MSK Elbow

Question 1

Name the normal elbow ranges of motion: 
Flexion: 
Extension: 
Supination: 
Pronation:

Answer 1

F: 135
E 0-5
Sup 90
Pron 90

Question 2

Name the 3 elbow joint articulations

Answer 2

humeroulnar joint
humeroradial joint
proximal radioulnar joint

Question 3

Name the 4 elbow flexors

Answer 3

1. Brachialis (musculocutaneous nerve - LC, C5-C7)
2. Biceps brachii (musculocutaneous nerve - LC C5-C6)
3. Brachioradialis (radial nerve, PC C5-7)
4. Pronator teres (median nerve, LC C6/7)

Question 4

Name the two elbow extensors

Answer 4

1. Triceps (radial nerve, PC C6-8)

2. Anconeus (radial nerve, PC C7-T1)

Question 5

Name the 2 forearm supinators

Answer 5

1 supinator (PIN - radial nerve, PC C5/6)
2. Biceps brachii (musculocutaneous nerve, LC C5/6)

Question 6

Name the 3 forearm pronators

Answer 6

1. Pronator quadratus (AIN, Median n, C7-T1)
2. Pronator teres (median n, LC; C6/7)
3. FCR (median n, LC C6/7)

Question 7

Name the three elbow ligaments

which is key stabilizer?

Answer 7

1. medial (ulnar) collateral ligament - MCL
   - key stabilizer of elbow joint (anterior band)
2. Lateral (radial) collateral ligament - LCL
3. Annular ligament
   - holds radial head in proper position

Question 8

Name the 6 muscles originating at the medial epicondyle of the humerus

Answer 8

FCR 
FDS
FDP
palmaris longus
pronator teres
FCU

Question 9

name the 6 muscles originating at the lateral epicondyle of the humerus

Answer 9

ECR-Longus
ECR-Brevis
ECU
EDS
Supinator
Anconeus

Question 10

The ____ is the anatomic valgus angulation between the upper arm and forearm when the arm is fully extended

Answer 10

carrying angle

Question 11

Normal carrying angle:
Male:
Female:
Angle > _____ is abnormal

Answer 11

Males: 5 degrees of valgus
Females: 10-15 degrees of valgus
>20 degrees is abnormal

Question 12

Indications for elbow arthrodesis? - 2

Fusion positions?

Answer 12

1. arthritis
2. failed surgical procedure

• unilateral - flexion 90 degrees
• bilateral - flexion 110 in one arm and 65 for the other.

Question 13

_____ also known as golfers elbow, little leaguer’s elbow (children) or pitchers elbow

Answer 13

medial epicondylitis

Question 14

Medial epicondylitis is caused by _____

Answer 14

repetitive valgus stress on theelbow.

Question 15

medial epicondylitis is seen in pitchers during______ phases and golfers during _____

Answer 15

Pitchers
- late cocking and acceleration phase

Golfers
- swing- back swing and downward follow-through swing just prior to ball contact.

Question 16

Name the 4 phases of pitcher’s throw

Answer 16

1. early cocking phase
2. late cocking phase
3. acceleration phase
4. follow-through

Question 17

Little leaguer’s elbow can lead to (3) and could result in _______ which cannot be overlooked

Answer 17

1. medial epicondylitis
2. medial epicondyle apophysitis
3. traction apophysitis - as a result of microtrauma

can have hypertrophy of the medial epicondyle leading to microtearing and fragmentation of the medial epicondylar apophysis.

***may lead to osteochondritis dissecans of the capitellum

Question 18

Pathology?

• tenderness just distal to the medial epicondyle over the common flexor tendon origin
• may be reproduced with resisted wrist flexion and pronation
• Ulnar neuropathy symptoms may occur secondary to valgus stretch of the nerve

Answer 18

Medial epicondylitis

Question 19

_____ is also known as tennis elbow

Answer 19

lateral epicondylitis

Question 20

What is mechanism of injury for lateral epicondylitis?

Answer 20

activities that require repetitive wrist extension and or forearm supination.

Question 21

What three poor techniques can preceed lateral epicondylitis in racquet sports?

Answer 21

1. improper technique for backhand swings
2. inappropriate string tension
3. inappropriate grip size.

Question 22

Lateral epicondylitis is due to chronic microtearing of which muscle tendon?

Answer 22

ECR-Brevis

Question 23

What pathology?

tenderness just distal to the lateral epicondyle at the extensor tendon origin

pain and weakness in grip strength

Answer 23

lateral epicondylitis

Question 24

What are the two provocative tests for lateral epicondylitis

Answer 24

1. Cozens test - examiner stabilizes the elbow with the thumb over the extensor tendon origin just distal to the lateral epicondyle. Pain in the lateral epicondyle is seen with the patient making a fist, pronating the forearm, and radially deviating and extending the wrist against resistance by the examiner. (the test may be more sensitive when done in full extension at the elbow)
2. Mill’s Test - passive extension of the elbow with forced flexion of the wrist with radial deviation may precipitate pain at the lateral epicondyle

Question 25

What is the surgical procedure for lateral epicondylitis

Answer 25

ECRB debridement

Question 26

Lateral epicondylitis - post treatment return to play, the player should (2)

Answer 26

1. increase grip size | 2. decrease string tension to <55lbs

Question 27

_____ is also known as draftsmans elbow, students elbow, or miners elbow

Answer 27

olecranon bursitis

Question 28

Mechanism of injury for olecranon bursitis

Answer 28

repetitive trauma, inflammatory disorder (gout, pseudogout, RA)

Question 29

_____ is the most common type of dislocation in children and 2nd most common type in adults (second to shoulder)

Answer 29

dislocation of the elbow

Question 30

dislocation of the elbow Adults _____ yoa are most affected sports activities account for almost ____% of these injuries

Answer 30

25-30 | 50%

Question 31

elbow dislocation | _____ direction is most common, occuring 98% of the time

Answer 31

posterior

Question 32

Associated injuries with elbow dislocation include 3

Answer 32

1 fracture of radial head 2. injury to brachial artery 3. median nerve

Question 33

4 potential adverse outcomes after elbow dislocation

Answer 33

1. loss of ROM, especially extension 2. ectopic bone formation 3. neurovascular injury 4. Arthritis of the elbow

Question 34

____ is caused by overloading of the biceps tendon, commonly due to repetitive elbow flexion and supination or resisted elbow extension

Answer 34

distal biceps tendonitis

Question 35

_____ is an overuse syndrome secondary to repetitive elbow extension

Answer 35

triceps tendonitis

Question 36

____ is due to decelerating counterforce during active elbow extension

Answer 36

triceps avulsion

Question 37

____ is a spectrum of overuse elbow injuries in baseball players caused by repetitive valgus forces during the throwing motion, especially in cocking and accelleration phase of throwing.

Answer 37

Valgus extension overload (VEO) syndrome of the elbow

Question 38

In valgus extension overload (VEO) syndrome, valgus force causes tensile stress in the _____ elbow and lateral shear stress in the _____ aspect of the elbow

Answer 38

``` medial elbow Posterior aspect (posteromedial olecranon) ```

Question 39

What is the provacative test for valgus extension overload (VEO) syndrome?

Answer 39

VEO test: flex elbow to 30 degrees and repeatedly extend the elbow fully while applying valgus stress. Pain may be elicited, particularly at the last 5-10 degrees of extension. Valgus stress test should also be performed at greater than 90 degrees to rule out MCL injury

Question 40

______ occurs with repetitive valgus stress occurring across the elbow most prominently during the acceleration phase of throwing

Answer 40

medial ulnar collateral ligament sprain (MCL)

Question 41

In elbow MCL injury, there is inflammation of ______ band of ulnar collateral ligament which is the segment that provides the majority of valgus stability

Answer 41

anterior bandd

Question 42

in MCL sprain ____ will occur on testing if UCL is torn

Answer 42

medial pain or instability on valgus stress with elbow flexed 20-30 degrees valgus stress test is definitive test but should also perform VEO test to differentiate between UCL injury and VEO syndrome

Question 43

Valgus stres radiographs demonstrate a ______ joint space suggestive of UCL injury

Answer 43

2mm

Question 44

after elbow dislocation after a traumatic event, ____ ligament sprain can occur

Answer 44

lateral (radial) collateral ligament sprain

Question 45

Pathology? recurrent locking or clicking of the elbow with extension and supination. Lateral pain or instability with varus stress with the elbow flexed 20-30 degrees

Answer 45

Lateral (radial) collateral ligament sprain; will have instability on varus stress if RCL is torn

Question 46

What are the two provocative tests for lateral (radial) collateral ligament (LCL) sprain?

Answer 46

1. Varus stress test - tenderness over lateral aspect of elbow, which may be increased with a varus stress 2. Lateral pivot-shift test - assesses the RCL for posterolateral instability

Question 47

Pronator syndrome is a ____ compression at the elbow

Answer 47

median

Question 48

what four structures may cause compression of the median nerve at the elbow in pronator syndrome

Answer 48

1. ligament of struthers or supracondylar spur 2. lacertus fibrosus 3. pronator teres muscle 4. beween two heads of FDS

Question 49

Pathology? - dull aching pain in proximal forearm just distal to the elbow - numbness in median nerve distribution of the hand.

Answer 49

pronation syndrome - symptoms will be exacerbated by pronation

Question 50

name the four structures that can compromise the ulnar nerve at the elbow

Answer 50

cubital tunnel syndrome: - arcade of struthers - hypermobility of the ulnar nerve - excessive valgus force at the elbow - impingement from osteophytes or loose bodies

Question 51

pathology? - medial forarm aching pain with parasthesias radiating distally to the fourth and fifth digits. - weakness in the ulnar innervated hand intrinsic musculature: weak grip strength, muscle atrophy - positive tinel's at the elbow - positive froment sign

Answer 51

cubital tunel syndrome froments sign - pincer grip test - assesses flexor pollicis longus

Question 52

____ is epiphysial aseptic necrosis of the capitellum

Answer 52

osteochondrosis of the elbow (Panners disease)

Question 53

etiology of osteochondrosis of the elbow? panners disease

Answer 53

believed to be caused by interference in blood supply to epiphysis, leading to resorption of the ossification center initially followed by repair/replacement

Question 54

osteochondrosis of the elbow (Panners disease) 1. will have tenderness and swellingon ____ aspect of elbow 2. usually seen in _____ elbow of ____(sex)

Answer 54

lateral | dominant elbow - boys

Question 55

what is conservative treatment for humeral shaft fractures?

Answer 55

splint for 2 weeks

Question 56

complication of concern in humeral shaft fractures?

Answer 56

radial nerve injury - 95% of patients will regain their nerve function within 6 months

Question 57

five complications of distal humerus fractures

Answer 57

1. neurovascular injury 2. nonunion 3. malunion 4. elbow contracture 5. poor ROM

Question 58

dislocations of the elbow are commonlyassociated with ____

Answer 58

radial head fractures typically occurs after fall on outstretched arm.

Question 59

Name the 3 types of radial head fractures and treatment for each`

Answer 59

Type I nondisplaced - shrot period of immobilization (3-5 days) followed by early ROM Type II Marginal radial head fracture, minimal displacement - surgical fixation for fracture greater than 2mm displacement or 30% radial head involvement Type III comminuted fracture - surgical fixation

Question 60

____ nerve might be involved in olecrenon fractures

Answer 60

ulnar nerve