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OCS > The Elbow > Flashcards

The Elbow Flashcards

1
Q

List 3 non-neuromusculoskeletal conditions that may refer pain to the elbow.

A
  1. Acute Myocardial Infarction
  2. Pancoast’s Syndrome (lung cancer causes damage to thoracic inlet / brachial plexus)
  3. Esophageal Motor Disorders
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2
Q

What are 3 symptoms of esophageal motor disorders? Why is this relevant when assessing upper extremity pain?

A
  1. difficulty swallowing
  2. heartburn
  3. chest pain
    - esophageal motor disorders can cause referred elbow pain
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3
Q

What is Pancoast’s Syndrome? Why is this relevant in assessing upper extremity pain?

A
  • malignant neoplasm (lung cancer) causes damage to thoracic inlet / brachial plexus
  • Pancoast’s Syndrome can refer pain to the elbow
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4
Q

How much elbow flexion is needed to bring food to the mouth?

A

115°-123°

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5
Q

From which epicondyle of the humerus does the pronator teres muscle originate?

A

medial epicondyle

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6
Q

From which epicondyle of the humerus does the supinator muscle originate?

A

lateral epicondyle

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7
Q

What attaches to the lateral border of the ulnar tuberosity & what is its function?

A
  • the oblique cord (thickening of supinator fascia that connects the ulnar tuberosity distally to the radial tuberosity)
  • assists in limiting supination
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8
Q

List 3 muscles that attach to the olecranon process

A
  1. triceps brachii
  2. anconeus
  3. flexor carpi ulnaris (FCU)
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9
Q

Why is the radial head considered essential to elbow stability? Under what circumstances would this be especially true?

A
  • contributes to all planes of motion
  • resists valgus forces
  • if collateral ligament is damaged/injured & the distal radioulnar joint is unstable, the humeroradial articulation is even more important for keeping the elbow stable
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10
Q

What is the optimal ROM for the radioulnar articulation?

A

70° pronation & 80° supination

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11
Q

When does the peak strain to the interosseous membrane between the ulna & radius occur?

A

during neutral forearm rotation

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12
Q

How does tension on the Triangular Fibrocartilage Complex (TFCC) change with radioulnar motion?

A
  • in full pronation (~70°), the anterior/volar ligament of the TFCC is taut
  • in full supination (~80°), the posterior/dorsal ligament of the TFCC is taut
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13
Q

In what ROM is the elbow capsule least tensioned?

A

70°-90° of flexion

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14
Q

List the 3 ligaments of the Ulnar Collateral Ligament complex

A
  1. anterior
  2. posterior
  3. transverse
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15
Q

How does the structure of the anterior part of the UCL affect elbow joint stability through the full range of elbow motion?

A
  • has two bands: anterior & posterior
  • anterior band is taut from full extension to 60° of flexion
  • posterior band is taut from 60° to 120° of flexion
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16
Q

Which soft tissue structure is the greatest restraint to valgus stresses at the elbow?

A

anterior portion of Ulnar Collateral Ligament complex

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17
Q

At what angle is the posterior portion of the UCL most taut?

A

90° of flexion

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18
Q

What is Cooper’s ligament? What role does it play in elbow stability?

A
  • transverse (or oblique) part of the UCL

- contribution to stability is limited (it’s variably present & often indistinguishable from the capsule)

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19
Q

List the 4 structures that make up the Radial Collateral Ligament complex (RCL)

A
  1. annular ligament
  2. radial portion
  3. ulnar portion
  4. (variably present) accessory portion
20
Q

Which soft tissue structure plays the primary role in elbow stabilization? Which other two structures play secondary roles in elbow stability?

A
  • the Radial Collateral Ligament complex

- elbow joint capsule & common extensor origin play secondary roles

21
Q

Which component of the UCL complex was originally implicated as playing the primary role in Posterolateral Rotatory Instability (PLRI)? What are its attachments?

A
  • ulnar portion

- medial epicondyle to the crest of the supinator on the ulna (blends with fibers of the annular ligament)

22
Q

Describe the Elbow Extension test & its general sensitivity/specificity.

A
  • patient actively fully extends elbow

- excellent specificity (97%) for elbow fracture, okay sensitivity (69%)

23
Q

Which 2 clinical tests would you use to determine dislocation and/or gross instability of the elbow?

A
  • Active Floor Push-Up Sign & Chair Sign (100% sensitivity with both)
24
Q

If a patient presents with elbow pain and an exaggerated bony prominence, effusion, and an appearance of an elongated forearm, what might you suspect

A

dislocation

25
Q

What is an example of a benign neoplasm of the elbow?

A

osteoid osteoma

26
Q

What is an example of a malignant neoplasm of the elbow? In which population are they most common?

A

Ewing’s sarcoma in patients 4-15 years old

27
Q

What are the 4 criteria for ruling out an elbow fracture?

A
  1. tenderness of anterior forearm radial head?
  2. tenderness of posterior/lateral radial head?
  3. any bruising?
  4. tenderness over olecranon or medial epicondyle?
    (100% sensitivity)
28
Q

Desribe Maudley’s test

A
  • resisted 3rd digit extension (test for lateral epicondylalgia)
29
Q

Decribe Cozen’s test

A
  • resisted wrist extension (test for lateral epicondylalgia)
30
Q

Describe Mill’s test

A
  • passive stretch of wrist extensors (test for lateral epicondylalgia)
31
Q

How do you know when to target the elbow and when to target the cervicothoracic spine for lateral epicondylalgia?

A
  • pain-free grip strength deficit predominates: local treatment
  • pressure pain threshold deficit predominates: remote treatment (C/T, wrist)
32
Q

What structures form the cubital tunnel?

A

medial epicondyle, flexor carpi ulnaris, and olecranon process (ulnar nerve travels through the tunnel)

33
Q

What are 4 neurological tests for Cubital Tunnel Syndrome?

A
  1. Tinel’s sign
  2. Pressure Provocation test
  3. Elbow Flexion test
  4. Upper Limb Tension test (Ulnar bias)
34
Q

What is Tinel’s sign? What is its general specificity/sensitivity?

A
  • tapping over the ulnar nerve at the cubital tunnel reproduces symptoms along the ulnar nerve distribution
  • moderate sensitivity (0.7), excellent specificity (0.98)
35
Q

Describe the Pressure Provocation test for the elbow. What is the general specificity/sensitivity?

A
  • elbow in 20° of flexion
  • pressure applied to the ulnar nerve at the cubital tunnel for 60 secs
  • (+) test is reproduction of symptoms along ulnar nerve distribution
  • good sensitivity (0.89), excellent specificity (0.98)
36
Q

Describe the Elbow Flexion test. What is the general specificity/sensitivity?

A
  • bilateral active elbow flexion with wrist extension, held for 3 minutes
  • (+) test is production of pain, numbness, or tingling along ulnar nerve distribution
  • moderate sensitivity (0.75), excellent specificity (0.99)
37
Q

What is Little League Elbow Syndrome? Which tissues are involved?

A
  • valgus overload or stress injury to the medial elbow as a result of repetitive throwing
  • ligament injury, but in more severe cases: apophysitis or stress fracture
38
Q

Describe the Moving Valgus Stress test. What is the general specificity/sensitivity?

A
  • pt is seated with shoulder abducted to 90°
  • starting with elbow in maximal flexion, apply a valgus torque until shoulder reaches max ER
  • maintain valgus torque & quickly extend elbow to ~30° of flexion
  • (+) test is reproduction of medial elbow pain, especially between 120° and 70° degrees
  • excellent sensitivity (1.0), moderate specificity (0.75)
39
Q

Which condition commonly occurs concomitantly with Ulnar Collateral Ligament laxity?

A

Cubital Tunnel Syndrome

40
Q

What is “Tommy John surgery”?

A

reconstruction of the anterior band of the ulnar collateral ligament complex with the palmaris longis (also anterior transposition of the ulnar nerve)

41
Q

What is the role of conservative management vs surgery for patients with Ulnar Collateral Ligament laxity?

A
  • conservative management for most

- Tommy John surgery for higher-level athletes (cost-effectiveness under question)

42
Q

What 2 tests should be performed for a patient with suspected Ulnar Collateral Ligament insufficiency / Little League Elbow?

A
  1. Valgus Stress test

2. Moving Valgus Stress test

43
Q

What motion of the shoulder is frequently limited in patients with UCL insufficiency / Little League Elbow?

A

internal rotation

44
Q

List 3 common impairments in patients with non-specific elbow pain.

A
  1. ROM
  2. ULTT ROM
  3. strength
45
Q

List 4 neurological tests for Cubital Tunnel Syndrome

A
  1. Tinel’s sign
  2. Pressure Provocation test
  3. Elbow Flexion test
  4. Upper Limb Tension Test 3 (Ulnar nerve bias)

OCS (13 decks)

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