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Boards Prep - MSK > Elbow > Flashcards

Elbow Flashcards

1
Q

Loss of ROM in a non capsular pattern may be the result of what?

A

loose both in the joint, ligamentous sprain, and.or complex regional pain syndrome

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2
Q

Elbow contracture - loss of ROM

A

typically in capsular pattern (loss of flex > ext)

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3
Q

diagnosis for elbow contracture

A
  • AROM
  • PROM
  • resistive test
  • palpation
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4
Q

PT goals for elbow contracture

A
  • address joint movement restrictions through manual therapy and exercise
  • soft tissue/massage, modalities, flexibility exercises, functional exercises
  • splinting may be effective adjunct
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5
Q

What is lateral epicondylagia/epicondylitis/tennis elbow

A

chronic degenerative condition of the ECRB at its proximal attach meant to the lat epicondyle of humerus

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6
Q

onset of lateral epicondylitis

A

gradual
- usually result of sports activities or occupations that require repetitive wrist extension or string grip with wrist extended, resulting in overload of ECRB

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7
Q

when examining lateral epicondylitis, what do you need to rule out?

A
  • involvement of c spine or radial nerve entrapment
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8
Q

what is normal range of motion of the elbow?

A

0-140 degrees flexion
- 80-90 degrees supination
- 75-85 degrees pronation

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9
Q

PT goals, outcomes, interventions for lateral epicondylitis

A
  • resistance training to improve strength and endurance are the cornerstone of treatment
  • address joint movement restrictions
  • education on preventions
  • ed to avoid gripping or lifting with palm down
  • hot, cold, hydrotherapy, sound agents, TENS
  • counterforce bracing is frequently used to reduce forces along ECRB
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10
Q

What is medial epicondylitis/ golfers elbow

A
  • degenerative condition of the printer tires and flexor carpi radials at their attachment to medial epicondyle of humerus
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11
Q

How does medial epicondylitis occur

A

overuse in sports, such as baseball pitching, driving golf swings, swimming, or occupations that require a strong hand grip and excessive pronation of the forearm

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12
Q

PT goals, outcomes, interventions for medial epicondylitis

A
  • similar to lateral epicondylitis
  • educate to avoid gripping or living with palm down
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13
Q

complications of distal humerus fractures

A
  • loss of motion, myositis ossificans, malalignment, neuromuscular compromise, ligamentous injury, CRPS
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14
Q

Supracondylar humeral fracture

A
  • typically due to FOOSH
  • distal fragment often displaces posteriorly
  • must be caught quickly due to radial nerve and vascular structures –> may lead to Volkmann’s ischemia
  • must assess growth plate –> high incidence of malunion
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15
Q

Intra-articular distal humerus fractures

A
  • “T or Y” fractures
  • due to blow to flexed elbow or longitudinal loading of an extended elbow
  • joint surface disrupted –> more challenging to regain full ROM
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16
Q

Lateral epicondyle fracture

A
  • common in long people and typically require an ORIF to ensure alignment (typically allowed to WB early with ORIF)
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17
Q

PT for Humeral fractures

A
  • pain reduction and limiting inflammatory response following trauma and/or surgery
  • improve flexibility of shortened structures, strengthening and training to report functional use of UE
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18
Q

Olecranon Fracture

A
  • due to direct trauma or triceps avulsion
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19
Q

Radial head fracture

A
  • typically due to axial loading on a pronated forearm or due to values compression (FOOSH)
  • may or may not involve annular ligament
  • radial head dislocation: typically in kids from their arms being yanked –> can cause stretching of annular lig
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20
Q

Osteochonritis dessecans of humeral capitulum can affect…

A
  • central and/or lateral aspect of capitulum or radial head
  • osteochondral bone fragment can become detached from articular surface, forming loose body in joint
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21
Q

Osteochonritis dessecans of humeral capitulum is caused by

A
  • repetitive compressive forces between the radial head and the humeral capitulum
  • occurs in adolescents between 12-15 yo
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22
Q

what is Panner’s disease

A

a localized avascular necrosis of the capitulum leading to loss of subchondral bone with fissuring and softening of articular surfaces of RC joint
- etiology unknown
- occurs in kids under 10

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23
Q

PT interventions for osteochondrosis of humeral capitulum

A
  • rest with abidance of any throwing or UE loading activities
  • when pain free: initiate flexibility and strengthening
  • during late phases of rehab: initiate program to slowly increase load on joint –> if symptoms persist, surgery is indicated
24
Q

PT interventions for post op osteochrondrosis of humeral capitulum

A
  • initial focus is to minimize pain and swelling
  • flexibility exercises are begun immediately following sx
  • then progressive strength program
  • joint restrictions then addressed
25
Q

what causes UCL injuries

A
  • repetitive valgus stresses to medial elbow with overhead throwing
26
Q

clinical signs of UCL injury

A
  • pain along medial elbow at distal insertion of ligament
  • sometimes paresthesias are reported in Ulnar nerve distribution w/ + Tinel’s
27
Q

diagnostic test for UCL injury

A

MRI

28
Q

PT goals, outcomes, interventions for UCL injury

A
  • rest and pain management
  • strengthening exercises that focus on elbow flexors are initiated
  • taping can be used for protection during return to sport
29
Q

what is Cubital Tunnel Syndrome

A
  • entrapment of ulnar nerve by aponeurosis of FCU, 2-3 cm below medial epicondyle
30
Q

What can cause Cubital Tunnel Syndrome

A
  • direct trauma at cubical tunnel, traction due to laxity, compression due to thickened retinaculum or hypertrophy of FCU, recurrent subluxation, DJD that affects cubital tunnel
  • increased carrying angle = increased risk of entrapment
  • leaning on elbow, over use, valves deformity
31
Q

what is Prontator Teres Syndrome

A
  • compression of median n between heads of the pronator teres muscle
  • similar to carpal tunnel, but also forearm mm involvement (PT, wrist flexors, finger flexors)
32
Q

how does Pronator teres syndrome occur

A
  • repetitive gripping activities required in occupations and with leisure activities (tennis)
33
Q

clinical findings of pronator teres syndrome

A
  • aching pain with weakness of forearm muscles and positive Tinel’s with paresthesias in median nerve distribution
34
Q

Radial n entrapment

A
  • entrapment of distal branches (post interosseous n) occurs within radial tunnel as a result of overhead activities and throwing
35
Q

clinical signs of radial nerve entrapment

A
  • lateral elbow pain tat can be consumed with lateral epicondylitis and epicondylopathy, pain over supinator muscle, and paresthesias in a radial nerve distribution
  • Tinel’s may be +
36
Q

diagnostic tests used for nerve entrapment

A
  • electrodiagnostic test
37
Q

medications for nerve entrapment

A
  • acetaminophen
  • NSAIDs
  • Neurontin for neuropathic pain
38
Q

PT for nerve entrapment

A
  • early intervention: rest, avoiding exacerbating activities, use of NSAIDs, modalities, soft tissue
  • neurodynamic mobilization may be indicated if abnormal neurotension is present
  • protective padding and night splints
  • with reduction in pain and n/t, focus on strengthening exercise of involved muscles to achieve muscle balance between agonist and antagonist. normal flexibility, normal strength/endurance/coordination
  • functional training, pt ed, self management
39
Q

posterolateral dislocations at elbow

A
  • most common
  • occurs as the result of elbow hyperextension or FOOSH
40
Q

posterior dislocations of elbow are defined by..

A

positing of olecranon relative to the humerus

41
Q

posterior dislocations of elbow frequently cause…

A

avulsion fractures of medial epicondyle secondary to traction pull of MCL

42
Q

what occurs with complete dislocation of radial head

A

UCL will rupture with possible rupture if anterior capsule, LCL, brachialis, wrist flexor/extensor muscles

43
Q

clinical signs of elbow dislocation

A
  • rapid welling, severe pain at elbow and deformity with the olecranon pushed posteriorly
44
Q

PT goals outcomes, interventions for elbow dislocation

A
  • initial intervention is reduction of dislocation
  • if elbow is stable, there is initial phase of immobilization followed by rehab focusing on regaining flexibility within limits of stability and strengthening
  • if elbow is not stable –> surgery
45
Q

Capsular pattern

A

loss of flexion > loss of ext

46
Q

radio ulnar convex/concave rule

A

proximal: convex on concave
distal: concave on convex

47
Q

humeroradial convex/concave rule

A

concave on convex

48
Q

humeroulnar convex/concave rule

A

concave on convex

49
Q

humeroulnar joint OPP

A

70 degrees flex, 10 degrees supination

50
Q

humeroradial joint OPP

A

full ext and supination

51
Q

humeroulnar joint CPP

A

full extension and supination

52
Q

humeroradial joint CPP

A

90 degrees flexion and 5 degrees supination

53
Q

proximal radio ulnar joint OPP

A

70 degrees flexion, 35 degrees supination

54
Q

proximal radio ulnar joint CPP

A

5 degrees supination

55
Q

distal radio ulnar joint OPP

A

10 degrees supination

56
Q

distal radio ulnar joint CPP

A

5 degrees supination

57
Q
A

Boards Prep - MSK (29 decks)

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