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MSK > Elbow and Forearm > Flashcards

Elbow and Forearm Flashcards

1
Q

what is the desired ROM for elbow flexion/extension to complete most daily activities

A

~130 degrees

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2
Q

what is the desired ROM for forearm pronation/supination to complete most daily activities

A

~100 degrees

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3
Q

what is the etiology of lateral elbow pain

A

tendinopathy (tendinosis/tendinitis)
trauma - abducted elbow
radial nerve entrapment
repetitive stress

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4
Q

what population is lateral elbow pain most common

A

tennis players
laborers - overuse of hand tasks

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5
Q

what are the risk factors of lateral elbow pain

A

dominanr arm > non-dominant arm
forceful/repetitive activities
smoking
poor posture
25-54 years of age

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6
Q

what are the primary involved tendons/muscles with lateral epicondylitis

which is the highest incidence

A

ECRL
ECRB
ED
EDM

ECRB is the highest incidence

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7
Q

what is the pathogenesis of lateral epicondylitis

A

tendinitis aka tennis elbow

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8
Q

what are the hallmark signs of tendinitis

A

TTP
P! with lengthening/use

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9
Q

what would the hallmark signs of tendinitis at the lateral elbow

A

pain distal to lateral epicondyle

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10
Q

how would you distinguish tendinitis from tendinosis with your patient

A

how long have you experienced the pain?

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11
Q

what would you expect to observe with lateral epicondylitis during ROM

A

P!/limited with lengthening during wrist flexion with/without elbow extension

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12
Q

what would you expect to observe with lateral epicondylitis during resisted/MMT

A

pain with wrist extension, possible 3rd finger ext, radial deviation especially in lengthened position

possible weakness

pain with gripping

abnormal muscle activation patterns

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13
Q

what would you expect to observe with lateral epicondylitis during palpation

A

common extensor tendon (CET) TTP

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14
Q

t/f
lateral epicondylitis will not become nociplastic pain

A

false
lateral epicondylitis can become nociplastic pain

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15
Q

what would be your Rx with pts with lateral epicondylitis with tendinitis

A

modify activity
decrease inflammation
treat neck/shoulder (most likely stabilization)

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16
Q

what would be your Rx for a patient with lateral epicondylitis

A

tendinitis RX
sport specific corrections
cuff, scap, trunk, and/or LE muscle coordination, endurance, strength training to decrease elbow stress

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17
Q

what is the etiology of tendinosis at the lateral elbow

A

recurrent tendinitis
regional interdependence
cervical nerve impingement

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18
Q

what factors could contribute to lateral epicondylitis in laborers or tennis players

A

tendinosis etiology
abducted elbow
radial nerve entrapment

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19
Q

what is the etiology of C5,6 regional interdependence

A

C5,6 hypermobility/instability d/t FHP, hypomobility of the thoracic region, age-related changes, hx/trauma

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20
Q

describe the effect of inaccurate C5,6 innervation

A

excitation of the nerve
over recruitment when muscles are asked to contract
overuse of the muscle without change in activity

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21
Q

describe the pathomechanics of C5,6 regional interdependence

A

over-recruited wrist extensors creating increased CET tension and compression

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22
Q

how does C6 spinal nerve impingement affect muscles at the wrist

A

creates decreased activation of wrist extensors and lowers supply

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23
Q

what are the signs and symptoms of nerve impingement

A

decreased sensation/paresthesias in dermatome
muscle weakness in myotome

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24
Q

what is the pathogenesis of lateral tendinosis

A

degeneration most often at musculotendinous junction

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25
Q

what are the signs and symptoms of tendinosis

A

TTP
tendon appears large if superficial d/t fat infiltration
persistent symptoms >4-6 weeks
pain/limitation in lengthened position
decreased tendon tolerances

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26
Q

what is the PT Rx for tendinitis/tendinosis

A

Pt education - soreness rule, load management
POLICED
bracing/taping

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27
Q

what provides a greater pain relief, wrist extension splint or elbow strap

A

wrist extension splint

stops wrist from moving, decreases muscle contractions

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28
Q

what is the recommendations for modalities for tendinitis/tendinosis

A

not very definitive

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29
Q

what is more beneficial, STM/exercise/injections with tendinitis/tendinosis

A

exercise and injections are more beneficial

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30
Q

how does cervical JM affect tendinitis/tendinosis of the elbow

A

manipulation is effective with pain and grip strength
fewer visits and equal success compared to elbow Rx

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31
Q

how does elbow and wrist JM affect tendinitis/tendinosis of the elbow

A

effective
Mill’s manipulation for P!/function and pulling apart scarring

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32
Q

t/f
cervical and elbow JM together is better than cervical and elbow JM alone

A

true

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33
Q

what is the effect of thoracic manipulation with tendinitis/tendinosis

A

not effective with pain but increases grip strength

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34
Q

what is the primary purpose of MET with tendinitis/tendinosis

A

tendon proliferation and possible cervical stabilization

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35
Q

are eccentric or concentric exercises better for tendinitis/tendinosis

A

eccentrics same or better as concentrics
additive benefit with isometrics
wrist extended or flexed

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36
Q

t/f
greater weekly exercise frequency provides greater pain control with tendinitis/tendinosis

A

true

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37
Q

what is an example of isometric loading without compression from lengthening

A

wrist hyper/extension in a shortened position

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38
Q

what is an example of isotonic loading without compression from lengthening

A

wrist hyper/extension from neutral to a shortened position

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39
Q

what is an example of isotonic loading with compression from lengthening

A

wrist hyper/extension from a lengthened position

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40
Q

what is an example of isometric loading in weight-bearing for the wrist

A

planks on hands or push ups

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41
Q

what is an example of plyometric loading in the UE

A

throwing

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42
Q

what is the prognosis of cortisone injections with elbow tendinitis/tendinosis

A

associated with poorer outcomes and higher recurrrence rates
more effective than TFM and STM

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43
Q

what surgery would be needed with elbow tendinitis/tendinosis

what is the purpose of the surgery

A

arthroscopic procedure to promote inflammation with tendinosis not responding to PT

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44
Q

what is the prognosis of tendinitis/tendinosis

A

prone to recurrent bouts
6-24 months - average 1 year
89% recover

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45
Q

what is the mechanism of abducted elbow

A

trauma - FOOSH
leads to medially fixated olecranon

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46
Q

what would you observe with a pt that has abducted elbow

A

increased carrying angle

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47
Q

what ROM limitations are expected with abducted elbow

A

elbow flexion and forearm supination d/t lack of lateral ulnar glide
wrist flexion, radial deviation d/t radius shifting distally from contact with capitulum

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48
Q

what are the resisted testing/MMT, accessory motion expected with abducted elbow

A

RST/MMT: wrist extension and radial deviation painful
AM: limited lateral glide at humeroulnar joint
palpation: CET TTP

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49
Q

what complications of abducted elbow are common

A

carpal fracture
subluxation

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50
Q

what is the PT Rx for abducted elbow

A

correct lateral glide with manipulation
stabilization with MET

51
Q

what are the other names for radial nerve entrapment

A

radial tunnel syndrome
posterior interosseous nerve syndrome (PINS)
wartenberg syndrome

52
Q

describe the radial nerve course

A

off posterior cord from brachial plexus
passes inferior to teres major
posterior to brachial artery in posterior arm
travels just anterior to lateral epicondyle before entering posterior forearm

53
Q

what condition is often confused with lateral elbow tendinopathy but provocation more distal than lateral elbow tendinopathy

A

radial tunnel syndrome

54
Q

what is the site of radial tunnel syndrome

A

begins where deep radial nerve branch courses over radiohumeral joint and ends at distal edge of supinator

55
Q

what symptoms are common with radial tunnel syndrome

A

dorsoradial forearm pain/parethesias
wrist extension weak and painful

56
Q

what is the cause of wartenberg syndrome

A

compression of superficial sensory radial nerve between brachioradialis and ECRL

57
Q

what symptoms are common with wartenberg syndrome

A

Only sensory symptoms or paresthesia’s and P! over 1st 3 ½ digits of dorsoradial forearm and HAND

58
Q

what special tests are used to confirm radial nerve entrapment
what are examples of these tests

A

radial nerve dural mobility

ULTT
resisted supination test

59
Q

what is the Rx for terminal nerve branch injury

A

POLI (no C) ED
STM/modalities for inflammatory phase
STM/JM/Splinting to assist with eliminating compression
MET

60
Q

why is compression not used during POLICED of terminal nerve branch Rx

A

compression is the cause of the symptoms with the injury

61
Q

what is the focus of MET for terminal nerve branch injury

A

create neural motion/flossing
eliminate compression

62
Q

what structures are involved with medial tendinitis/tendinosis

A

pronator teres
FCR
FCU
FDS
FDP

63
Q

what are the hallmark S&S of medial tendinitis/tendinosis

A

pain with lengthening - wrist flexion/supination
TTP over medial epicondyle

64
Q

what is the PT Rx for medial tendinitis/tendinosis

A

modify activity
decrease inflammation
treat neck/shoulder (most likely stabilization)

65
Q

what complications are common with medial tendinitis/tendinosis

A

medial epicondyle apophysis in adolescent overhead throwers

66
Q

what is another name for medial epicondyle apophysitis

A

little league elbow

67
Q

what population is most commonly diagnosed with medial epicondyle apophysitis

A

adolescent males
mostly overhead throwers and racquet sports

68
Q

what is the etiology of medial epicondyle apophysitis

A

growth with high activity

69
Q

what are the pathomechanics of medial epicondyle apophysitis

A

bone growth exceeds wrist flexor and pronator lengthening

increased tendon tension

most often inflammation

70
Q

what structure is considered the weak spot in adolescents and adults in regards to medial epicondyle apophysitis

A

adolescents - growth plate

adults - tendon

71
Q

what are common complications of medial epicondyle apophysitis

A

avulsion and/or premature closure

72
Q

what are symptoms of medial epicondyle apophysitis

A

gradual onset with overuse
“pop” may indicate trauma/avulsion
possible loss of velocity

73
Q

what ROM is expected with medial epicondyle apophysitis

A

possible loss of extension

74
Q

what RST/MMT is expected with medial epicondyle apophysitis

A

possibly weak/painful muscles that attach to common flexor tendon

75
Q

what is expected during palpation of medial epicondyle apophysitis

A

TTP over medial epicondyle

76
Q

what is expected during special test of medial epicondyle apophysitis

A

UCL possible +

77
Q

what is the PT Rx for medial epicondyle apophysitis

A

Pt education - soreness rule, load management, movement cues

POLICED

78
Q

what is the mechanism of valgus stress overload

A

trauma (FOOSH)
repetitive stress like overhead throwing or racquet sports

79
Q

what structure is involved with valgus stress overload

A

ulnar collateral ligament

80
Q

what are the S&S of sprains

A

pain with motions that cause lengthening
+ distraction

81
Q

when would you preform a stability test with a possible sprain

A

before accessory motion to confirm sprain

82
Q

what special tests would be performed for a sprained ligament at the elbow

A

valgus stress test @ 0 and 90 degrees

UCL instability

83
Q

describe valgus

A

distal segment (forearm) goes lateral
joint goes more medial

84
Q

describe the medial/ulnar collateral ligament

A

triangular shaped
medial epicondyle to coronoid to olecranon process
provides medial stability/prevents valgus stress

85
Q

what structure is involved in varus stress overload

A

radial collateral ligament (RCL)

86
Q

what S&S are common with varus stress overload

A

S&S of sprains

87
Q

what special tests would be used for varus stress overload

A

varus stress test 0 and 90 degrees

88
Q

describe the lateral/radial collateral ligament

A

triangular shaped
lateral epicondyle to annular ligament to lateral radius
provides lateral stability/prevents varus stress

89
Q

what is the PT rx for sprain

A

POLICED
bracing/taping prm
MET

90
Q

what is the goal of MET for sprains

A

ultimate emphasis on stabilization and increase integrity

91
Q

what are the MD Rx for sprains

A

reconstructive surgery - Tommy John surgery for the UCL
12-18 month recovery

92
Q

describe radial head proximal/pushed subluxation/dislocation

A

radial head goes through annular ligament

93
Q

what is the mechanism of radial head proximal/pushed subluxation/dislocation

A

FOOSH

94
Q

t/f
radial head proximal subluxation/dislocation can also cause a fracture of distal radius and ulna

A

yes

95
Q

what is a colles fracture

A

fracture of distal radius and ulna

96
Q

how does radial head distal or pulled subluxation/dislocation

A

forceful traction through lateral forearm
mostly caused by pulling on distal arm

97
Q

describe the annular ligament

A

attaches anteriorly and posteriorly on the radial notch
encompasses radial head and holds it against ulna

98
Q

describe humeroulnar dislocation

A

primarily in males and usually on non-dominant side
can injure major nerves or brachial artery
frequent loss of terminal extension

99
Q

what is the PT rx for subluxation/dislocation

A

like ligamentous sprains for greater hypermobility/instability

100
Q

what are condylar fracture complications

A

volkmann’s ischemic flexion contracture d/t brachial artery damage

emergency referral

101
Q

t/f
its common for difficulty when regaining full extension with olecranon fractures

A

true

102
Q

what are the special tests performed after fractures

A

lack of extension ROM - high sensitivity
other motions restricted - high specificity
lack of supination ROM - LR+ = 14
lack of pronation ROM - LR+ = infinity

103
Q

when is PT started with fracture

A

after clinical union occurs
between 4-8 weeks

104
Q

t/f
any pain that is experienced after clinical union is formed is typically from bone

A

false
any pain that occurs after the clinical union is formed not due to bone

105
Q

what is the focus of PT after fractures

A

focuses more on the consequences of prolonged immobilization where every tissue is negatively influenced

106
Q

t/f
elbow is immobilized in flexion after all fractures/surgery making the regaining of full extension difficult

A

true

107
Q

where is the ulnar nerve typically entrapped

A

medial condyle

108
Q

where is the radial nerve typically entrapped

A

lateral condyle

109
Q

where is the median nerve typically entrapped

A

at wrist

110
Q

what is the second most common compression neuropathy seen by hand surgeons

A

ulnar nerve entrapment

111
Q

what are the locations where the ulnar nerve is commonly entrapped

A

cubital tunnel at elbow
FCU heads in proximal forearm
Guyon’s canal in hand

112
Q

what is the etiology of ulnar nerve entrapment at cubital tunnel

A

OA
trauma
age-related changes (not common at elbow)

113
Q

what are the symptoms of ulnar nerve entrapment at the elbow

A

medial hand/finger paresthesia’s
weak grip

114
Q

what are the signs of ulnar nerve entrapment at the elbow (ROM, RST, neuro)

A

ROM - limited elbow flexion with possible paresthesia’s, possible limited extension

RST - weak wrist and 4th and 5th digit flexion, thumb adduction, grip

neuro - possible diminished sensation over ulnar cutaneous distribution

115
Q

__% of neurological conduction is lost resulting in muscle weakness

A

80%

116
Q

what special tests are used for ulnar nerve entrapment at the elbow

A

elbow flexion test
tinel’s
wartenberg’s sign

117
Q

what would palpation show with ulanr nerve entrapment

A

provocation with ulnar nerve pressure up to 60 seconds
possible ulnar nerve subluxation

117
Q

what would palpation show with ulanr nerve entrapment

A

provocation with ulnar nerve pressure up to 60 seconds
possible ulnar nerve subluxation

118
Q

what is the difference of ulanr nerve entrapment at the elbow

A

ROM - elbow WNL

palpation - no paresthesia’s or ulnar nerve subluxation in cubital tunnel

119
Q

what is ulnar nerve entrapment at the elbow called

A

cubital tunnel syndrome

120
Q

what is ulnar entrapment at the hand called

A

guyon’s canal

121
Q

what is the difference of cubital tunnel syndrome vs guyon’s canal

A

etiology - cyst/repetitive stress with hand and onto hook of hamate

ROM - elbow WNL

RST - hand but no wrist weakness

palpation - no paresthesia’s or ulnar nerve subluxation in cubital tunnel

122
Q

why is there wrist weakness but no hand weakness with ulnar nerve entrapment at guyon’s canal

A

entrapment is at hand
entrapment causes symptoms/weakness distally from the entrapment

123
Q

what is the Rx for terminal nerve branch injury

A

POLI (no C) ED - compression is the issue

STM/modalities - inflammatory phase
STM/JM/Splinting - decreases compression
MET - neural motion, decreases compression

MSK (7 decks)

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