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The Elbow
Orthopedics
146
Other
Graduate
02/17/2010

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Cards

Term
What is the primary function of the of the elbow? 
Definition
To work together with the shoulder to position the hand for functional activities
Term
What are the three articulation of the elbow? 
Definition

1) Humeroulnar Joint

2) Radiocapitellar

3)Proximal  Radial Ulnar Joint 

Term
What is the Carrying angle for males? For Females?
Definition

Males = 11-14 degrees

Female= 13-16 degrees

Term
What is the articulation of the proximal Radioulnar joint? (2)
Definition

1) Convex radial head

2) fibrous osseous ring 

Term
The Humeral Ulnar Joint Capsule is             anteriorly and posteriorly to allow for flexion and extension.
Definition
1. loose
Term
The humeral ulnar joint capsule does not respond well to what? (2) 
Definition

1) Injury 

2) Immobilaztion

Term
What is the most important ligament in the elbow? 
Definition
UCL
Term
What does the UCL provide stabity against and in what degrees? 
Definition
valgus stress between 20 and 130 degrees. 
Term
What are the 3 components of the UCL ?
Definition

1) Anterior Bundle

2) Posterior Bundle 

3) Transverse Bundle

 

Term
What is the strongest band of the elbow ligaments?
Definition
Anterior Band
Term
In what degrees does the anterior band primarily stabilize? 
Definition
From 20- 120 degrees
Term
What degrees is the posterior band taut? 
Definition
55-60 degrees 
Term
The Posterior band is a primary restraint to which elbow motion? 
Definition
Passive elbow extension
Term
What does the UCL Posterior bundle provide?
Definition
Secondary resistance to valgus stress with flexion > 90 degrees
Term
What is another name for the UCL transverse Bundle?
Definition
Cooper's Ligament 
Term
What is the function of the UCL transverse bundle? 
Definition
it has little role in elbow stability 
Term
What does the Radial Collateral Ligament consist of? (4)
Definition

1) Annular Ligament 

2) RCL 

3) Accessory Collateral Ligament 

4) Lateral UCL 

 

Term
What is the function of the RCL? 
Definition
maintain ulnohumeral and radiohumeral joints in a reduced position when the elbow is loaded in supination
Term
What is the Function of the Annular Ligament? 
Definition
Maintain the relationship between the head of the radius and the humerus and ulna
Term

What is the function of the Quadrate Ligament? 

Definition
Structural Support to the proximal R-U Joint 
Term
What is the main bursae of the elbow? 
Definition
Olecranon Bursa
Term
What are the primary elbow flexors? (3) 
Definition

1) Biceps 

2) Brachialis

3) Brachioradialis

Term
What are the weak elbow flexors? (4)
Definition

1) Pronator Teres 

2) FCR

3) FCU

4) ECRL

Term
What are the primary elbow extensors? (2)
Definition

1) Triceps 

2) Anconeus

Term
What are the Primary Forearm pronators? (3) 
Definition

1) Pronator teres

2) Pronator Quadratus

3) FCR

Term
What are primary forearm supinators? (2)
Definition

1) Biceps

2) Supinator

Term
What is contained in the cubital tunnel? 
Definition
Ulnar nerve
Term
What is the 1) floor 2) Roof 3) Posterior Border 4) Anterior and 5) Lateral Borders of the cubital tunnel?
Definition

1) UCL

2) Aponeurosis and arcuate ligament

3) Medial Head of Triceps

4) Medial epicondyle 

5) Olecranon

Term
What are the contents of the cubital fossa? (5)
Definition

1) tendon of the bicep

2) Median Nerve

3) Brachial Artery 

4) Radial Nerve

5) Median Cubital Vein 

Term
What are the nerves of the elbow? (3) 
Definition

1) Median 

2) Radial 

3) Ulnar

Term
What is the peak acceleration of the elbow?
Definition
3000 Degrees/sec
Term
What is the functional ROM of the elbow?  
Definition
30-130 degrees
Term
What is the open pack position of the Humeralulnar joint? 
Definition
70 degrees of flexion with 10 degree of FA supination
Term
What is the close packed position of the Humeralulnar joint? 
Definition
Full and maximal supination 
Term
What is the capsular pattern for the humerulnar joint? 
Definition
much more limitation of flexion than extension
Term
What is the resting position for the humeroradial joint? 
Definition
extension and FA supination 
Term
What is the closed pack position of the Humeroradial Joint? 
Definition
90 degree of elbow flexion and 5 degrees of supination 
Term
What is the resting position of the R-U Joint?
Definition
70 degrees of flexion and 35 of FA supination 
Term

  • What is the close packed position of the R-U joint? 

Definition
5 degree of FA supination
Term
What is the capsular pattern of the R-U joint? 
Definition
minimal loss of motion, with px at end range of pronation and supination 
Term
What are the force couple of elbow extension/flexion? 
Definition
triceps and biceps
Term
What are the force couple of wrist flexion/extension? (3)
Definition
FCR,FCU,FDC/ECRL,ECRB,EC
Term
what are the force couples during pronation/supination? 
Definition
PT, PQ/ Supinator
Term
What is the MOI for lateral Epicondylosis? 
Definition
repetitive pronation/supination with elbow near extension 
Term
What is muscle is most frequently involved with Tennis Elbow? 
Definition
ECRB
Term
What may tennis elbow be associated with?
Definition
cervical/shoulder pathology esp c5-6 facilitated segment
Term
Where is a tennis elbow pt usually tender? (3)
Definition

1) ECRB

2) ED

3) ECRL

Term
What are differential dx of lateral epicondylosis? (7) 
Definition

1)Radial Nerve Entrapment

2) Elbow joint disease

3) Entrapment of interosseous nerve

4) OCD of RH jount 

5) Intra-articular loose body

6) Cervical dysfuction

7) Nerve Root Compression 

Term
What is stage 1 tennis elbow? 
Definition
inflammatory injury 
Term
What stage of tennis elbow is associated with changes and structural failure? 
Definition
Stage III
Term
What is Stage IV tennis Elbow? 
Definition
tendinosus and structural failure with fibrosis and hard calcification 
Term
What are the treatments for lateral epicondylitis? (9)  
Definition

1) Correct faulty mechanics

2) Cryotherapy 

3) Modality therapy 

4) NSAIDS

5) Therapeutic Exercise

6) Bracing 

7) Extracorporal Shockwave therapy 

8) Injection of Buffered platelet rich plasma

9) Surgery 

 

Term
What should you place emphasis on when performing therapeutic exercise for Lateral Epicondylitis?
Definition
Eccentric Exercise
Term
What is the appropriate size for a tennis racket grip? 
Definition
Proximal Palmer crease to the end of the ring finger. 
Term
What is Medial Epicondylosis? (Golfer's Elbow) 
Definition
overuse condition of the flexor/pronator mass
Term
What are three reason for golfer's elbow? 
Definition

1) Flexor/pronator fatigue

2) change in level of stress 

3) UCL fails to stabilize valgus force

Term
What is usually affected by golfer's elbow? (2) 
Definition

1) pronator Teres

2) Flexi Carpi Radialis

Term
What population does golfer's elbow usually affect? (3) 
Definition

1) golfers

2) racket players

3)throwing athletes

Term
When are sx usually reproduced for golfers elbow? (2)
Definition

1) resisted wrist flexion/pronation 

2) passive wrist extension/supination

Term
What are differential dx for golfer's elbow?(3) 
Definition

1) MCL insufficiency

2) Ulnar Nerve entrapment

3) Medial elbow intra-articular pathology 

Term
What are the rx for Medial Epicondylitis? 
Definition

1) Conservative 

2) Surgical 

Term
What is an UCL injury caused by? 
Definition
repetitive high-velocity valgus stress to medial aspect of elbow? 
Term
What is a common complaint of pt with UCL injury? 
Definition
losing significant throwing speed? 
Term
Where is the pain usually found in an UCL injury? 
Definition
Medially, localized to the ligament from the medial epicondyle to the sublime tubercle 
Term
Tenderness to the anterior band of the UCL usually differentiates between what 2 pathologies?  
Definition
differentiates between flexor-pronator group pathology and UCL laxity or tear. 
Term
What band of the UCL is usually affected in an UCL injury? 
Definition
Anterior band
Term
What is a good test to dx a UCL injury?
Definition
Moving Valgus Stress Test
Term
What can be used for the surgical reconstruction of an UCL? 
Definition

1) Palmaris Longus

2) Gracilis

3) Semitendinousus

4) Plantaris Longus

Term
What is little leager's elbow? 
Definition
an avulsion lesion of the medial apophysis
Term
What are the 4 areas of associated with little leager's elbow?
Definition

1) Medial Tension Overload

2) Lateral Articular Surface

3) Posterior Medial Shear Forces

4) Extension overload of lateral restraints 

Term
What may little leager's elbow be presented as? (6)
Definition

1) Panner's disease (necrosis of Capitellum)

2) OCD

3) Medial epicondylar Fx

4) Medial Apophysitis

5) UCL Rupture 

6) Posterior osteophyte formation 

Term
What are the treatments to little leager's elbow? (3) 
Definition

1) Rest 

2) Rehab 

3) Throwing avoided for 6-12 wks 

Term
What are the two classifications of olecranon bursitis? 
Definition

1) septic (infected) 

2) non septic (traumatic and idiopathic) 

Term
What is the MOI of Olecranon Bursitis? 
Definition

1) Blunt Trauma

2) Chronic repeated trauma with gradual fluid accumulation 

Term
What is the occurrence of 1)septic and 2)traumatic Olecranon Bursitis from a skin abrasion ?
Definition

1) Common 

2) Occasional 

Term

What is the occurrence of 1)septic and 2)traumatic Olecranon Bursitis from local warmth?

Definition

1) Common 

2) Rare

Term

What is the occurrence of 1)septic and 2)traumatic Olecranon Bursitis from local erythema?

Definition

1) Common 

2) Rare

Term
What are the Rx for olecranon bursitis? (5) 
Definition

1) Compression Dressing

2) Cryotherapy

3) Protective padding

4) Steroid Injection (nonseptic)

5) Antibiotic Therapy (septic) 

Term
What is the MOI of Bicipital Tendinosis? (3) 
Definition

1) Repetitive hyperextension with pronation

2) Repetitive flexion with stressful pronation/supination

3) Direct Blow

Term
Where will palpable tenderness be found for bicipital tendinosis? (3)
Definition

1) Distal Biceps belly

2) MT portion of biceps

3) Insertion at radial tuberosity 

Term
What sports is bicipital tendinosis found? (5)
Definition

1) Wt Lifting 

2) gymnastics

3) body building

4) Rock Climbing

5) throwing

Term
When is pain going to be felt for bicipital tendinosis? (2)
Definition

1) resisted elbow flexion 

2) Passive shoulder and elbow extension

Term
What is the Rx for Bicipital tendinosus? (5) 
Definition

1) Exercise and stretching for flexor/supinator mechanism

2) Strengthening of shoulder stabilizer

3) Modalities

4) Transverse friction Massage

5) Joint Mobs

Term
What is the MOI for Bicipital tendon Rupture? 
Definition
Sudden eccentric contraction of the biceps against a load with the elbow flexed 90 degrees
Term
Where does the rupture occur? (2) 
Definition

1) Musculo Tendonous juction

2) insertion to radial tuberosity 

Term
1)When and 2)who does a biceps tendon rupture occur? 
Definition

1) 5 decade

2) Males

Term
Where do a majority of biceps tendon rupture occur?
Definition
Proximally
Term
What are some clinical Findings of biceps tendon rupture? (3) 
Definition

1) Palpable defects

2) Ecchymosis

3) Loss of strength of elbow flexion/supination

Term
What can pt expects with a non surgical Rx of a biceps tendon Rupture? (2) 
Definition

1) 30% loss of elbow flexion strength

2) 40%-50% loss of supination strength

Term
What is triceps tendonosis? 
Definition
Overload injury due to repetitive extension
Term
Triceps Tendonosis is almost exclusively seen in what sex? 
Definition
Male 
Term
Where will tenderness be found? 
Definition
 triceps insertion of the olecranon
Term
In what motion will pain be found for triceps tendonosis? 
Definition
Resisted elbow extension
Term
What is the treatment for Triceps Tendonosis?
Definition
PRICEMEM
Term
What is the MOI for a Triceps Tendon Rupture? 
Definition

1) Deceleration force during extension 

2) uncoordinated contraction against the flexing elbow

Term
What are the signs for a triceps tendon rupture? (3) 
Definition

1) Pain 

2) Inability to extend elbow against gravity 

3) Tendon Defect

Term
What is the MOI for a Supracondylar Fracture? 
Definition

1)Hyperextension 

2) Fall on a flexed elbow

Term
The distal fragment is usually displaced           ?
Definition
1) Posteriorly 
Term
What are the signs of a Supracondylar Fx? 
Definition

1) Marked Swelling Above Elbow

2) Obvious Deformity 

3) Vascular/ Neural Complication 

Term
What is the Rx for a nondisplaced Supracondylar Fx? 
Definition
Sling For 3 Wks
Term
What is the Rx for a supracondylar Fx that has an angulation > 20%
Definition
Surgery
Term
What are complications of supracondylar fx? (6)
Definition

1) Neurovascular Injury 

2) Nonunion

3) Malunion 

4) Contracture

5) Px

6) decreased ROM 

Term
What is the MOI of Radial Head Fx? 
Definition
FOOSH with axial loading on the radial head
Term
What is a type I radial head Fx? 
Definition
Nondisplaced
Term
What type of radial head fx is associated with comminuted fx involving entire radial head? 
Definition
Type III
Term
What is a Type II Radial Head Fx? 
Definition
Partial Articulation with displacement 
Term
What type of radial head fx is associated with ligament injuries ?
Definition
Type IV
Term
What is the Rx for a type I Radial Head Fx? 
Definition

Splint up to 7 wks then allow flexion/extension motion

 

Term
What is the Rx for a Type II Radial Head Fx? 
Definition

1) Nosurgical, begin AROM with good reduction 

2) ORIF if > 30% surface involvement 

Term
What is the Rx for type III Radial Head Fx? 
Definition
Replace radial head with metal implant
Term
What is the treatment for a type IV radial head fx? 
Definition

1) Surgical repair with ORIF 

2) metallic radial head replacement 

Term
How long do you want to delay pronation/supination exercises? 
Definition
6 weeks
Term
What are complications with radial head fx? (4)
Definition

1) Loss of motion 

2) PIN injury

3) Radial Shortening

4) Synovitis

Term
What is a Monteggia Fracture/Dislocation? 
Definition
Combination fx of ulna and dislocation of radial head
Term
What is the MOI of a Monteggia Fx/Dislocation? (2)
Definition

1) Direct blow

2) FOOSH

Term
What is the most common type of Monteggia Fx/Dislocation?
Definition
Type I at 60%
Term

What is the MOI of olecranon Fx? (2)

 

Definition

1) Backward fall

2) FOOSH

Term
What are the signs of an olecranon Fx? (4)
Definition

1) Pain

2) Swelling

3) Palpable Gap 

4) Obvious Deformity

Term
What are the Treatment for a olecranon fx? 
Definition

1) < 1-2 mm displacement posterior splint with early motion 

2) ORIF

3) Fragment excision

Term
What are complications with an olecranon fx? (5)
Definition

1) Decreased ROM

2) Degenerative Joint Disease

3) Ulnar Nerve Neuropraxia

4) Instability 

5) Symptoms from hardware

Term
What is the MOI of a Coronoid Fx? 
Definition
 Hyperextension with joint capsule tension
Term
Coronoid fx occur in only    % of elbow dislocation.
Definition
10
Term
What type of coronoid fx are usually treated with ORIF? (2)
Definition

1) Type I 

2) type II

Term
What are the complication with coronid Fx? (2) 
Definition

1) Medial instability

2) DJD

Term
What are the 3 timing classification for an elbow dislocation? 
Definition

1) Acute 

2) Chronic

3) Recurrent

Term
What are the articulation involved in an elbow dislocation? (2)
Definition

1) Ulnohumeral Joint

2) Proximal R-U Joint

Term
What are the directions of displacement? (5) 
Definition

1) Valgus 

2) Varus

3) Anterior

4) Posterior 

5) Divergent

Term
what are the two MOI for Valgus displacement? 
Definition

1) Post-traumatic

2) Chronic Overload

Term
What are the 3 locations for Ulnar Nerve Entrapment? 
Definition

1) Proximal to Medial Epicondyle

2) Level of MEdial epicondyle

3) Distal to Medial Epicondyle

Term
What are the Etiology of Ulnar Nerve Entrapment? (4) 
Definition

1) Trauma

2) Rheumatic Changes in the medial epicondyle

3) DJD

4) Repetitive Microtrauma

Term
What are the signs of Ulnar Nerve Entrapment? (3)
Definition

1) Paresthesia Medial Hand

2) Hand Clumsiness

3) Hypothenar atrophy

Term
What are the Rx of ulnar nerve entrapment? 
Definition

1) Splinting at 30 degrees

2) Address Instability

3) Soft Tissue mobilization

4) Neural Mobilization

5) ADL assesment

6) Surgery 

 

Term
What are the four site of Median Nerve entrapment? 
Definition

1) Ligament of Struthers

2) Laceratus Fibrosus

3) Pronator Teres

4) Flexor Digitorum Superficialis

Term
What are the signs of median nerve entrapment? (3) 
Definition

1) Vague FA achiness

2) Hand paresthesias

3) Palmar side pain digits 1-4 

Term
What is the treatment of Median Nerve Entrapment? (5)
Definition

1) Splinting in Neutral Rotation 

2) Soft tissue mobilization 

3) Neural mobilization 

4) Ergonomic Assesment

5) Sugery

Term
What are the three sites of Anterior Interosseous Nerve syndrome? 
Definition

1) Accessory head Flexor Policis Longus

2) Palmaris Profundus

3) FCR

Term
What are the signs for Anterior Interosseous Nerve Syndrome? (3) 
Definition

1) FA pain 

2) Motor loss of FPL, pronator quadratus, and lateral half FDP

3) Unable to perform the OK sign

Term
What is the most injured peripheral Nerve?
Definition
Radial Nerve
Term
The radial nerve is commonly injured with what injury?  
Definition
Humeral Fx
Term
What does radial nerve entrapment usually involve? (2)
Definition

1) contusion

2) mild Stretch

Term
What are the two sites of Radial Nerve Entrapment? 
Definition

1) Lateral inermuscular septum 

2) Radial Tunnel 

Term
What are the 5 boundaries for the radial tunnel 
Definition

1) Fibrous Bands over radial head

2) Leash of Henry

3) ECRB

4) Arcade of Frohse

5) Supinator Exit

Term
What are the signs of radial nerve entrapment? (3)
Definition

1) Lateral Elbow Pain

2) Pain with Gripping 

3) Aching at night

Term
What is the most common site of compression? 
Definition
Arcade of Frohse
Term
What is the Rx for Radial Nerve entrapment? (4) 
Definition

1) Surgical Decompression

2) ST mobilization

3) Neural Mobilization

4) ADL assessment 

Term
What are the three symptoms of radial nerve entrapment? 
Definition

1) Tenderness when  palpating the radial tunnel anterior to the neck of the radius 

2) Reproduction of Symptoms with resisted supination

3) Lateral elbow pain with resisted extension of the ipsilateral middle finger

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