Elbow + Forearm Physical Exam

the capitulum is a common spot for what kind of pathology

Osteochondritis Dissecans

when referring to the "true elbow joint" which joint are we talking about

humeroulnar joint

the humeroulnar joint consists of what structures articulating together

trochlear notch of ulna

trochlea of humerus

the humeroradial joint consists of what structures articulating together

radial head of radius

capitulum of humerus

the proximal radioulnar joint consists of what structures articulating together

radial head

radial notch of ulna

the distal radioulnar joint joint consists of what structures articulating together

ulnar head

ulnar notch of radius

which joints in the elbow permit flexion and extension

humeroulnar

humeroradial

which joint in the elbow permits pronation and supination

proximal radioulnar

the humeroulnar articulation allows for how many degrees of freedom

1 degree of freedom

in what degrees of flexion is the posterior bundle of the ulnar collateral ligament the most taut

beyond 60 degrees

the radial collateral ligament prevents what motion at the elbow

varus force

which band of the UCL is the primary restrainer against valgus force

anterior bundle

which band of the UCL deepens the elbow joint

oblique band

which ligament is the most important lateral stabilizer of the elbow joint

lateral ulnar collateral ligament

which m. is the primary elbow flexor in forearm supination

biceps brachii

which m. is the primary elbow flexor in forearm pronation

brachialis

which m. is the primary elbow flexor in neutral forearm position

brachioradialis

which m. is the primary supinator with the arm extended

supinator

which n. innervates the majority of the superficial layer of the flexor compartment

median n.

what mm. in the superficial layer of the flexors of the forearm are innervated by the median n.

pronator teres

flexor carpi radialis

palmaris longus

which m. of the superficial layer of the flexor of the forearm is not innervated by the median n., and what n. is it innervated by

flexor carpi ulnaris

ulnar n.

what is a normal male carrying angle

11-14 degrees

what is a normal female carrying angle

13-16 degrees

cubitus valgus refers to a _____________ than normal carrying angle

greater

cubitus varus refers to a _____________ than normal carrying angle

smaller

what structures run through the cubital fossa

biceps tendon

brachial a.

median n.

cubital recurvatum refers to what motion

hyperextension

what is the normal range of elbow flexion

0-150 degrees

what is the normal range of elbow extension

0 degrees

what is the normal range of supination/pronation

90 degrees for each

170-180 total for both

what is the most common MOI for an elbow dislocation

large axial force through the forearm with slight elbow flexion

when an elbow is dislocated, in what direction does it most commonly displace

posteriorly or posterolaterally

what are s/s that would be observed for an elbow dislocation

deformity

pain

swelling

numbness/tingling

what are the components of the terrible triad of the elbow

posterior dislocation

coronoid process fracture

radial head fracture

what are the most common MOI for a supracondylar fracture

fall on flexed elbow

hyperextension

following a supracondylar fracture, what type of deformity is commonly observed

Gunstock deformity

what neurovascular structures should be assessed when evaluating a supracondylar fracture

median n.

brachial a.

following a supracondylar fracture, what hand/wrist pathology might you be concerned about

Volkmann's contracture

what impairments are associated with Volkmann's contracture

wrist flexion

MCP extension

finger flexion (claw)

what is the most common MOI for an olecranon fracture

direct fall on flexed elbow

following an olecranon fracture, what motions may have decreased and cause p!

active elbow extension

passive hyperextension

which type of elbow fracture is most commonly observed in an adolescent population

supracondylar fracture

which type of elbow fracture is most commonly observed in an older/mature population

olecranon fracture

what are the most common MOI for a radial head/neck fracture

FOOSH

secondary to elbow dislocation

following a radial head/neck fracture what motions may cause p!

pronation/supination

flexion/extension

what are the most common MOI for a forearm fracture

FOOS

Direct trauma

what is important to do when assessing a forearm fracture

checking neurovascular symptoms, distal pulse, capillary refill

what are common MOIs for an acute elbow UCL sprain

valgus force/stress

hyperextension

what are common MOI for an chronic elbow UCL sprain

repetitive overhead throwing motion (cocking + acceleration)

what is the chief complaint associated with a UCL sprain

pain at the medial aspect of the elbow that increases with movement

if a patient has a UCL sprain and is complaining of radicular symptoms, what structure may be affected

ulnar n.

what special test will allow you to rule in a UCL sprain

Valgus stress test

moving valgus stress test

Milking sign

true/false: an RCL sprain is more common than a UCL sprain

false

what other ligament may be affected if you have RCL damage

annular lig.

besides flexion/extension, what ROM may be affected if someone has an RCL sprain

supination/pronation

what special test should be used to rule in an RCL sprain

Varus stress test

lateral epicondylitis is commonly referred to as what

tennis elbow

what are chief complaints for someone with tennis elbow

pain over lateral epicondyle

decreased and painful grip strength and wrist extension

if someone has tennis elbow what PROM may cause pain

wrist flexion

true/false: tennis elbow is more common in the older population (+40 y/o)

true

what neurological pathology may mimic the s/s of tennis elbow

radial n. entrapment

which sports are commonly associated with lateral epicondylitis

racquet sports

which sports are commonly associated with medial epicondylitis

throwing or overhead sports

what are chief complaints for someone with medial epicondylitis

pain over medial epicondyle

decreased and painful grip strength

what MMT may rule in medial epicondylitis

wrist flexion

pronation

if someone has medial epicondylitis what PROM may cause pain

wrist extension (especially if elbow is extended)

what special test can be used to rule in medial epicondylitis

golfer's elbow test

little leaguers elbow refers to an _______________ of the common flexor tendon from its attachment site

avulsion

what is the MOI for a distal biceps tendon rupture

eccentric loading of biceps @ 90 degrees of elbow flexion

what AROM and MMT will be affected in the case of a distal biceps tendon rupture

elbow flexion

supination

what special test is used to rule in a distal biceps tendon rupture

Hook test

what bony forearm pathology may be associated with a distal biceps tendon rupture

avulsion of radial tuberosity

what is the primary MOI of osteochondritis dissecans of the capitellum

increased valgus loading causing compressive and shear forces on capitellum and radial head

Osteochondritis dissecans of the capitellum develops secondary to what pathology

osteochondral defects cause by disrupted blood flow

what is the chief complaint of someone who may have osteochondritis dissecans of the capitellum

dull lateral elbow pain that increases with activity

what ROM symptoms may be observed for someone with osteochondritis dissecans of the capitellum

decreased elbow extension

flexion contracture

what special test can be used to rule in osteochondritis dissecans of the capitellum

valgus stress test w/ pain at the radial head

what imaging techniques are most useful when trying to diagnose osteochondritis dissecans

CT

MRI

what are the main MOIs for an olecranon bursitis

direct or repetitive trauma to the olecranon

Numbness on the dorsal aspect of the hand is indicative of ulnar neuropathy in the area of the ___________

elbow

Numbness specifically on the palmar side of the ulnar nerve distribution is indicative of what neuropathy

ulnar n. compression distal to the tunnel of Guyon

what prolonged elbow and wrist motion may increase ulnar neuropathy symptoms

elbow flexion

wrist extension

what radicular symptoms are associated with acute trauma to the ulnar nerve

burning/numbness/tingling sensation in medial forearm, little finger, lateral ring finger

what special test is used to rule in a ulnar nerve pathology

Tinel's sign

what are the 2 most common MOIs for radial nerve pathology

deep laceration to the elbow

humeral/radial fractures

if a patient is experiencing sensory loss or paresthesia results on the posterior forearm and hand, what nerve is affected

superficial branch of radial n.

true/false: there is no sensory loss associated with trauma to the posterior interosseous n.

true

what motor functions would be affected in the case of radial neuropathy

wrist/thumb/finger extension

supination

clinically radial n. entrapment can resemble lateral epicondylitis, what is the main difference between the two

symptoms of radial n. entrapment are more distal on the forearm

Compression of the radial nerve distal to the elbow usually results in what wrist and finger extension strength

normal wrist extension

weak finger extension

what pathology is characterized by the patient's inability to pinch the tips of the thumb and index fingers together

pronator teres syndrome

what nerve is affected in pronator teres syndrome

anterior interosseous n. (branch of median n.)

what is the most common median n. neuropathy

carpal tunnel

a (+) valgus stress test with a firm end feel is indicative of what injury

grad 1 UCL sprain

what end feel is associated with a grade 2 UCL sprain when performing a valgus stress test

soft end feel

when performing a valgus stress test what structures are stressing (be as specific as possible)

anterior band of UCL

a (+) Cozen's test is indicative of what pathology (be as specific as possible)

lateral epicondylitis of the extensors carpi radialis brevis and longus

which test involves the patient performing resistive wrist extension while radially deviated

cozen's test

a (+) Maudsley's test is indicative of what pathology (be as specific as possible)

lateral epicondylitis of extensor digitorum

a (+) Mill's test is indicative of what pathology (be as specific as possible)

lateral epicondylitis of extensors carpi radialis brevis and longus