Quiz
Elbow
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Questions in this quiz (50)
1The biceps is the primary flexor of the elbow with the forearm held in [blank_start]supination[blank_end], but not when the forearm is in [blank_start]pronation[blank_end]
- Asupination
- Bpronation
2Accessory elbow flexors are the [blank_start]ECRL[blank_end], [blank_start]anconeus[blank_end], and [blank_start]pronator teres[blank_end]
- AECRL
- Banconeus
- Cpronator teres
3The [blank_start]FCU[blank_end] runs directly over the anterior bundle of the UCL
- AFCU
4The [blank_start]anterior[blank_end] bundle part of the UCL is typically injured in throwers
- Aanterior
5Mobile wad of henry consists of:
1) [blank_start]Brachioradialis[blank_end]
2) [blank_start]ECRL[blank_end]
3) [blank_start]ECRB[blank_end]- ABrachioradialis
- BECRL
- CECRB
6Biceps
Both the long and the short heads of the biceps originate above the [blank_start]glenohumeral[blank_end] joint. The long head originates from the tendon that contributes to the [blank_start]supraglenoid[blank_end] tendon, with the short head originating from the [blank_start]coracoid process[blank_end] of the scapula. They both insert to the [blank_start]radial tuberosity[blank_end].
The long head of the biceps runs through the [blank_start]suprahumeral[blank_end] (or subacromial) space along with the bursa, and [blank_start]supraspinatus[blank_end] muscle tendon. This is a site of clinical importance due to impingement syndrome- Aglenohumeral
- Bsupraglenoid
- Ccoracoid process
- Dradial tuberosity
- Esuprahumeral
- Fsupraspinatus
7Panners disease
Osteochondritis of the [blank_start]capitellum[blank_end]
Umbrellas a range of conditions, from idiopathic osteochondrosis to osteochondritis dissecans with a loose body formation
Idiopathic Osteochondrosis = the [blank_start]blood supply[blank_end] to an area of developing bone in the elbow is temporarily disrupted, leading to bone [blank_start]necrosis[blank_end]
Osteochondritis dissecans = similar to above but is in [blank_start]older[blank_end] children where the [blank_start]growth plates[blank_end] are no longer involved
Common in young boys, particularly throwing/pitching athletes. Treatment has good prognosis, and includes rest and minimises athletic activity- Acapitellum
- Bblood supply
- Cnecrosis
- Dolder
- Egrowth plates
8Nurse Maids Elbow / Pulled Elbow Syndrome
When the radial head separates from the [blank_start]annular ligament[blank_end], resulting in pain and instability to rotate the radial head.
In most cases, the annular ligament is not ruptured, but mainly because if generalised ligamentous laxity of the elbow.
Nursemaids elbow is most commonly seen in children between [blank_start]6[blank_end] mo and [blank_start]3[blank_end] years, as the radius grows and becomes more ossified, pulled elbow syndrome is less common.- Aannular ligament
- B6
- C3
9[blank_start]Deep[blank_end] branch of the [blank_start]radial[blank_end] nerve (also referred to as the [blank_start]PIN[blank_end]) is often compressed at the arcade of Frohse within the [blank_start]supinator[blank_end] muscle.
This nerve can be a cause of [blank_start]lateral[blank_end] elbow pain, and forearm pain.- ADeep
- Bradial
- CPIN
- Dsupinator
- Elateral
10Lateral epicondylitis:
Tendinosis / degeneration and angiofibroblastic changes which typically occur within the [blank_start]ECRB[blank_end]- AECRB
11Elbow ossification by age. (remember the acronym CMRTOL)
C[blank_start]apitellum[blank_end]: [blank_start]2[blank_end] yo
M[blank_start]edial epicondyle[blank_end]: [blank_start]4[blank_end] yo
R[blank_start]adial head[blank_end]: [blank_start]5[blank_end] yo
T[blank_start]rochlea[blank_end]: [blank_start]8[blank_end] yo
O[blank_start]lecranon[blank_end]: [blank_start]9[blank_end] yo
L[blank_start]ateral epicondyle[blank_end]: [blank_start]10[blank_end] yo- Aapitellum
- B2
- Cedial epicondyle
- D4
- Eadial head
- F5
- Grochlea
- H8
- Ilecranon
- J9
- Kateral epicondyle
- L10
12Distal biceps rupture
The distal biceps typically ruptures off the [blank_start]radial tuberosity[blank_end]. It's usually the result of a singular traumatic episode and usually requires surgical reattachment.
Common in [blank_start]weightlifters[blank_end], and in right dominant, well conditioned males.
Mechanism of injury is commonly a sudden [blank_start]extension[blank_end] force to the elbow when the elbow is in [blank_start]90[blank_end] degrees of [blank_start]flexion[blank_end].- Aradial tuberosity
- Bweightlifters
- Cextension
- D90
- Eflexion
13PRP injections.
PRP = p[blank_start]latelet[blank_end] r[blank_start]ich[blank_end] p[blank_start]lasma[blank_end]
PRP was found to be more effective than autologous blood injections for pain relief, but only for [blank_start]6[blank_end] weeks.
PRP was more effective than CSI in terms of pain relief and improved function with results that lasted up to [blank_start]2[blank_end] years.
PRP injection = patients blood, which is first centrifuged to collect a concentration of plasma is injected to the area
Autologous injections = take patients blood from one part of their body and inject it into another
The theory behind both is that the [blank_start]platelets[blank_end] stimulate healing in a degenerative tendon- Alatelet
- Bich
- Clasma
- D6
- E2
- Fplatelets
14Essex-Lopresti lesion:
# of the [blank_start]radial head[blank_end] with concomitant [blank_start]DRUJ[blank_end] dislocation and interruption of the [blank_start]interosseous membrane[blank_end].
# must be repaired (usually with ORIF) to re-establish congruence of the [blank_start]DRUJ[blank_end].
[blank_start]DRUJ[blank_end] dislocation can be pinned for 6 weeks in supination to allow healing of the [blank_start]interosseous membrane[blank_end], prevent proximal radius migration (resulting in [blank_start]positive[blank_end] ulnar variance), and prevent distal wrist issues.- Aradial head
- BDRUJ
- Cinterosseous membrane
- DDRUJ
- EDRUJ
- Finterosseous membrane
- Gpositive
15Compartment syndrome of the forearm, also known as [blank_start]Volkmanns ischemia[blank_end].
A loss of [blank_start]perfusion[blank_end] of the hand and forearm
Pathology and clinical manifestations of compartment syndrome: the four Ps
P: [blank_start]Pain[blank_end] and [blank_start]swelling[blank_end] that is disproportionate to injury, [blank_start]pain[blank_end] particularly with [blank_start]passive[blank_end] stretch
P: [blank_start]Pallor[blank_end]
P: [blank_start]Pulselessness[blank_end]
4) [blank_start]Paresis[blank_end] secondary to nerve compression and a tense compartment ([blank_start]paraesis[blank_end] = weakness (not complete loss which would be [blank_start]paralysis[blank_end]))
[blank_start]Crush[blank_end] injuries are particular prone to developing into compartment syndrome, but it may develop from a series of injuries.
Differential diagnosis: [blank_start]arterial[blank_end] injury- AVolkmanns ischemia
- Bperfusion
- CPain
- Dswelling
- Epain
- Fpassive
- GPallor
- HPulselessness
- IParesis
- Jparaesis
- Kparalysis
- LCrush
- Marterial
16Hanses disease, otherwise known as [blank_start]leprosy[blank_end]
A curable disease, mainly affecting the [blank_start]skin[blank_end] and [blank_start]nerves[blank_end]- Aleprosy
- Bskin
- Cnerves
17Galeazzi #
A fracture of the [blank_start]distal third[blank_end] of the radial [blank_start]shaft[blank_end], with an associated [blank_start]DRUJ[blank_end] dislocation
[blank_start]DRUJ[blank_end] dislocation can be diagnosed and classified on xray by looking at the displacement of the [blank_start]ulna[blank_end] ([blank_start]volar[blank_end] or [blank_start]dorsal[blank_end] displacement)- Adistal third
- Bshaft
- CDRUJ
- DDRUJ
- Eulna
- Fvolar
- Gdorsal
18Monteggia #
Fracture of the [blank_start]ulna[blank_end] [blank_start]shaft[blank_end] with associated [blank_start]anterior[blank_end] dislocation of the [blank_start]radial[blank_end] head- Aulna
- Bshaft
- Canterior
- Dradial
19Smiths #
Fracture of the [blank_start]distal radius[blank_end], usually from a FOOSH with the wrist [blank_start]flexed[blank_end]. The distal fracture fragment is displaced [blank_start]volarly[blank_end] ([blank_start]volar[blank_end] angulation)- Adistal radius
- Bflexed
- Cvolarly
- Dvolar
20Colles #
Fracture of the [blank_start]distal radius[blank_end], usually from FOOSH with wrist [blank_start]extended[blank_end], that results in [blank_start]dorsal[blank_end] displacement of distal fragment ([blank_start]dorsal[blank_end] [blank_start]angulation[blank_end]).- Adistal radius
- Bextended
- Cdorsal
- Ddorsal
- Eangulation
21Heterotopic Ossification (HO)
The formation of [blank_start]mature bone[blank_end] in [blank_start]non-osseous[blank_end] tissue.
Can be the result of any elbow trauma, can have associated TBI
Clinical presentation:
1) [blank_start]pain[blank_end]
2) [blank_start]swelling[blank_end]
3) [blank_start]warmth[blank_end]
4) [blank_start]restricted ROM[blank_end]
Aggressive [blank_start]PROM[blank_end] has been associated with HO development- Amature bone
- Bnon-osseous
- Cpain
- Dswelling
- Ewarmth
- Frestricted ROM
- GPROM
22Primary structures involved with medial epicondylitis (2)
- AFCR
- BPT
- CFDP
- DFDS
- EECU
- FSupinator
- GFCU
- HUlnar nerve
23Symptoms of medial epicondylitis also referred to as [blank_start]Golfers[blank_end] elbow
[blank_start]Pain[blank_end] with [blank_start]palpation[blank_end]
[blank_start]Weakness[blank_end] with [blank_start]gripping[blank_end] and [blank_start]pronation[blank_end]- AGolfers
- Bpalpation
- CPain
- DWeakness
- Egripping
- Fpronation
24Lateral epicondylitis involves the
- AECRL
- BECRB
- CECU
- DEDC
- ESupinator
25Lateral epicondylitis, often referred to as Tennis elbow
Pain with [blank_start]palpation[blank_end], or [blank_start]burning[blank_end] sensation on outer elbow
Weak [blank_start]grip[blank_end]- Apalpation
- Bburning
- Cgrip
26Anterior Interosseous Nerve
A branch of the [blank_start]median[blank_end] nerve.
[blank_start]Motor[blank_end] innervation only, no [blank_start]sensory[blank_end] fibres
Muscles Innervated:
[blank_start]FPL[blank_end]
[blank_start]PQ[blank_end]
[blank_start]FDP IF/MF[blank_end]
Testing for AIN injury may be done by asking the pt to complete a [blank_start]pinch[blank_end] grip test.- Amedian
- BMotor
- Csensory
- DFPL
- EPQ
- FFDP IF/MF
- Gpinch
27Which would test for ulnar neuritis at the elbow level?
- APhalens
- BTinels
- CUlnar relocation test
- DJobe test
28Cozen's test
Tests for [blank_start]lateral epicondylitis[blank_end]
It involves static, resisted [blank_start]wrist extension[blank_end] with palpation over the proximal [blank_start]ECRB[blank_end]
Positive with sudden, intense [blank_start]pain[blank_end]- Alateral epicondylitis
- Bwrist extension
- CECRB
- Dpain
29Hand shake test for conservative mx of lateral epicondylitis
Firmly shake examiners hand with [blank_start]elbow extended[blank_end]
Then, [blank_start]supinate[blank_end] the forearm against resistance.
Repeat the hand shake with [blank_start]elbow flexed[blank_end] to [blank_start]90[blank_end] degrees.
Note pain over lateral ep when the [blank_start]elbow[blank_end] was [blank_start]extended[blank_end] vs [blank_start]flexed[blank_end].
If reported pain is less with [blank_start]elbow flexed[blank_end], than with [blank_start]elbow extended[blank_end], conservative mx may be favourable.- Aelbow extended
- Bsupinate
- Celbow flexed
- D90
- Eelbow
- Fextended
- Gflexed
- Helbow flexed
- Ielbow extended
30Cubital tunnel:
Compression of the ulnar nerve as it passes through the tendon of [blank_start]FCU[blank_end]
Forceful, repetitive contractions of [blank_start]FCU[blank_end] may therefore result in cubital tunnel syndrome
[blank_start]FCU[blank_end] may be palpated by starting at the [blank_start]medial[blank_end] epicondyle and moving distally, as it is the most lateral muscle in the wrist flexor/pronator group- AFCU
- BFCU
- CFCU
- Dmedial
31Causes of elbow contractures, intrinsic vs extrinsic
Capsular contracture = [blank_start]intrinsic[blank_end]
heterotopic bone = [blank_start]extrinsic[blank_end]
muscle contracture = [blank_start]extrinsic[blank_end]
loose bodies = [blank_start]intrinsic[blank_end]- Aintrinsic
- Bextrinsic
- Cextrinsic
- Dintrinsic
32Radial head fracture types
Type I - non or minimally [blank_start]displaced[blank_end], no mechanical block to [blank_start]rotation[blank_end]
Type II - [blank_start]Displaced[blank_end] more than 2mm, or [blank_start]angulated[blank_end]. [blank_start]Possible[blank_end] mechanical block to rotation
Type III - [blank_start]Comminuted[blank_end], [blank_start]displaced[blank_end]. Mechanical block to rotation
Type IV - Fracture and [blank_start]dislocation[blank_end]- Adisplaced
- Brotation
- CDisplaced
- Dangulated
- EPossible
- FComminuted
- Gdisplaced
- Hdislocation
33The [blank_start]radial[blank_end] nerve is most at risk with an elbow arthroscopy as it's only 3mm away from the anterolateral portal.
- Aradial
34Endoscopic cubital tunnel decompression is contraindicated with preoperative ulnar nerve [blank_start]subluxation[blank_end] - this will only destabilise the nerve further and lead to more symptoms. This requires an open [blank_start]transposition[blank_end].
- Asubluxation
- Btransposition
35Open release for medial or lateral epicondylitis / tendonitis
Realistic return to sport afterwards is not for [blank_start]5[blank_end] to [blank_start]8[blank_end] months- A5
- B8
36Pinning a supracondylar fracture is safest from the [blank_start]lateral[blank_end] side, as on the [blank_start]medial[blank_end] side there is risk to the [blank_start]ulnar nerve[blank_end].
- Alateral
- Bmedial
- Culnar nerve
37UCL reconstruction:
Entails placing a ligament graft transosseously ([blank_start]through the bone[blank_end]) and spans the [blank_start]medial[blank_end] epicondyle to the [blank_start]coronoid[blank_end].- Athrough the bone
- Bmedial
- Ccoronoid
38MCL / LCL injuries
For optimal healing of these structures, post op orthotics should be elbow at [blank_start]90[blank_end] degrees of [blank_start]flexion[blank_end], and forearm:
- in pronation for the [blank_start]LCL[blank_end] injury
- in supination for the [blank_start]MCL[blank_end] injury
For injury of both LCL and MCL, forearm should be in [blank_start]neutral[blank_end]- A90
- Bflexion
- CLCL
- DMCL
- Eneutral
39Total elbow arthroplasty (TEA):
- usually reserved for [blank_start]elderly[blank_end] or patients with low [blank_start]functional[blank_end] demands
- can have complications of infection, [blank_start]ulnar[blank_end] neuritis, loosening of [blank_start]hardware[blank_end], [blank_start]heterotopic[blank_end] bone formation
- Important information following TEA:
* status of [blank_start]ulnar[blank_end] nerve (can be transposed during surgery )
* status of [blank_start]triceps[blank_end] tendon (may have been reflected off the olecranon and therefore needs protection by means of limiting [blank_start]extension[blank_end])
* Linked or unlinked implant? [blank_start]Linked[blank_end] prosthesis is more stable than [blank_start]unlinked[blank_end]. [blank_start]Unlinked[blank_end] requires post op ROM guidelines within stable arc of motion.- Aelderly
- Bfunctional
- Culnar
- Dhardware
- Eheterotopic
- Fulnar
- Gtriceps
- Hextension
- ILinked
- Junlinked
- KUnlinked
40UCL repair
Return to throwing sports can be implemented gently into rehab program at approx [blank_start]4[blank_end] months- A4
41Monteggia # post op
- Monteggia = # of the ulnar shaft with a radial head dislocation
- Inadequate fixation of this injury can lead to [blank_start]radial head subluxation[blank_end]
- This may present as decreased ROM early into rehab process, painful ROM, and a prominence on the [blank_start]lateral[blank_end] side of the elbow- Aradial head subluxation
- Blateral
42Radial tunnel syndrome
[blank_start]Radial[blank_end] nerve compression at elbow
Test for radial tunnel is the resisted [blank_start]MF extension[blank_end] test, which causes the [blank_start]ECRB[blank_end] to painfully compress the nerve
Can present with similar symptoms to [blank_start]lateral epicondylitis[blank_end], with the difference being that LE will be painful on the LE and RT will be [blank_start]2[blank_end]cm [blank_start]distal[blank_end].
PIN compression can be ruled out with MMT, as a PIN compression at the elbow will result in [blank_start]motor[blank_end] effects on [blank_start]digit[blank_end] and [blank_start]wrist[blank_end] [blank_start]extension[blank_end].- ARadial
- BMF extension
- CECRB
- Dlateral epicondylitis
- E2
- Fdistal
- Gmotor
- Hdigit
- Iwrist
- Jextension
43A comminuted radial head fracture is [blank_start]not[blank_end] amenable to [blank_start]fixation[blank_end].
[blank_start]Radial head replacement[blank_end] is preferred over [blank_start]excision[blank_end] in situations where there is compromised [blank_start]stability[blank_end] of the elbow- Anot
- Bfixation
- CRadial head replacement
- Dexcision
- Estability
44Conservative management of LE
Initial goal: reduce [blank_start]pain[blank_end] and [blank_start]inflammation[blank_end]
This can be accomplished through various techniques:
1) [blank_start]Wrist[blank_end] splint
2) N[blank_start]SAIDS[blank_end]
3) R[blank_start]est[blank_end]
4) A[blank_start]ctivity modification[blank_end] or c[blank_start]essation[blank_end] of causation activity
This initial phase may take [blank_start]3[blank_end] weeks or longer to accomplish.
Phase two: continues focus on tissue healing via:
1) a[blank_start]voidance[blank_end] of causative activities
2) C[blank_start]ounterforce bracing[blank_end]
3) [blank_start]Wrist extensor[blank_end] stretches
4) A[blank_start]ctivity modification[blank_end]
5) Exercises with the [blank_start]elbow flexed[blank_end] to decrease the load to the [blank_start]wrist extensors[blank_end]. Exercises are introduced as [blank_start]pain[blank_end] allows. Starting with no weight, and gradually increasing weight.
6) Finally, a strengthening program for the entire upper limb, including the parascapular muscles. The goal is to increase the demand on the muscles without increasing [blank_start]pain[blank_end]- Apain
- Binflammation
- CWrist
- DSAIDS
- Eest
- Fctivity modification
- Gessation
- H3
- Ivoidance
- Jounterforce bracing
- KWrist extensor
- Lctivity modification
- Melbow flexed
- Nwrist extensors
- Opain
- Ppain
45Cubital tunnel release
Initiation of AROM should be discussed with the surgeon as literature varies.
Generally speaking, for a subcutaneous transposition, beginning unprotected AROM within [blank_start]5-10[blank_end] days is not unusual.
Neurologic symptoms (parasethesias) typically diminish over time following surgery. It is not unusual for this process to take up to [blank_start]12[blank_end] months or longer. Also note that axonal regeneration will increase discomfort, or even pain, because pain fibres regenerate fastest.
A soft elbow pad can help control discomfort.- A5-10
- B12
46Burns of the elbow
- [blank_start]Active-assisted[blank_end] exercises are ideal to prevent contractures
- [blank_start]Passive[blank_end] ROM and [blank_start]static progressive[blank_end] splinting should also be considered as soon as physiologically stable- AActive-assisted
- BPassive
- Cstatic progressive
47ORIF post olecranon #
1/7 post op, a [blank_start]long arm[blank_end] splint should be applied with [blank_start]elbow[blank_end] positioned in [blank_start]70[blank_end] degrees flexion, and protected [blank_start]AROM[blank_end] and [blank_start]AAROM[blank_end] of elbow and forearm can be commenced.
Elbow SP splinting for extension shouldn't be commenced until pt loses extension - usually in the [blank_start]fibroplastic[blank_end] phase ([blank_start]2-8[blank_end] weeks)- Along arm
- Belbow
- C70
- DAROM
- EAAROM
- Ffibroplastic
- G2-8
48Turnbuckle extension splints are the most effective in gaining extension in elbows with greater than [blank_start]30[blank_end] degrees of contracture
Beyond [blank_start]30[blank_end] degrees of extension, the turnbuckle loses its mechanical advantage to increase extension to neutral. To achieve further gains, the splint can be converted into a [blank_start]3 point[blank_end] splint- A30
- B30
- C3 point
49A [blank_start]hinged fixator[blank_end] is used to provide a stable arc of motion following the compromise of elbow stability, such as a [blank_start]LCL[blank_end] repair.
- Ahinged fixator
- BLCL
50Strengthening following distal triceps repair
- Typically begins around [blank_start]12[blank_end] weeks
- Typically begins with submaximal [blank_start]isometric[blank_end] elbow extension exercises
- When pain controlled, advances to submaximal isotonic [blank_start]concentric[blank_end] exercises with free weight or theraband. Focus is on elbow extension with forearm in all 3 positions (supination/pronation/neutral) to target all [blank_start]3 heads of triceps[blank_end]
- Lastly- [blank_start]eccentric[blank_end] exercises are added- A12
- Bisometric
- Cconcentric
- D3 heads of triceps
- Eeccentric
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- CHT hand therapy (Elbow) Quiz on Elbow, created by Rosie C on 23/09/2018.
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- Rosie C
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