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What is the primary joint for flexion and extension?
humeroulnar jt (HU)
What joint moves with flex/ext but primarily affects pronation/supination?
humeroradial jt (HR)
What joint participates in pronation/supination?
proximal radioulnar jt (RU)
What 3 joints are commonly considered the elbow joint?
- proximal radioulnar
What are the characteristics of the mid radioulnar jt?
radius and ulna work together to allow pronation/supination
not a true joint..soft tissues move
What motions do the distal radioulnar jt allow?
What type of jt is the humeroulnar jt?
modified hinge....really a saddle jt
What are the concave/convex bony partners of the humeroulnar jt?
- trochlea of humerus - convex (ant/post)
- trochlea fossa of ulna - concave
concave bony partner moving
During flexion/extension of the humeroradial jt, in which direction is the slide?
concave trochlea fossa slides in the same direction as the mvmt of ulna
What mvmt also occurs at the humeroulnar jt to allow for full elbow ROM?
medial and lateral gliding
What type of angulation occurs with elbow extension?
What type of angulation occurs with elbow flexion?
When the HU jt is moving in a medial/lateral direction, what type of joint does it become, and what are the convex/concave bony partners?
becomes a saddle jt (varus/valgus)
- trochlear ridge of ulna - convex
- trochlear groove of humerus - concave
sliding motion is opposite of bone mvmt
With the HU jt, what direction is the slide of the ulna during flexion?
With the HU jt, what direction is the slide of the ulna during varus angulation (flexion)?
With the HU jt, what direction is the slide of the ulna during extension?
With the HU jt, what direction is the slide of the ulna during valgus angulation (extenstion)?
What is the resting position (loose pack postion) of the HU joint?
70 flexion, 10 supination
What is the close packed postion of the HU jt?
full extension and full supination
What is the capsular pattern of the HU jt?
flex > ext
What type of jt is the humeroradial jt?
What are the convex/concave bony partners of the humeroradial jt?
- capitulum of humerus - convex
- head of radius - concave
slide moves in the same direction as the bone mvmt
With the HR joint, which direction is the slide during pronation/supination?
- one of the few jts with a true spin
- transverse plane
With the HR joint, which direction is the slide during flexion?
With the HR joint, which direction is the slide during extension?
With the HR joint, which direction is the slide during supination?
With the HR joint, which direction is the slide during pronation?
What is the resting position for the HR jt?
elbow extension and full supination
(closed pack position for the HU jt)
What is the closed pack position for the HR joint?
90 flexion, 5 supination
What is the capsular pattern for the HR joint?
flex > ext
What are the convex/concave bony partners int he proximal radioulnar jt?
- rim of radial head - convex
- radial notch of the ulna - concave
slide is opposite the direction of mvmt
With the proximal RU joint, the slide moves in which direction during pronation?
With the proximal RU joint, the slide moves in which direction during supination?
During rotation, what does the radius spin on?
annular ligament and against the capitulum
What are the convex/concave bony partners of the distal radioulnar jt?
- head of ulna - convex
- ulnar notch of radius - concave
slide is the same direction as bone mvmt
With the distal RU jt, which direction is the slide during pronation?
With the distal RU jt, which direction is the slide during supination?
When the arm is extended in the anatomical position, the longitudinal axis of the elbow and forearm form a lateral valgus angle called what?
What is the normal carrying angle?
Where does the carrying angle allow the elbow to fit?
fit closely into the depression at the waist immediately superior to the iliac crest
What is an abnormal (severe/excessive) carrying angle called?
can be caused by epiphyseal damage secondary to lateral epicondylar fracture and may cause a delayed nerve palsy, which presents in the ulnar nerve distribution in the hand
What is a decrease in the carrying angle of the arm?
- cubitus varus (gun stock deformity) (varus angle)
- more common than cubitus valgus
often a result of trauma such as supracondylar fracture in a child where the distal end of the humerus is subject to either malunion or growth retardation at the epiphyseal plate
What are the characteristics/symptoms of ulnar nerve compression?
ulnar border of hand, little finger, and ulnar half of ring finger sensory changes (in cutaneous distribution)
overuse of flexors, pressure of the ulnar nerve at the cubital tunnel
nerve is superficial to olecranon fossa, post to medial epicondyle and covered by fibrous sheath then passes between the heads of the flexor carpi ulnaris
What are the symptoms/characteristics of radial nerve distribution?
progressive weakness in the wrist and finger extensor and supinator muscles
deep branch of nerve may become entrapped as it passes under the edge of the extensor carpi radialis brevis and fibrous slit of supinator, or injured with radial head fracture
superficial nerve may recieve direct trauma that causes sensory changes in the lateral aspect of the forearm and the radial side of the dorsum of the wrist and hand and radial 3 1/2 digits
What are the symptoms/characteristics of median nerve compression?
- very common
- nerve runs deep in the cubital fossa medial to the tendon of the biceps and brachial artery the progresses between the ulnar and humeral head of pronator teres and dips under the flexor digitorum profundus
- can affect pronation/supination
- entrapment occurs between head of pronator teres causing sensory changes duplicating carpal tunnel syndrome (palmar aspect of the first 3 fingers and 1/2 the ring finger, and dorsal aspect of the distal phalanges of index and ring finger
What disorder occurs when the radial head is pushes proximally in the annular ligament and impinges against the capitulum, commonly from falling on an outstretched hand?
limited flexion (some) or extension of elbow, linmited wrist flexion and limited pronation
What disorder occurs when the radial head is dislodged down farther from the annular ligament and limits supination?
- pain in elbow region following a forceful traction to the forearm (parent pulling a childs arm)
- usually seen as acute injury in children
- AKA "nurse maids elbow"
What disorder causes pain in the common wrist extensor tendons along the lateral epicondyle and radiohumeral joint?
lateral epicondylitis (tennis elbow)
activities with repeated wrist extension (tennis, pullin weeds, requires firm wrist stability) can inflame the musculotendinous unit
What disorder causes pain in the common flexor/pronator tendon near the medil epicondyle?
medial epicondylitis (golfers elbow)
repetitive mvmts into wrist flexion (golf, pitching, work related grasping)
Which overuse disorder (lateral/medial epicondylitis) is most common?
What is the special test for ligamentous stability?
- check for tears in medial/lateral epicondylitis (check stability)
- (+) if too much play/too much motion
hold pts elbow in your hand, and push the sides of the elbow in one direction, check for gapping, repeat on opposite side
What is the special test for the tinel sign?
- check for elicit tenderness over a neuroma within a nerve
- (+) if tapping on the ulnar nerve (groove between olecranon and medial epicondyle) creates tingling sensations down the forearm to the ulnar distribution of the hand (reproduces pts symptoms = neuroma/extra senstivity)
What is the special test for the tennis elbow test?
- check for tennis elbow
- (+) if reproduces pain of tennis elbow- sudden severe pain at lat epicondyle
have pt extend arm, and wrist then apply pressure at the wrist (try to force into flexion)