MS II 9 - elbow

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Author:
shmvii
ID:
205132
Filename:
MS II 9 - elbow
Updated:
2013-04-14 13:58:08
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MS II
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Description:
rosen & pivko spring
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  1. humeral-ulnar jt - what type?
    saddle
  2. humeral-radial jt - what type?
    ball and socket
  3. sup radio-ulnar jt - what type?
    trochoid joint / pivot joint
  4. trochoid / pivot joint def
    • a synovial joint in which one bone pivots within a bony or an osseoligamentous ring,  allowing only rotary movement;
    • ex: the joint between the first and second cervical vertebrae, and the sup radio-ulnar joint
    • Called also rotary joint.
  5. inf radio-ulnar jt - what type?
    trochoid/pivot
  6. the long joint between radius and ulna - tell me about it?
    syndesmosis w interosseus membrane
  7. ginglymus jt def
    • hinge joint
    • articular surfaces are molded to each other in such a manner as to permit motion only in one plane
  8. elbow jt is arguably ginglymus, but functions as tho __
    saddle joint - it has too much mvmnt to be hinge or uniaxial
  9. what kind of joint is the elbow?
    compound (not complex bc no disk)
  10. 3 joints that make up the elbow
    • humero-ulnar (saddle jt)
    • humero-radial (ball n socket)
    • sup radio-ulnar (trochoid)
  11. at the elbow, flex/ext abd/add, sup/pron happen at which joints?
    • flex/ext: hum-uln
    • abd/add: hum-uln
    • sup/pron: hum-rad
  12. trochlea capitulum - which is where?
    • troch is medial w ulna
    • capitulum is lat w radius
  13. how is the trochlea angled? why?
    45 degrees ant to promote flexion
  14. contours fo trochlea
    • ant post it's convex
    • med to lat it's concave
  15. end feel of elbow extension/flexion?
    • ext: bony bc of olecranon hitting olecranon fossa
    • flex: muscular, - only bone on bone if there's no muscle mass
  16. contour of radial head?
    rel of radius to capitulum?
    • concave
    • concave on convex
  17. prox rel of radius to ulna contours
    • convex on concave (the radial notch of the ulna is concave)
    • radial head spins in this notch
  18. annular lig
    • attaches only to the ulna, not at all to radius
    • attaches ant and post to ulna and surrounds the radius, protects it, keeps it close to ulna
  19. distal radio ulnar jt contours
    • radius to ulna: concave to conves
    • the ulnar notch of the radius is concave, and the ulnar head is convex
  20. where do the ulna and radius see a disk?
    • at the distal radio-ulnar joint
    • there's a triangular disc there
  21. tell me about the triangular disc at the distal radio-ulnar joint?
    • it reinforces the joint
    • fills the gap btwn distal ulna & prox carpals
    • gets reinforced by ant & post RU ligs
    • it's a space filler
    • stabilizes wrist
    • shock absorber
  22. if the disc at the distal radio-ulnar jt is present, what's the wt distribution? if it's not?
    • w disk: radius bears 60% ulna 40%
    • if disc is disrupted: radius gets 95% of load
  23. TFCC
    • triangular fibroartilagionous complex
    • it's housed with the disc at the distal radio-ulnar jt
  24. distal ulna concave/convex?
    • convex where it meets the radius
    • concave for the carpals
  25. when is there rolling at the humero-ulnar jt?
    going in and out of terminal ext/flex
  26. which way does the ulna roll on the humerus going from terminal ext into flex?
    5 degrees IR
  27. fwhich way does the ulna roll on the humerus going into terminal flexion
    5 degrees ER
  28. how does the ulna move during sup and pro?
    • sup: forward and medially
    • pro: post and lat
    • it's as if it's trying to join the radius
  29. three fibers of the medial/ulnar collateral ligament of the elbow
    • anterior
    • intermediate
    • posterior
  30. the anterior fibers of the medial/ulnar colateral lig do what?
    • valgus stability
    • strengthen anular lig
    • couple w flexor carpi ulnaris to create cubital tunnel for ulnar nerve
  31. the intermediate fibers of the medial/ulnar colateral lig do what?
    most helpful in valgus stability
  32. the posterior fibers of the medial/ulnar colateral lig do what?
    not as distinct or powerful as rest of fibers in this lig
  33. Tardy Ulnar Plsy
    a stretch injury on the ulnar nerve
  34. 3 lateral ligs of the elbow
    • the lateral/radial collateral ligaments:
    • lateral ulnar collateral lig
    • radial collateral lig
    • accessory lateral collateral lig
  35. where's the lat ulnar collateral lig
    when is it most stretched?
    • attaches hum to ulna
    • lat epicondyle --> supinator crest
    • flexion
  36. tell me about the 3 parts of the radial collateral lig at the elbow - gen shap and where are they taut?
    • it's fan shaped
    • ant is taut in ext
    • middle is taut thru both
    • post is taut in flex
  37. pic of lat collateral ligs
  38. tell me about the 3 parts of the radial collateral lig at the elbow - gen shap and where are they taut?
    attaches radius to ulna
  39. when is the interosseous lig of the forearm most taut?
    5 degrees sup
  40. tell me about the annular lig
    • fibrocartilage
    • very strong
    • makes a ring around the radius, but only attaches to the ulna (it's continuous to radius, not attached)
  41. quadrate lig
    • from radius to ulna
    • at radial notch/neck of radius on ant side, going to supinator fossa of ulna
    • sits right below anular lig
    • it's tiny, just connecting the two bones for stability and to limit spin
  42. oblique ligament/cord
    • proximal to interosseous lig
    •  it run from medial radius to lateral ulna, more proximally
    • kinda twists in pronation
  43. zero starting position aka anatomical position for elbow
    upper arm and forearm in frontal plane w forear sup and elbow straight
  44. how's the synovium in the elbow?
    • there's lots
    • bursa over olecranon can get big as a baseball
  45. resting pos of humero-ulnar joint?
    • flex 70
    • sup 10
  46. resting pos of humero radial joint?
    fully ext and sup
  47. resting pos of prox RU joint?
    flex 70 sup 35
  48. resting pos of distal RU joint?
    sup 10
  49. close-packed pos for humero-ulnar jt?
    fully ext and sup
  50. close packed for humero-radial jt?
    flex 90 sup 5
  51. close packed for prox and dist RU jts?
    sup 5
  52. capsular pattern of elbow
    • flex limited > ext
    • (roughly 90:10)
  53. capsular pattern of forearm?
    • sup = pro
    • only occurs when there's significant restriction of flex and ext
  54. stretch elbows?
    • NO! it'll give heterotropic bone formation
    • but a controlled prolonged stretch in a DynaSplint is ok
    • work on active ext to get ROM
  55. double crush injury
    nerve impingement in cervical spine and in extremity (often in cubital fossa)
  56. triangle sign at elbow
    epicondyles plus olecranon make a triangle when flexed, straight line in ext

    (if not, sign of olecranon bursitis??)
  57. AROM and PROM for elbow
    • flex: 140-150
    • ext:  0 (or 5 hyperext is ok)
    • pro: 80-90
    • sup: 90

    and for PROM, add abotu 10-15
  58. end feels of elbow flex ext
    • ext - boney
    • flex - soft tissue
  59. end feels for sup/pro
    • sup: abrupt and firm
    • pro: hard, bone on bone

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