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DPT 730/1: MSK > E4- Lateral Epicondylitis-TMJ > Flashcards

E4- Lateral Epicondylitis-TMJ Flashcards

1
Q

what is the average functional range of the elbow

A

130 avg arc

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2
Q

what is the average functional range for pronation and supination

A

103

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3
Q

what is the average functional range for keyboarding

A

65 deg pronation

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4
Q

what is the average functional range for opening a door

A

77 deg supination

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5
Q

what can cause lateral elbow pain

A

tendinopathy
trauma
radial n entrapment

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6
Q

what are the RF for lateral elbow pain

A

dominant arm> non dominant
forceful activities
repetitive activities
smoking
poor posture
35-54 yrs of age

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7
Q

what are the primary tendons involved with lateral epicondylitis

A

ECRL
ECRB- most common
ED
EDM

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8
Q

what are the hallmark signs of tendinitis

A

TTP
pain with lengthening in ROM
pain with RST especially in lengthened position

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9
Q

what are the ROM signs of lat epicondylitis

A

pain and limitation with lengthening during wrist FLX w/ or w/out elb EXT

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10
Q

what are the RST signs of lat epicondylitis

A

pain with wrist EXT, R. dev, especially in lengthened position
possible weakness
pain with gripping
abnormal m activation

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11
Q

where can be TTP with lat epicondylitis

A

common extensor tendon

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12
Q

how do we treat lat epicondylitis

A

tendinitis RX
sport specific correction - tennis swing or larger grips
cuff, scapular, trunk, and LE m coordination, endurance, and strength

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13
Q

what about lat elbow pain without overuse at the elbow of a laborer or tennis player

A

tendinosis
abducted elbow
radial n entrapment

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14
Q

how might C5-6 regional interdependence affect the elbow

A

C5-6 hypermobility
over recruited wrist EXt creating CET tension
n is hypersensitive not impinged

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15
Q

what symptoms of regional interdependence can be present that affects the elbow

A

no change in activity
nociplastic pain
FHP
trauma
age- ARJC

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16
Q

what can happen with C6 n impingement in the elbow

A

creates decreased activation of wrist extensors and lowers supply

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17
Q

what are the S&S of sp n impingement

A

paresthesia with head movement
DTR hyperactive
sensation loss
80% conduction loss for myotomes

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18
Q

how do we treat C6 spinal n impingement that is affecting the elbow

A

tendinosis- MT, pt edu,, MET- heavy, eccentric
neck- mechanical traction, thoracic manip, postural edu, neural mob, MET- aerobic, local m stabilization

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19
Q

where is lat tendinosis most often

A

degeneration most often at musculotendinous junction

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20
Q

what are the S&S of lateral tendinosis at the elbow

A

persistent 4-6 wks, decrease tendon tolerance
ROM- limited and painful mostly EXT
RST- painful, mostly EXT
Palpation - tender at CET
(+) Mill’s test for CET scarring

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21
Q

what do we need to edu the patient on for lat elbow tendinitis/osis

A

soreness rule
load managent - ergonomic corrections

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22
Q

what does bracing/taping do for elbow tendinitis/osis

A

unload tendon and decrease lever arm
decrease wrist motion= decrease load on extensors (shorten tendon)

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23
Q

what are benefits of cervical JM for elbow tendinitis/osis

A

improve pain and grip strength

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24
Q

what are benefits of cervical and elbow JM for elbow tendinitis/osis

A

better than either alone

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25
Q

what are benefits of thoracic JM for elbow tendinitis/osis

A

increase grip strength

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26
Q

what are benefits of Mill’s JM for elbow tendinitis/osis

A

improve pain and function
pulling apart scar tissue

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27
Q

what is the MET for elbow tendinitis/osis

A

tendon proliferation and possible cervical stabilization
tendinosis prescription
eccentric

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28
Q

Where do you start with exercises for tendinitis/osis

A

isometric in shortened position
isotonic in neutral to shortened position
isotonic in lengthened position
WB
plyometric

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29
Q

why do cortisone injections have poor outcomes

A

weakens structures

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30
Q

what is the prognosis of lateral tendinitis/osis in the elbow

A

prone to recurrent bouts
avg year

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31
Q

what can happen to cause abducted elbow

A

trauma- FOOSH
leads to medially fixated olecrannon

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32
Q

what can you see in a SCAN for abducted elbow

A

ob- increased carrying angle
ROM- limited elbow FLX and sup, wrist FLX and R dev
RST- pain in wrist EXT and R dev
AM- limited lat glide at HU jt
palpation- CET TTP

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33
Q

what complications can occur with abducted elbow

A

carpal fx
subluxation

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34
Q

how do we treat abducted elbow

A

correct lat glide with manip
stabilization MET
tendinosis RX

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35
Q

what are common symptoms of radial tunnel syndrome

A

dorsoradial forearm and hand pain/paresthesia
wrist and finger extension weak and painful

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36
Q

what is wartenberg syndrome

A

compression of superficial sensory radial n between brachioradialis and ECRL

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37
Q

where can wartenberg syndrome have sensory symptoms

A

paresthesia over dorsoradial 1st 3.5 digits

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38
Q

what sp test are important for diagnosing radial n entrapment

A

ULTT
resist supination

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39
Q

how do we treat a n branch injury

A

POLI (C)ED
STM/JM/Splinting eliminate compression
MET neural motion/flossing

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40
Q

what structures are involved with medial tendinitis/osis

A

pronator teres
FCR
FCU
FDS
FDP

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41
Q

who can have med tendinitis/osis

A

throwers, little league, or golfers

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42
Q

what are hallmark signs of med tendinitis/osis

A

TTP at common flexor tendon
Pain with wrist ext
Pain with resisted sup, wrist FLX, U dev

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43
Q

what is med epicondyle apophysitis

A

bone growth exceeds wrist flexor and pronator lengthen
increased tendon tension
growth plate weak spot
inflammation

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44
Q

what are complications of med epicondyle apophysitis

A

avulsion and or premature closure
UCL sprain

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45
Q

what are symptoms of med epicondyle apophysitis

A

gradual onset of overuse
pop - maybe indicates trauma or avulsion

grows out of clothes
pitches or throws a lot

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46
Q

what is in a scan for med epicondyle apophysitis

A

ROM- loss of ext
RST- weak and painful muscles attach to CFT
palpation- TTP over medial epicondyle

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47
Q

what sp tests can we do to assess for med epicondyle apophysitis

A

UCL sprain tests
TTP at CFT

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48
Q

how do we treat med epicondyle apophysitis

A

Pt edu- load management
POLICED
MET
proper stretching
throwing progressions

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49
Q

what is the MET for med epicondyle apophysitis

A

trunk, cuff, scapular, and LE impairments

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50
Q

what sp test can stress the UCL

A

valgus stress test at 0 and 90 deg
UCL instability

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51
Q

what can be found in scan for a sprain

A

ROM- limited/painful with lengthen, AROM=PROM
RST- strong/painful
CM- inconsistent
ST- (+) for distraction

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52
Q

what would we do in our BE if we suspect a sprain

A

stability tests- more stress on lig
sp test- (+) for lig, laxity — late, soft, empty end feel
AM- hyper
palpation

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53
Q

how can we sprain the elbow

A

trauma (FOOSH)
repetitive stress like overhead sports

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54
Q

a 13 yr old pt reports a pop in his elbow while he was pitching. He is tender to palpation, has pain with lengthening and RST, What do you suspect and what do we do?

A

avulsion of growth plate
send to imaging and immobilize

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55
Q

what structure is injured with varus stress overload

A

RCL or LCL

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56
Q

how do we treat sprains

A

POLICED
immobilization
bracing/taping
MET

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57
Q

how might an MD fix a UCL sprain

A

direct repair or reconstruction with palmaris longus
12-18 months

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58
Q

described a pushed dislocation

A

FOOSH
radial head is pushed proximal out of annular lig
fx of distal radius and ulna

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59
Q

describe a pulled dislocation

A

radial head is pulled distally out of annular lig
forceful traction

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60
Q

what complications can occur during a humeroulnar dislocation

A

3 major n
brachial artery disruption
radial head fx

61
Q

how do we treat dislocations

A

like ligamentous sprains
stabilization and tissue integrity

62
Q

what is a condylar fx complication

A

volkmann’s ischemic FLX contracture due to brachial a damage
emergency referral

63
Q

what position is an olecrannon fx casted in

A

no flexion >90 deg for 2 months

64
Q

what motion is hard to regain after an olecrannon fx

A

ext

65
Q

what are the sp test of elbow fx after trauma

A

lack of ext ROM
other motions are restricted
lack of sup ROM
lack of pro ROM

66
Q

how do we treat a fx

A

POLICED- ice even with a cast
isometrics while immobilized
Exercise non-immobilized parts to prevent secondary impairments
STM/JM to improve ROM
MET with optimal stresses

67
Q

where can ulnar n entrapment be

A

cubital tunnel at elbow
FCU heads
Guyons canal in hand

68
Q

what symptoms are present with cubital tunnel syndrome

A

medial hand/finger paresthesia
weak grip

69
Q

what can cause ulnar n entrapment at cubital tunnel

A

OA/Trauma

70
Q

what is in a scan for cubital tunnel syndrome

A

ROM- limited elbow FLX with paresthesia, possible limited ext
RST- weak wrist and 4/5th finger FLX, thumb ADD, and grip
Neuro- possible diminished sensation over ulnar cutaneous distribution

71
Q

what sp test would be positive for cubital tunnel syndrome

A

elbow flexion test
tinels
wartenbergs sign

72
Q

how can Palpation tell us it is the ulnar n

A

provocation with ulnar n pressure up to 60 sec
possible ulnar n subluxation

73
Q

what is different about FCU heads causing ulnar n entrapment than cubital tunnel syndrome

A

etiology
ROM- elbow WNL
palpation- no paresthesia or ulnar n subluxation

74
Q

what causes Guyon’s canal

A

cyst/repetitive stress with hand and onto hook of hamate carpal bone

75
Q

what does Guyon’s canal scan look like

A

ROM- elbow WNL
RST- hand but no wrist weakness
Palpation- no paresthesia or ulnar n subluxation

76
Q

what is the functional ROM for drinking activities

A

6-24 deg ext

77
Q

what is the functional ROM for using a telephone

A

40 deg ext

78
Q

what is the functional ROM for turning a doorknob

A

40 deg ext
40 deg flx
30 deg ulnar dev

79
Q

what is the functional ROM to rise from a chair

A

60 deg ext
25 deg ulnar dev

80
Q

what is the ideal functional ROM for the wrist

A

30-50 flexion
60 deg ext
20 deg radial dev
40 deg ulnar dev

81
Q

what is the optimal position for strength and precision in the wrist

A

slightly hyperextended
2-5 fingers- slightly flexed
thumb opposition

82
Q

what can cause a de quervains tenosynovitis

A

repetitive thumb use with ulnar dev and gripping

83
Q

what is de quervains tenosynovitis

A

inflammation or thickening of tendons/sheath just prox of snuff box

decreased grip and pinch strength at thumb

84
Q

what sp test can be used for de quevains tenosynovitis

A

(+) finkelstein

85
Q

what is the Rx for de quervains tenosynovitis

A

POLICED
workplace ergonomics
tendinosis MET
tendon glides
thumb splint

86
Q

what can cause mallet finger

A

tendon rupture or avulsion fx of the extensor hood at DIP

87
Q

what is the mallet finger

A

results in DIP flexion contracture

88
Q

what can cause a boutonniere deformity

A

rupture or stretch of extensor tendon at PIP

89
Q

what is boutonniere deformity

A

PIP flexion with DIP extension

90
Q

what can cause swan neck deformity

A

rupture of volar plate at PIP

91
Q

what is a swan neck deformity

A

hyperextension at PIP and flexion at DIP

92
Q

how does a wrist sprain occur

A

hyperextension with a FOOSH

93
Q

what is skier’s/gamekeepers thumb

A

excessive valgus with hyperextension ABD during FOOSH, UCL at MCP

94
Q

what is the function of fibrocartilage

A

primary stabilizer
resist tension
shock absorption
resist compression

95
Q

how can the TFCC be injured

A

sprains/fx
repetitive U dev
prolonged U dev

96
Q

what is the Rx for articular disc

A

POLICED
tissue proliferation
stabilization due to laxity
bracing

97
Q

what can cause dupuytren’s contracture

A

disease affecting the collagen formation of palmar fascia or aponeurosis

98
Q

what are the S&S of dupuyren’s contracture

A

flexion contracture- limited ROM/AM into ext
elastic/firm end feel
in 4/5 digit
palpation- non-painful nodules

99
Q

what is the PT Rx for dupuytren’s contracture

A

MT
MET- elasticity/mobility
splinting/bracing- mobility- at night

100
Q

what are we emphasizing with MT for dupuytren contracture

A

emphasizing mobility
improve ROM and function with 8 wks of 2 min ea of multiplanar TFM and max finger EXt

101
Q

what is the most common mononeuropathy entrapment

A

carpal tunnel syndrome

102
Q

what are the RF for CTS

A

obesity
>45 yrs of age
female gender
forceful hand activity

103
Q

what can cause CTS

A

local inflammation at wrist
systemic inflammation
benign ganglion cyst

104
Q

what are the factors of local inflammation at the wrist that can cause CTS

A

repetitive/forceful use
age-related jt changes
trauma- subluxation

105
Q

what are the factors of systemic inflammation that can cause CTS

A

autoimmune conditions
circulatory conditions

106
Q

what structures are involved with CTS

A

FCR
FPL
FDS
FDP
median n
all under the transverse carpal lig

107
Q

what is the distribution of the median n

A

sensation to volar surface of the first 3.5 fingers/dorsal tips
NOT ENTIRE PALM

108
Q

what does the median n innervate

A

1/2nd lumbrical
opponens pollicis
ABD pollicis brevis
flexor pollicis brevis

109
Q

what are the symptoms of CTS

A

gradual onset of tingling/numbness 1st 3.5 digits
worse at night, prolong/repetitive activities, especially FLX
weaken grip, tip, pinch strength

110
Q

what function is lost with CTS

A

limited dexterity- fine motor control

111
Q

what can you find in a SCAN for CTS

A

ob- thenar atrophy
ROM- symptoms with prolong wrist FLX and EXT
neuro- diminished sensation of peripheral n

112
Q

what can AM look like due to CTS

A

hypo or hyper in carpal, RC, distal RU jts due to immobilization or trauma

113
Q

what sp test can be performed for CTS

A

wainners CPR- 4 or 5/5
two point discrimination - >6mm
monofilament testing- 2.83-3.22

114
Q

what are the passive treatments for CTS

A

Pt. edu - work ergonomics, RF
POLI(C)ED
modalities
orthotics

115
Q

what physical treatments can we do for CTS

A

JM- neck, FA, wrist
neural glides
MET- lack evidence
combo of stretching and orthoses

116
Q

what is the Rx/prognosis of CTS

A

combo of STM and neural/tendon glides

117
Q

what are the MD rx for CTS

A

cortisone injection
CTS sx

118
Q

what happens in CTS sx

A

cutting of transverse carpal lig

119
Q

what is the ape hand

A

degeneration of median n

120
Q

what can we observe with ape hand

A

weakness in thenar m
thenar atrophy causing hand to be in the same plane
inability to FLX, oppose, or ABD

121
Q

what is the result of ulnar n damage

A

claw hand

122
Q

what can you observe with claw hand

A

hypothenar atrophy
deficient interossei m
claw deformity

123
Q

what is a colles fx

A

most common
distal radius displaces dorsally

124
Q

what is a smith fx

A

distal radius displaces proximally
FOOSH on dorsal side

125
Q

describe a scaphoid fx

A

most common carpal fx
wrist hyperextension with ulnar dev
pain at snuff box

126
Q

what are sp test for scaphoid fx

A

pain with thumb to index pinch
pain with wrist ext and pronation
stethoscope test

127
Q

what is a boxers fracture

A

neck of 2,3,4 or 5
most common in fingers

128
Q

what is a bennett fx

A

most common fx of thumb
subluxation of prox MC

129
Q

describe scapho-lunate

A

most common instability
watsons

130
Q

what is the resting position of TMJ

A

lips closed, teeth not touching, and tongue resting on roof of mouth

131
Q

what are the opening m of TMJ

A

digastric
lateral pterygoid
hyoids

132
Q

what are the swallowing m of TMJ

A

hyoids
digastric

133
Q

what are the closing m of TMJ

A

temporalis
masseter
medial and lateral pterygoid

134
Q

what m do lateral dev of TMJ

A

massester
pterygoids
temporalis

135
Q

what hx may indicate a TMJ disorder

A

thumb sucking
nail/ice biting
excessive teeth grinder
gum/smokeless tobacco chewer

136
Q

what S&S of TMJ disorder

A

ob- FHP
localized pain and/or crepitus
trigeminal n sensitization
impaired motor/function

137
Q

what is and when could acute capsular pattern of TMJ occur

A

earlier dev with loss of function after recent trauma
dev would be toward painful side

138
Q

what is and when could chronic capsular pattern of TMJ occur

A

earlier dev with loss of function due to past trauma
dev away from hypermobile TMJ
AM limited on side of dev

139
Q

what are the S&S of TMJ with earlier dev without loss of function

A

hx of trauma
dev away from UNILATERAL hypermobility
click at end range

140
Q

what are the S&S of TMJ with end range dev without loss of function

A

no hx of trauma
gradual and less hypermobility developed bilaterally due to FHP
click at end range

141
Q

what can FHP influence of TMJ

A

increased tension/lengthening of m and lig
anterior displacement

142
Q

what occurs in FHP assessment of TMJ

A

opening in neutral and FHP
Swallowing in neutral and FHP

143
Q

what is the hx of pt with anterior displacement

A

FHP
trauma sudden opening
excessive opening

144
Q

what can be found for S&S with ant displacement

A

full opening/no dev
likely pain and limitation with closing

145
Q

how do we treat for ant displacement of TMJ

A

distx with posterior glide
MET for stabilization of TMJ and neck

146
Q

what is the hx of pt with posterior displacement of TMJ

A

hx of trauma with closing

147
Q

what can be found for S&S with post displacement

A

likely pain and limitation on opening
full closing

148
Q

how do we treat for post displacement of TMJ

A

distx with anterior glide
sleep with small neck roll for slight neck extension
avoid excessive chewing
possible night splint to maintain opening

149
Q

what is the PT Rx for TMJ disorder

A

POLICED
Posture edu
Oral habit modification
diaphragmatic breathing
activity modification
MT
MET

DPT 730/1: MSK (11 decks)

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