week 7

Question 1

what is the elbows carrying angle

Answer 1

5-20 degrees

Question 2

what is the elbows flexionvROM

Answer 2

145 degrees.

Question 3

3 joints of the elbow

Answer 3

• Humero-ulnar joint
• Radio-humeral joint
• Superior radio-ulnar joint

Question 4

Humero-ulnar joint joint type

Answer 4

hinge joint

Question 5

what prevents lateral movement of the elbow

Answer 5

semi lunar notch

Question 6

head of radius held strongly in radial notch by

Answer 6

annular ligamanet

Question 7

annular ligament thicker where

Answer 7

more posteriorly than anteriorly

Question 8

4 major ligaments of elbow

Answer 8

• Ulnar collateral ligament
• Radial collateral
• Annular ligament
• Quadrate ligament

Question 9

Ulnar collateral Ligament

Answer 9

• Anterior oblique band – anterior medial epicondyle to coronoid process – ulnar nerve crosses this section
• Posterior band – posterior medial epicondyle to coronoid process
• Resists valgus force

Question 10

Nerves around the Elbow

Answer 10

• Median
• Radial
• Ulnar nerve

Question 11

Median Nerve travels

Answer 11

enters the arm from axilla at
the inferior margin passes vertically down and courses with brachial artery on medial side of arm between biceps and brachialis.
* Enters forearm anteriorly at Cubital fossa
* Continues into hand via carpal tunnel

Question 12

Radial Nerve course

Answer 12

• Travels through quadrangular space in axilla around the spiral groove
  humerus and emerges laterally
• Pierces lateral intermuscular septum /branches and travels between
  brachialis and brachioradialis
• In distal humerus travels anterior to lateral epicondyle

Question 13

Ulnar Nerve

Answer 13

• descends on the posteromedial
  aspect of the humerus
• Travels behind medial
  epicondyle (ulna tunnel)
• Enters anterior (flexor)
  compartment of the forearm
  through the two heads of flexor
  carpi ulnaris and runs
  alongside the ulna
• enters the hand via the ulnar
  canal

Question 14

radio-humeral joint closed pack position

Answer 14

90 degrees flexion 5 degrees supination

Question 15

radio-humeral joint loose pack position

Answer 15

extension and supination

Question 16

humeroular closed pack position

Answer 16

extension

Question 17

humeroular loose pack position

Answer 17

70 degrees flexion

Question 18

superior radio- ulnar joint closed pack position

Answer 18

5 degrees supination

Question 19

superior radio- ulnar joint loose pack position

Answer 19

70 ⁰flexion+ 35⁰ supination

Question 20

Factors limiting elbow movement. flexion

Answer 20

• Anterior muscle bulk
• Radial head and coronoid apposition and tension in posterior capsule
  and triceps

Question 21

Factors limiting elbow movement extension

Answer 21

• Olecranon opposition and tautness in ant oblique portion of ulnar
  collateral ligament and anterior capsule
• Biceps and brachial musculotendinous structures

Question 22

Factors limiting elbow movement rotation 85/ supination 75

Answer 22

annular ligament

Question 23

common lateral elbow pain

Answer 23

Lateral elbow
tendinopathy (tennis elbow)

Question 24

common medial elbow pain

Answer 24

Flexor tendinopathy
(Golfer’s elbow)

Question 25

common posterior elbow pain

Answer 25

Olecranon bursitis Triceps tendinopathy Posterior impingement

Question 26

what is the most common cause of dislocation

Answer 26

MVA then sporting injuries

Question 27

elbow dislocation MOI

Answer 27

FOOSH Elbow hyperextension Combination of valgus, supination and ER of forearm during axial loading

Question 28

elbow dislocation normally happen in which direction

Answer 28

posterior or posteriolateral

Question 29

elbow dislocations common in what age group

Answer 29

10-30 years old

Question 30

elbow dislocation pt presentation

Answer 30

* severe pain and supporting arm * forearm shortened with olecranon and radial head protruding posteriorly * soft tissue swelling and deformity * potential for damage to the brachial artery, median and ulnar nerves

Question 31

Associated Injuries from elbow dislocation

Answer 31

* avulsion of either medial or lateral epicondyle * coronoid and radial head fractures * osteochondral lesions

Question 32

Terrible Triad Injury

Answer 32

Terrible triad: posterior elbow dislocation + radial head # + ulna coronoid process #

Question 33

stable elbow fracture

Answer 33

* Stable – Most isolated elbow dislocations – Most radial head #

Question 34

Radial head subluxations (Nursemaid’s Elbow)

Answer 34

often sustained when the forearm is pronated * Dislocation head of the radius from the annular ligament that is often caused by an abrupt yanking of the arm. * In small children, held by a stronger adult

Question 35

Radial head subluxations (Nursemaid’s Elbow) symptoms

Answer 35

pain that presents low in the forearm away from the injury site, slight swelling, and the inability to supinate the forearm, or turn the hand palm-up * Child often complains of wrist pain

Question 36

Radial head fracture

Answer 36

* Most common fracture site in the elbow * Mechanism of injury similar to dislocation (i.e.FOOSH in pronation) * Fracture and damage to collateral ligaments are commonly linked.

Question 37

how is a radial head fracture diagnosed

Answer 37

* Diagnosis confirmed by X rays

Question 38

Medial Epicondyle Avulsion

Answer 38

Avulsion can occur via traction produced by forearm flexors rapid strong contraction of the forearm flexors is capable of avulsing the medial epicondyle in teenagers / young adult

Question 39

Medial Epicondyle Avulsion MOI

Answer 39

* Valgus strain of the joint, producing traction on the medial epicondyle through the flexor muscles or ulna collateral ligament * 50-65% of cases are associated with dislocation of the elbow * A FOOSH injury can result in sudden traction of wrist flexors * Hard pitching may also cause an avulsion

Question 40

Medial and lateral collateral ligament sprains associated with

Answer 40

awkward landing or twisting injury, or with throwing

Question 41

* Medial (ulna) collateral ligament

Answer 41

– Valgus force – Can be an overuse injury too

Question 42

* Lateral collateral ligament

Answer 42

– Not to be missed as an LCL injury can result in elbow instability – Often associated with trauma

Question 43

Olecranon Bursitis

Answer 43

* Often painless * +/- history of injury(direct blow) * noticeable swelling

Question 44

Olecranon Bursitis Causes

Answer 44

Fall on tip elbow Resting elbow on hard surface

Question 45

Olecranon Bursitis Signs and Symptoms

Answer 45

Large swelling /inflammation /pain/ slight limitation flexion

Question 46

Olecranon Bursitis Treatment

Answer 46

Avoid provocative activity /rest/ ice/ NSAID’s/compression