745 Flashcards
reversing impairments
remediation
changes in the environments and tasks
compensation or adaptation
management of anticipated problem
prevention
SINSS
severity irritability nature stage staility
patient profile
age occupation current daily activity leve recreation/hobbies psychosocial factors
body chart
location description clear other areas number each complaint establish relationship btw complaints
intensity of the symptoms and the effect on functional ability
severity
amount of activity to produce an exacerbation of symptoms and the time to subside or ease
irritability
treatment plan should include
education modalities ther ex manual therapy assistive device HEP
contraindications to mob/manip
malignancy neurological vascular bone diseases inflammatory conditions infection acute symptomatic disc herniation undiagnosed pain
distraction grading system
grade 1: unloading and decompressing the joint surfaces
grade 2: separation of joint surfaces
grade 3: joint capsule and ligament stretch
distraction time for pain
10-20 sec
distraction time for stretching joint capsule
30-60 sec
maitland grade I
first 25% small amplitude
maitland grade II
large amplitude middle 50%
maitland grade III
last 50%
maitland grade IV
last 25%
maitland grade V
high velocity small amplitude
manipulation
manual technique for treating pain
grade I and II
manual technique for resistance
III and IV
hip inferior glide facilitates
joint mobility
pain relief
hip posterior glide facilitates
flexion
IR
hip anterior glide facilitates
extension
ER
hip lateral distraction facilitates
joint mobility
pain relief
knee distraction facilitates
joint mobility
pain relief
knee anterior glide facilitates
extension
knee posterior glide facilitates
flexion
ankle talocural distraction facilitates
joint mobility
pain relief
ankle talocural posterior (dorsal) glide facilitates
dorsiflexion
ankle talocural anterior (ventral) glide facilitates
plantarflexion
ankle subtalar distraction facilitates
joint mobility
pain control
ankle subtalar medial glide facilitates
inversion
ankle subtalar lateral glide facilitates
eversion
glenohumeral anterior glide facilitates
ER
extension
horizontal abduction
glenohumeral posterior glide facilitates
IR
flexion
horizontal adduction
glenohumeral inferior glide facilitates
elevation
glenohumeral lateral glide facilitates
general hypomobility
scapular superior glide facilitates
elevation
scapular inferior glide facilitates
depression
scapular lateral glide facilitates
abduction/protraction
scapular medial glide facilitates
adduction/retraction
humeroulnar distraction facilitates
joint mobility
humeroulnar medial glide facilitates
elbow extention
humeroulnar lateral glide facilitates
elbow flexion
humeroradial distraction facilitates
joint mobility
distal radioulnar volar glide facilitates
pronation
distal radioulnar dorsal glide facilitates
supination
wrist volar glide facilitates
wrist extension
wrist dorsal glide facilitates
wrist flexion
wrist ulnar glide facilitates
radial deviation
wrist radial glide facilitates
ulnar deviation
MCP volar glide facilitates
flexion
MCP dorsal glide facilitates
extension
MCP radial glide facilitates
abduction
MCP ulnar glide facilitates
adduction
MCP traction facilitates
joint mobility
ther ex components for bone
biomechanical energy int he line of stress
avoid sheer forces
ther ex components for cartilage
intermittent compression and decompression with gliding
avoid excessive overload
ther ex components for collagen
modified tension in the line of stress
ther ex goals in the acute phase
rest
relieve pain
protect
ther ex goals in the sub-acute phase
optimal stimulus for regeneration
protect
gain motion
ther ex goals in the chronic phase
increase tissue stress
full motion
strengthen
return to pain free function
when you are doing 4 reps for strength you should be at ____% rep max
90%
when you are doing 16 reps for strength/endurance you should be at ____% rep max
75%
when you are doing 25 reps for endurance you should be at ____% rep max
65%
pain in the anterosuperior part of the shoulder: weakness and stiffness
impingement syndrome
rotator cuff weakness
overuse of the shoulder
degenerative tendinopathy
intrinsic impingement syndrome
instability (classic)
shape of the acromion
degeneration of the AC joint
impingement by the coracoacromial ligament or coracoid process
extrinsic impingement syndrome
age position of the arm during activities repetitive overhead muscles imbalances capsular tightness postural imbalance structural asymmetry impaired scapular kinematics
MOI of impingement syndrome
more than 40 years+ overuse + painful arc
primary impingement
young + repetitive overhead/athletic activity + painful arc
secondary impingement
education for impingement syndrome
avoid overhead activities and positions of shoulder impingement
ther ex for impingement syndrome
postural corrections
ROM
stretching and strengthening
manual therapy for impingement syndrome
inferior and posterior glides
recurrent shoulder dislocation (chronic phase)
apprehension test positive
traumatic shoulder instability
tendinitis, sensation of instability and laxity
apprehension test negative
atraumatic shoulder instability
education for shoulder instability
avoid MOI and overhead activities
ther ex for shoulder instability
scapular stabilization exercises and rotator cuff strengthening
sudden eccentric biceps contraction as in trying to grab an object while falling from a height or a fall onto the outstretched hand
repetitive overhead activity, specially in baseball players (they show sig GH IR deficits with the shoulder in 90 degrees abduction, which predispose excessive ER)
MOI SLAP lesion
Superior labral tear form anterior to posterior
pain is the most common long term complaint along with a feeling of instability or lack of control of the are in the overhead as well as abducted ER positions
SLAP lesion
education for SLAP
avoid MOI and overhead activities
ther ex for SLAP
scapular stabilization exercises and posterior capsular stretching
education for frozen shoulder
explain the nature of the disease and prepare them for extended recovery
ther ex for frozen shoulder
stretching - progressive in the amount of stress and time (according to the stage)
hold relax stretching and low load prolonged stress is indicated
Manual therapy for frozen shoulder
ER with inferior glide (rotator cuff interval RIC)
posterior glide and maneuvers for general mobility
location of symptoms ant capsular strain biceps rupture elbow dislocation pronator syndrome
anterior
location of symptoms med epicondylitis MCL injury ulnar neuritis fracture
medial
location of symptoms
olecranon bursitis
olecranon process
stress frcture, triceps tendinitis
posterior
lat epicondylitis LCL injury capitelum fracture osteocondral degenerative osteocondritis dissecans radial head fracture
lateral
inflammation of one of the epicondyles, which includes both the periosteum and the tendons
epicondylitis
tennis elbow
lateral epicondylitis
golfers elbow or throwers elbow
medial epicondylitis
inflammation in the insertion of the extensor carpi radialis brevis and extensor carpi radialis longus
lateral epicondylitis
lateral elbow pain with insidious onset, pain with wrist extension and weakened grip strength
lateral epicondylitis
overuse: repetitive grasping with wrist in extension
trauma
MOI for lateral epicondylitis
radicular pain into the elbow
neck pain
symptoms with spine compression/extension
cervical spondylosis
insidious onset of lateral elbow pain
pain 2-4 cm distal to epicondyle
radial tunnel syndrome
insidious onset of lateral elbow pain and weakness
weakness of wrist and finger extensors
PIN compression
trauma
weight lifting
clicking or limitation of ROM
intra-articular loose bodies
sickle cell anemia, alcohol abuse, HIV, corticosteroids
joint effusion, mechanical symptoms
avascular necrosis
adolescent, gymnasts, throwers
joint effusion, mechanical symptoms
osteochondritis dessicans
inflammation in the insertion of the flexor carpi radiales and pronator teres
medial epicondylitis
medial elbow pain, pain with wrist flexion and pronation
medial epicondylitis
pain in the medial aspect of the elbow, edema can also be seen
MOI: excessive valgus stress and hyperextension and overuse
little leaguers elbow
elbow flexion
ulna slides
radial head
anteriorly, distally and laterally
anteriorly
elbow extension
ulna slides
radial head
posteriorly, proximally and medially
posteriorly
arm is held in extension and pronated: pian moving the elbow, the child stops using the arm and can not flex or supinate the forearm. minimal swelling could be seen
lack of accuracy locallizing the injury. can often lead to thinking that the injury is elsewhere
subluxation of the radial head
a sudden pull on the extended pronated arm
pulling and uncooperative child
swinging the child by the arms
subluxation of the radial head
a joint condition in which a piece of cartilage, along with a thin layer of the bone beneath it, comes loose from the end of a bone
pain/swelling lat/ant
limited ROM
clicking, locking
osteochondritis dissecans
MOI for osteochondritis dissecans
repetitive trauma
radiohumeral lateral compression forces
FOOSH wrist extended
radius fx
FOOSH wrist extended >80 degrees
carpal fx
FOOSH wrist ext with radial deviation
scaphoid fx
FOOSH wrist flexion
radius or ulnar fx
fracture of distal radius with dorsal displacement
colles fx (dinner fork deformity)
MOI for colles fx
extension and compression
fx of distal radius with volar displcement
smiths fx
MOI for smiths fx
flexion and compression
MOI scaphoid fx
fall with ext and RD
pain in anatomical snuffbox
painful/limited wrist movement
painful compression/load
scaphoid fx
fx of neck of 5th MC
boxers fx
MOI for boxers fx
boxing or punching
avulsion of extensor tendon from DIP
mallet finger
MOI for mallet finger
direct force causing forced flexion
fall or trauma
localized pain, swelling, clicking
pain with extension
positive watsons
scaphoid lunate disassociation
pt seated, elbow 90 degrees flexed
forearm pronated
passively move from UD to RD while stabilizing scaphoid
+ if increased movement: pain or clunk into dorsal dir.
watson’s test
scaphoid shift
osteonecrosis/AVN of lunate following a fx
History: FOOSH, compression fx
local tenderness, swelling, limited wrist motion, pain with gripping
kienbocks disease
median nerve compression in forearm
carpal tunnel syndrome
trauma overused of flexor muscles, posture of hands pain and paresthesia numbness nocturnal pain hand falling asleep thenar atrophy
carpal tunnel syndrome
norm step length
72 cm/23 in
norm stride length
144
norm cadence
90-120 steps/min
norm gait speed
1.4 m/sec
greatest hip ext and when during giat
20 degrees
terminal stance
greatest knee flex during gait
60 degrees
initial swing
greatest ankle DF
10 degrees
terminal stance
defined as the ability of the structures or segments of the body to move or be moved to allow the presence of range of motion for functional activities
mobility
the ability to move a single joint or a series of joints smoothly and easily through an unrestricted pain free ROM
flexibility
decreased mobility or restricted motion. one cause is contractures
hypomobility
an adaptive shortening of the muscle tendon unit and other soft tissues that cross or surround the joint that results in significant resistance to passive or active stretch and limitation of ROM
contracture
adaptive muscle shortening with reduction in the number of sarcomeres units in series, individual sarcomere length is also shortened
myostatic contracture
loss of mobility in the connective tissues that cross or attach to a joint or joint capsule
periarticular contracture
results from intra-articular pathology (adhesions, synovial proliferation, joint effusion, irregularities in the articular cartilage or osteophyte formation
arthrogenic contracture
limited ROM due to hypertonicity associated with central nervous system
pseudomyostatic contracture
the connective tissues are replaced by great amount of non-extensible tissue: fibrotic adhesions, scar tissue, and heterotopic bone
fibrotic and irreversible contracture
parameters for static stretching
30-60 sec 1-3 times
parameters for cyclic stretching
low velocity/low intensity held between 5-10 sec several times
involved in the stabilization of joints by opposing the effects of gravity. become tight and then weak
antigravity muscles
locomotion susceptible to atrophy and then weakness
muscles assisted by gravity
posterior muscular chain
erector spinae
deep plevic trochanter muscles
hamstrings
triceps surae
anterior muscular chain
sternocleidomastoid and scalenes anterior fascial tissues of the thoracic spine diaphragm psoas adductors soleus muscles
hip ER muscles
piriformis superior gemellus inferior gemellus obturator internus obturator externus quadratus femoris gluteus maximus gluteus medius and minimus
hip IR muscles
piriformis semitendinosus semimembranosus adductors pectineus tensor fascia latae glut med and min
increase joint reaction force
muscles in mechanical disadvantage
modify angle at knee joint
coxa valga
decrease joint reaction force
increase the shear forces on the femoral head and neck
damage at the epiphyseal plate
coxa vara
normal axis of femoral head
8-15 degrees of anteversion
most likely diagnosis for hip in older population
hip osteoarthritis
most likely diagnosis for hip in women
slap lesion
trochanter bursitis
most likely diagnosis for hip in children
legg-calve-perthes
most likely diagnosis for hip in middle age
avascular necrosis
most likely diagnosis for hip in athletes
labral tear
gradual onset anterior thigh/groin pain worsening with weight bearing
limited ROM with pain, especially IR
abnormal FABER test
osteoarthritis
anteiror hip pain
history of overuse or sports injury
pain with resisted muscle testing
tenderness over specific muscle or tendon
Hip flexor muscle strain/tendonitis
anterior pain and associated snapping sensation
tenderness with deep palpation over femoral triangle
positive snapping hip manuever
etiology from overused, acute trauma, or rheumatoid arthritis
iliopsoas bursitis
anterior hip pain
fall or trauma followed by inability to walk
limb externally rotated, abducted and shortened
pain with any movement
hip fx (proximal femur)
anterior hip pain
history of overuse or osteoporosis
pain with weight bearing activity; antalgic gait
limited ROM
stress fx
anterior hip pain
morning stiffness or associated systemic symptoms
previous history of inflammatory arthritis
limited ROM and pain with passive motion
inflammatory arthritis
anterior hip pain
activity related sharp groin/anterior thigh pain, esp upon hip extension
deep clicking felt
positive thomas flexion-extension test
acetabular labral tear
anterior hip pain
dull ache in groin, thigh, and buttock usually with risk factors (corticosteroid exposure, alcohol abuse)
limited ROM with pain
avascular necrosis of femoral head
Lateral hip pain
F:M ratio 4:1 fourth to sixth decade
spontaneous, insidious onset lateral hip pain
point tenderness over greater trochanter
greater trochanteric bursitis
Lateral hip pain
pain with resisted hip abduction
tender over gluteus medius
trendelenburg test
gluteus medius muscle dysfunction
Lateral hip pain
lateral hip pain or snapping associated with walking, jogging or cycling
positive obers
iliotibial band syndrome
posterior hip pain
history of low back pain
pain reproduced with isolated lumbar flexion or extension
radicular symptoms or history consistent with spinal stenosis
Referred pain from lumbar spine
Lateral hip pain
controversial diagnosis
posterior hip or buttocks pain usually in runners
pelvic asymmetry found on exam
SI joint dysfunction
Lateral hip pain
history of overuse or acute injury
pain with resisted muscle testing
tender over gluteal muscles
hip extensor or rotator muscle strain
a slowly progressive joint disease typically seen in middle aged to elderly people. the degenerative changes of this include articular cartilage break down and loss, capsular fibrosis, and osteophyte formation on the joints margins
hip osteoarthritis
MOI for hip OA
aging process joint trauma repetitive abnormal stress obesity systemic diseases
inclusion criteria for hip OA
hip pain AND hip IR _ 15 degrees AND pain on hip IR AND morning stiffness _ 50
insidious onset of pain in anterolateral hip and groin region; decreased ROM
AG factors:
standing, walking or sitting for too long
squatting
active hip flexion causing lateral hip pain
scour test with adduction causing lateral hip or groin pain
active hip extension causing pain
possible gait alterations
Hip OA
doubtful narrowing of joint space and possible osteopytic lipping
grade 1 OA
definite osteophytes, definite narrowing of the joint space
grade 2 OA
moderate multiple osteophytes, definite narrowing of joint space, some sclerosis and possible deformity of contour
grade 3 OA
large osteophytes, markes narrowing of joint space, severe sclerosis and definite deformity of bone contour
grade 4 OA
education for OA
lose weight
a tear of the acetabular labrum resulted from excessive forces at the hip joint
labral tear
pain is usually anterior/groin and can also have clicking, catching, giving way and stiffness
patients are often seen by multiple health care providers before obtaining a definitive diagnosis
labral tear
MOI for labral tear
MVA sporting activities forced movements: torsional or twisting, hyperabdution/extention and hyperextension with lateral rotation repetitive microtrauma hip dysplasia
tests for OA
FABER
scour
resisted SLR
Flex-Add-IR
education for OA
limited weight bearing, avoid pivoting motions under load and excessive extension, be careful walking on treadmil
chronic, intermittent pain accompanied by tenderness to palpation overlying the lateral aspect of the hip
may be associated to tendinitis, muscle tears, trigger points, IT band disorders
Greater trochanteric pain syndrome
MOI for Greater trochanteric pain syndrome
chronic microtrauma regional muscle dysfunction overuse acute injury obesity muscle fatigue
persistent pain in the lateral hip and or buttock AGG factors: lying on affected side prolonged standing transitioning to standing position sitting with the affected leg crossed climbing stairs running or other high impact activities
Greater trochanteric pain syndrome
education for Greater trochanteric pain syndrome
ice, avoid MOI, avoid laying on hard surfaces, lose weight
most common knee diagnosis for adolescents
epiphysitis
most common knee diagnosis for young adults
femoral condyle defects
meniscus
lig injuries
most common knee diagnosis for middle aged population
tendinopathies
articular surface damage
osteoarthritis
most common knee diagnosis for older population
osteoarthritis
most common knee diagnosis for women
PF symdrome
most common knee diagnosis for athletes
meniscus
lig injuries
locking in the tib fem
loose body or meniscus
difficulty with extension
locking in the tib fem
loose body
difficulty with flexion
giving way of buckling in the tib fem
ligament
meniscal injury
giving way or buckling in the pat fem
patellar tracking problem
sports trauma, cause unknown pain, swelling, catching focal tenderness joint effusion limited ROM pain with weight bearing
femoral condyle injury
MOI for meniscus injury
trauma: compression and rotation
flex+rotation or ext+ rotation during WB
sudden acceleration or deceleration combined with a change in direction
Degenerative
knee pain and limited motion
locking, giving out
limited extension, hard end feel
joint line palpation
meniscus injury
ACL prevents
ant translation of tibia in NWB and guides tibial rotation
ACL MOI
hyperextension with ant translation
PCL MOI
hyperflexion with posterior translation
MCL MOI
valgus stress
LCL MOI
varus stress
ACL +med meniscus MOI
hyperextension with rot
ACL+med meniscus+ MCL MOI
ext, valgus with rotation
knee giving out pain, edema, joint stiffness immediate dysfunction inability to walk unassisted lack of quad control
ACL injury
should OKC ext exercises be performed for ACL rehab?
initially NO!!
dashboard injury causing forceful posterior translation of tibia
PCL injury
restrains valgus and lateral rotation of the tivia
MCL
restrains varus and medial rotation of tibia
LCL
increased Q angle, patella alta, pes planus
muscle weakness: hip abductors, quads
flexibility: tight ITB or lat retinaculum
motor control: poor muscle control during sports or training errors
PF pain syndrome
anterior/lateral knee pain/ retro-patellar pain
duss ache
clicking or popping
knee giving out
Agg: walking, stair climbing, kneeling, squatting or sit to stand
PF pain syndrome
training for PFJ OCK performed at
90-45 degrees
training for PFJ CKC performed at
0-45 degrees
pain over the posterior aspect of the patellar tendon
mild stiffness in am or after prolonged sitting
pain worsens with activities
AGG: jumping, landing: severely limits and athletic career
palpation or proximal patellar tendon
tissue thickness with palpation
Patellar tendinopathy
subtalar joint anteriorly
convex talus
concave calcaneus
subtalar joint posteriorly
concave talus
convex calcaneus
subtalar joint roll and glide are in the
opposite direction
common ankle injuries for adults
achilles tendonitis/tendinosis, plantar fascitis, ligamentous sprains rheumatoid arthritis gout
common ankle injuries for children and adolescents
osteochondritis dissecans of the talus
juvenile rheumatoid arthritis
epiphyseal fractures
excessive load on a supinated ankle. rolling the foot inward
inversion sprains
excessive load on a pronated ankle. Rolling the foot outward
eversion sprains
grade 1 ankle sprain
26-75% tearing, moderate pain and swelling, loss of ROM and slight instability. patient may only manage partial weight bearing with crutches. loss of anywhere from 2-6 weeks of activity
grade 2 ankle sprain
total disruption of the ligament, severe pain and swelling, loss of ROM and instability present. patient will typically not be able to weight bear. loss of as few as 4 weeks to as many as 26 weeks from full activity
grade 3 ankle sprain
heel strike and weight acceptance with excessive pronation. increased tibial internal rotation/delayed tibial external rotation
rearfoot varus
excessive mobility in midstance and propulsion (decreased supination)
forefoot varus
compensation of equinus
increase pronation
knee hyperextension
presents itself as a sharp short pain between the toes at or about the met heads
primary symptom is pain at the end of one or more of the metatarsal bones. typically aggravated when walking or running
most often pain comes on over a period of several months rather than suddenly
metatarsalgia
pain along the back of your foot and above your heel, especially with stretching your ankle or standing on your toes; with this, pain my be mild and worsen gradually.
tenderness
swelling
stiffness
difficulty flexing your foot or pointing your toes
achilles tendonitis
D1 UE flexion scapula shoulder forearm wrist fingers
elevation, protraction flexion, adduction, ER supination flexion flexion
D1 UE extension scapula shoulder forearm wrist fingers
depression, retraction extension, abduction, IR pronation extension extension
D2 flexion UE scapula shoulder forearm wrist fingers
elevation, retraction flexion, abduction, ER supination extension extension
D2 extension UE scapula shoulder forearm wrist fingers
depression, protraction extension, adduction, IR pronation flexion flexion
D1 LE flexion Hip Knee Ankle Toes
Flexion, Adduction, ER
Either
DF, inversion
DF
D1 LE extension Hip Knee Ankle Toes
Extension, Abduction, IR
Either
PF, eversion
PF
D2 LE flexion Hip Knee Ankle Toes
Flexion, abduction, IR
Either
DF, Eversion
DF
D2 LE extension Hip Knee Ankle Toes
Extension, adduction, ER
either
PF, inversion
PF
take muscle to point of limitation
end-range isometric contraction into direction of stretch (contraction of antagonist muscles)
relax and passively move limb to new range
useful if tight muscle is painful to contract
Hold relax
take muscle to point of limitation
end-range contraction with rotation into opposite direction of stretch (contraction of agonist/tight muscles)
relax and passively move limb to new range
contract relax
a low severity injury that typically leads to complete recovery. the structure of the nerve remains intact but electrical conduction down the axon is interrupted, typically by ischemia or compression injury, additionally secondary injuries can be caused by vascular damage leading to intrafascicular edema
neurapraxia
disruption of the neuronal axon takes place but the myelin sheath is still intact. Typically this is caused by a crush based injury, and not a laceration. If the neuronal tubules are maintained in place, regeneration and restoration of sensory or motor ability my return
Axonotmesis
characterized by not only loss of nerve conduction, but damage to surrounding nerve trunk connective tissue. in extreme cases of this injury category complete transection occurs. commonly a neuroma forms over the proximal stump of the nerve, preventing normal continued regeneration to occur
Neurotmesis
never affected in thoracic outlet syndrome
brachial plexus
never affected in cubital tunnel syndrome
ulnar nerve
never affected in radial nerve compression
radial nerve
never affected in carpal tunnel syndrome
medial nerve
never affected in tunnel of guyon
ulnar nerve
never affected in piriformis syndrome
sciatic nerve
never affected in peroneal nerve compression
peroneal
never affected in tarsal tunnel syndrome
tibial nerve
shoulder depression and lateral flexion of the neck
loss of shoulder abduction, ER weakness of the arm flexion and forearm supination
waiters tip position
upper plexus injury
C5,6
compression of cervical rib or stretching the arm overhead
paralysis of the intrinsic muscles of the hand
Lower plexus injury
C8. T1
brachial plexus pain paresthesia, numbness, weakness. nerve tension when the plexus is stretched
TOS
MOI for axillary nerve (C5, 6)
acute dislocation
fractures of the humerus’s neck
squared shoulder from deltoid muscle atrophy
shoulder abd, ER weakness
sensory lateral deltoid
axillary nerve
C5,6
atrophy along the flexor surface of the upper arm (flatness)
weakness of the elbow flexion with forearm supinated
sensory: radial side of forearm
musculocutaneous N.
C5-7
MOI for median nerve (C6-8, T1)
impingement in hypertrophied pronator teres
carpal tunnel syndrome
burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers
Palsy: ape hand with atrophy in the thenar eminence
no arm pronation, weak grip, no thumb abduction and opposition
sensory: thenar region
median nerve C6-8,T1
MOI for ulnar nerve (C8,T1)
cubital tunnel syndrome
compression in the guyons canal
pain, numbness and or tingling int he ring and little fingers
partial claw with atrophy between the metacarpals and hypothenar region
loss of use of 4th and 5th digits for spherical and cylindrical power grip
thumb for adduction finger abduction and adduction are lost
sensory: hypothenar region
Ulnar nerve
C8, T1
MOI for radial nerve
C5-8, T1
Crutch palsy, saturday night palsy (compression site radial sulcus)
posterior interosseious nerve syndrome PINS
compression sites: radial head, ECRB and supinator
pain and tenderness in the proximal forearm, finger extension weakness
numbness should not be present
PINS
wrist drop
high lesions affecting the triceps, can not push, weak supination
unable to make fist or grip objects unless wrist is stabilized in extension
sensory: posterior arm, forearm, and hand radial side
radial nerve palsy
C5-8, T1
pain radiating to posterior thigh and leg; atrophy posterior thigh, leg and foot; calf atrophy
weak knee flexion, loss of ankle and foot control affecting all phases of gait
sensory: lateral, posterior leg. lateral, posterior lower leg and plantar part of the foot
sciatic nerve
L4,5, S1-3
MOI for common peroneal nerve deep and superficial
L4-S2
compression from crossing legs, fracture at head/neck of fibula
deep- foot drop
superficial - eversion weakness
gait impairment during the loading response with foot slap, excessive hip flexion to clear the toes
sensory: anterior- lateral of lower leg and dorsal part of the foot
common peroneal nerve (deep and superficial)
L4-S2
MOI for tibial nerve L4-S3
tarsal tunnel syndrom
compression site: between medial malleolus and flexor retinaculum
sensory: tingling, burning, or a sensation similar to an electical shock, numbness, pain, including shooting pain felt on the inside of the ankle and/or on the bottom of the foot
inability to plantar flex ankle or flex the toes
gait impairment during terminal stance
tibial nerve
L4-S3
