notes from lecture
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| humeroulnar | flex & ext. ulna connects w/troclea
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| humeroradial | pronation & supination. radial head spins on capitulum. radius surface is concave also
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| radioulnar | pronation & supination
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| what moves during pronation and supination? | radius/ ulna does NOT move
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| carrying angle | bc medial surface ext farther distally, in ext the elbow is in valgus position of 10-15 degrees
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| ligaments of elbow | medial (ulnar) collateral, lateral (radial) collateral, annular (holds radial head to ulna @ radial notch)
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| elbow end feel in ext | bony
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| elbow end feel in flex | soft tissue
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| elbow end feel in pronation & supination | ligamentous
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| brachialis OIAN | O:distal 1/2 of humerus, ant surface. I:coronoid process & ulnar tuberosity of ulna. A:elbow flex. N:musculocutaneous
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| biceps OIAN | O:long head:supraglenoid tubercle of scap. short head:coracoid process of scap. I:radial tuberosity of radius A:elbow flex, forearm sup N:musculocutaneous
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| brachioradialis OIAN | o:lat supracondylar ridge on the humerus. I:styloid process of the radius A:elbow flex N:radial
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| triceps OIAN | O:long head:infraglenoid tubercle of scap. lat head:inferior to greater tubercle on post humerus. Medial head:post surface of humerus. I:olcranon process of ulna. A:elbow ext N:radial
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| supinator OIAN | O:lat epicondyle of humerus & adjacent ulna. I:ant surface of the proximal radius. A:forearm supination N:radial
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| pronator teres OIAN | O:medial epicondyle of humerus & coranoid process of ulna. I:lat aspect of radius @ its midpoint A:forearm pronation, assist in elbow flex N:median
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| pronator quad OIAN | o:distal 1/4 of ulna. I: distal 1/4 of radius. A:forearm pronation. N:median
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| most common elbow fx | fx of head of radius-often head will dislocate and needs ORIF
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| elbow fx rx | pt in splint for 3-5 days which is removed for PROM, AROM, isometrics. over next 2-6 wks progress to strengthening & stretching w/goal to return to activity in 6 wks
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| another common elbow fx | supracondylar
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| severe complication to supracondylar fx | Volkmans Ischemic contracture
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| Volkmans Ischemic contracture cause | obstruction to the brachial artery & venous return due to bone displacement or vascular damage. if not restored will get mm fibrosis. wrist flexors contracted
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| early signs of Volkmans Ischemic contracture | cyanosis, loss of radial pulse, sensory loss, severe forearm pn esp w/mvmnt
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| Volkmans Ischemic contracture rx | elevation, ROM & splinting, stretching when appropriate. paralysis is permanent but if caught early can be managed medically
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| overuse syndromes:repetitive trauma syndromes | lat elbow tendonopathy (tennis elbow), medial elbow tendinopathy (golfer's elbow)
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| lateral epicondylitis | microtrauma of wrist ext mechanism esp extensor carpi radialis brevis. brevis is most commonly injured bc when elbow is ext & wrist is flexed, brevis rolls over radial head. chronic inflammation develops
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| lateral epicondylitis S&S | local tenderness, pn, edema over common extensor area that increases w/activity or stretching. may be referred pn into arm. can be work related (typing, power tools) or recreational (back hand, piano)
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| lateral epicondylitis acute rx | RICE, gentle PROM/AROM in painfree range, modalities such as Estim, US or massage, ionto, phono, immobilization in brace, cock up splint
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| lateral epicondylitis subacute rx | AROM. cont to rest is real key
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| lateral epicondylitis chronic rx | teach pt self stretch, isometrics & progress to strengthening using theraband or wt to both agonist & antagonist & pronators & supinators. asses mechanism of injury & look for correction or prophylaxis. gradual return to activity
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| medial epicondylitis | also overuse of wrist flex (FCR, FCU, FCS) cause by improper golfing technique, gripping tools
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| medial epicondylitis acute rx | RICE, gentle PROM/AROM in painfree range, modalities such as Estim, US or massage, ionto, phono, immobilization in brace, cock up splint
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| medial epicondylitis subacute rx | AROM. cont to rest is real key
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| medial epicondylitis chronic rx | teach pt self stretch, isometrics & progress to strengthening using theraband or wt to both agonist & antagonist & pronators & supinators. asses mechanism of injury & look for correction or prophylaxis. gradual return to activity
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| PNI ulnar | sensory loss of ulnar hand, little finger, ulnar 1/2 of ring finger-wkness of ulnar 1/2 FDP & FCU, hypothenar mm, interossei, 3,4 lumbricals, FPB, add pl
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| PNI radial | wk wrist & finger ext, supinator- sensation loss dorsum of hand & radial side of 3rd metacarpal, dorsum of thumb & 1st 2 fingers
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| periperal neuropathy median | wkness of pronator teres, wrist flexors, extrinsic finger flexors, thenar & lumbricales 1-2- sensory loss is radial palm & palm side of thumb, index & middle finger
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| olecranon bursitis | caused by pressure (leaning on elbows) sometimes aspiration needed
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| total elbow | not common. indicated by severe arthritis, gross instability. result is not full range or strength. maybe 90 degrees
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