Elbow

Question 1

What are the static stabilizers of the elbow?

Answer 1

Ulnohumeral articulation, anterior portion of MCL, and the LUCL

Question 2

What are the dynamic stabilizers of the elbow?

Answer 2

Biceps, brachialis, and triceps

Question 3

What is the overall goal of rehab?

Answer 3

Protection of static stabilizers while maximizing function in the dynamic stabilizers

Question 4

What are the causes of cubital tunnel? (select all that apply)

A. Direct compression over tunnel
B. Direct compression over lateral epicondyle
C. Direct trauma to lateral elbow
D. Direct trauma to medial elbow
E. Repetitive or prolonged elbow flexion
F. Subluxation/snapping
G. Stress
H. Stretch

Answer 4

A, D, E, F, G, H
A. Direct compression over tunnel
D. Direct trauma to medial elbow
E. Repetitive or prolonged elbow flexion
F. Subluxation/snapping
G. Stress
H. Stretch

Question 5

What are the symptoms of cubital tunnel?

Answer 5

• Sharp or aching pain in the medial/proximal side of the forearm
• Paresthesia: volar and dorsal (ulnar ring finger and small finger)
• Weakness
• Decreased pinch strength
• Flattening of hand arches
• Intrinsic wasting
• Clawing
• Wartenberg’s sign

Question 6

Why is weakness a symptom of cubital tunnel?

Answer 6

The Ulnar Nerve innervates all intrinsic muscles playing a role in power grip

Question 7

Why is decreased pinch strength a symptom of cubital tunnel?

Answer 7

The Ulnar Nerve innervates the intrinsic muscle needed for pinch strength

Question 8

Why is flattening of hand arches a symptom of cubital tunnel?

Answer 8

The Ulnar Nerve innervates the hypothenar muscles; atrophy of these causes flattening of the hand

Question 9

What motor assessments would you do during a physical exam for cubital tunnel?

Answer 9

• Ulnar Nerve innervated muscles
• Grip strength

Question 10

What are the provocative tests for cubital tunnel?

Answer 10

• Tinel’s sign
• Elbow flexion (at least 60 seconds)
• Pressure provocation

Question 11

What are the OT interventions for cubital tunnel?

Answer 11

• Rest and protect
• Activity modification
• Postural exercises
• Nerve gliding

Question 12

What is the purpose of nerve gliding?

Answer 12

To gently increase movement of the nerve and its surrounding tissue to improve blood flow and nutrition to the nerve using active-assistive ROM

Question 13

True or False: nerve gliding shouldn’t be painful but patient may report a “pulling” sensation

Answer 13

True

Question 14

In regard to nerve gliding (aka nerve flossing) what does the acronym FLOSS stand for?

F:
L:
O:
S:
S:

Answer 14

F: fix the adjacent segment
L: limit the ROM
O: oscillate proximal or distal segment
S: slow/rhythmic motion
S: symptom free

Question 15

What consists of OT management after cubital tunnel surgery?

Answer 15

• Education about procedure and precautions
• Scar management
• Elbow mobility
• Wound care and edema management

Question 16

What muscle originates from the lateral epicondyle and is most commonly affected by lateral epicondylitis?

Answer 16

ECRB

Question 17

What are the symptoms of lateral epicondylitis?

Answer 17

• Tenderness at the lateral epicondyle
• Pain aggravated by heavy gripping or lifting activities
• Sharp, dull, or excruciating pain
• Weakness with grip
• Difficulty with functional impairments

Question 18

Lateral epicondylitis involves pain with the forearm __________ and the elbow __________.

Answer 18

Pronated and extended

Question 19

Medial epicondylitis involves pain with resisted forearm __________ and wrist ___________.

Answer 19

Pronation and flexion

Question 20

Medial epicondylitis involves pain with stretch in elbow __________ and wrist ___________.

Answer 20

Extension and extension

Question 21

What are the forms of treatment for medial epicondylitis?

Answer 21

Activity modification, counterforce brace-placement, stretching, strengthening to UE, LE, and core

Question 22

True or False: Simple elbow dislocation involves ligament damage whereas complex elbow dislocation involves fractures.

Answer 22

True

Question 23

3 goals of conservative management:

Answer 23

1. Protect healing structures
2. Restore mobility
3. Progress within time (cannot rush healing process)