Chapter 18: The Elbow and Forearm Complex

The mechanism of injury for a pulled elbow could be any of the following except: A) A fall on an outstretched hand B) Lifting a child off of the ground by the hand C) Hanging by the arms from a high bar at the playground D) Jerking to lift a heavy object such as a suitcase

A) A fall on an outstretched hand

To strengthen the elbow extensors in a closedchain, you decide to have the patient perform pushups, using body weight as the source of resistance. Which of the following variations of pushups provides the greatest amount of resistance to the elbow extensors? A) Bilateral pushups while in a fully prone position on the floor with weight on the hands and toes B) Bilateral wall pushups while in a standing position and leaning into and pushing away from the wall C) Bilateral pushups while standing and leaning on the hands on a kitchen countertop D) Bilateral pushups in a prone position with weight on the hands and knees

A) Bilateral pushups while in a fully prone position on the floor with weight on the hands and toes

A dynamic splint used to help improve an elbow flexion contracture is affecting which of these soft tissue properties? A) Creep B) Shear C) Elasticity D) Recoil

A) Creep

When a period of continuous immobilization of the elbow is required after trauma or surgery, the elbow often is positioned in only a moderate amount of flexion (20° to 30°) rather than 90° of flexion. This position is selected to: A) Decrease the risk of ulnar neuropathy from compression of the ulnar nerve in the tunnel of Guyon B) Decrease the risk of radial neuropathy from compression of the radial nerve in the cubital tunnel C) Decrease the risk of median nerve neuropathy from compression in the cubital tunnel D) Decrease the risk of overstretching the lateral collateral ligament complex of the elbow that could cause posterior translation of the radial head

A) Decrease the risk of ulnar neuropathy from compression of the ulnar nerve in the tunnel of Guyon

You place your patient's wrist in a splint because he is experiencing an acute episode of lateral epicondylitis. Which of the following is the least appropriate intervention while the inflamed soft tissue is healing? A) Have the patient wear a splint to immobilize the wrist continuously for at least 2 weeks or until there is no pain B) Have the patient remove the splint several times each day and perform active or self- assisted ROM of the wrist within painfree ranges C) Have the patient remove the splint several times a day and perform gentle muscle- setting exercises, elongating the involved muscletendon unit slightly after each contraction but not beyond the painfree ranges D) Apply crossfiber massage at the site of the lesion

A) Have the patient wear a splint to immobilize the wrist continuously for at least 2 weeks or until there is no pain

Factors that could lead to implant loosening of an elbow arthroplasty can include any of the following except: A) Poor quality triceps tendon B) High impact activities C) Infection D) Lack of adherence to postoperative activity modification

A) Poor quality triceps tendon

In an adult, a displaced fracture of the radial head typically is managed surgically by reduction and internal fixation of the fracture site or excision of the radial head with or without a prosthetic implant. Which of the following is incorrect about the indications, advantages, or disadvantages of these two procedures? A) Resection of the radial head coupled with prosthetic implant is typically performed arthroscopically, allowing a rapid postoperative recovery B) Open or arthroscopically assisted reduction and internal fixation is typically the procedure of choice if the patient is young and active C) Early postoperative motion is permissible after open reduction and internal fixation unless extensive repair of elbow ligaments was required D) Excision of the radial head is the only option if the fracture is severely comminuted

A) Resection of the radial head coupled with prosthetic implant is typically performed arthroscopically, allowing a rapid postoperative recovery

Open chain combined pushing motions to focus on the elbow could be any of the following except: A) Rowing motions B) Bench press C) Upper extremity ergometry D) "Walking" hands on a stairclimbing machine

A) Rowing motions

Precautions after a total elbow arthroplasty would include any of the following except: A) Avoid recreational activities such as golf and tennis B) Avoid any single lift of more than 25 pounds C) Perform range of motion exercises only within the range achieved during surgery D) If symptoms of ulnar nerve compression are noted, avoid prolonged positioning in end- range flexion

B) Avoid any single lift of more than 25 pounds

Any of the patients with the following conditions could be at risk to develop myositis ossificans except one with: A) A burn B) Cardiovascular accident C) Traumatic brain injury D) Tear of the brachialis tendon

B) Cardiovascular accident

Each of the following is a precaution that should be taken after total elbow arthroplasty involving a tricepsreflecting or tricepssplitting approach except: A) Limit assisted elbow flexion to about 90° to 100° for the first 3 to 4 weeks postoperatively. B) For about the first 3 to 4 weeks perform active elbow flexion/extension only while lying in the supine position C) Postpone elbow extension against manual resistance or light weights for 6 weeks or D) Avoid pushing motions with the operated upper extremity during functional activities, such as pushing up from a chair, for at least 6 weeks

B) For about the first 3 to 4 weeks perform active elbow flexion/extension only while lying in the supine position

Which of the following is true about myositis ossificans (heterotopic bone formation) in the elbow region? A) The muscle most often affected in the elbow region is the biceps brachii B) It is distinguished from traumatic arthritis of the humeroulnar joint in that passive extension is more limited than flexion C) After the acute inflammatory period, heterotopic bone is laid down within muscle fibers and within the joint D) Before the bony mass in the muscle has matured, the muscle should be stretched and massaged regularly to prevent a contracture

B) It is distinguished from traumatic arthritis of the humeroulnar joint in that passive

Your patient, a 19yearold college student, sustained a nondisplaced fracture of the distal humerus, which was managed by closed reduction and 6 weeks of immobilization in a cast. Yesterday the cast was removed and the patient is to begin exercises to improve ROM and strength of the elbow. Your examination reveals significant limitation of elbow flexion/extension and forearm pronation/supination as well as reduced joint play at the elbow. The patient describes his elbow as feeling "very stiff," but pain occurs only when overpressure is applied at the end of the available ranges. One of the goals in this patient's treatment plan is to increase elbow ROM. Which of the following techniques should you begin with to increase ROM? A) Crossfiber massage of the tendons inserting at the elbow B) Joint mobilization techniques to stretch the restricted joints (Grade III sustained glide or Grade IV oscillation techniques) after evaluating the reactivity of the elbow joints with Grade II sustained glides C) Manual passive stretching to lengthen muscles that cross the elbow D) Passive ROM within painfree ranges

B) Joint mobilization techniques to stretch the restricted joints (Grade III sustained glide or Grade IV oscillation techniques) after evaluating the reactivity of the elbow joints with Grade II sustained glides

Your patient with medial epicondylitis is in the controlled motion phase of recovery, and you are initiating muscle performance exercises with free weights. You use which of the following dosages of exercise? A) Low weight, low repetitions B) Low weight, high repetitions C) High weight, low repetitions D) High weight, high repetitions

B) Low weight, high repetitions

A patient who is a golfer places the most stress on which of the elbow ligaments? A) Lateral collateral ligament B) Medial collateral ligament C) Annular ligament D) Coracoacromial arch ligament

B) Medial collateral ligament

Which of the following interventions is contraindicated in your patient with traumatic injury to the brachialis muscle? A) Submaximal isometric exercises B) Stretching to the elbow flexors C) Cryotherapy to the injured area D) Passive range of motion of the elbow

B) Stretching to the elbow flexors

The elbow flexor that is least affected by shoulder or elbow position is which of the following? A) Pronator teres B) Biceps brachii C) Brachialis D) Brachioradialis

C) Brachialis

Your patient has lateral epicondylitis and is in the acute stage of recovery. You want to initiate gentle isometric exercise and so place the wrist in which of the following positions? A) Flexion B) Neutral C) Extension D) Radial deviation

C) Extension

Plyometric exercises for the elbow are primarily done to improve which of the following? A) Strength B) Endurance C) Power D) Flexibility

C) Power

A person with a long history of polyarticular rheumatoid arthritis is experiencing severe, dominantside elbow pain that is interfering with personal grooming, light housework, and workrelated responsibilities as a computer programmer. In addition to pain, physical findings include persistent synovitis despite ongoing medical management, limited elbow ROM, and complete loss of the joint space of the humeroulnar (HU) and humeroradial (HR) joints. Given these findings, this person is most likely a candidate for which of the following surgical procedures to relieve pain and improve daily function? A) Synovectomy B) Excision of the radial head coupled with prosthetic implant C) Total elbow arthroplasty D) Arthrodesis of the elbow

C) Total elbow arthroplasty

Using a handheld weight as the source of resistance, which of the following positions to strengthen the elbow extensors begins with the long head of the triceps brachii fully lengthened? A) Have the patient assume a pronelying position with the shoulder in 90° abduction, the upper arm supported on the table, and the elbow flexed to 90° B) Have the patient assume the supine position with the shoulder flexed to 90° and the elbow flexed so the handheld weight touches the opposite shoulder C) With the patient standing or sitting in a chair, begin with the elbow fully flexed and the arm elevated overhead and stabilized to maintain the shoulder in as much flexion as possible D) While the patient is in a standing position and the hips are flexed to 90°, begin with the shoulder in hyperextension

C) With the patient standing or sitting in a chair, begin with the elbow fully flexed and the arm elevated overhead and stabilized to maintain the shoulder in as much flexion as possible

Surgical options for a person with elbow joint disease include any of the following except A) Elbow arthroplasty B) Resection of the radial head C) Arthrodesis D) Bankart procedure

D) Bankart procedure

The best starting position in which to use a wrist roller to build strength and endurance of the muscles affected my medial epicondylitis is which of the following? A) Elbows flexed, forearms pronated B) Elbows flexed, forearms supinated C) Elbows extended, forearms pronated D) Elbows extended, forearms supinated

D) Elbows extended, forearms supinated

You are modifying a home exercise program for a patient recovering from an episode of medial epicondylitis. Although pain has subsided, there is evidence of mild limitation of motion and pain when the involved muscletendon unit is placed on a stretch and overpressure is applied at the end of the available ROM. To fully lengthen the muscletendon unit typically involved in medial epicondylitis, have the patient perform a selfstretch by using the opposite hand to: A) Flex and ulnarly deviate the wrist and flex the fingers while the elbow is extended and the forearm is pronated B) Flex and radially deviate the wrist and flex the fingers while the elbow is extended and the forearm is supinated C) Extend and ulnarly deviate the wrist and extend the fingers while the elbow is extended and the forearm is pronated D) Extend and radially deviate the wrist and extend the fingers while the elbow is extended and the forearm is supinated

D) Extend and radially deviate the wrist and extend the fingers while the elbow is extended and the forearm is supinated

Which of the following is true about total elbow arthroplasty (TEA)? A) A semiconstrained, linked prosthesis allows flexion and extension of the elbow but not varus, valgus, or rotational motions B) The typical method of fixation of the implants is allcementless (allbiological) fixation C) The surgical approach most often used leaves the triceps tendon intact. D) One of the more common, longterm complications after TEA is joint instability, particularly with unlinked implants or if the patient previously underwent excision of the radial head

D) One of the more common, longterm complications after TEA is joint instability, particularly with unlinked implants or if the patient previously underwent excision of the radial head

Your goal is to increase elbow flexion using joint mobilization techniques. Which of the following techniques is appropriate? A) Stabilize the distal humerus and apply proximal glide of the ulna B) Apply a valgus stress at the elbow C) Stabilize the humerus and apply dorsal glide to the head of the radius D) Stabilize the distal humerus and apply radial glide of the ulna

D) Stabilize the distal humerus and apply radial glide of the ulna

The distal upper extremity nerve that passes through the cubital tunnel posteromedial to the olecranon process is which of the following? A) Hypothenar nerve B) Radial nerve C) Median nerve D) Ulnar nerve

D) Ulnar nerve