Chapter 4 - Arm

Front 1

Clinical application of Triceps

Back 1

Can be palpated on posterior aspect of arm. A tendon / avulsion rupture can be palpated immediately proximal to the olecranon

Front 2

Clinical application of Biceps

Back 2

Can be palpated on the anterior aspect of the arm

Front 3

Clinical application of Cubital fossa

Back 3

Biceps tendon can be palpated here. If ruptured, the tendon cannot be palpated.

Front 4

Clinical application of Lateral Epicondyle

Back 4

Site of common extensor origin. Tender in lateral epicondylitis (tennis elbow)

Front 5

Clinical application of Medial epidcondyle

Back 5

Site of common flexor origin. Tender in meidal epicondylitis. (golfer's elbow)

Front 6

Clinical application of olecranon

Back 6

proximal tip of ulna. Tenderness can indicate fracture

Front 7

Clinical application of Radial head.

Back 7

Proximal end of radius. Tendeness can indicate fracture.

Front 8

Deforming force in humeral fracture

Back 8

Deltoid

Front 9

Elbow ossification order mnemonic

Back 9

Captain Roy Makes Trouble On Leave.

Capitellum
Radial head
Medial epicondyle
Trochlea
Olecranon
Lateral epicondyle

can be used to determine the approximate age of patient

Front 10

Remodeling potential in distal radius fractures

Back 10

limited

Front 11

Holstein-Lewis Fracture

Back 11

fracture of the distal third of the humerus resulting in entrapment of the radial nerve

Front 12

What aligns with the radial head on x-ray?

Back 12

capitellum

Front 13

Ligament of Struthers

Back 13

Struthers' ligament is a ligament that extends between the shaft of the humerus and the medial epicondyle of the humerus.[1] It is not a constant ligament[2][3][4], and can be acquired or congenital. Its clinical significance arises form the fact that the median nerve, passes in the space between the ligament and the humerus, and in this space the nerve may be compressed leading to supracondylar process syndrome.

Front 14

Where does ulnar nerve run in relation to medial epicondyle?

Back 14

Ulnar n runs posterior to medial epicondyle

Front 15

Fat Pad Sign

Back 15

The fat pad sign is a sign that is sometimes seen on lateral radiographs of the elbow following trauma. Elevation of the anterior and posterior fat pads of the elbow joint suggests the presence of an occult fracture.
The fat pad sign is invaluable in assessing for the presence of an intra-articular fracture of the elbow. A anterior fat pad is often normal. However a posterior fat pad seen on a lateral x-ray of the elbow is always abnormal.

Front 16

Which portion of radial head is most susceptible to fracture?

Back 16

Anterolateral portion of radial head has less subchondral bone and is the most susceptible to fracture

Front 17

Where does radial tuberosity poitn in supination

Back 17

ulnarly

Front 18

What does the olecranon articulate with?

Back 18

trochlea

Front 19

Humeral Shaft Fracture

Back 19

Common long bone fracture, usually due to a fall or a direct blow. Displacement is based or fracture location and insertion sites. Pectoralis major and deltoid are main deforming forces. High union rate and is a common site of pathologic fractures.

Rx: Cast/brace for minimal displaced fxs with acceptable alignment (> 3cm shortening, < 20 degrees A/P angulation, < 30 degrees varus/valgus alignment.

Surgical Rx: open fx, floating elbow, segmental fx, polytrauma or vascular injury via ORIF, ex fix, or IM nail

Front 20

Distal humerus fractures

Back 20

Most are intraarticular (in adults); extraarticular in children (supracondylar) Unicondylar or bicondylar.

CT is essential for complete evaluation of fracture / joint.

Rx: non op is rarely indicated, surgial ORIF (plates and screws), Ulnar nerve often needs to be transposed anteriorly. Early ROM is importan.

Can perform total elbow arthroplasty is fx is too comminuted for ORIF

Front 21

complications of elbow fx

Back 21

Elbow stiffness, heterotopic ossification (prophylaxis is indicated), ulnar nerve palsy, nonunion

Front 22

Supracondylar humerus fx

Back 22

common pediatric fx, Extraphyseal at the thin portion of bone (1mm) between distal humeral fossae. Extension type is most common.Malreduction leads to deformity: cubitus varus most common, and relatively high incidence of neurovascular injury

Front 23

Complications of supracondylar fx

Back 23

Malunion (cubitus varus #1); neurovascular (median nerve / AIN #1), radial n., brachial artery)

Front 24

Radiographic finding w/ supracondylar fx

Back 24

Elbow series. Lateral view: anterior humeral line is anterior to capitellum in displaced fxs. Posterior fat pad indicates fx.

Front 25

Rx of supracondylar fx's

Back 25

Type I: long arm cast
Type II/III: Closed reduction and percutaneous pinning, 2 or 3 pins (crossed or divergent). Medial pins can injure ulnar n.

Open reduction for irreducible fx's (uncommon)
Explore pulseless/underperfused extremity for artery entrapment.

Front 26

RADIAL HEAD SUBLUXATION (NURSEMAID'S ELBOW)

Back 26

Hx: Pulled by hand, child will not use arm., Mechanism: child pulled or swung by hand or forearm

Annular ligament stretches, radial head lodges within it.

PE: Arm held pronated/flexed. Radial head & supination tender.

XR: only if suspect fracture

Reduce: with gentle, full supination and flexion (should feel it “pop” in). Immobilize a recurrence

Front 27

Ulnohumeral “Trochlear joint” joint
TYPE
ARTICULATION
LIGAMENTS
COMMENTS

Back 27

Type: Ginglymus [Hinge] jiont

Articulation: Trochlea and trochlear notch

Ligamnets:
Ulnar(medial) collateral:
1. Anterior band
2. Posterior band
3. Transverse band

Front 28

Radiohumeral joint,

TYPE
ARTICULATION
LIGAMENTS
COMMENTS

Back 28

Radiohumeral Trochoid [Pivot] joint

Capitellum & radial head

Radial (lateral) collateral
1. Ulnar part
2. Radial part

Weak, Gives posterolateral stability

Front 29

Proximal radioulnar

ARTICULATION
LIGAMENTS
COMMENTS

Back 29

Radial head & radial notch

Ligaments:
Annular (Keeps head in radial notch)
Oblique cord
Quadrate (Supports rotary movements)

Front 30

3 joints of the elbow

Back 30

Ulnohumeral “Trochlear joint”
Radiohumeral joint,
Proximal radioulnar joint

Front 31

What is fxn of Annular ligament of elbow?

Back 31

Keeps head in radial notch

Front 32

What is the fxn of the anterior band of the UCL

Back 32

Strongest: resists valgus stress

Front 33

What is fxn of Quadrate ligament?

Back 33

Supports rotary movements

Front 34

Normal carrying angle?

Back 34

5-15 degrees

Front 35

Causes of negative or decreased elbow carrying angle

Back 35

(< 5 degrees)

Cubitus varus: physeal damage (e.g. malunion supracondylar fracture)

Front 36

Causes of increased elbow carrying angle

Back 36

Positive (> 15 degrees)

Cubitus valgus: physeal damage (e.g. lateral epicondyle fracture)

Front 37

CORACOID PROCESS

Origins and Insertions:

Back 37

Origins:
Biceps (SH)
Coracobrachialis

Insertions:
Pectoralis minor

Front 38

GREATER TUBEROSITY
Origins and Insertions:

Back 38

Insertions:
Supraspinatus
Infraspinatus
Teres minor

Front 39

ANTERIOR PROXIMAL HUMERUS Origins and Insertions:

Back 39

Insertions:
Pectoralis major
Latissimus dorsi
Teres major

Front 40

MEDIAL EPICONDYLE Origins and Insertions:

Back 40

Origins:
Pronator Teres
Common Flexor Tendon [FCR, PL, FCU, FDS]

Front 41

LATERAL EPICONDYLE Origins and Insertions:

Back 41

Origins:
[FCR, PL, FCU, FDS]
Common Extensor Tendon[ECRB, ED, EDM, ECU]