elbow outline

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Elbow Outline
What is the most common complication after elbow trauma? How does it affect functional activities?
Stiffness has been noted to be the most common complication of elbow trauma. The stiffness of the elbow affects functional activities by inhibiting mobility and stability. In order to withstand the forces associated with daily activities, the elbow is supposed to be not only mobile but stable as well.
Define “Carrying Angle”.
The carrying angle also is known as the valgus angle that occurs when the elbow is fully extended. This occurs because the trochlea of the humerus is at an angled orientation. Radiography measurements average the carrying angle in adults at 17.8%.
Label the three components (Anterior Bundle, Posterior Bundle, and Transverse Ligament) of the medial collateral ligament of the elbow on the picture below.
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7759694705358045459905900 Anterior Bundle
Posterior Bundle
Transverse Ligament
The Medial/Ulnar Collateral Ligament resists against ___Valgus___ forces.
The Lateral/Radial Collateral Ligament resists against _____Varus____ forces.
Pg. 258-Clinical PearlDescribe patient symptoms when they have excessive pressure at the cubital tunnel of the elbow?
When patients have excessive pressure at the cubital tunnels, the small finger experiences tingling and numbness, similar symptoms may be experienced on the ulnar aspect of the ring finger. Grip weakness is also another noted symptom.

The ulnar nerve in the cubital tunnel is the nerve involved (Cooper 258).
Pg. 258 What is the most common bone that is fractured in the Elbow? ____Radial head___
Pg. 259. What is the difference in treatment protocols for a stable isolated elbow fracture and an unstable postoperative elbow fracture? Include in your answer when strengthening exercises are introduced.
In stable isolated elbow fracture, an active movement is initiated in the first week. When the elbow fracture is nondisplaced and stable, patients are referred to therapy several days following the injury. In unstable elbow fractures, the operation is carried out to restore stability and bone alignment. Fractures, in this case, are allowed to heal by protection from uncontrolled forces that might lead to malunion. Strengthening exercises are withheld until fracture consolidation occurs. This takes about 8 to 12 weeks after the surgery. Resumption of previous activities may take 3 to 6 months. This is the period within which the fracture will have fully consolidated (Cooper 259).
Define Heterotropic Ossification.
This refers to the development of a bone in the nonosseous tissue following the fractures of the distal humerus
Define Anterior Ulnar Nerve Transposition.
This refers to a form of fracture repair performed during surgery to reduce the chances of postoperative ulnar neuropathy from occurring.
pg. 388List the three joints that make up the elbow complex.
Ulnohumeral Joint
Radiohumeral Joint
Superior radioulnar joint
Pg. 389 List the structures that form the cubital tunnel.
The cubital tunnel is formed by the three parts of the ulnar collateral ligament and the flexor carpiulnaris muscle. The three parts are; anterior bundle, posterior bundle and the transverse bundle (Cooper 389).
Define Tardy Ulnar Nerve Palsy.
This refers to the resultant effect of the double crush cubicle tunnel problem in combination with a cervical spine problem. It may result from an injury that increases the carrying angle causing abnormal stress on the ulnar nerve.
Define “little leaguer’s elbow”. Include the mechanism of injury and what structures are involved.
Little League Elbow refers to a common injury normally associated with throwing. It occurs on the medial elbow and its caused by repetitive throwing motion causing overstress or overload.
Define “gunstock deformity”.
This refers to the resultant effect of the misalignment of the distal humerus. It causes a change in carrying angle. It may result when the medial column collapses from the comminution. This form of deformity does not remodel and remains static.
Pg. 395. What is the “normal” acceptable amount of elbow hyperextension, especially in women, if it is noted in both arms?
Active elbow extension is normally 0o, in some cases, a hyperextension of up to 10o may be exhibited. This mostly occurs in women. This type of hyperextension is assumed to be normal when it is equal on both arms and no trauma has been experienced in the past (Cooper 395).
Starting on pg. 405 Specialty Tests – Define each, list the expected positive sign/symptom for each test, and explain why they work based on the anatomy.
Ligamentous:Valgus instability test
The patient stands with an abducted arm and a fully flexed elbow. As he/she maintains a valgus stress, the doctor quickly extends the elbow. Reproduction of the pain within the range of 120o to 70o indicates a positive test. This also indicates a partial tear of the medial collateral ligament.
Varus instability tests
When the patient’s elbow is flexed slightly within the range of 20o to 30o and stabilized by the examiner, a varus force is applied to the distal forearm to carry out a lateral collateral ligament test. Normally, the examiner will feel the ligament tensing when stress is applied.
Muscle:Biceps Squeeze Test
This test is carried out to determine whether there is a rupture of the biceps brachii tendon. The patient sits with the forearm on the lap. The forearm is pronated slightly and the elbow is flexed within 60-80 degrees. The examiner then squeezes the biceps brachii with both hands, one at the muscle belly and the other one at the myotendinous junction. While squeezing the biceps, the muscle belly is pulled away from the humerus. Lack of a forearm supination is an indication of a positive test for biceps brachii rupture.
Lateral Epicondyle Test (Tennis elbow/ Mill’s)
When the patient is seated, the examiner palpates the patient’s lateral epicondyle while pronating the patient’s forearm, flexing the wrist fully and extending the elbow. If the pain is reproduced in the insertion area at the lateral epicondyle, it indicates a positive test.
Medial Epicondyle Test (Golfer’s Elbow)
When the patient is seated and makes a fist with the injured side, the clinician palpates along the medial epicondyle at the same time grasping the patient’s wrist. The clinician passively supinates the forearm and extends the elbow, wrist, and fingers. A positive test would be discomfort along the medial aspect of the elbow.
Pinch Grip Test- Include what Nerve is involved in the pathology.
When the patient is seated, the clinician instructs him/her to pinch the thumb tips and index finger together. The inability to touch both tips together proves a positive test. The nerve involved in the pathology is the anterior interosseous nerve.
Tinel Sign (at the elbow) Include what Nerve is involved in the pathology.
When the patient is seated with a slightly flexed elbow, the clinician grasps the wrist of the athlete with distal hand. The clinician then stabilizes the wrist and makes a tap on the ulnar nerve in the ulnar notch using the index finger. A tingling sensation along the ulnar distribution of the forearm, hand, and fingers, proves a positive test.
Pg 414 figure 6-48 Define and explain pronator syndrome:
The pronator syndrome refers to the compression of the median nerve against the flexor digitorum superficials muscle. This compression causes weakness of the pronator teres.
Works Cited
Cooper, Cynthia, ed. Fundamentals of hand therapy: clinical reasoning and treatment guidelines for common diagnoses of the upper extremity. Elsevier Health Sciences, 2013.