Elbow and Forearm Flashcards
1
Q
what is the desired ROM for elbow flexion/extension to complete most daily activities
A
~130 degrees
2
Q
what is the desired ROM for forearm pronation/supination to complete most daily activities
A
~100 degrees
3
Q
what is the etiology of lateral elbow pain
A
tendinopathy (tendinosis/tendinitis)
trauma - abducted elbow
radial nerve entrapment
repetitive stress
4
Q
what population is lateral elbow pain most common
A
tennis players
laborers - overuse of hand tasks
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
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
7
Q
what is the pathogenesis of lateral epicondylitis
A
tendinitis aka tennis elbow
8
Q
what are the hallmark signs of tendinitis
A
TTP
P! with lengthening/use
9
Q
what would the hallmark signs of tendinitis at the lateral elbow
A
pain distal to lateral epicondyle
10
Q
how would you distinguish tendinitis from tendinosis with your patient
A
how long have you experienced the pain?
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
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
13
Q
what would you expect to observe with lateral epicondylitis during palpation
A
common extensor tendon (CET) TTP
14
Q
t/f
lateral epicondylitis will not become nociplastic pain
A
false
lateral epicondylitis can become nociplastic pain
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)
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
17
Q
what is the etiology of tendinosis at the lateral elbow
A
recurrent tendinitis
regional interdependence
cervical nerve impingement
18
Q
what factors could contribute to lateral epicondylitis in laborers or tennis players
A
tendinosis etiology
abducted elbow
radial nerve entrapment
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
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
21
Q
describe the pathomechanics of C5,6 regional interdependence
A
over-recruited wrist extensors creating increased CET tension and compression
22
Q
how does C6 spinal nerve impingement affect muscles at the wrist
A
creates decreased activation of wrist extensors and lowers supply
23
Q
what are the signs and symptoms of nerve impingement
A
decreased sensation/paresthesias in dermatome
muscle weakness in myotome
24
Q
what is the pathogenesis of lateral tendinosis
A
degeneration most often at musculotendinous junction
25
what are the signs and symptoms of tendinosis
TTP
tendon appears large if superficial d/t fat infiltration
persistent symptoms >4-6 weeks
pain/limitation in lengthened position
decreased tendon tolerances
26
what is the PT Rx for tendinitis/tendinosis
Pt education - soreness rule, load management
POLICED
bracing/taping
27
what provides a greater pain relief, wrist extension splint or elbow strap
wrist extension splint
stops wrist from moving, decreases muscle contractions
28
what is the recommendations for modalities for tendinitis/tendinosis
not very definitive
29
what is more beneficial, STM/exercise/injections with tendinitis/tendinosis
exercise and injections are more beneficial
30
how does cervical JM affect tendinitis/tendinosis of the elbow
manipulation is effective with pain and grip strength
fewer visits and equal success compared to elbow Rx
31
how does elbow and wrist JM affect tendinitis/tendinosis of the elbow
effective
Mill's manipulation for P!/function and pulling apart scarring
32
t/f
cervical and elbow JM together is better than cervical and elbow JM alone
true
33
what is the effect of thoracic manipulation with tendinitis/tendinosis
not effective with pain but increases grip strength
34
what is the primary purpose of MET with tendinitis/tendinosis
tendon proliferation and possible cervical stabilization
35
are eccentric or concentric exercises better for tendinitis/tendinosis
eccentrics same or better as concentrics
additive benefit with isometrics
wrist extended or flexed
36
t/f
greater weekly exercise frequency provides greater pain control with tendinitis/tendinosis
true
37
what is an example of isometric loading without compression from lengthening
wrist hyper/extension in a shortened position
38
what is an example of isotonic loading without compression from lengthening
wrist hyper/extension from neutral to a shortened position
39
what is an example of isotonic loading with compression from lengthening
wrist hyper/extension from a lengthened position
40
what is an example of isometric loading in weight-bearing for the wrist
planks on hands or push ups
41
what is an example of plyometric loading in the UE
throwing
42
what is the prognosis of cortisone injections with elbow tendinitis/tendinosis
associated with poorer outcomes and higher recurrrence rates
more effective than TFM and STM
43
what surgery would be needed with elbow tendinitis/tendinosis
what is the purpose of the surgery
arthroscopic procedure to promote inflammation with tendinosis not responding to PT
44
what is the prognosis of tendinitis/tendinosis
prone to recurrent bouts
6-24 months - average 1 year
89% recover
45
what is the mechanism of abducted elbow
trauma - FOOSH
leads to medially fixated olecranon
46
what would you observe with a pt that has abducted elbow
increased carrying angle
47
what ROM limitations are expected with abducted elbow
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
48
what are the resisted testing/MMT, accessory motion expected with abducted elbow
RST/MMT: wrist extension and radial deviation painful
AM: limited lateral glide at humeroulnar joint
palpation: CET TTP
49
what complications of abducted elbow are common
carpal fracture
subluxation
50
what is the PT Rx for abducted elbow
correct lateral glide with manipulation
stabilization with MET
51
what are the other names for radial nerve entrapment
radial tunnel syndrome
posterior interosseous nerve syndrome (PINS)
wartenberg syndrome
52
describe the radial nerve course
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
what condition is often confused with lateral elbow tendinopathy but provocation more distal than lateral elbow tendinopathy
radial tunnel syndrome
54
what is the site of radial tunnel syndrome
begins where deep radial nerve branch courses over radiohumeral joint and ends at distal edge of supinator
55
what symptoms are common with radial tunnel syndrome
dorsoradial forearm pain/parethesias
wrist extension weak and painful
56
what is the cause of wartenberg syndrome
compression of superficial sensory radial nerve between brachioradialis and ECRL
57
what symptoms are common with wartenberg syndrome
Only sensory symptoms or paresthesia’s and P! over 1st 3 ½ digits of dorsoradial forearm and HAND
58
what special tests are used to confirm radial nerve entrapment
what are examples of these tests
radial nerve dural mobility
ULTT
resisted supination test
59
what is the Rx for terminal nerve branch injury
POLI (no C) ED
STM/modalities for inflammatory phase
STM/JM/Splinting to assist with eliminating compression
MET
60
why is compression not used during POLICED of terminal nerve branch Rx
compression is the cause of the symptoms with the injury
61
what is the focus of MET for terminal nerve branch injury
create neural motion/flossing
eliminate compression
62
what structures are involved with medial tendinitis/tendinosis
pronator teres
FCR
FCU
FDS
FDP
63
what are the hallmark S&S of medial tendinitis/tendinosis
pain with lengthening - wrist flexion/supination
TTP over medial epicondyle
64
what is the PT Rx for medial tendinitis/tendinosis
modify activity
decrease inflammation
treat neck/shoulder (most likely stabilization)
65
what complications are common with medial tendinitis/tendinosis
medial epicondyle apophysis in adolescent overhead throwers
66
what is another name for medial epicondyle apophysitis
little league elbow
67
what population is most commonly diagnosed with medial epicondyle apophysitis
adolescent males
mostly overhead throwers and racquet sports
68
what is the etiology of medial epicondyle apophysitis
growth with high activity
69
what are the pathomechanics of medial epicondyle apophysitis
bone growth exceeds wrist flexor and pronator lengthening
increased tendon tension
most often inflammation
70
what structure is considered the weak spot in adolescents and adults in regards to medial epicondyle apophysitis
adolescents - growth plate
adults - tendon
71
what are common complications of medial epicondyle apophysitis
avulsion and/or premature closure
72
what are symptoms of medial epicondyle apophysitis
gradual onset with overuse
"pop" may indicate trauma/avulsion
possible loss of velocity
73
what ROM is expected with medial epicondyle apophysitis
possible loss of extension
74
what RST/MMT is expected with medial epicondyle apophysitis
possibly weak/painful muscles that attach to common flexor tendon
75
what is expected during palpation of medial epicondyle apophysitis
TTP over medial epicondyle
76
what is expected during special test of medial epicondyle apophysitis
UCL possible +
77
what is the PT Rx for medial epicondyle apophysitis
Pt education - soreness rule, load management, movement cues
POLICED
78
what is the mechanism of valgus stress overload
trauma (FOOSH)
repetitive stress like overhead throwing or racquet sports
79
what structure is involved with valgus stress overload
ulnar collateral ligament
80
what are the S&S of sprains
pain with motions that cause lengthening
+ distraction
81
when would you preform a stability test with a possible sprain
before accessory motion to confirm sprain
82
what special tests would be performed for a sprained ligament at the elbow
valgus stress test @ 0 and 90 degrees
UCL instability
83
describe valgus
distal segment (forearm) goes lateral
joint goes more medial
84
describe the medial/ulnar collateral ligament
triangular shaped
medial epicondyle to coronoid to olecranon process
provides medial stability/prevents valgus stress
85
what structure is involved in varus stress overload
radial collateral ligament (RCL)
86
what S&S are common with varus stress overload
S&S of sprains
87
what special tests would be used for varus stress overload
varus stress test 0 and 90 degrees
88
describe the lateral/radial collateral ligament
triangular shaped
lateral epicondyle to annular ligament to lateral radius
provides lateral stability/prevents varus stress
89
what is the PT rx for sprain
POLICED
bracing/taping prm
MET
90
what is the goal of MET for sprains
ultimate emphasis on stabilization and increase integrity
91
what are the MD Rx for sprains
reconstructive surgery - Tommy John surgery for the UCL
12-18 month recovery
92
describe radial head proximal/pushed subluxation/dislocation
radial head goes through annular ligament
93
what is the mechanism of radial head proximal/pushed subluxation/dislocation
FOOSH
94
t/f
radial head proximal subluxation/dislocation can also cause a fracture of distal radius and ulna
yes
95
what is a colles fracture
fracture of distal radius and ulna
96
how does radial head distal or pulled subluxation/dislocation
forceful traction through lateral forearm
mostly caused by pulling on distal arm
97
describe the annular ligament
attaches anteriorly and posteriorly on the radial notch
encompasses radial head and holds it against ulna
98
describe humeroulnar dislocation
primarily in males and usually on non-dominant side
can injure major nerves or brachial artery
frequent loss of terminal extension
99
what is the PT rx for subluxation/dislocation
like ligamentous sprains for greater hypermobility/instability
100
what are condylar fracture complications
volkmann's ischemic flexion contracture d/t brachial artery damage
emergency referral
101
t/f
its common for difficulty when regaining full extension with olecranon fractures
true
102
what are the special tests performed after fractures
lack of extension ROM - high sensitivity
other motions restricted - high specificity
lack of supination ROM - LR+ = 14
lack of pronation ROM - LR+ = infinity
103
when is PT started with fracture
after clinical union occurs
between 4-8 weeks
104
t/f
any pain that is experienced after clinical union is formed is typically from bone
false
any pain that occurs after the clinical union is formed not due to bone
105
what is the focus of PT after fractures
focuses more on the consequences of prolonged immobilization where every tissue is negatively influenced
106
t/f
elbow is immobilized in flexion after all fractures/surgery making the regaining of full extension difficult
true
107
where is the ulnar nerve typically entrapped
medial condyle
108
where is the radial nerve typically entrapped
lateral condyle
109
where is the median nerve typically entrapped
at wrist
110
what is the second most common compression neuropathy seen by hand surgeons
ulnar nerve entrapment
111
what are the locations where the ulnar nerve is commonly entrapped
cubital tunnel at elbow
FCU heads in proximal forearm
Guyon's canal in hand
112
what is the etiology of ulnar nerve entrapment at cubital tunnel
OA
trauma
age-related changes (not common at elbow)
113
what are the symptoms of ulnar nerve entrapment at the elbow
medial hand/finger paresthesia's
weak grip
114
what are the signs of ulnar nerve entrapment at the elbow (ROM, RST, neuro)
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
__% of neurological conduction is lost resulting in muscle weakness
80%
116
what special tests are used for ulnar nerve entrapment at the elbow
elbow flexion test
tinel's
wartenberg's sign
117
what would palpation show with ulanr nerve entrapment
provocation with ulnar nerve pressure up to 60 seconds
possible ulnar nerve subluxation
117
what would palpation show with ulanr nerve entrapment
provocation with ulnar nerve pressure up to 60 seconds
possible ulnar nerve subluxation
118
what is the difference of ulanr nerve entrapment at the elbow
ROM - elbow WNL
palpation - no paresthesia's or ulnar nerve subluxation in cubital tunnel
119
what is ulnar nerve entrapment at the elbow called
cubital tunnel syndrome
120
what is ulnar entrapment at the hand called
guyon's canal
121
what is the difference of cubital tunnel syndrome vs guyon's canal
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
why is there wrist weakness but no hand weakness with ulnar nerve entrapment at guyon's canal
entrapment is at hand
entrapment causes symptoms/weakness distally from the entrapment
123
what is the Rx for terminal nerve branch injury
POLI (no C) ED - compression is the issue
STM/modalities - inflammatory phase
STM/JM/Splinting - decreases compression
MET - neural motion, decreases compression
