Elbow pre class Flashcards

1
Q

WHat are the main joint of the elbow?

A

ulnohumeral
radiohumeral
superior radioulnar

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2
Q

Ulnohumeral joint

A
  • uniaxial hinge joint
  • b/w trochlear notch of ulna and trochlea of humerus
  • trochlea is asymmetrical
  • joint gaps medially in full extension and laterally in full flexion
  • joint glides side to side in pronation and supination
  • —> ulna rotates internally 5deg in early flexion, ulna rotates externally 5 deg in end range flexion
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3
Q

axis of motion of the ulnohumeral joint

A
  • axis is downward and medial
  • -carrying angle 10-15 deg in men
  • -carrying angle 20-25 deg in women
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4
Q

Ulnohumeral joint resting position

A

70 deg elbow flexion, 10 deg supination

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5
Q

ulnohumeral joint close packposition

A
  • extension with supination
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6
Q

ulnohumeral joint capsular pattern

A

flexion, extension

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7
Q

Radiohumeral Joint

A
  • uniaxial hinge joint
  • B/w head of radius and capitulum
  • rafdial collateral ligament provides lateral stability
  • trauma here may interfere with flexion and extension
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8
Q

radiohumeral resting position

A

full extension and full supination

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9
Q

radiohumeral joint close pack position

A

elbow flexed to 90 deg, forearm supinated to 5 deg

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10
Q

radiohumeral joint capsular pattern

A

flexion,extension

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11
Q

superior radioulnar joint

A
  • uniaxial Pivot joint
  • allows rotation of radius for pronation and supination
  • annular ligament is the main ligament
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12
Q

superior radioulnar resting position

A

70 deg elbow flexion, 35 deg supination

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13
Q

superior radioulnar close pack position

A

5 deg supination

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14
Q

superior radioulnar capsular pattern

A

equal limitation of supination and pronation

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15
Q

elbow joint capsule

A
  • anterior capsule usually thin
  • taut in ectension
  • lax in flexion
  • collateral ligaments reinforce capsule laterally and medially
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16
Q

medial ligament Complex

A
  • anterior Bundle
  • Posterior Bundle
  • Transverse Bundle
  • some portion of the complex is always taut
  • anterior is the strongest valgus stress restraint
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17
Q

Lateraal Ligament Complex

A
  • 4 main components
  • Radial collateral ligament
  • lateral ulnar collateral ligament
  • accessory collateral ligament
  • annular ligament
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18
Q

Radial collateral ligament

A

-taut throughout flexion and extension

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19
Q

lateral ulnar collateral ligament

A

-primary restraint to varus stress

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20
Q

annular ligament

A
  • keeps the radial head in contact with ulna
  • anterior portion is tight with supination
  • posterior portion tight with pronation
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21
Q

elbow flexors muscle

A
  • biceps
  • brachialis
  • brachioradialis
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22
Q

elbow extensor muscles

A
  • triceps

- anconeus

23
Q

elbow extensor-supinator muscles

A
  • supinator
  • ECRL
  • ECRB
  • extensor digitorum communis
  • ECU
24
Q

elbow flexor-pronator muscles

A
  • pronator teres
  • FCR
  • Palmaris longus
  • FCU
  • flexor digitorum superficialis
25
Q

elbow bursae

A
  • there are numerous bursae in elbow

- superficial olecranon bursa commonly injured

26
Q

radial nerve course C6-C8

A
  • Innervates triceps
  • travels ant. to lateral epicondyle
  • just proximal to elbow it splits into superficial and deep
  • superficial is sensory
  • deep become PIN
  • innervates ext/supinator
  • superficial branch courses under branchioradialis and over supinator and pronator
  • PIN may course in between supinator
  • in 30% of population, Radial n. course through arcade of FRoshe, just proximal to supinator
27
Q

ulnar nerve course

A
  • From C8-T1 nerve roots
  • Passes through upper arm “arcade of struthers” about 8 cm proximal to medial epicondyle
  • enters elbow in cubital tunnel just post. to medial epicondyle
  • enters elbow in cubital tunnel just post. to medial epicondyle
  • innervates medial capsule
  • courses trhough 2 heads of FCU
  • Innervates FCU, ring +small finger of FDP and most of hand intrinsics
28
Q

musculocutaneous nerve C5-C7

A
  • innervates Biceps and brachialis
  • Travels lateral to the biceps tendon
  • Terminates as the lateral antebrachial cutaneous nerve
29
Q

median nerve course C5-T1

A
  • travels medially along arm over the brachialis
  • into anteromedial aspect of elbow
  • if present median n. can be entrapped in ligament of struther
  • Cont. under bicipital aponeurosis into pronator teres
  • Gives rise to AIN and innervates flexor-pronator group
30
Q

radial nerve entrapment sites

A
  • radial groove
  • radial head
  • arcade of Froshe
  • Supinator
31
Q

ulnar nerve entrapment sites

A
  • arcade of Struthers
  • Cubital Tunnel
  • Flexor carpiUlnaris
32
Q

musculocutaneous nerve entrapment site

A

-Biceps tendon Brachial fascia

33
Q

median nerve entrapment site

A
  • Ligament of struthers
  • Bicipital aponeurosis
  • pronator teres
34
Q

Possible sources causing pain in posterior elbow

A
  • humero-ulnar articulation
  • humero-ulnar/olecranon synovitis/bursitis
  • triceps tendon insertion tendinitis/strain/tear
  • extrinsic sources: C7 somatic referral, C7 radicular referral, Dysfunction in neural tissue mobility
35
Q

Possible sources causing pain in Anterior Central Deeo

A
  • humero-ulnar articulation; whole joint or coronoid process of ulna on trochlea of humerus
  • Biceps/brachialis tendon insertion strain/tendinitis/tear
  • bursitis
  • extrinsic sources: C5 somatic referral, C5 radicular referral, Dysfunction in neural tissue mobility, G-H joint referral
36
Q

Possible sources causing pain in medial elbow

A
  • humero-ulnar articulation
  • medial collateral ligament complex
  • origin of common flexor group tendinitis/strain/tear
  • extrinsic sources: C8/T1 somatic referral, C8/T1 radicular referral, Ulnar nerve mobility issue
37
Q

Possible sources causing pain in Lateral elbow

A
  • Humero-radial articulation
  • superior radio-ulnar articulation
  • radial head/annular ligament
  • lateral collateral ligament complex
  • origin of common extensor group
  • supinator tendinitis/strain/tear
  • Extrinsic factors C5/6 somatic referral
  • C5/6 radicular referral
  • Radial nerve mobility issues
  • G-H joint referral
38
Q

Colles fracture

A

-distal radius fracture with the distal component dorsal “silver fork”

  • -most common fracture of forearm
  • mechanism of injury is fallen and outstretched arm
39
Q

Smith’s fracture

A
  • distal radius fracture with the distal component volar

- mechanism: fall and an outstretched arm

40
Q

Volkmans Ischemic contractures

A

-Anterior compartment syndrome

41
Q

monteggia

A

Proximal ulnar fracture with radial head dislocation

42
Q

Pulled ELbow/” Nursemaid elbow”

A

-Mechanism of injury: a young child lifted with the forearm pronated

43
Q

Radial Head Dislocation

A

-Mechanism of injury: forceful contraction of the biceps

44
Q

humero-ulnar dislocation

A

-Mechanism: fall on an outstretched arm, posterior sublaxation. hyperextension injury

45
Q

Osteoarthritis

A
  • medial aspect of the olecranon fossa and process

- radial head

46
Q

Rheumatoid arthritis

A

-destructive erosion of the annular ligament with radial head dislocation

47
Q

Panner’s Disease/ osteochondritis Dissecans

A

-erosive arthropathy of the capitulum,oesteochondrosis, could lead to avascular necrosis

48
Q

Tommy John injury

A

-Rupture of the medial collateral ligament and ulnar neuropathy

49
Q

Little league elbow

A

-osteochondritis of the medial epicondyle, growth plate. injury is exacerbated if trying to throw curveballs

50
Q

Myositis Ossificans

A
  • Widespread ossification of connective tissue
  • episodes of fever and soft-tissue inflammation
  • tissues can harden
  • often in early childhood or after trauma
  • Maybe from massage or STM too early in rehab
  • Lack of RICE after injury
  • Brahcialis
  • biceps brachii
  • Triceps
  • STOP MASSAGING AND USING HEAT!!
51
Q

lateral epicondylitis “Tennis elbow”

A
  • Primarily the common extensor tendon with the extensor carpi radialis brevis predominating
  • the supinator muscle is another reason for lateral epicondylitis
52
Q

medial epicondylitis “golfers elbow”

A

-the common flexor tendon

53
Q

Elbow bursitis

A

olecranon “goose egg elbow”

-mechanism: trauma