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ROM - elbow
- Flexion - 150
- Supination/Pronation - 80
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Elbow - Concave-Convex @ humeroradial jt
Concave moving on convex
-
Elbow - Concave-Convex @ humeroulnar jt
Concave moving on convex
-
Forearm - Concave-Convex @ proximal radioulnar jt
Convex radial head moving on concave radial notch of ulna
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Forearm - Concave-Convex @ distal radioulnar jt
Concave moving on convex - opposite of proximal
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Elbow - which ligament is stronger radial collateral or ulnar collateral?
Radial collateral ligament
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Elbow - Annular ligament - primary function
Protects radial head - encircles it
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Elbow - Quadrate ligament - primary function - 2
- Reinforces inferior radioulnar capsule
- Limits amount of spin in supination/pronation
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What ligament stabilizes the Radiohumeral joint?
- Lateral - Radial collateral ligament
- Medial - Ulnar collateral ligament
-
Interosseous membrane stabilizes elbow during what motion?
Pushing movements
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Oblique cord resists distal displacement of radius during what motion?
Pulling movements
-
Brachial artery - palpation, compression. occlusion/laceration lead to what?
- Can be palpated over anterior region of the cubital fossa
- Compression mostly most effected near middle of humerus
- Occlusion/laceration - ischemia of Deep flexor mms of forearm
- Injury - Volkmann's ischemic contracture
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Carrying angle - at what jt? Male/Female
- Humeroulnar jt
- Male - 10°-15°
- Female - 20°-25°
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Elbow - Tensile/compressive forces during functional activities
- Tensile - Medially
- Compressive - Laterally
-
Elbow - biomechanics - screw home mechanism w/conjunct rotation of ulna
- Flexion - Ulna ER (supinates)
- Extension - Ulna IR (pronates)
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Elbow Flexion - Prime movers (3) & assistant (2)
- Prime - Brachialis, Biceps brachii, Brachioradialis
- Assistant - Flexor carpi ulnaris , Pronator teres
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What muscles facilitate elbow extension in closed chain movements (e.g.,push-ups or pushing heavy objects)? - 2
- Pectoralis major
- Anterior deltoid
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Elbow - muscle is active w/low loads & w/slow movements in supination?
Supinator
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Elbow - What muscle performs supination when elbow is flexed to 90°?
Biceps brachii
-
Elbow - What muscle is active during low loads during pronation?
Pronator quadratus
-
Elbow - What muscle is used for pronation & stabilization during elbow flexion?
Pronator teres
-
Turning doorknobs or screwdrivers clockwise requires what muscle coupling?
- Biceps & Triceps
- Biceps supinate while triceps counter the flexion action
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Lateral epicondylitis – S/S; degeneration of what mm? Tx
- PROM - Pain on wrist flexion w/forearm pronation & elbow extension
- Pain INC w/activities involving wrist extension
- Weak grip strength
- Chronic degeneration of ECRB
- Tx - Counterforce brace - placed over wrist extensors
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Medial epicondylitis – S/S; degeneration of what mm? Tx
- PROM - Pain on combined wrist extension & forearm supination
- AROM – pain on wrist extension
- Chronic degeneration of Pronator teres + FCR
-
 What is pictured? S/S - 6
- Volkmann's contracture - Wrist extension & finger flexion contractures
- Severe pain in forearm within 2 hours INC by passive finger ext
- Sensation of P if compartment syndrome
- Pallor
- Paresis
- Pulselessness
-
What is pictured? What does it indicate?
- Fat pad sign
- Supracondylar fracture
-
Nurse-maid’s (pulled) elbow - mechanism; pain; static & dynamic changes
- Longitudinal pull on forearm
- Pain localized to SUPERIOR radioulnar jt
- Static - Arm held in pronation
- Dynamic - Inability to spinate w/o pain
-
Pronator teres syndrome - describe
Median nn entrapment in pronator teres mm
-
Elbow contracture - loss of motion in non-capsular pattern d/t what? - 3
- Loose body in joint
- Ligamentous sprain
- CPRS
-
Ulnar nerve entrapment - causes - 2
- Cubital tunnel impingement between heads of FCU
- Compression in tunnel of Guyot at wrist
-
Ulnar nn entrapment - difference in symptoms - Cubital tunnel vs. Guyot tunnel - sensory
- Cubital tunnel - Hand + digits involved
- Guyot tunnel - Digits involved ONLY - no sensory distribution into palmar/dorsal surface
-
What nn palsy is pictured?
Ulnar nn
-
Ulnar nerve entrapment - deformity - 3
- Partial claw w/atrophy between metacarpals
- Atrophy of hypothenar eminence
- Ulnar drifting of little finger
-
Ulnar nerve entrapment - functional loss - 5
- Gripping strength - Pinch gripInability to fully close hand
- Use of 4th & 5th digits
- Thumb ADD
- Finger ADD/ABD
-
Ulnar nn entrapment - mms affected - 7
- Lumbricals III, IV
- Interossei
- Hupothenar mms - ABD/Flexor/Opponens - all digiti minimis
- Thenar mms - FPB/ADD pollicis
-
Ulnar nn entrapment - distribution of parasthesias
- 1/2 of 4ht / 5th digit
- Medial dorsum & palm
-
Name test; What is being tested? Describe compensation
- Froment's sign
- Ulnar nn - esp ADD pollicis
- Excessive thumb flexion
-
Median nn entrapment - causes - 2
- Impinegement in pronator teres
- Compression in carpal tunnel
-
Median nn entrapment - deformity
- Sign of Benediction
- Atrophy in thenar eminence
- Inability to make “OK” sign
-
Median nn entrapment - Functional loss - 3 + sensory loss location
- Grip strength - esp cylindrical power grips
- Absent forearm pronation
- No thumb ABD / opposition
- Paresthesias - 1,2,3 & 1/2 of 4th digits; lateral palm
-
What nn palsy is pictured?
Median nn
-
What is pictured? Describe functional loss
- Anterior interosseous syndrome
- Inability to perform “OK” sign from median nn entrapment
-
Radial nn entrapment - causes
From overhead activities & throwing
-
Radial nn entrapment - deformity
Wrist drop
-
What nn palsy is pictured?
Radial nn
-
Radial nn entrapment - functional loss - 3
- High lesions (triceps) - cannot push
- Weak supination
- Unable to make fist or grip objects unless wrist is stabilized in extension
-
Radial nn entrapment - S/S - 3
- Lateral elbow pain
- Pain over supinator mm
- Paresthesias in lateral dorsum of hand
-
What test is pictured? What is tested? (+)
- Tennis elbow test (Cozen's)
- Lateral epicondylitis
- PT stabilizes pt elbow in 90 flexion
- PT resists forearm pronation/wrist extension & radial deviation
- (+) Pain in lateral area
-
What test is pictured? What is tested? (+)
- Mill's test
- Lateral epiconylitis
- PT palpates lateral epicondyle
- PROM forearm pronation/ full wrist flexion/ elbow extension
- (+) Pain in lateral area
-
What test is pictured? What is tested? (+)
- Medial epicondylitis test of "Golfer's" elbow test
- Medial epicondylitis
- Sitting elbow @ 90 flexion
- Supinate forearm while extending elbow & wrist
- Pain
-
Difference between Tennis elbow test and Mill’s test
- Tennis elbow test is active
- Mill’s test is passive
-
What test is pictured? What is tested? Describe; (+)
- Pronator teres syndrome test
- Median nn entrapment in pronator teres
- Sitting elbow @ 90
- PT & pt hold hands & PT resist attempt to pronate
- (+) Weakness
-
What test is pictured? What is tested? Describe; (+)
- Wartenberg's sign
- Ulnar nn
- Hand on table/Fingers extended & ADD
- PT pulls 4th & 5th fingers into ABD
- (+) Weakness
-
Special tests for MCL tears - 2
- Valgus stress test @ 30, 60 of elbow flexion
- Moving valgus stress test
-
Elbow Valgus stress test @ 30 vs @ 60 elbow flexion
- 30 - anterior band of MCL
- 60 - Posterior band of MCL
-
What test is pictured? What is tested? Describe; (+)
- Moving valgus stress test
- MCL
- Pt standing/ABD shoulder to 90
- PT maximally flexes elbow & places valgus force + GH ER
- (+) Pain at medial elbow
- Max pain bet 120-70 elbow flexion
-
Concave/Convex - Pronation - look at what for reference?
- Thumb
- Pronation - thumb goes anterior, so glide is posterior (bc convex on concave)
-
Concave/Convex - glides to INC supination - 2
- Proximal radioulnar anterior glide
- Distal radioulnar posterior glide
-
Concave/Convex - glides to INC pronation - 2
- Proximal radioulnar posterior glide (remember All Ps - Proximal/Posterior/Pronation)
- Distal radioulnar anterior glide
-
Concave/Convex - INC elbow flexion - 2
- Radiohumeral anterior glide
- Ulnahumeral radial glide
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Concave/Convex - INC elbow extension - 2
- Radiohumeral posterior glide
- Ulnahumeral ulnar glide
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