EEO: Lecture 7 Flashcards
elbow and forearm mobility position hand for _________ tasks
elbow and forearm mobility position hand for functional tasks
elbow and forearm stability is for __________ through the upper extremity
elbow and forearm stability is for weight bearing through the upper extremity
normal cubitus valgus
8-15 degrees
excessive cubitus valgus stretched versus compressed tissues
too much carrying angle
stretched: UCL, ulnar n, flexor tendons
compressed: extensor tendons, RCL, radial n
cubitus varus stretched versus compressed structures
too little carrying angle
stretched: brachioradialis, extensor tendons, RCL, radial n
compressed: UCL, ulnar n, flexor tendons
Does excessive cubitus valgus or cubitus varus require more shoulder ROM for functional movement?
cubitus varus
What is the source of hyperextended elbows with weight bearing?
lack of shoulder flexion
tricep weakness
locations of entrapment for the ulnar nerve
nerve roots
first rib
pec minor
humeral head
cubital tunnel
guyon’s canal
peripheral nerve cutaneous innervation of the palmar hand
ulnar nerve: 5th digit and medial 4th digit
median nerve: 1st, 2nd, 3rd digits and lateral half of 4th digit
peripheral nerve cutaneous innervation of the dorsal hand
ulnar nerve: 5th digit and medial 4th digit
median nerve: tips of 1st, 2nd, 3rd digits and tip of lateral 4th digit
radial nerve: dorsum of hand digits 1-3 and lateral 4th digit (not the finger tips!)
what nerve roots comprise ulnar nerve?
C8-T1
what is the motion that screens for a compromised ulnar nerve ?
claw hand
what population is notorious for having ulnar nerve problems?
baseball players (pitchers) tend to have excessive valgus
cyclists
what muscles are atrophied due to ulnar nerve injury
hypothenars, intrinsics
how do you screen for ulnar nerve?
finger cross
key fob - watch for PIP flexion compensation
locations of median nerve entrapment
nerve roots
scalenes
pec minor
humeral head
pronator teres
carpal tunnel
does first rib elevation or depression compress the ulnar nerve?
elevation
how can the humeral head compress the ulnar nerve?
internal rotation
what nerve roots comprise the median nerve?
C5-T1
median nerve entrapment sites
nerve roots
between scalenes
pec minor
humeral head
pronator teres
carpal tunnel
median nerve entrapment clinical tests
tinels
phalens
reverse phalens
tinels
nerve tap
median nerve entrapment hand positions
at rest: Ape Hand
make a fist: hand of benediction
how to screen median nerve?
OK sign, opposition
what nerve roots comprise radial nerve
C5-T1
radial nerve locations of entrapment
nerve roots
scalenes
triangular space
spiral groove
lateral epi
ECRB
arcade of froshe (supinator)
what are the borders of the triangular space
superior: teres minor
inferior: teres major
lateral: long head of triceps
clinical tests for radial nerve entrapment
tinels (laterally)
resisted supination
clinical appearance of radial nerve entrapment
wrist drop
radial nerve screen
thumbs up
causes of lateral elbow tendinopathy
(tennis elbow)
repetitive wrist extension w/ radial deviation
pt presentation of LET
crepitus
pain with eccentric wrist flex
pain with gripping
profession with repetitive wrist/hand movements (barbers)
what is the major functional outcome measure to use for a patient with tennis elbow?
grip strength
causes of medial epicondylagia (golfers elbow)
repetitive wrist flexion, gripping/twisting
Does lateral epicondylitis or medial epicondylagia heal faster? Why?
Medical epicondylagia heals faster due to its better blood supply
What are 2 function outcome measures you can use for a patient with medial epicondylagia?
grip strength
key fob: ulnar nerve runs behind medial epicondyle
what are the borders of the cubital tunnel?
roof: arcuate ligament
floor: UCL
medial/anterior: medial epicondyle
lateral/posterior: olecranon
cubital tunnel syndrome causes
ulnar nerve entrapment
repetitive microtrauma in flexion
sustained position- full flexion in sleeping
trauma to posteromedial elbow
patient presentation of cubital tunnel syndrome
- numbness/tingling in ulnar nerve distribution
- weakness in ulnar sided gripping
- weakness with fine motor control
- ulnar nerve snapping
causes of osteochondritis dessicans
repetitive, forceful valgus (pitchers), repetitive weight bearing
is osteochondritis dessicans intra-articular or extra-articular?
intra-articular
pt of osteochondritis dessicans are usually…
younger athletes, males more than females
patient presentation of osteochondritis dessicans
catching/locking in joint
loss of elbow extension
what is important to assess in patients with OCD?
elbow flexion/extension ENDFEEL
what are the 3 bands of the UCL?
anterior cord
posterior cord
oblique cord
what is little leaguers elbow?
ulnar collateral ligament sprain
causes of UCL sprain
repetitive VALGUS
UCL sprain presentation
may have heard snap with MOI
pain with valgus force
pain over medial elbow (stretched)
may have underlying shoulder issue
may see ulnar nerve irritation
How can an underlying shoulder issue cause problems with the UCL?
decreased shoulder ER leads to compensation within the elbow
lateral collateral ligament sprain causes
trauma with varus force
VARUS
chronic crutch users
patient presentation of LCL sprain
radial head subluxation
lateral elbow pain
feeling unstable
popping clicking, catching
is a LCL intra-articular or extra-articular?
intra-articular –> popping, clicking, catching
what intrinsic hand muscles does median nerve innervate?
recurrent: thenar muscles
- FPB (superficial)
- APB
- OP
Digital:
- 1st/2nd lumbricals
what intrinsic hand muscles does the ulnar nerve innervate?
deep branch:
- hypothenar muscles:
flexor digiti minimi
abductor digiti minimi
opponens digiti minimi
- FPB (deep)
- adductor pollicis
- 3rd/4th lumbricals
- PADs
-DABs
what passes through the carpal tunnel?
median nerve
FDS
FPD
FPL
*the palmar cutaneous branch of the median nerve does NOT pass through the carpal tunnel
carpal tunnel syndrome causes
sustained/repeated wrist flexion and extension
how do you differentiate between carpal tunnel syndrome and a median nerve injury higher up?
the palmar cutaneous branch of the median nerve does NOT pass through the carpal tunnel, so sensation over the thenar eminence is usually spared in CTS
what is an outcome measure you would use for a patient with CTS?
lateral pinch (key fob)
- testing opponens pollicis
what is the main test/measurement you should use for a patient with CTS?
hand/wrist circumference (swelling)
- should be 2:1
dequervains tenosynovitis causes
tenosynovitis between EPB and APL, repetitive radial deviation
what do you need to rule out with DeQuervain’s?
radial nerve!
radial nerve innervates the extensors
(PIN is only motor)
how do you screen for DeQuervain’s?
thumb tuck
scaphoid fracture causes
TRAUMATIC
FOOSH, especially wrist hyperextension
patient presentation scaphoid fractures
- pain with compression
- pain in snuff box (ext tunnels 1 &3)
- pain worsens with extension and radial deviation
- weak grip - thenar eminence muscles attach to scaphoid
CMC Arthritis causes
NON_TRAUMATIC
repetitive loading through thumb, especially CMC hyperextension
CMC arthritis is correlated in what populations?
female, older
patient presentation CMC arthritis
pain with compression
dull pain at base of thumb
loss of grip and pinch strength
do patients with CMC arthritis present with numbness and tingling?
no, just muscle atrophy
mallet finger deformity
DIP flexion
extensor digitorum tendon
AROM vs. PROM mallet finger
AROM: patient cannot actively extend the DIP joint
PROM: PT can extend the DIP joint because it is a problem with the tendon, not the joint
patient presentation with radial head compression factor
lateral elbow pain
limited pronation/supination
DRUJ or ligament issues
post-op elbow patient presentation
-elbow post op brace
- limit PROM in all planes
- ORIF: AROM only
- tendon/ligament: PROM only
Causes of Radial head compression fracture
FOOSH- elbow extension, forearm pronation
