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MSK 1 > 10/7 - Elbow Complex Part 2 > Flashcards

10/7 - Elbow Complex Part 2 Flashcards

1
Q

what attachment is likely implicated in lateral tendinosis

A

origin of extensor carpi radialis brevis

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2
Q

what is tendinopathy in general terms

A

degenerative condition, NOT INFLAMMATORY

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3
Q

what are the 3 possible etiologies of tendinopathies

A
  1. vascular
    - degeneration d/t vascular compromise
    - ability to absorb and generate force declines
  2. mechanical loading
    - microscopic degeneration leading to scar tissue
  3. neural modulation
    - neurally mediated mast cell degranulation and release of substance P
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4
Q

what is a way that we might be able to detect a mechanical loading etiology to a tendinopathy

A

might be able to palpate changes
could have some tenderness

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5
Q

what are 4 risk factors for a tendinopathy

A

inc age
tendons crossing 2 joints
excessive loading (volume, magnitude, speed)
altered biomechanics

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6
Q

how do altered biomechanics contribute to a risk factor for tendinopathies

A

weakness
limited flexibility
poor form w movement

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7
Q

how is inc age a risk factor for tendinopathy

A

age has a cumulative effect of load over time

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8
Q

what impact does prox weakness have on distal mobility

A

inc demand on distal mobility
- will rely on distal ms to work harder to create stability

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9
Q

what is the most typical MOI behind a tendinopathy

A

overuse

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10
Q

what is the main way to rehab a tendinopathy

A

loading the tissue
- inc collagen formation in the area

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11
Q

why are isometrics chosen initially for management of a tendinopathy

A

d/t high reactivity

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12
Q

what type of resistance do we want to be adding when rehab-ing a tendinopathy

A

heavy and slow
- for concentric exercise

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13
Q

what are other names for tendinosis

A

epicondylitis
epiconylalgia

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14
Q

what does lateral tendinosis lack

A

an inflammatory response

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15
Q

what is the best way to try to recreate sx at any ms

A

ask ms or work or put ms on stretch

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16
Q

what actions do pts w lateral tendinosis have difficulty with

A

gripping
passive wrist flex
active wrist/finger ext

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17
Q

what is the demographics for lateral tendinosis

A

females 35-50
physical/office work (ie typing)

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18
Q

what are tests to r/i lateral tendinosis

A

cozen test - resist wrist ext in pronation and RD (getting ECRB to work)

maudsley - 3rd finger resistance (EDC)

mill - elbow flex to 90, pronation
- support elbow & flex wrist and extend elbow

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19
Q

what modification can be added to the mill test to further provoke sx if mill test not sufficient

A

add ulnar deviation

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20
Q

what are differential dx for lateral tendinosis (6)

A
  1. tendinitis vs tendinosis
  2. C6-7 nerve root
  3. radial tunnel syndrome
  4. posterolateral rotary insufficiency
  5. posterior interosseous n. compression
  6. intra-articular pathology
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21
Q

what is a main way that can tease out lateral tendinosis from other differential dx

A

assessing the end feel
- degenerative n. vs muscular restriction
- capsular or bony?

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22
Q

what intervention was helpful in lateral tendinosis? what wasn’t?

A

MWM - improved pain and grip

Mill’s manip - improve pain but not grip

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23
Q

what is another term for lateral tendinosis

A

tennis elbow

24
Q

is a tendinosis acute or chronic? what are the implications of this?

A

chronic
lacks inflammatory response

25
Q

what is one reason other than chronicity that you don’t see inflammatory process in individuals w tendon irritation

A

taking anti-inflammatory meds

26
Q

what are the main structures implicated w a medial tendinosis

A

FCR
pronator teres

27
Q

what is another term for medial tendinosis

A

golfer’s elbow

28
Q

what are MOI for medial tendinosis (3)

A

flexor-pronator fatigue
UCL fails to stabilize valgus forces
rapid change in level of stress

29
Q

what are components to a physical exam to r/i medial tendinosis (4)

A
  1. palpation of medial epicondyle
    - pain w/i 5 cm
  2. grip strength
    - (+) pain, deficit
  3. strength - wrist flex, pron
  4. stretch - wrist ext, sup
30
Q

what is a precaution when utilizing a HHD to assess grip strength in someone you suspect medial tendinosis in

A

caution in the presence of ulnar neuritis

31
Q

what are 4 differential dx for medial tendinosis

A

C7, C8, T1 n. compression
thoracic outlet syndrome
ulnar n. injury
medial elbow instability (UCL)

32
Q

C7,8/T1 and thoracic outlet vs medial tendinosis

A

thoracic outlet and cervical pain are more diffuse and broader area
- not pinpoint area like MT

33
Q

sx of ulnar n. damage/irritation

A

weakness w opposition
weakness, paresthesias, numbness

34
Q

what intervention will benefit majority of people with tendinosis

A

conservative management or PT

35
Q

what is the criteria to require surgical intervention for tendinosis (3)

A

failure of conservative management >1yr
constant pain
intra-articular pathology

36
Q

which tendinosis is more commonly requiring an intervention

A

lateral tendinosis

37
Q

what are 3 typical surgical procedures for lateral tendinosis

A
  1. release of common extensor origin
  2. debridement &/or repair of extensors
  3. decortication or drilling of lateral epicondyle
38
Q

what is the typical post-op rehab after a surgical intervention for tendinosis

A

gradual restore of motion
once mobility is back, then restoring strength

39
Q

location of sx and c/o in bicipital tendinopathy

A

c/o pain at radial tuberosity
sx w resisted elbow flex and supination

40
Q

rehab program for bicipital tendinopathy (4)

A

relative rest
restore ms length & GHJ capsular mobility
eccentric loading of elbow flexors & supinators
progressive return to throw program

41
Q

MOI for distal biceps tendon rupture

A

rapid eccentric contraction while in supination

42
Q

what motions will cause pain and weakness in a distal biceps tendon rupture

A

elbow flex and supination

43
Q

what are visible signs of a distal biceps tenodn rupture

A

popeye deformity
(+) ecchymosis in antecubital fossa

44
Q

what is super important in the management of a distal biceps tendon rupture and why

A

TIMELINE - direct referral to surgeon
- if surgical, needs to be as soon as possible, the longer it takes to get to a surgeon - the less option surgery is

as biceps retracts up, harder to restore anatomic footprint
- quality of tissue deteriorates and length of tissue dec

45
Q

general progression of post op management of distal biceps tendon rupture repair

A

focus on restoring full ROM by 6 weeks
- gradual ext
triceps strengthening first
then biceps isometrics
- do co-contraction exercises first to avoid isolated biceps contractions
unrestricted activity by 16 weeks

46
Q

what are risk factors for a nerve injury (3)

A

superficial location of nerve
pathway thru narrow bony canal or in b/w ms
nerve location high risk area for trauma

47
Q

what are typical nerve injury mechanisms

A

direct or indirect trauma
traction
friction
compression

48
Q

what is the most common MOI for ulnar nerve (2)

A

traction
valgus force at elbow

49
Q

what are the components of the pathway that the ulnar n. passes through

A

walls - medial epicondyle and olecranon
roof - aponeurosis
floor - UCL, joint capsule, olecranon

50
Q

what is the MOI for cubital tunnel syndrome (2)

A

traction (valgus force in throwers)
postures of valgus

51
Q

what are differential dx for cubital tunnel syndrome

A

cervical radiculopathy
thoracic outlet syndrome

52
Q

what is a consideration w the common c/o with cubital tunnel syndrome

A

c/o painless “snapping” or “popping” during A/P flex/ext
- if accompanies by numbness and tingling that is the rubbing the nerve which will cause irritation

53
Q

what are 4 tests to r/i cubital tunnel syndrome

A

tinel @ ulnar n.
froment sign
elbow flex test
pressure provocation test

54
Q

what are the keys to success in non-operative management of cubital tunnel syndrome (2)

A

prevent excessive flex postures
prevent ext pressure on nerve

55
Q

what are patient education points for cubital tunnel syndrome

A

avoid elbow flex >90
avoid valgus stress
avoid excessive wrist/finger flex

56
Q

what are indications for surgical intervention for cubital tunnel syndrome (3)

A

failure of conservative management
evidence of ms atrophy
(+) nerve conduction findings

57
Q

what type of outcome measures are often used and what are 2 examples

A

patient reported outcome measures
- DASH and qDASH

MSK 1 (31 decks)

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