The Elbow & Scapular MMT Flashcards
Objectives
9: Differentiate among ROM, AAROM, AROM and FROM
11: Perform PROM on the trunk, UEs and Cspine
12: Measure functional, active, and passive ROM with a goniometer and accurately record
13: Discuss manual muscle testing principles
14: Recognize a variety of muscle strength scales used in PT
15: Demonstrate accurate technique for performing manual muscle tests
16: Interpret results from a manual muscle test
FYI
Bones and Landmarks of the Elbow
The scapula:
- Infraglenoid tubercle – attachment of the long head of the triceps
- Supraglenoid tubercle – attachment of the long head of the biceps
- Coracoid process – attachment of the short head of the biceps
Bones and Landmarks of the Elbow
The humerus:
- Trochlea – articulates with the ulna
- Capitulum – articulates with the radial head
- Medial epicondyle – attachment of pronatorteres
- Lateral epicondyle – attachment of anconeus and supinator
- Lateral supracondylar ridge – attachment of the brachioradialis
- Olecranonfossa – articulates with the ulna
Bones and Landmarks of the Elbow
The ulna:
- Olecranon process – articulates with the humerus
- Trochlear notch – articulates with the humerus
- Coronoid process – attachment of the brachialis
- Radial notch – articulation for the radial head
- Ulnartuberosity – attachment for the brachialis
- Styloid process – distal end of the posterior medial surface
Bones and Landmarks of the Elbow
The radius:
- Head – articulates with the humerus
- Radial tuberosity – attachment for the biceps
- Styloid process – attachment for the brachioradialis
what are the Ligaments and Structures OF THE ELBOW?
- Medial collateral ligament
- Lateral collateral ligament
- Annular ligament
- Joint capsule
- Interosseous membrane
triangular shaped and spans the medial side of the elbow
Medial collateral ligament
triangular shaped and spans the lateral portion of the elbow
Lateral collateral ligament
attaches anteriorly and posteriorly to the radial notch of the ulna and encompasses the radial head
Annular ligament
attaches around the distal end of the humerus, encompassing the trochlea and capitulum and fossas located above them
Joint capsule
broad, flat membrane located between the radius and ulna
Interosseous membrane
Muscles of the elbow and forearm
YOU WILL BE RESPONSIBLE FOR THE FOLLOWING MUSCLES AND THEIR OIAN’S
- Brachialis
- Brachioradialis
- Biceps
- Supinator
- Triceps
- Anconeus
- Pronatorteres
- Pronatorquadratus
Fun Facts:
- The humerus articulates with the radius and ulna forming a hinge joint
- Ligaments, nerves and muscles aid in movement of the elbow
- Very prone to repetitive and overuse injuries
- Activities that place the arm in extension tend to cause most injuries
what did Ben say?
If the elbow had been placed closer to the hand, the forearm would have been to short to bring a glass to your mouth and if the elbow had been closer to the shoulder, the forearm would have been too long and it would have carried a glass beyond the mouth Benjamin Franklin (1706-1790)
Common injury to the elbow as a result of a direct blow to the area
Signs and Symptoms:
- Brusing
- Subsequent bleeding
- Pain
- Stiffness during function and active range of motion
Can result in myositisosssificans in which bone grows into the skeletal muscle
Contusions
Bursitis is an inflammation of the bursa
- Bursa is a tiny, fluid filled sac that functions as a gliding surface to reduce friction between tissues of the body
- Major bursae are located adjacent to the tendons near the large joints such as shoulders, elbow, hips and knees
Caused by a direct blow to the subcutaneous olecranon process of the ulna
Olecranon Bursitis
Olecranon Bursitis: Signs and Symptoms
Inflammation/Swelling
Palpable bursa
Pain
Possible infection of the bursa if an abrasion is present
- Nearly everyone has suffered an ulnar nerve contusion
- The ulnar nerve passes behind the medial epicondyle of the humerus and subcutaneously runs in a grove and passes through the cubital tunnel
- The lack of bony protection makes the ulnar nerve vulnerable to trauma
- A direct blow to the area may cause immediate pain and burning sensations shooting down the ulnar side of the forearm to the ring and little finger
- “Hitting the funny bone”
Ulnar Nerve Contusion
Elbow strains are common athletic injuries that occur to the muscles and other structures
Divided into acute and chronic types
- Acute – when a sudden overload is applied to the elbow joint
- Chronic – overuse and repetitive injuries
Most common areas of acute strain are the common flexor tendon around the medial epicondyle and the common extensor tendon around the lateral epicondyle
Elbow Strain
Elbow Strain:Signs and Symptoms: Acute
- Incident of sudden excessive overload followed by tenderness over the involved area
- Pain with function or resisted motion
- If there is a ruptured tendon, there may be a palpable gap, bunching of ruptured muscle or loss of efficient motion of the affected muscle
Elbow Strain: Signs and Symptoms: chronic
- Overuse injuries
- Irriation of muscle fibers resulting in microscopic tears
- Degenerative changes in the joint
- Pain
- Chronic strains commonly occur in the region of the lateral and medial epicondyle
- Usually caused by repeated overload of the musculotendinous units attaching to one of the epicondyles
- Faulty techniques or mechanics, weak muscle groups and inappropriate equipment can aggravate this condition
Epicondylitis
Nicknamed “Tennis Elbow” was first recognized in tennis players.
Lateral Epicondylitis
Nicknamed “Golfer’s Elbow” because it was first seen in golfers
Medial Epicondylitis
Epicondylitis: Signs and Symptoms:
- Local tenderness over the involved epicondyle
- Pain with use of the involved muscles
- Swelling
- Resisted wrist motion will reproduce pain
- Moderately common in athletics
- The elbow is relatively stable an injuries involving the ligamentous system of the elbow most commonly result from forced hyperextension or valgus/varus (side to side) forces
Sprains
Sprains: Signs and Symptoms:
- “Click” or “Pop” along with sharp pain at the time of injury
- Tenderness at the site of injury
- Localized swelling and pain on attempt to reproduce MOI
- Swelling and muscle spasms limit full extension
- Pain is usually relieved by flexing the elbow
- The elbow is the second most frequently dislocated major joint (after the shoulder)
- Not common, but can be serious
- Posterior dislocation is most common, typically resulting from a fall on an outstretched hand (FOOSH)
- As the elbow is forced into hyperextension, the olecranon process is levered against the humerus which can force the ulna backwards
- Severely stretches or ruptures the collateral ligaments but the annular ligament remains intact
Dislocations
Dislocations: Signs and Symptoms:
- Obvious deformity with the olecranon process abnormally prominent
- Loss of elbow function
- Considerable pain
- Loss of a radial pulse
- Decrease in sensory and motor function
- Typically results from direct trauma to the forearm or elbow or indirect stresses transmitted through the upper extremity
- Frequent in children and skeletally immature athletes
- Many involve the distal humerus, proximal ulna or radius
- Simple avulsions or serious and traumatic fractures
Fractures
Fractures: Signs and Symptoms:
- May or may not visually show a deformity
- Point tenderness
- Varying amounts of hemorrhaging or swelling are common
- Demonstrates limited ROM
- Disability at the elbow or hand
- Increase in pain at the fracture site upon attempted movement
- A serious condition that occurs in the absence of blood flow or ischemia to the forearm.
- Can be caused by increased pressure in the arm from swelling, trauma, decreased blood flow to the arm
- If left undiagnosed, the decrease in blood flow will injure the muscle, causing it to shorten
- When the muscle shortens, it pulls on the joint at the end of the muscle as it would if it were normally contracting
- The joint remains bent and it cannot be straightened
Volkmann’s Contracture
- The ulnar nerve passes through the cubital tunnel (important) in the posterior aspect of the medial epicondyle covered by fascial bands
- Repetative movement of the ulnar nerve (swinging, throwing) can become irritated, compressed or entrapped in this tunnel
- Called cubital tunnel syndrome
Ulnar Nerve Injury
Ulnar Nerve Injury: Signs and Symptoms:
- Pain along the inner aspect of the elbow
- Tenderness over the medial epicondylar groove
- Paresthesia in the distribution of the ulnar nerve in the hand
- Little and ring fingers
- Passes anteriorly to the lateral epicondyle and lies in a tunnel formed by several muscles and tendons
- The radial nerve can become entrapped in the tunnel area, especially during activities that require repetitive pronation and supination of the forearm
- Called radial tunnel syndrome
- Occurs infrequently but should be considered in the assessment of lateral epicondylitis
Radial Nerve Injury
Radial Nerve Injury: Signs and Symptoms:
- Pain over the lateral aspect of the elbow
- Tenderness may be present over the anterior radial head instead of the common extensor tendon (with entrapment)
- Symptoms reproduced by resisting supination with the elbow flexed to 90 degrees or resisting extension of the middle finger with the elbow extended
- Median nerve crosses the anterior elbow and passes between the heads of the pronatorteres muscle just distal to the joint
- Vulnerable to entrapment or compression d/t hypertrophy of the pronatorteres or activites that involve repetitive pronation
- Referred to as pronatorteres syndrome
Median Nerve Injury
Median Nerve Injury: s/s
- Pain radiating down the anterior forearm
- Numbness and tingling in the thumb, index and middle fingers
- Resistive pronation may increase pain
