ATH_302_elbow

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itzlinds
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256000
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ATH_302_elbow
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2014-02-08 12:53:16
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chapter 17 elbow forearm pathologies
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chapter 17 elbow and forearm pathologies
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  1. this feature of the radius is disk shaped and concave to allow gliding and rotation on the capitellum, significantly enhancing the elbows stability:
    radial head
  2. list the motions that occur at the humerunlar and humeroradial joint:
    elbow flexion and extension
  3. list the joints at which supination and pronation occur:
    • humeroradial
    • superior radioulnar
    • inferior radioulnar
  4. valgus support of the medial elbow is obtained from the:

    list the 3 sections in which this structure is divided into:
    • unlar collateral ligament (aka medial collateral ligament)
    • anterior, transverse, posterior
  5. describe where the anterior bundle of the UCL origniates and inserts:

    list the force for which the anterior bundle is the primary restrain against:
    • originates: inferior surface of the medial epicondyle
    • inserts: on the medial aspect of teh cornonid process
    • primary restraint against: valgus force
    • posterior band of the anterior bundle is primarly stressed in overhead throwing athletes
  6. describe the origin and instertion of the transverse bundle of the UCL:
    • origin: medial epicondyle
    • insertion: cornonid process
    • does not cross the axis of the elbow and therefore, provides little medial support
  7. describe where the lateral ulnar collateral ligament (LUCL) originates and inserts:

    disruption of this ligament results in:
    • origin: middle of the lateral eipcondyle
    • inserts: tubercle of the unla
    • disruption of this ligament results in: rotatory instability
    • provids lateral support that is independent of the other lateral ligaments
  8. what are the 2 fxns of the radial collateral ligament (RCL):
    • resists varus stresses
    • maintains the close relationship between the humeral and radial articulating surfaces
  9. the fibro-osseous structure that permits internal and external rotation of the radial head is called:

    describe which motions cause the fibers to become taut:
    • annular ligament
    • anterior fibers taut: excessive supination
    • posterior fibers taut: the end of pronation
  10. what is the fxn of the accessory lateral collateral ligament:
    assists the annular ligament adn the RCL in preventing the raidus from separating from the ulna when a varus force is applied
  11. what is the fxn of the interosseous membrane:
    to transmit the force absorbed by the radius at the wrist to the ulna
  12. which muscle provides the primary contribution to the movement of the forearm in the following positions...

    pronated:
    supinated:
    neutral:
    • pronated: brachialis
    • supinated: biceps brachii
    • neutral: brachioradialis (contributes to both when forearm is at the end of the opposite motion)
  13. list the 3 primary nerves that cross the elbow:
    • median nerve
    • ulnar nerve
    • radial nerve
  14. list the muscles in which the median nerve supplies:

    list the name of the branch that projects off the median nerve:
    • median nerve supplies
    • pronator teres
    • pronator quadratus
    • all of the wrist flexor muscles...
    • except: flexor carpi ulnaris and flexor digitorum profundus

    anterior interosseous nerve projects off the median nerver to pass under the 2 heads of the pronator teres
  15. what type of innervation does the ulnar nerve provide?
    sensory and motor innervation to the hand
  16. list the 2 branches of the radial nerve and the innervation which each provides
    • superficial branch: provides sensation to the dorsum of the wrist, hand and thumb
    • deep branch: provides motor innervation exclusively to the muscles

    it is possible to injury the deep branch without experiencing any sensory loss, however critical motor loss does occur
  17. an elbow that chronically locks, clicks or pops during movement may indicate:
    • osteochondritis dissecans
    • -or-
    • unstable joint
  18. describe the position that patients with acutely injured elbows will assume:
    approximately 70 degress of flexion to minimize stresses on the joint
  19. describe 2 limitations in the elbow motion that results in adaptions at the shoulder or wrist:
    • a limitation in elbow extension may result in increased scapular protraction during elevation
    • limited pronation or supination may compensate with increased internal an external glenohumeral motion, respectively
  20. complaints of pain during the late cocking and acceleration phases of throwing may invoke stress on:
    the ulnar collateral ligament
  21. the angle formed by the long axis of teh humerus and the ulna, ranging from 5 to 15 degrees is called:

    cubitus valgus:
    cubitus varus:
    • carrying angle
    • cubitus valgus: increased carrying angle
    • cubitus varus: decreased carrying angle
  22. which variation of the carrying angle will baseball pitchers exhibit:

    what is this adaption the result of:
    • cubitus valgus
    • results of: repeated valgus load during the throwing motion
  23. compression of the radial nerve as it crosses the elbow joint can inhibit:

    what is the result of this:
    • inhibits: wrist extensors
    • results in: drop wrist syndrome
  24. extension of the elbow beyone 0 degrees is called:
    • cubital recurvatum
    • commonly found in women
  25. list the 3 structures that form an isoceles triangle when the elbow is flexed to 90 degrees:
    • medial epicondyle
    • lateral epicondyle
    • olecranon process

    these structures form a straight line when the elbow is extended
  26. what type of force can rupture the biceps brachii tendon:
    forcefull eccentric contractions
  27. palpation of the medial epicondyle elicits exquisit tenderness in the presence of:
    medial epicondylalgia
  28. list 2 forces that may cause a fx of the olercranon process:
    • forced hyperextension
    • direct backwards fall on the elbow
  29. a positive tinel's sign, burning, pain, or paresthesia along the medial border of the forearm and little finger during palplation may be the result of inflammation of which never?
    ulnar nerve
  30. patients who demonstrate the clinical signs of lateral epicondylagia but are more sensitive to palpation over the radial tunnle should also be examined to rule out:
    radial tunnle syndrome
  31. most of the elbows ROM occurs in flexion, ragning from:
    145 to 155 degrees
  32. the total ROM of pronation and supination is:
    • 170 to 180 degrees
    • approx. 90 degress of motion in each direction
  33. list the following end feels...

    ulnohumeral and radiohumeral joint..
    flexion:
    extension:

    superior radioulnar joint..
    radioulnar supination:
    radioulnar pronation:

    distal radioulnar joint..
    radioulnar supination:
    radioulnar pronation:
    • ulnohumeral/radiohumeral joint
    • flexion: soft
    • extension: hard
    • superior radioulnar joint..
    • radioulnar supination: firm
    • radioulnar pronation: hard or firm
    • distal radioulnar joint..
    • radioulnar supination: firm
    • radioulnar pronation: firm
  34. a hard (abnormal) end feel during passive flexion is indicative of:
    ostephyte (bone spur, or bony projections) formations or a loose body in the joint
  35. list the 3 injuries that make up the "terrible triad of the elbow":
    • posterior dislocation
    • fx of the radial head
    • fx of the coronoid process
  36. elbow dislocations..

    pain characteristics:
    mechanism:
    • pain characteristics
    • localized to the elbow
    • radicular symptoms may be described in the forearm, wrist or hand with nerve involvement

    • mechanism
    • an axial load placed on the forearm when the arm is weight bearing
    • e.g. falling on an outstretched arm
  37. list and describe the 4 types of fxs that can be found about the elbow:

    list 2 mechanisms that can cause elbow fxs:
    • supracondylar: adolescent athletes
    • olecranon process fx: skeletally mature adults
    • radial head: occurs as a result of longitudinal compress (FOOSH)
    • forearm fx: radius and ulna

    • mechanisms
    • fall on the elbow (FOOSH)
    • hyperextension
  38. ulnar collateral ligament sprains...

    pain characteristics:
    mechanism:
    predisposing conditions:
    pain characteristics: medial aspect of the elbow

    • mechansim
    • acute: valgus stress placed on the UCL
    • insidious: repeated valgus loading of the elbow

    • predisposing conditions
    • repeated activites that exert tensile stress (throwing)
    • internal rotation deficits in throwing athletes
    • cubits varus
  39. a collection of tensile, shear, and compressive forces that result from mild UCL laxity is called:

    what is the consequence of these forces:
    • valgus extension overload
    • consequence: osteophyte (bone spur, bone projections) formation or loose bodies
  40. moving valgus stress test...

    patient position:
    positive test:
    implications:
    • patient position:
    • sitting
    • shoulder abducted to 90 degrees
    • the elbow is flexed to the end ROM

    • positive test
    • pain at the medial elbow that reproduces fxnal pain, often apprehension response
    • AND
    • pain that occurs between 120 to 70 degrees

    implications: partial tear or attenuation (gradual loss of fxn) of the UCL
  41. tears of the LUCL that permit a transient rotation subluxation of the radius and ulna relative to the humerus is called:
    posterolateral rotatary instability
  42. posterolateral rotatary instablilty test (pivot shift)..

    patient postion:
    positive test:
    implication:
    • pateint position: supine, the shoulder and elbow flexed to 90 and the forearm is fully supinated
    • positive test: the elbow subluxates as it is extended and can be felt to relocate as it is flexed
    • implications: chronic instablitiy of the elbow
  43. inflammation or repetitive stresses at the lateral epicondyle irritates the common attachment of the wrist extensor group is called:

    which muscle of the extensor group is most commonly effected:
    • lateral epicondylalgia or tennis elbow
    • most commonly effected: extensor carpi radialis
  44. tennis elbow test...

    patient position:
    positive test:
    implications:
    • patient position: seated with tested elbow flexed to 90, forearm pronated, and the fingers flexed
    • positive test: pain in the lateral epicondyle
    • implications: tennis elbow
  45. examination findings for latera epicondylalgia (tennis elbow)..

    pain characteristics:
    mechanisms:
    predisposing conditions:
    • pain characteristics:
    • latera epicondyle and proximal portion of the common tendons of the wrist extensors
    • radicular pain into the wrist extensor muscle is possible with advanced cases

    • mechanisms:
    • overuse syndrom involving repeated, foreceful wrist extension, radial devation, supination or grasping in overhand position

    • predisposing conditions:
    • repeated eccentric loading of the wrist extensor muslces
    • occupation requiring prolonged computer use
    • inexperience or newness in playing racquet sports
  46. examination findings for lateral epicondylalgia...

    ROM:
    MMT:
    fxnal assesment:
    • ROM: wrist flexion, elbow extension, and pronation are all limited passively and actively
    • MMT: pain with wrist extension and MCP joint extension when elbow extended

    • fxn assessment:
    • pain with gripping activites
    • decreased grip strength
    • pain/weakness in combind elbow flexion and wrist extension motions
  47. examinatin findings for medial epicondylalgia (little leaguer's elbow)..

    pain characterstics:
    mechanism:
    predisposing conditions:
    • pain characterstics: medial epicondyle and the proximal portion of the adjacent wrist flexor and pronator muscles
    • mechanism: repeated, forceful flexion or pronation of the wrist (or both)
    • predisposing conditions: repeated activites tha eccentrically load the medial elbow muscles (throwing, golfing)
  48. examination findings for distal biceps tendon rupture...

    mechanism:
    pain chacteristics:
    MMT:
    fxn assesment:
    differential diagnosis:
    • mechanism: eccentric loading of the biceps brachii while the elbow is flexed
    • pain charactersitics: immediate pain and the senesation of a pop
    • MMT: decreased strength for elbow flexors and forearm supinators
    • fxn assesment: demonstrate weakness in activites that require lifting
    • differentail diganosis: biceps tendon strain, avulsion fx of the radial tuberosity
  49. examination findings for osteochondritis dissecans of the capitellum...

    pain characterstics:
    mechansim:
    other frequently assoicated conditions:
    • pain: dull, lateral elbow pain that is increased with activity
    • mehcanism: repetitive valgus loading of the elbow joint, compressive loading of the humeroulnar joint
    • associated conditions: osteochondral fx, avascular necrosis, detached bony fragments
  50. examination findings for osteochondritis dissecans of the capitellum...

    ROM:
    MMT:
    • ROM: decreased extension, felxion contracture possible (both AROM and PROM)
    • MMT: pain secondary to compression placed throught the joint
  51. dysfunction in the wrist, hand, and fingers can be the result of:

    list the various dysfunctions that can occur:
    inhibition of the the ulnar, radial, and median nerves in the area of the elbow that causes the symptoms to radiate distally

    • dysfunctions
    • paresthesia
    • decreased grip strenght
    • inability to actively extend the wrist
  52. a buring sensation in the medial forearm, little finger, and ring finger is the result of:

    list the muscles that will demonstrate decreased strength as a result of this:
    a buring sensation in the medial forearm, little finger, and ring finger is the result of: ulnar nerve pathology

    • decreased muscle strength
    • finger flexor muscles
    • lumbricals
    • interossei
    • thumb abductors
    • flexor carpi ulnaris
  53. ulnar nerve compression that exhibits numbess on the dorsal aspect of the hand indicates:

    ulnar nerve compression that exhibits numbess  on only the palmer aspect of the hand indicates:
    • dorsal aspect: neuropathy in the area of the elbow
    • palmer aspect: nerve compression distal to the tunnle of guyor (where the nerve diverges into palmer and dorsal branches)
  54. the inability to maintain adduction of the little finger leaving it resting in an abducted position, caused by ulnar nerve deficit is called:
    wartenberg sign
  55. lack of flexion in the fourth and fifth distal interphalangeal (DIP) joint, as a result of ulnar nerve deficit is characterized by:
    clawhand position
  56. how does radial tunnel syndrome differ from epicondylalgia?
    the symptoms of RTS are located more distally on the forearm
  57. what is the mechanism for radial nerve pathologies:
    often injured by deep lacerations of the elbow or secondary to fractures of teh humerus or radius
  58. what is the mechanism of medial nerve pathologies:
    mechanism: compression of the distal forearm or cubital fossa
  59. the inability to pinch the tips of the thumb and index fingers together as a result of median nerve pathology is called:
    pronator teres syndrome
  60. list the 3 compartments identifiable in the forearm:

    list some symptoms of compartment syndrome in the forearm:
    • volar
    • dorsal
    • mobile wads

    • symptoms
    • pressure in the forearm
    • sensory distruption in hand/fingers
    • decreased musclar strength
    • pain during passive elongation of the involved muscles
  61. chronic or increased in severity, a decreased or absence of the radial or ulnar pulses are noted as:
    volkmann's ischemic contracture
  62. Motions, such as throwing, place ______  forces on the medial elbow, also place ________ forces on the lateral elbow.


    during which phases are these stresses the greatest:
    Motions, such as throwing, place tensile  forces on the medial elbow, also place compressive forces on the lateral elbow.


    • greatest stresses
    • late cocking
    • accereraltion
  63. it is rare for the other segments of the ulnar collateral ligament to be damaged without 1st damaging this structure:
    the anterior oblique portion
  64. acquired elbow laxity can produce either subtle or gross ___________ similar to that seen in the knee or shoulder.
    acquired elbow laxity can produce either subtle or gross instability similar to that seen in the knee or shoulder.
  65. because of the # of nerves crossing the elbow, both ___________ and _________   injuires can lead to neurological dysfxn in the wrist, hand, and fingers.
    because of the # of nerves crossing the elbow, both acute and repetitive stress injuires can lead to neurological dysfxn in the wrist, hand, and fingers.
  66. which elbow and forearm motions increase the activity of the biceps brachii?
    • flexion
    • supination
  67. which 2 peripheral nerves pass thru the cubital fossa?

    which artery passes thru the cubital fossa?

    tendon thru the cubital fossa?
    • peripheral nerves: medial nerve and musculocutaneous nerve
    • artery: brachial artery
    • tendon:  biceps brachii tendon
  68. what are the 4 structures that originate on the medial epicondyle:
    • palmaris longus
    • flexor carpi radialis
    • flexor carpi ulnaris
    • flexor digitorum
  69. how many degress of freedom does the humeral ulnar joint have?
    1 degree of freedom
  70. how does one instruct a pt to make the palpation of the palmaris longus tendon more prominent?
    pinch the little finger and the thumb together while flexing the wrist. the small tendon that pops up on the anterior wrist is the palmaris longus

    note: some people are bone w/o this muscle
  71. resisting what 2 combined motions makes the flexor carip ulnaris most active?
    flexion and ulnar deviation
  72. what 5 muscles  originate on the lateral epicondyle:
    • extensor carpi radialis brevis
    • extensor carpi ulnaris
    • extensor digiti minimi
    • extensor digitorum communis
    • supinator
  73. what motions occur at the humeroradial joint?
    • flexion/extension
    • pronation/supination
  74. which elbow flexor inserts on the radial styloid process?
    brachioradialis
  75. which surface is Lister's tubercle palpable from?
    dorsal surface
  76. what is the fxn of the annular ligament:
    permits internal/external rotation of radial head on the capitellum of the humerus
  77. the most superifical wrist extensor is the:

    the most inferior wrist extensor is the:

    would these muscles be more active with a backhand or forehand in tennis?
    • most superficical: extensor carpi radialis longus
    • most inferior: extensor carpi radialis brevis

    more active with a backhand
  78. is the humerulnar joint more stable in flexion or extension?
    extension
  79. what motions does the ulnar collateral ligament restrict?
    valgus force
  80. which hand bone is located about 1/2 inch distal from the most medial aspect of the ulnar styloid process ?
    triquetrum
  81. what forms the lateral humeral articulating surface on the distal border of the lateral epicondyle?

    A. trochlea
    B. radial fossa
    C. semilunar notch
    D. capitellum
    D. capitellum
    (this multiple choice question has been scrambled)
  82. what is the  indention of the lateral epicondyle that accepts the radial head during elbow flexion?

    A. trochlea
    B. capitellum
    C. radial fossa
    D. semilunar notch
    C. radial fossa
    (this multiple choice question has been scrambled)
  83. the radial tuberosity is the insertion for what muscle?

    A. pronator teres
    B. radiobrachialis
    C. brachialis
    D. biceps brachii
    D. biceps brachii
    (this multiple choice question has been scrambled)
  84. the radio ulnar joints are classified as what type of joint?

    synovial 
    hinge
    syndesmotic
    saddle
    syndesmotic joint
  85. which elbow ligament is divisible into 3 unique sections?

    radial collateral ligament
    annular ligament
    lateral ulnar collateral ligament
    ulnar collateral ligament
    ulnar collateral ligament

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