Elbow Flashcards
(32 cards)
Brachialis Nerve Innervation
Musculocutaneous Nerve
C5-C7
Brachialis Nerve Innervation
Nerve: Musculocutaneous Nerve
Radial Nerve Innervations and Roots
Nerve Roots: C5-T1 Brachioradialis Triceps Supinator Anconeus
Pronator Teres Innervation
Medial Nerve
Nerve Roots: C6-C7
A 14-year-old female competitive gymnast presents to your clinic with complaints of lower lumbar pain after falling during a floor routine at a competition over the weekend. She was unable to finish the routine. She is seeking your advice as a sports certified specialist on her next steps. Which of the following diagnoses is least likely to occur in this patient? Spondylolisthesis Psychosocial factors Scheuermann's disease Mechanical low back pain
Scheuermann’s Disease
Occurs in thoracic spine and accompanied by significant thoracic kyphosis and lumbar hyperlordosis
The "Scottie dog" deformity seen on diagnostic imaging is used to diagnose lumbar spondylolisthesis. Which of the following is the most accurate to identify lumbar spondylolisthesis? Oblique view x-ray Posterior view x-ray Lateral view x-ray CT
CT
Most likely to identify lumbar spondylolisthesis
What are the criteria for the mobility category of cervical dysfunction?
Low pain, limited mobility, lack of radicular symptoms, and no positive neuro signs
What are the criteria for the centralization category for cervical dysfunction?
UE symptoms/radicular sign/symptoms impacted by cervical activities
Describe the levels of severity with OA
Severe OA: joint space less than 1-2 mm and subchondral scelerosis
Moderate OA: more than 1-2 mm of space on x-ray and small cysts present
What is the correct progression of mobilizations to restore hip flexion ROM in a post-op hip surgery patient?
Long-axis distraction; inferior glides at 90°; inferior glides with progressive passive flexion
Common findings in Osgood-Schlatter disease
Swelling, decreased quad flexibility, tenderness at tibial tuberosity, quad lag with SLR
Not likely to find patellar hypomobility
With periodization, plyos in a post-op cartilage injury patient should be performed during late off-season and beginning of preseason at what frequency and intensity?
Low to moderate intensity 2x a week
On radiograph, the athlete who fell onto his shoulder demonstrates a 2cm shortening compared to the uninvolved side. What is the best treatment option? Open reduction and plate fixation Figure-8 brace for 3-6 weeks Closed reduction and figure-8 brace Immobilization for 6 weeks
Open reduction and plate fixation
Early plate fixation for displaced clavicles results in improved outcomes, early return to function, and decreased rates of nonunion/malunion
The athlete with clavicular fracture complains on the field of left-hand numbness. What injury is suspected? Subclavian arter TOS Brachial Plexus injury Brachial arter
Subclavian artery
Despite no muscle weakness, the full hand numbness is often associated with clavicle fracture after penetrating and blunt trauma.
Compression between 1st rib and clavicle for brachial plexus injury would often cause ulnar symptoms or symptoms based on a specific nerve versus the whole hand
For the athlete with a clavicular fracture, when would you expect him to return to play if non-operated? 8-10 weeks 10-12 weeks 12-14 weeks 14-16 weeks
10-12 weeks
Mean time to return to play is 83 days, but 8 weeks is often pushing it in time for full return.
A 16-year-old male wide receiver tore his right knee when he was running a route; his right foot caught in the turf as he planted and twisted. He underwent anterior cruciate ligament reconstruction (ACLR) using a hamstring autograft. Other concomitant injuries include a medial meniscus repair of the posterior horn with two sutures and an osteochondral lesion on the medial femoral condyle addressed using a microfracture procedure. His main goal is to get back to running as soon as possible as he is also involved in track, where he runs the 4x100 meter relay. The patient arrives today, and his examination is as follows:
Range of motion (ROM): right knee = 0-1-114 degrees, left knee = 5-0-134 degrees
Knee extension MMT: right knee = 4/5 (good), left knee = 5/5 (normal)
Functional Assessment: poor control during descent of stair climbing
Based on the above history and examination findings, which intervention at eight weeks post-op is the most appropriate to help this patient restore function and achieve his goal?
Isotonic R knee ext exercises at 3x8-10 for hypertrophy
Prolonged low-load knee extension stretching and grade III extension mobilizations for increased knee extension ROM
Wall squats with unilateral eccentric lowering at 2 sets of 12–15 repetitions for muscle endurance
Modified prone quad stretching performed at 3 sets of 30 seconds each to increase knee flexion ROM
Prolonged low-load knee extension stretching and grade III extension mobilizations for increased knee extension ROM
Performing knee ext exercises with a combined knee flexion contracture puts the quad in a disadvantaged position when contracting thus reducing max recruitment
It is the responsibility of the sports certified specialist to help determine an athlete’s readiness for returning to full sport participation. Which tests have the best evidence to support this athlete’s ability to return to sport participation after ACL reconstruction?
- Y-Balance Test: 4 cm
- FMS Overhead Squat: 2
- Balance Error Scoring System (BESS): 5 errors on unstable surface
- Symmetrical Hop Test: 90%
1 and 4 only
BESS is mainly for concussion and FMS overhead squat has evidence backing importance of movement symmetry in injury prevention but only YBT and hop testing have research behind readiness for RTS
A 16-year-old male wide receiver tore his right knee when he was running a route; his right foot caught in the turf as he planted and twisted. He underwent anterior cruciate ligament reconstruction (ACLR) using a hamstring autograft. Other concomitant injuries include a medial meniscus repair of the posterior horn with two sutures and an osteochondral lesion on the medial femoral condyle addressed using a microfracture procedure. His main goal is to get back to running as soon as possible as he is also involved in track, where he runs the 4x100 meter relay. The surgeon cleared the athlete of all precautions at 12 weeks and prescribed progressive resistance exercises to address strength deficits. As the athlete gets closer to returning to participating in his sports, the sports certified specialist can progress from general athletic fitness to a more sport-specific athletic fitness. Which variables would provide the most benefit to address the inherent demands of the athlete’s sports?
- Resistance training consisting of loaded hip hyperextension exercises performed for 3–4 sets at an RPE of 4–6 and resisted sled sprint conditioning for 4 sets of 15 yards
- Resistance training consisting of bilateral compound knee extension exercises performed for 4–5 sets at an RPE of 3–4 emphasizing bar speed and conditioning consisting of 3 sets of 300-yard shuttles
- Resistance training consisting of bilateral and unilateral compound concentric and eccentric hamstring exercises performed as a superset with unilateral compound knee extension exercises performed for 3 sets at an RPE of 3–4 with a work-to-rest ratio of 1:3
1 and 3 only
Sprinting involves horizontally directed acceleration produced primarily by the posterior chain muscle groups. During the late swing and through the stance phase of the running cycle, the leg is slowed down and brought underneath the body by an eccentric to concentric contraction of the hamstrings. With the foot on the ground, the hip extensor group rapidly produces horizontal propulsive forces into a hip-hyperextended position right before toe-off. Performing choice 1 and choice 3 addresses these focal muscle groups in a similar action as produced when running, as well as addressing the phosphagen energy system utilized during the sprinting activity. Choice 2 involves rapidly producing a primary vertical force and improves conditioning utilizing the glycolytic energy system.
A sports clinical specialist is providing coverage at a collegiate track meet. After running of the 3000 m race, a female athlete reports tightness and cramping pain in the right lower leg. The patient reports the pain increasing as the race progressed. She reports that similar pain usually occurs at approximately 1500 m during practice runs but that she can usually run through it. She reports today's pain was much more intense after the race. Now that the race has ended, she reports that the pain is subsiding but is taking much longer than usual. During your on-field exam, you notice a unilateral decrease in dorsiflexion strength of the right foot. In which nerve and which lower leg compartment are symptoms consistent? Tibial; Anterior compartment Common Fibular; Posterior compartment Tibial; Posterior compartment Deep Fibular; Anterior compartment
Deep fibular; Anterior
Deep fibular innervates the anterior tibialis, and anterior compartment Is the most commonly involved
Which modality is used to best diagnose exertional compartment syndrome?
Needle manometer
Dynamic bone scan
MRI
ABI
Needle Manometer
Assesses intercompartmental pressure and is the only one listed that assess pressure within various compartments
What intercompartmental pressures are indicative of one being clinically diagnosed with exertional compartment syndrome?
Pre-exercise pressure > 15 mmHg
1 minute post exercise > 30 mmHg
5 minutes post exercise > 20 mmHg
Athlete decides to go surgical route to address exertional compartment syndrome. They ask you when they will be back to competitive running. Your recommendation for safe return is:
2-4 weeks
12-16 weeks
24-28 weeks
36-40 weeks
12-16 weeks
Once the wound heals, walking and bicycling are encouraged. Patients may begin a light jog in two weeks and resume running at 6 weeks. Often takes 3 months prior to return to competition
A 16-year-old male baseball player is seen in the clinic for medial elbow pain. He reports his pain began while pitching in a showcase a few weeks after the season ended. He reported he was unable to finish the showcase due to the pain and inability to maintain his usual pitching speed. Upon examination, he presents with pain with palpation on his medial epicondyle, ulnar collateral ligament, and flexor-pronator mass. Elbow ROM measures a lack of 5 degrees from full extension. He demonstrates 110 degrees of shoulder external rotation and 50 degrees of shoulder internal rotation. He presents with positive milking sign and moving valgus stress test. Based on the these findings, you would:
x-ray to rule out medial epicondyle avulsion
MRI to rule out UCL tear
Avoid pitching for 6 weeks and treat conservatively for medial epicondyle apophysitis
Dynamic splinting for elbow extension to treat for valgus extension overload syndrome (thrower’s arm)
MRI
Clinical findings and subjective highly suggest UCL tear. While repeated throwing contributes to thrower’s elbow, and a loss of extension ROM is present, UCL tear is most signficant
Extremes in positive and/or negative emotionality
Mood Disorders
