Description
Joint Structure and Function 5th Edition Levangie Norkin Test Bank
ISBN-13: 978-0803623620
ISBN-10: 0803623623
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Chapter 8: The Elbow Complex
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. Which of the following describes the arthrokinematic motion that occurs at the humeroulnar joint when the elbow is flexing to bring your hand to your mouth?
| a. | Caudal/anterior/cephalic glide of ulna on trochlea; medial glide of ulna on trochlea |
| b. | Cephalic/posterior/caudal glide of ulna on trochlea; medial glide of ulna on trochlea |
| c. | Caudal/anterior/cephalic glide of ulna on trochlea; lateral glide of ulna on trochlea |
| d. | Cephalic/posterior/caudal glide of ulna on trochlea; lateral glide of ulna on trochlea |
____ 2. During elbow extension from 90° flexion at the humeroradial joint, the radial head rolls in a(n) ____________________ direction and glides in a(n) ____________________ direction on the capitulum at the humeroradial joint.
| a. | anterior/cephalic, posterior/inferior |
| b. | posterior/caudal, posterior/inferior |
| c. | anterior/cephalic, anterior/inferior |
| d. | posterior/caudal, anterior/inferior |
____ 3. Which of the following structures is the primary stabilizer of elbow to valgus stress between 20° and 120° flexion?
| a. | Quadrate ligament |
| b. | Oblique cord |
| c. | Annular ligament |
| d. | Medial collateral ligament |
____ 4. A football offensive lineman takes his three-point stance. The base of support (BOS) includes 1 upper extremity (hand placed on ground) and both lower extremities with his right elbow in 30° of flexion. Which of the following would best resist a valgus stress applied to the humeroulnar joint by an opposing player?
| a. | Lateral collateral ligament |
| b. | Anterior medial collateral ligament |
| c. | Lateral ulnar collateral ligament |
| d. | Posterior medial collateral ligament |
____ 5. In full elbow extension, varus stability is provided by which of the following bony and/or noncontractile soft tissue structures?
| a. | Configuration of the joint surfaces, medial collateral ligament, anterior ligament |
| b. | Posterior ligament, configuration of the joint surfaces, annular ligament |
| c. | Oblique cord, quadrate ligament, configuration of the joint surfaces |
| d. | Configuration of the joint surfaces, joint capsule, lateral collateral ligament |
____ 6. Which of the following elbow flexors produces the greatest amount of compression in the elbow joint and therefore is a stabilizer of the elbow?
| a. | Biceps brachii |
| b. | Pronator teres |
| c. | Brachioradialis |
| d. | Brachialis |
____ 7. The ____________________ radioulnar joint has a disc that is also known as ____________________.
| a. | superior, annular ligament |
| b. | superior, triangular fibrocartilage complex (TFC) |
| c. | inferior, annular ligament |
| d. | inferior, triangular fibrocartilage complex (TFC) |
____ 8. Which of the following groups of soft tissue structures could potentially limit full forearm supination?
| a. | Oblique cord, quadrate ligament, distal palmar radioulnar ligament |
| b. | Lateral collateral ligament, oblique cord, distal anterior radioulnar ligament |
| c. | Quadrate ligament, distal posterior radioulnar ligament, oblique cord |
| d. | Distal posterior radioulnar ligament, interosseous membrane, oblique cord |
____ 9. Which of the following would you consider to be a limiter of motion when a patient cannot achieve full elbow extension?
| a. | Passive tension of the flexor muscles |
| b. | Tension in the posterior ligaments |
| c. | Passive tension of the elbow extensor muscles |
| d. | Posterior capsular tightness |
____ 10. Which of the following wrist muscles can play a significant role in resisting valgus stress to the elbow?
| a. | Brachioradialis |
| b. | Flexor carpi ulnaris |
| c. | Extensor carpi radialis |
| d. | Flexor carpi radialis |
____ 11. Which of the following structures will resist a valgus stress to the elbow at 30° of flexion?
| a. | Interosseous membrane |
| b. | Annular ligament |
| c. | Medial collateral ligament |
____ 12. In which position is the central band of the interosseous membrane the most taut?
| a. | Midway between supination and pronation |
| b. | At full supination |
| c. | At full pronation |
____ 13. Which of the following muscles helps to support the medial collateral ligament when exposed to large valgus forces?
| a. | Brachioradialis |
| b. | Flexor carpi ulnaris |
| c. | Pronator quadrates |
| d. | Anconeus |
____ 14. Which of the following muscles works to dynamically support the distal radioulnar joint?
| a. | Pronator quadratus |
| b. | Pronator teres |
| c. | Flexor carpi radialis longus |
| d. | Palmaris longus |
Short Answer
- What causes the carrying angle of the elbow joint? What functional purpose does the carrying angle serve?
- If there is no angulation between the long axis of the humerus and the long axis of the forearm, what condition exists?
- Where would you position the elbow joint to optimize the biomechanical effects of both the brachialis and the biceps brachii?
- When the elbow is flexed using a lot of speed with the forearm in neutral (midposition), which elbow flexors are active?
- When unresisted elbow extension against gravity is required, which of the elbow extensors is/are active?
- Which muscles are the first recruited in forearm supination and pronation?
- What is the causative mechanism and the structure(s) involved in “tennis elbow”?
- What is the causative mechanism and the structure(s) involved in “Nursemaid’s elbow”?
- What is the causative mechanism and the structure(s) involved in “cubital tunnel syndrome”?
- What is the causative mechanism and the structure(s) involved in avascular necrosis of the radial head?
Chapter 8: The Elbow Complex
Answer Section
MULTIPLE CHOICE
- ANS: C
The concave trochlear ridge of the ulna glides along the trochlear groove of the humerus until the coronoid process reaches the coronoid fossa. As the semicircular-shaped trochlear notch moves in a generally anterior direction, the motion is also noted to be cephalic at the bottom of the notch and caudal at the top of the notch. Because the trochlea is more inferior than the trochlear groove, there is also a lateral glide of the ulna on the trochlea.
PTS: 1
- ANS: B
The shallow concave radial head articulates with the larger convex capitulum. This would constitute a concave on convex joint articular, and so the role and glide of the joint surface would occur in the same direction.
PTS: 1
- ANS: D
The anterior portion of the medial collateral ligament is considered to be the primary stabilizer of the elbow to valgus stress from 20° to 120° of flexion.
PTS: 1
- ANS: B
The lateral collateral ligaments primarily resist varus force; therefore, that would not be a suitable answer. Both the anterior medial collateral ligament and posterior collateral ligament resist valgus stress; however, the posterior medial collateral ligament is a better resistor of valgus stresses after 55° of flexion.
PTS: 1
- ANS: D
Configuration of the boney components of the elbow joint provide one half of the resistance to varus stress. The lateral collateral ligament and joint capsule provide the other half of the resistance.
PTS: 1
- ANS: C
The biceps brachii and brachioradialis have insertions that lie close to the joint axis and therefore lend themselves to mobility and range of motion. The brachioradialis inserts at a distance from the joint, and the largest component of the muscle force goes toward joint compression. The pronator teres exerts only a slight amount of force at the elbow.
PTS: 1
- ANS: D
The inferior radioulnar joint has an articular disc that is often referred to as the TFC. The superior radioulnar joint does not have a disc.
PTS: 1
- ANS: A
The quadrate ligament limits the spin of the radial head in the radial notch, and the distal palmar radioulnar ligament becomes taut in full supination. The role of the oblique cord is not well understood, but based on its attachments just below the radial notch and just below the biceps tuberosity, the oblique cord would become taut during supination and therefore could limit motion in that direction.
PTS: 1
- ANS: A
Prolonged immobilization of the elbow in a passively flexed position can lead to shortening of the flexor muscles. All of the other structures listed are posterior to the joint and would more likely limit flexion.
PTS: 1
- ANS: B
The flexor carpi ulnaris (FCU) is the only muscle to lie directly over the anterior portion of the medial collateral ligament (MCL) during elbow flexion. Due to its position, the FCU can assist in reinforcing the MCL when the elbow is flexed.
PTS: 1
- ANS: C
The medial collateral ligament is the primary restraint to valgus forces between 20° and 120° of elbow flexion.
PTS: 1
- ANS: A
The central band of the interosseous membrane is tightest in a neutral position between supination and pronation.
PTS: 1
- ANS: B
The humeral head of the flexor carpi ulnaris lies directly anterior to the anterior portion of the medial collateral ligament and can give significant reinforcement as a dynamic stabilizer to the elbow during valgus forces.
PTS: 1
- ANS: A
The pronator quadrates and flexor carpi ulnaris provide dynamic stabilization for the distal radioulnar joint. Additionally, the flexor carpi radialis brevis acts as a stabilizer.
PTS: 1
SHORT ANSWER
- ANS:
The carrying angle is created by the obliquity of the humeral condyles and elbow joint axis. Although the elbow is a hinge joint, the axis is tilted slightly (down on the medial side). Thus, as the elbow flexes, the forearm moves medially on the humerus (like folding a piece of paper on a crooked fold). The effect is that elbow flexion brings the hand closer to the mouth (a very functional movement) without any glenohumeral rotation.
PTS: 1
- ANS:
Cubitus varus (decrease in the normal medial angulation of the joint) exists.
PTS: 1
- ANS:
At 90° of elbow flexion, the moment arms of the muscles are maximal. Optimal length occurs at approximately 60° of flexion. Peak torque will occur between 60° and 90°, but closer to 90°.
PTS: 1
- ANS:
Elbow joint muscles that cross only the humeroulnar joint cannot be affected by shoulder or radioulnar motion. These muscles are the medial and lateral heads of the triceps brachii, anconeus, and brachialis.
PTS: 1
- ANS:
The medial head of the triceps is the first of the three heads of the triceps to be recruited. The lateral head joins the medial head with any need for additional force. The long head will come in only when additional force is necessary, or when simultaneous shoulder extension is desired. The anconeus, as a one-joint elbow extensor, is presumed to be active during most active elbow extension tasks.
PTS: 1
- ANS:
The single-joint supinator and pronator are the supinator muscle and the pronator quadratus. One might assume, therefore, that these muscles are the most consistently active during active supination and pronation, respectively. The two-joint supinator is the biceps brachii, and the two-joint pronator is the pronator teres. These are likely to be active when additional force is necessary, or simultaneous elbow flexion is desired.
PTS: 1
- ANS:
Tennis elbow is presumed to be microtears in the wrist extensors created by forceful and repeated wrist extension.
PTS: 1
- ANS:
Nursemaid’s elbow is a dislocation of the radial head from within the annular ligament. It occurs primarily in children whose annular ligament is elastic and whose radial head is not yet well developed. Dislocation generally occurs when there is a sudden distraction applied to the forearm, without the compressive stabilization of the elbow joint muscles.
PTS: 1
- ANS:
Cubital tunnel syndrome is compression of the ulnar nerve generally created by two factors: excessive tension in the nerve created by entrapment at the medial epicondyle, and excessive compression of the nerve created by repeated or forceful contractions of the flexor carpi ulnaris through which the ulnar nerve passes.
PTS: 1
- ANS:
Avascular necrosis of the radial head is the result of a series of steps: (1) repeated valgus stress to the elbow joint; (2) stretching of the medial collateral ligament; (3) excessive compression of the radial head against the capitulum, resulting in cartilage deterioration; and (4) compression and reduction of the vascular supply of the head of the radius, resulting in bone death.
PTS: 1
