The Elbow

Question 1

Introduction

What type of joint is the elbow?

Answer 1

The elbow is a hinge joint

Question 2

Introduction

What movement does the elbow joint allow?

Answer 2

Allows flexion, extension, pronation and supination to occur

Question 3

Introduction

Bones of the elbow?

Answer 3

There are three long bones which meet in the middle portion of the arm, forming three separate joints which are held together by ligaments (Humeral-Radial and Ulnar and Radio-Ulnar Joints)

Question 4

Introducion

Injuries that occur to this region (elbow)?

Answer 4

• Muscular strains
• Tendonitis (anterior, posterior, medial and lateral)
• Bursitis
• Neurological injury
• Fractures
• Dislocations

Question 5

Observations

Term “cubital” refers to?

Answer 5

The term “cubital” makes reference to the elbow joint

Question 6

Observations

“Cubital” - how are they observed? What do variances indicate?

Answer 6

During observation, “cubital” or carrying angles are observed bilaterally as variances may indicate injury or pathology

Question 7

Observations

Cubital angles?

Answer 7

The normal cubital angle variation is 5 degrees in males and 10-15 degrees in females

Question 8

Observations

Increase or decrease in these angles indicates?

Answer 8

Any increase or decrease in these angles when compared bilaterally may indicate certain conditions or injuries such as fracture or epiphyseal injury

Question 9

Observations

Excessive cubital varus? When is it evident?

Answer 9

Excessive cubital varus is known as “gunstock deformity” and is evident post fracture (epiphyseal) or dislocation

Question 10

Observations

What does the elbow look like extended?

Answer 10

With the elbow extended, the olecranon and medial and lateral epicondyles should line up and with the elbow extended to 90 degrees, these structures should form an isosceles triangle

Question 11

Ligament Injury

Ligaments medially and laterally

Answer 11

Medially and laterally are the “collateral” ligaments

Question 12

Ligament Injury

What do the “collateral” ligaments protect against? How are they tested?

Answer 12

Protect against a valgus and varus stress, and are tested in much the same way that they are injured

Question 13

Ligament Injury

Annular ligament location and function

Answer 13

The annular ligament encircles the head of the radius and holds it to the radial notch and ulna

Question 14

Ligament Injury

Sports that cause sprains to the collateral ligaments occur from?

Answer 14

Sprains of the collateral ligament of the elbow occur in contact sports such as wrestling, football and rugby as well as non-contact sports such as gymnastics

Question 15

Ligament Injury

Ulnar or medial collateral shape and forms?

Answer 15

The ulnar or medial collateral ligament is a triangular shaped ligament which forms the roof of the cubital tunnel in the elbow

Question 16

Ligament Injury

What travels in the cubital tunnel?

Answer 16

The ulnar nerve travels in this tunnel

Question 17

Ligament Injury

Why is the collateral ligament the most frequently injured ligament? Why?

Answer 17

This is the most frequently injured ligament because a valgus stress is the most common force traumatically

Question 18

UCL Tear/Reconstruction

Tears leading to medial elbow instability need?

Answer 18

Tears leading to medial elbow instability may need a surgical graft procedure where the ulnar collateral ligament is replaced with a tendon from elsewhere in the body

Question 19

UCL Tear/Reconstruction

Name of this surgery?

Answer 19

This is known as “Tommy John Surgery” after the major league pitcher who was operated on in 1974 by Dr. Frank Jobe

Question 20

UCL Tear/Reconstruction

“Tommy John Surgery” procedure?

Answer 20

Holes are drilled into the ulna and humerus and a new harvested tendon is inserted in a figure eight pattern

Question 21

UCL Tear/Reconstruction

“Tommy John Surgery” recovery?

Answer 21

A 2010 study noted that the recovery rate was 90%

Question 22

Muscle/Tendon Injuries of the Elbow

Muscles/tendons surrounding the joint may be involved in? How are they assessed?

Answer 22

Any one of these may be involved in a tendonitis or a strain and are assessed through muscle testing

Question 23

Muscle/Tendon Injuries of the Elbow

Anterior muscles

Answer 23

Biceps, brachialis, brachioradialis

Question 24

Muscle/Tendon Injuries of the Elbow

Posterior muscles

Answer 24

Triceps muscles

Question 25

# Muscle/Tendon Injuries of the Elbow Medial muscles

Answer 25

Flexor/pronator muscles

Question 26

# Muscle/Tendon Injuries of the Elbow Lateral muscles

Answer 26

Extensor/supinator muscles

Question 27

# Muscle/Tendon Injuries of the Elbow Anterior muscle testing

Answer 27

* Biceps tested in mid range as well "corkscrew test" * Brachialis tested with arm straight

Question 28

# Medial Epicondylitis What is medial epicondylitis?

Answer 28

Medial epicondylitis is a common medial elbow condition which involves inflammation of the common flexor pronator muscle group on or near the insertion on the medial epicondyle of the humerus

Question 29

# Medial Epicondylitis Names for the condition?

Answer 29

Medial epicondylitis has a number of different names including Golfer's and Pitcher's elbow

Question 30

# Medial Epicondylitis Muscle group effected in?

Answer 30

This muscle group is effected in throwing sports such as baseball (pitching), golf, javelin and gymnastics

Question 31

# Medial Epicondylitis What does a repetitive stress cause?

Answer 31

A repetitive stress causes pain, microtearing and inflammation resulting in tendonitis and muscle weakness

Question 32

# Medial Epicondylitis What may also be involved?

Answer 32

Due to the proximity of the cubital tunnel, the ulnar nerve may also be involved

Question 33

# Medial Epicondylitis Symptoms?

Answer 33

There is localized tenderness as well as weakness with resisted wrist flexion and pronation

Question 34

# Lateral Epicondylitis What is it?

Answer 34

Lateral epicondylitis or "tennis elbow" is a lesion affecting the common tendon origin of the lateral extensor, supinator muscle group

Question 35

# Lateral Epicondylitis Repetitive use causes?

Answer 35

Repetitive use causes microtearing, swelling, pain and degeneranative changes in the tendon

Question 36

# Lateral Epicondylitis What can also be affected?

Answer 36

The periosteum can also be affected

Question 37

# Lateral Epicondylitis This injury affects? Most frequently involved tendon?

Answer 37

This injury affects the common tendon of the extensor/supinator muscle group with the extensor carpi radialis brevis tendon being the most frequently involved tendon

Question 38

# Lateral Epicondylitis Who does this injury affect?

Answer 38

Lateral epicondylitis affects both sexes equally and is frequently seen after age 20 in both an athletic and non-athletic population

Question 39

# Lateral Epicondylitis Non-athletic population - causes?

Answer 39

* Overuse/overstress * Repetitive hammering * Stirring * Painting

Question 40

# Lateral Epicondylitis Athletic population - causes?

Answer 40

* Sporting activities using wrist extension and supination * Inadequate power, flexibility or endurance * Involves the novice tennis player * Poor stroke mechanics, using arm instead of body * Equipment * Racquet Stringing

Question 41

# Lateral Epicondylitis Assessment - Subjective

Answer 41

* History - any changes in equipment, technique, etc. * Pain with movements involving wrist extension

Question 42

# Lateral Epicondylitis Assessment - Objective

Answer 42

* Weakness with active and resistive wrist extension and supination movement * Palpation

Question 43

# Olecranon Bursitis Also known as?

Answer 43

Olecranon bursitis is also known as "student's elbow", "popeye elbow" or "baker's elbow"

Question 44

# Olecranon Bursitis What is this condition?

Answer 44

This condition is an irritation of the olecranon bursa found at the posterior elbow region

Question 45

# Olecranon Bursitis This injury can occur due to?

Answer 45

This injury can occur due to a hard blow to the tip of the elbow or repeated leaning on a hard surface

Question 46

# Traumatic Elbow Injuries Traumatic injuries to the elbow joint involve?

Answer 46

Traumatic injuries to the elbow joint may involve: * Dislocations * Boney * Soft tissue * Neurovascular

Question 47

# Traumatic Elbow Injuries Concerns?

Answer 47

One concern, especially with dislocations and fractures is the proximity of the brachial artery and the three peripheral nerves crossing the elbow joint

Question 48

# Traumatic Elbow Injuries Common traumatic injury?

Answer 48

Elbow fractures and dislocations are a common traumatic injury, especially in children

Question 49

# Traumatic Elbow Injuries Common complication?

Answer 49

One common vascular complication from traumatic elbow injury is known as "Volkmann's Ischemic Contracture"