Elbow Tendinopathy
How long is the period of immobilization of Total Elbow Arthroplasty (TEA)?
8-12 days to weeks
TRUE OR FALSE: A patient may already try to perform push-ups 4 weeks after TEA to facilitate healing.
False.
The patient must avoid this activity for 6 weeks.
What peripheral nerve injury is associated with the ulnar nerve?
cubital tunnel syndrome
____ is a cumulative trauma disorder, not from a sudden injury.
overuse syndrome
Enumerate the 5 possible etiology of joint hypomobility
Fracture
Dislocation
Arthritic conditions
Burns
Myositis ossificans
Determine what is the intervention scenario done in each condition?
- Total Elbow Arthroplasty
- Elbow Tendinopathy
- Peripheral Nerve Injury (Acute Phase)
- Peripheral Nerve Injury (Recovery Phase)
- Peripheral Nerve Injury (Chronic Phase)
A. to restore & to compensate
B. to compensate & prevent
C. to restore only
- B
- C
- A
- C
- B
What is the ROM necessary for function of the elbow? Answer for flexion, extension, pronation, and supination.
flexion-extension: 30-130*
supination-pronation: 50* each
Source: Chegg Elbow Evaluation
4 possible etiology of lateral epicondylalgia?
- overuse phenomenon
- gripping activities with repetition or sustained force
- tennis players, factory workers
- potential for degenerative changes at tendon
Source: Chegg Elbow Evaluation
2 possible etiology of medial epicondylalgia?
- overuse of wrist flexion or pronation
- overhead throwers and golfers
Source: Chegg Elbow Evaluation
What is the intervention for simple dislocations?
Closed reduction and splint in flexion for 7-10 days
Source: Chegg Elbow Evaluation
Determine the sensory loss if entrapment of median nerve at ligament of struthers occurs?
- palmar fingers 2, 3, and1/2 of 4
- thumb
- radial palm
Source: Chegg Elbow Evaluation
Determine which activity elicit symptoms of the elbow tendinopathy:
- Shuffling papers
- Backhand stroke
- Pulling weeds
- Lifting heavy objects
- Computer keyboarding
A. Lateral Elbow Tendinopathy
B. Medial Elbow Tendinopathy
- B
- A
- A
- B
- A
In tennis elbow the wrist ____ are strained.
extensors
To develop soft tissue & joint mobility in overuse syndrome, a PT must provide ____ resistance for 6 seconds x 10 times.
isometric
Wrist position progression of wrist flexor muscles for tendinopathies
Flexion β Neutral β Extension
Residual stiffness are common in (1)_____ and may present with (2)____ degrees loss of terminal (3)____.
- joint hypomobility
- 10-15
- extension
What bone is usually dislocated in the elbow?
ulna
Heterotopic ossification is common to develop in elbow (1)____, (2)____ muscle, & (3)____.
- trauma
- brachialis
- burns
To fix a nursemaidβs elbow, a PT must apply (1)___ perform (2)____ to return the radial head into position.
- compression
- supination
For a pushed elbow, a PT must perform ____.
Gr. III distraction
When there is an ulnar dislocation present, itβs best to place the elbow in _____ to prevent ulnar neuropathy.
20-30 degrees flexion
Determine where the following nerves might be impinged:
- Cubital tunnel
- Musculospiral groove
- Supinator
- Pronator Teres
- 2 heads of the flexor carpi ulnaris
A. Median Nerve
B. Radial Nerve
C. Ulnar Nerve
D. None
- C
- B
- B
- A
- C
Determine where the following nerves might be impinged:
- flexor digitorum superficialis
- Arcade of FrΓΆhse
- Ligament of Struthers
- extensor carpi radialis brevis
- bicipital aponeurosis
A. Median Nerve
B. Radial Nerve
C. Ulnar Nerve
D. None
- A
- B
- A
- B
- A
Determine where the following nerves might be impinged:
- Median Nerve
- Radial Nerve
- Ulnar Nerve
A. Cubital tunnel
B. Musculospiral groove
C. Supinator
D. Pronator Teres
- D
- B and C
- A
Determine what body movements is seen in the following peripheral nerve mobilization technique:
- Wrist Extension and radial deviation
- Elbow & FA extension & pronation
- Finger Flexion
- Wrist Extension
- 10Β° shoulder abduction and medial rotation
A. Radial nerve
B. Median nerve
C. Ulnar nerve
- C
- A
- A
- B
- A
What is the position for immobilization the radial head when excised?
90 degrees flexion
Return to play activities for athletes are only prescribed if pt reaches ____% of the strength of the other UE.
90
Progression of strengthening muscles & improving endurance for overuse syndrome intervention.
Isometric β isotonic β eccentric resistive exercises
What are the 2 approaches for TEA ? Explain their procedure.
- Triceps-reflecting: triceps tendon which inserts
in the olecranon process is removed to expose
more of the elbow during operation and is later placed
back after the operation - Triceps-splitting: surgeon only a creates split in the middle of the triceps tendon
What is the correct sequence of movements for peripheral nerve mobilization?
Cervical spine β shoulder β elbow & forearm β
wrist β fingers
TRUE OR FALSE: Loss of terminal flexion of the elbow contributes to greater limitation of function than loss of terminal extension
True
Source: Kisner& Colby 7th ed., page 623
What are the 2 major ligaments that supports the elbow?
Medial and Lateral Collateral Ligament
Source: Kisner& Colby 7th ed., page 623
TRUE OR FALSE: The brachioradialis is unaffected by the position of the forearm or the shoulder.
False. It is the brachialis.
Source: Kisner& Colby 7th ed., page 625
The ____ muscle acts as a pronator when the forearm is in supination and a supinator when the forearm is in pronation
Brachioradialis
Source: Kisner& Colby 7th ed., page 625
The ____ muscle is capable of generating significant force regardless of the elbow position, speed, or power of the motion.
Supinator
Source: Kisner& Colby 7th ed., page 626
_____ is the most active and consistently used pronator muscle.
Pronator quadratus
Source: Kisner & Colby 7th ed., page 627
Radicular symptoms from the C5 and C6 nerve roots will present pain in the (1)_____, while C6 and C7 nerve roots in the (2)____.
- lateral elbow
- medial elbow
Source: Kisner & Colby 7th ed., page 627
How do you perform joint tracking of the elbow to improve elbow flexion?
Apply a gentle lateral glide to the proximal ulna with the belt while having pt perform flexion & extension of elbow.
Source: Kisner & Colby 7th ed., page 629
In adults, the most common fracture in the elbow region is a fracture of the ____.
head and neck of the radius
Source: Kisner & Colby 7th ed., page 630
Radial head excision is contraindicated in ____
a growing child
Source: Kisner & Colby 7th ed., page 631
Arthroplasty is contraindicated in the presence of ____
an active infection
Source: Kisner & Colby 7th ed., page 631
2 approaches that may be performed for radial head incision:
- Posterolateral (kocher) approach - between the extensor carpi ulnaris and anconeus muscles
- Kaplan approach - between the extensor digitorum and the extensor carpi radialis brevis
Source: Kisner & Colby 7th ed., page 631
Active ROM is generally allowed within (1)____ postoperatively and begins no longer than (2) ____ postoperatively if there was an unstable fracture or dislocation requiring immobilization.
- 1 week
- 3 weeks
Source: Kisner & Colby 7th ed., page 632
If a triceps-reflecting approach was used for a linked TEA, in what position should the elbow & forearm be?
full elbow extension and a neutral position of the forearm
Source: Kisner & Colby 7th ed., page 636
Primary structures involved in lateral epicondylalgia?
extensor carpi radialis brevis & extensor digitorum
Source: Kisner & Colby 7th ed., page 642
What activities or movements are not allowed after TEA?
- High-load progressive resistive exercise (PRE)
- heavy lifting
- high-impact recreational activities with high impact on the upper extremities
Source: Kisner & Colby 7th ed., page 640
To improve pain-free grip strength in patients with lateral epicondylitis, use an ____ to help reduce the load on the musculotendinous unit
elbow orthosis
Source: Kisner & Colby 7th ed., page 644
Add _____ to the program if the patientβs goals include returning to sports or occupational activities that require elbow and forearm ____
- plyometrics
- power
Source: Kisner & Colby 7th ed., page 644