table, figures and new Flashcards
What non MSK can refer pain to the elbow?
- acute MI
- pancoast tumour
- esophageal motor disease
What non MSK can cause elbow pain?
- Gout/pseuodogout
- Septic arthtitis
- hemarthrosis
- soft tissue abscess
- cellulitis
- reactive athritis
- CA
What are the gender differences in carrying angle
females 13-16
males 11-14
What are the greater and lessor sigmoid notch of the ulna
greater - articular surface of the proximal unla with the trochlea of the humerus
lessor - articular surface of the proximal ulna with the radial head
What are the three fossae of the distal humerus
- radial
- coraonoid
- olecranon
How much of the radial head articulates with the ulnar
- 240 degrees articulates as some point during pronation and supination
- the ramaining 140 degrees is the “safe zone” for surgery
What muscle attaches to the coronoid process
brachialis
What is the oblique cord of the elbow
thickening of the fascia of the supinator extending from the medial side of of the proximal ulnar just past the biceps insertion on the radius
Describe the mechanics of the forearm interosseus membrane
- constructed of a central band and several accessory bands
- distributes load from radius to ulna during weight bearing
- peak strain in neutral forearm position
- dictates ulnar movement
What joints does the elbow capsule surround
All three elbow joints
At what point is the elbow joint most lax
70-90
what are the parts of the UCL and when are the tight in the ROM
- anterior - anterior - full extension to 60 - posterior 60 to 120
- posterior - 90 flexion
- transverse
What the parts of the LCL of the elbow and when are they tensioned
- annular ligmaent
- radial portion
- ulnar portion
tensioned in flexion and extension and into supintion
Describe the attachments of the radial portion of the LCL of the elbow
- lateral epicondyle
- annular ligament
Supinator is most closely associated with which ligmemt of the wlbow
- radial portion of the LCL
- oblique cord
Which anterior elbow flexor has thee greatest mechanical advatage?
brachioradialis
what muscle make up the “mobile wad”
- ECRB
- ED
- EDM
- ECU
What muscle it the primary supinator
biceps
What are the main aterial structures of the elbow
- brachial
- radial
- ulnar
Is supination greater in elbow extension or flexion
flexion
what is the primary stabilizer for varus and valgus stress at 0 and 90 degree elbow flexion
vlagus - 0 degree - ECL, ant cap and bone about same
valgus - 90 degree - UCL primary followed by bone and capsuel
Varus - 0 degree - BONE, ant cap, RCL
varus - 90 degre - BONE slight cap and RCL
what are the risk factors for developing lateral elbow tendinopathy
- 35-50
- female
- high work levels
- low social support at work
- strenuous categories of work
What is Mill’s test
- flexion of the fingers and wrist
-extension of elbow and shoulder
production of elbow pain
Risk facotres for medial elbow pain
- men and women equal
- dominate arm
- “forceful work’
Risk factors for biceps tendon rupture
male, 4th-6th decade, anabolic steriod use
Describe basics of the bicep rupture repair
- highest risk for re-rupture is 3 weeks
- full PROM by 4 weeks
- strengthening starts 6-8 weeks
- unrestricted activity 8-16 weeks
What are the most common senarios leading the varus instability of the elbow
- complex elbow dislocation
- varus elbow stress
- iatrongenic causes
What is a posterolateral rotatory instability (PLRI)?
the proximal radius and ulna externally rotate together as a unit in relation to the humerus causing posterior subluxation or dislocation of the radial head relative to the capitellum, without associated instability of the proximal radioulnar joint
What is Varus posteromedial instability?
elbow instabiltiy associated with subluxation of the elbow resulting in RCL avulsion and fracture of the anteriomedial tip of the coronoid
What is best way to approach Varus posteromedial instability
surgery
what is the most common mechanism of injury for PLRI?
combination of axial compression, valgus stress, and supination
How long she shoulder abudction be avoided with RCL is repaired
4-6 weeks
What are the phases of throwing?
- wind-up
- stride
- arm cocking
- arm acceleration
- arm deceleration
- follow through
UCL strains typically occur in what part of the throwing phases
cocking to acceleration
What special test would you use to confirm PLRI?
lateral pivot shift - Supine with the shoulder passively
flexed past 90.° The elbow begins in extension, the examiner applies axial compression through the ulna and radius towards the humerus with a supination and valgus force causing the elbow to subluxate at ~40° - 70° of elbow flexion. If the patient allows the passive examination to continue, then an observable clunk occurs with continued flexion as the elbow reduces.
medial elbow differential diagnosis
1. c spine C7-T1 2 TOS 3. shoulder MSK 4. ulnar nerve 5. medial elbow instability 6. medial tendinosis 7. posteromedial impingement/valgus etension overload syndrome
how should you brace a person with an LCL and MCL deficient elbow
- LCL put them in pronation
- MCL put inte in supination
- both mid range
Normal return to sport time from follow ostechondritis dissicans injury
6 months
