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MSK Final - ELBOW/ WRIST & HAND/ TMD > Elbow and FA- Sprains thru Ulnar n. Entrapment > Flashcards

Elbow and FA- Sprains thru Ulnar n. Entrapment Flashcards

1
Q

How does valgus stress overload happen?

A
  • Trauma (FOOSH)
  • Overuse/repetitive stress with overhead sports
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2
Q

What structures are involved with valgus stress overload?

A

3 portions of UCL

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3
Q

What does the Anterior portion of the UCL do? Where is it?

A
  • primary stabilizer
  • medial epicondyle to coronoid, anterior to ulnar nerve
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4
Q

Where is the posterior portion of the UCL?

A

Medial epicondyle to olecranon

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5
Q

Where is the transverse portion of the UCL?

A

Olecranon to coronoid

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6
Q

What does the transverse portion of the UCL do?

A

Provides varus stability and prevents valgus stress

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7
Q

What would be signs of UCL sprains?

A

limited and painful ROM in extension, creates more valgus position

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8
Q

What are some signs of valgus stress overload?

A
  • ROM painful and limited with extension
  • Stress tests positive with distraction and relief with compression
  • Positive stability tests
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9
Q

What stability tests are positive with a valgus stress overload?

A
  • Valgus stress test at 0 and 90 degrees
  • UCL instability
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10
Q

What other conditions must we differentiate valgus stress overload from?

A

Medial epicondyle apophysitis and tendiopathy

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11
Q

What is the mechanism of Varus stress overload?

A

Same as UCL but with Varus stress

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12
Q

What structure is involved with varus stress overload?

A

RCL

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13
Q

What shape is the RCL?

A

Triangular

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14
Q

What does the RCL do?

A

Provides lateral stability and prevents varus stress

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15
Q

Where does the RCL run?

A

Lateral epicondyle to annular ligament to lateral radius

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16
Q

What are some specific S&S for varus stress overload?

A

ROM more pain and limitation with flexion
Positive stability tests (varus stress test at 0 and 90 degrees)

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17
Q

What is the general Rx for Sprains?

A

POLICED
-possible brief period of immobilization
- bracing and taping PRN
-MET

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18
Q

What is MET for sprains ultimately for?

A

Tissue integrity and stabilization

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19
Q

What is the MD rx for UCL?

A
  • Direct repair vs. reconstruction with palmaris longus graft
  • Reconstructive surgery known as Tommy John sx
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20
Q

How long is the ideal recovery from UCL surgeries?

A

12-18 months

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21
Q

Why is a palmaris longs graft repair of the UCL successful?

A

Both are made of the same collagen type so that they both resist tension

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22
Q

What is a pushed dislocation?

A

When the radial head goes proximal or is pushed into a subluxation/dislocation

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23
Q

What is the mechanism of a pushed dislocation?

A

Falling on an outstretched hand (FOOSH), usually on thenar eminence which shoves radial head proximally

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24
Q

What are some complications of a pushed dislocation?

A

may also cause a fx of distal radius and ulna aka Colle’s fx

25
Q

What is a pulled dislocation?

A

Radial head distal or pulled subluxation/dislocation - forceful traction through lateral forearm

26
Q

What structures are involved with a pulled subluxation?

A

Radioulnar articulations held together by:
- annular ligament
- interosseous membrane

27
Q

Where does the annular ligament run?

A

Attaches anteriorly and posteriorly on radial notch, encompasses radial head and holds It against ulna

28
Q

What does the Interosseous membrane do?

A

Keeps radius and ulna together, serves as a muscle attachment for forearm and wrist muscles

29
Q

What are some complications of a humeroulnar dislocation?

A
  • the three nerves around elbow: radial, ulnar, median
  • Brachial artery emergency referral
  • fractures of radial head
  • frequent loss of terminal extension
30
Q

Why can humeroulnar dislocations result in a loss of terminal extension?

A

Due to intimate bony congruency of deep joint, immobilization makes it hard to get the extension back

31
Q

What is the Rx for subluxations/dislocations?

A

Like ligamentous sprains for worse case hyper mobility/instability

32
Q

How many sets and reps for acute dislocations?

A

1-2 sets of 10-15 with light resistance

33
Q

What is a supracondylar fracture?

A

Distal humeral segment is fractured and displaced

34
Q

What is an intercondylar fracture?

A

Fracture within the humeral condyles

35
Q

What are some complications with the brachial artery along with condylar fractures?

A
  • Volkmann’s ischemic flexion contracture
    ** EMERGENCY REFERRAL
36
Q

What are the 3 types of radial head fractures?

A
  • Nondisplaced
  • Displaced
  • Comminuted
37
Q

What can be difficult after an olecranon fracture?

A

Regaining full extension

38
Q

What are typical S&S of fractures?

A

Multiple planes of limitation and weakness, won’t like distraction or vibration

39
Q

What are special tests after trauma / fracture?

A
  • lack of pronation (highest LR)
  • lack of supination
  • lack of extension ROM - high sens
  • Other motions restricted - high spec
40
Q

When does PT begin after a fracture?

A

When clinical union occurs - between 4-8 weeks

41
Q

What is pain from fracture typically NOT from?

A

Bone

42
Q

What is PT for fractures focused on?

A

Consequences of prolonged immobilization where every tissue is negatively influenced

43
Q

Why is elbow extension difficult after fractures/surgery?

A

Elbow is immobilized in flexion after all fractures / surgeries making the regaining of full extension difficult

44
Q

What is the 2nd most common compression neuropathy seen by hand surgeons?

A

ulnar nerve entrapment

45
Q

Where can ulnar nerve entrapment happen?

A
  • cubital tunnel at elbow
  • FCU heads in proximal forearm
  • Guyon’s canal in hand
46
Q

What is the etiology of ulnar nerve entrapment?

A
  • Trauma (FOOSH)
  • Overuse/repetitive stress with elbow/hand
  • Age related joint changes/ RA at elbow/wrist
47
Q

What two nerve roots make up the ulnar nerve in the cubital tunnel?

A

C8 and T1

48
Q

What are some symptoms of cubital tunnel syndrome?

A
  • Medial hand/finger paresthesias
  • Weak grip
49
Q

What are signs of cubital tunnel syndrome with ROM?

A
  • possible limitation with elbow flexion and paresthesias and radial deviation
  • Possible limited ext at end range
50
Q

What are some signs of cubital tunnel syndrome found in resisted testing?

A

Possible weak wrist and 4th and 5th digit flexion, thumb abduction, and grip

51
Q

What are some neurological signs of cubital tunnel syndrome?

A
  • possible diminished sensation over ulnar nerve distribution
  • positive ulnar nerve dural mobility test
52
Q

What are some special tests for cubital tunnel syndrome?

A
  • elbow flexion test
  • Tinel’s ( Tap test)
  • Wartenberg’s sign
53
Q

Where can we palpate for cubital tunnel syndrome? Why?

A

Over ulnar nerve
- Provocation with ulnar nerve pressure up to 60 seconds
- May be able to sublux ulnar nerve

54
Q

What are some specific S&S for flexor carpi ulnaris ulnar nerve subluxation?

A
  • ROM - elbow WNL
  • ONLY Wartenberg special test positive
  • NO provocation or ulnar nerve subluxation in cubital tunnel with palpation
  • Provoked at FCU heads
55
Q

What are some specific S&S for Guyon’s canal ulnar nerve subluxation?

A
  • ROM: elbow WNL
  • Resisted testing - hand but NO wrist weakness
  • ONLY Wartenberg special test positive
  • Palpation: No paresthesias or ulnar nerve subluxation in cubital tunnel; Provocation at guyon’s canal
56
Q

Where is Guyon’s Canal?

A

Hook of hamate at wrist

57
Q

What is the Terminal nerve branch injury Rx?

A
  • POLI (NO C) ED - when compression is the cause
  • Bracing/splinting to assist with eliminating compression
  • MET with optimal stresses
58
Q

What is the MET prescription for terminal nerve branch injury?

A

MET with optimal stresses to create neural motion/flossing and elimination of compression

** want movement without undesirable symptoms

MSK Final - ELBOW/ WRIST & HAND/ TMD (6 decks)

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