1
Q
WHat are the main joint of the elbow?
A
ulnohumeral
radiohumeral
superior radioulnar
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
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
4
Q
Ulnohumeral joint resting position
A
70 deg elbow flexion, 10 deg supination
5
Q
ulnohumeral joint close packposition
A
- extension with supination
6
Q
ulnohumeral joint capsular pattern
A
flexion, extension
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
8
Q
radiohumeral resting position
A
full extension and full supination
9
Q
radiohumeral joint close pack position
A
elbow flexed to 90 deg, forearm supinated to 5 deg
10
Q
radiohumeral joint capsular pattern
A
flexion,extension
11
Q
superior radioulnar joint
A
- uniaxial Pivot joint
- allows rotation of radius for pronation and supination
- annular ligament is the main ligament
12
Q
superior radioulnar resting position
A
70 deg elbow flexion, 35 deg supination
13
Q
superior radioulnar close pack position
A
5 deg supination
14
Q
superior radioulnar capsular pattern
A
equal limitation of supination and pronation
15
Q
elbow joint capsule
A
- anterior capsule usually thin
- taut in ectension
- lax in flexion
- collateral ligaments reinforce capsule laterally and medially
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
17
Q
Lateraal Ligament Complex
A
- 4 main components
- Radial collateral ligament
- lateral ulnar collateral ligament
- accessory collateral ligament
- annular ligament
18
Q
Radial collateral ligament
A
-taut throughout flexion and extension
19
Q
lateral ulnar collateral ligament
A
-primary restraint to varus stress
20
Q
annular ligament
A
- keeps the radial head in contact with ulna
- anterior portion is tight with supination
- posterior portion tight with pronation
21
Q
elbow flexors muscle
A
- biceps
- brachialis
- brachioradialis
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
elbow bursae
- there are numerous bursae in elbow
| - superficial olecranon bursa commonly injured
26
radial nerve course C6-C8
- 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
ulnar nerve course
- 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
musculocutaneous nerve C5-C7
- innervates Biceps and brachialis
- Travels lateral to the biceps tendon
- Terminates as the lateral antebrachial cutaneous nerve
29
median nerve course C5-T1
- 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
radial nerve entrapment sites
- radial groove
- radial head
- arcade of Froshe
- Supinator
31
ulnar nerve entrapment sites
- arcade of Struthers
- Cubital Tunnel
- Flexor carpiUlnaris
32
musculocutaneous nerve entrapment site
-Biceps tendon Brachial fascia
33
median nerve entrapment site
- Ligament of struthers
- Bicipital aponeurosis
- pronator teres
34
Possible sources causing pain in posterior elbow
- 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
Possible sources causing pain in Anterior Central Deeo
- 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
Possible sources causing pain in medial elbow
- 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
Possible sources causing pain in Lateral elbow
- 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
Colles fracture
-distal radius fracture with the distal component dorsal "silver fork"
- -most common fracture of forearm
- mechanism of injury is fallen and outstretched arm
39
Smith's fracture
- distal radius fracture with the distal component volar
| - mechanism: fall and an outstretched arm
40
Volkmans Ischemic contractures
-Anterior compartment syndrome
41
monteggia
Proximal ulnar fracture with radial head dislocation
42
Pulled ELbow/" Nursemaid elbow"
-Mechanism of injury: a young child lifted with the forearm pronated
43
Radial Head Dislocation
-Mechanism of injury: forceful contraction of the biceps
44
humero-ulnar dislocation
-Mechanism: fall on an outstretched arm, posterior sublaxation. hyperextension injury
45
Osteoarthritis
- medial aspect of the olecranon fossa and process
| - radial head
46
Rheumatoid arthritis
-destructive erosion of the annular ligament with radial head dislocation
47
Panner's Disease/ osteochondritis Dissecans
-erosive arthropathy of the capitulum,oesteochondrosis, could lead to avascular necrosis
48
Tommy John injury
-Rupture of the medial collateral ligament and ulnar neuropathy
49
Little league elbow
-osteochondritis of the medial epicondyle, growth plate. injury is exacerbated if trying to throw curveballs
50
Myositis Ossificans
- 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
lateral epicondylitis "Tennis elbow"
- Primarily the common extensor tendon with the extensor carpi radialis brevis predominating
- the supinator muscle is another reason for lateral epicondylitis
52
medial epicondylitis "golfers elbow"
-the common flexor tendon
53
Elbow bursitis
olecranon "goose egg elbow"
| -mechanism: trauma
