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T3 MSK > 8 Elbow & Wrist > Flashcards

8 Elbow & Wrist Flashcards

1
Q

What are the joints of the elbow?

A
  • ulnohumeral
  • radiohumeral
  • proximal radioulnar (pivot joint)
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2
Q

How many joint capsules are in the elbow?

A

One continuous joint capsule surrounds all three joints

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3
Q

What are the ligaments of the elbow?

A
  • Medial (ulnar) collateral ligament supports the medial aspect of the elbow
  • Lateral (radial) collateral ligament supports the lateral elbow
  • Annular ligament in circles and supports the head of the radius in the radial notch of the ulna and allows for a pivoting movement at the joint
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4
Q

What are the available ROMs of the elbow joint?

A
  • Flexion: 140 to 150°
  • Extension: 0 to 10°
  • Supination: 90° (tissue stretch end feel)
  • Pronation: 80 to 90° (tissue stretch end feel)
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5
Q

What nerves supply the muscles of the elbow? Which muscles?

A
  • Musculocutaneous supplies biceps brachii and brachialis (rarely becomes entrapped or injured)
  • The radial nerve supplies the elbow extensors as well as the wrist extensors (it crosses the elbow and is susceptible to injury here)
  • The median and ulnar nerves innervate the muscle of the anterior forearm (They cross the elbow and are, therefore, susceptible to injury here as well)
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6
Q

What is the AKA for lateral epicondylitis?

A

Tennis elbow

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7
Q

What are the two methods for testing for lateral epicondylitis?

A
  1. (aka tennis elbow test aka Cozen’s test [akas not testable]) – the patient’s elbow is stabilized by the examiner’s thumb which rests on the patient’s lateral epicondyle. The patient is asked to make a fist, pronate the forearm, and radially deviate and extends the wrist while the examiner resists the motion. A sudden severe pain in the area of the lateral epicondyle of the humerus is a positive sign.
  2. (aka tennis elbow test aka Mill’s test [akas not testable]) – while palpating the lateral epicondyle, the examiner passively pronates the patient’s forearm, flexes the wrist fully, and extends the elbow. Pain over the lateral epicondyle of the humerus indicates a positive sign.
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8
Q

What factors contribute to the development of RSIs?

A
  • Weak muscles (load gets transferred to the musculotendinous junction)
  • Joint laxity (If the joint is unstable the muscles have to work harder to stabilize it)
  • Rapid/excessive repeated eccentric loading of the muscles
  • Sudden increase in unusual activities.
  • Return to activity too soon following injury
  • Sustained faulty posture/workstation ergonomics
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9
Q

Which tendon is affected with lateral epicondylitis?

A

Tendinopathy of the common extensor tendon

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10
Q

What is the aka for medial epicondylitis?

A

Golfer’s elbow

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11
Q

What is medial epicondylitis?

A

Tendinopathy of the common flexor tendon/pronator tendon

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12
Q

What neuropathy is an often associated with tendinopathy of the common flexor tendon?

A

ulnar neuropathy (ulnar nerve is close to CFT)

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13
Q

What are common impairments/functional limitations with elbow RSIs?

A
  • Gradually increasing pain in the elbow region after excessive wrist activities
  • Decreased muscle strength and endurance
  • Decreased grip strength limited by pain
  • Tenderness with palpation at the site of inflammation
  • Inability to participate in provoking activities such as racquet sports, throwing, assembling small parts, typing on the keyboard or using a mouse, gripping activities, turn screwdriver, playing a percussion instrument
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14
Q

How many bones, intrinsic and extrinsic muscles are there in the hand customer

A
  • 28 bones
  • 19 intrinsic muscles
  • 20 extrinsic muscles
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15
Q

Which carpal bones does the radius directly articulate with?

A

Scaphoid and lunate

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16
Q

Which nerve can easily become compressed within the Tunnel of Guyon?

A

ulnar nerve

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17
Q

Which digits are included in the median nerve distribution?

A

Lateral three and a half digits

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18
Q

What composes the roof and floor of the carpal tunnel?

A
  • Roof: carpal bones
  • Floor: flexor retinaculum
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19
Q

What structures travele through the carpal tunnel?

A
  • The median nerve
  • The four tendons of flexor digitorum superficialis
  • The four tendons of flexor digitorum profundus
  • The tendon of flexor pollicis longus
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20
Q

What are some causes of carpal tunnel syndrome?

A
  • Repetitive wrist movements (primarily flexion/extension) leading to edema, fibrosis and thickening of the tendons (RSI scenario)
  • Thickening of the retinaculum
  • System conditions that resulted in edema, fluid retention, or connective tissue degeneration such as diabetes, RA, pregnancy
  • Bony callus formation after carpal bone or distal radius fracture
  • Bony changes that occur with arthritis
  • Acute RA flare ups
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21
Q

What are some observations/palpation findings associated with carpal tunnel syndrome?

A
  • Possible edema may be local to the wrist and hand or more diffuse over the whole forearm and hand
  • Possible weakness of the thenar muscles with difficulty holding a pen/utensils
  • Possible inflammation and tenderness over the carpal tunnel
  • Possible increased resting tone, trigger points, and fascial restrictions of the forearm due to overuse
22
Q

Which nerve can also become compressed in pronator teres mimicking carpal tunnel syndrome?

A

Median nerve

23
Q

Where are Bouchard’s nodes and Herberden’s nodes found?

A
  • Bouchard: PIPs
  • Herberden: DIPs
24
Q

What are Bouchard and Herberden nodes? (not location, what are the “nodes”?)

A

Calcified spurs (osteophytes) that develop in later stages of OA to help stabilize the joint

25
Q

What is a typical end feel with osteoarthritis?

A

Limited ROM with firm capsular end feel is typical

26
Q

What are the primary treatment goals for osteoarthritis?

A
  1. Pain control–techniques to address: inflammation, mechanical pain
  2. Mobility –consider why a joint is restricted. Is it related to connective tissue adhesions? Muscular tension? Capsular restrictions? Muscle weakness? Assess the tissues through ago patient, functional testing and end feels and choose your techniques accordingly
27
Q

What is rheumatoid arthritis?

A

Autoimmune disease affecting the joints of the body (and sometimes the internal organs such as eyes, lungs, heart) causing swelling, pain, inflammation, and joint degeneration.

28
Q

Does rheumatoid arthritis affect women or men more frequently?

A

affects women three times more often than men

29
Q

At what age range does rheumatoid arthritis tend to present?

A

Generally between 25 to 50 years old

30
Q

What joints are most commonly affected by rheumatoid arthritis?

A

Most commonly affects the elbows, wrists, fingers, knees, ankles, toes in a symmetrical pattern. RA can spread to other joints in the body.

31
Q

With RA there will be periods of flareups and remissions. During the acute flareups, how will the joints present?

A

Joints will be painful and swollen with limited ROM. Fever, malaise, and weight loss may also accompany flareups.

32
Q

What happens if RA is left untreated?

A

Chronic flareups will lead to permanent joint degeneration with the joint capsule weakening and subluxations/deformities (Boutoniere/swan neck)

33
Q

What are some medical interventions for RA?

A

NSAIDS, chemotherapy, corticosteroid injections

34
Q

What are massage considerations during an RA flareup?

A

Manage inflammatory pain: cool hydro, lymphatic drainage, relaxation techniques to help client rest

35
Q

What are massage considerations between RA flareups?

A

Specific techniques to affected joints to maintain or improve ROM. Techniques to consider: warm hydro to decrease tone in muscles and to prepare for deeper petrissage techniques to decrease tone and triggerpoints, pain free joint play to promote joint health (low grade).

36
Q

What self-care would I recommend for someone with RA?

A
  • hydro: warm or cool depending on flareup or remission period
  • remex:
    • isometric exercises to maintain strength and promote stability of the joints
    • Gentle self stretching and AF movements to prevent contracturing of affected joints
37
Q

What’s DeQuervain’s Tenosynovitis?

A

RSI of the tendon sheath of abductor pollicis longus and extensor pollicis brevis

38
Q

What’s trigger finger?

A

A condition in which the fingers can become stuck in a flexed position (fingers can normally be passively extended [out of the flexed position])

39
Q

What is the cause of trigger finger?

A
  • can result from overuse/RSI of the flexor tendon
  • results from thickening or nodular development of the tendon and/or thickening of the tendon sheath
40
Q

Which digits are most commonly affected by trigger finger?

A

Most commonly affects the third and fourth digits (a ‘pop’ may be felt as the tendon slips past the narrowed spot)

41
Q

What’s Dupuytren’s contracture?

A

Contracture of the palmar fascia that pulls the fingers into a permanently flexed position making it difficult to perform simple tasks such a shaking hands, putting on gloves or reaching into pockets (the contracture itself is not commonly painful)

42
Q

Which digits are commonly affected by Dupuytren’s contracture?

A

Most commonly affects the fourth and fifth digits

43
Q

How does Dupuytren’s contracture onset and what causes it?

A
  • insidious onset
  • Primarily idiopathic
  • Diabetes, epilepsy, and alcoholism may contribute to the development of Dupuytren’s but the association is not clear
  • Prolonged immobilization may also contribute to development
  • The condition is not caused by overuse/RSI or an inflammatory process
44
Q

What’s the clinical presentation of Dupuytren’s contracture?

A
  • Often bilateral
  • Palmar fascia may be tender, thickened, nodular
  • as the condition progresses, flexion of the digits increases
  • affected fingers may feel cool/cold due to myofascial restrictions affecting circulation
45
Q

What are some common findings with Dupuytren’s contracture?

A
  • MF restrictions in the palmar fascia and anterior forearm
  • Increased tone in the forearm muscles
  • Trigger points in the forearm and hand muscles
  • Adhesions in the palm of the hand and attachments of the palmar fascia
  • Wrist/finger ROM restrictions especially into extension
46
Q

What are some treatment considerations with Dupuytren’s contracture?

A
  • condition not likely to resolve with massage treatment
  • goals of treatment are to promote connective tissue mobility, maintain ROM, and maintain soft tissue and joint health
  • in some cases surgery is needed
47
Q

Where does the axillary nerve often get entrapped?

A

often entrapped in the quadrangular space

48
Q

What are the borders of the quadrangular space?

A
  • superiorly: subscap and teres minor
  • inferiorly: teres major
  • medially: long head of triceps
  • laterally: neck of the humerus
49
Q

Where does the radial nerve travel in the arm?

A

Travels due to triceps. Resurfaces in the septum between brachialis and brachioradialis near the lateral supracondylar ridge

50
Q

Where is the radial nerve palpable?

A
  • Palpable in the groove between extensor carpi radialis longus and brachioradialis
  • Palpable between the convergence of pronator teres and brachioradialis
51
Q

Where is the median nerve palpable?

A
  • Palpable in the cubital fossa medial to brachial pulse, deep to pronator teres
  • Also found three finger widths proximal to wrist crease between palmaris longus and flexor carpi radialis tendons
52
Q

Where is the ulnar nerve palpable?

A
  • the cubital tunnel
  • between flexor carpi ulnaris and flexor digitorum
  • the tunnel of guyon
  • between the metacarpals in the interosseous muscles

T3 MSK (18 decks)

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