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DPT 730: MSK > Elbow and Forearm: Final > Flashcards

Elbow and Forearm: Final Flashcards

1
Q

Functional ROM for elbow and forearm

A

elbow = 130 out of 142

forearm = avg 103 with pro/sup;
-max pro 65 for keyboard, max sup 77 with opening door

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2
Q

etiologies of lateral elbow pain

A

tendinopathies

trauma (i.e. abducted elbow)

radial n entrapment

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3
Q

prevalence of lateral elbow pain

A

1-3% population

15% of laborers with overuse of hands

40% tennis players

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4
Q

risk factors for lateral elbow pain

A

dominant arm

forceful activities

repetitive activities

smoking

poor posture (causes regional interdependence)

35-45 years of age

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5
Q

primary involved tendons and muscles for lateral epicondylitis

A

ECRL

ECRB

Extensor digitorum

extensor digiti minimi

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6
Q

etiology of lateral epicondylitis

A

overuse/repetitive stress

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7
Q

pathogenesis of lateral epicondylitis

A

tendinitis

aka tennis elbow

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8
Q

ROM signs for lateral epicondylitis

A

pain and limit with lengthening during wrist flex without/with elbow ext

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9
Q

resisted/MMT results with lateral epicondylitis

A

pain with wrist extension and possible 3rd finger ext, R dev, especially in lengthened position

possible weakness

pain with grip

abnormal muscle activation patters including scapular mm (insufficient synergistic chain)

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10
Q

palpation findings with lateral epicondylitis

A

TTP at common extensor tendon on the lateral epicondyle

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11
Q

Rx for lateral epicondylitis

A

tendinitis Rx

sport specific corrections if needed

possible cuff, scapular, trunk, and/or LE m coordination, endurance, and strength training to decrease elbow stress

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12
Q

possible causes of lateral elbow pain without repetitive stress/overuse

A

recurrent tendinitis
regional interdependence
cervical n impingement
abducted elbow
radial n entrapment

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13
Q

etiology and pathomechanics of C5/C6 regional interdependence

A

C5,6 hyper mobility/instability

over recruited wrist extensors create increased CET tension and compression (more recruitment b/c of the dysfunction)

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14
Q

C6 spinal nerve impingement characteristics

A

creates decreased activation of wrist extensors and lowers supply

overuse/lower supply of wrist extensors even without changing activity levels

S&S of spinal n impingement

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15
Q

pathogenesis of lateral tendinosis

A

degeneration most often at musculotendinous junction

typical tendinosis S&S plus a positive Mill’s test for CET scarring

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16
Q

PT Rx for tendinitis/tendinosis

A

soreness rule

load management/ergonomic corrections

POLICED

bracing/taping (i.e. elbow strap, wrist ext splint, or kinesiology tape)

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17
Q

modalities and their evidence for tendinosis

A

no consensus for shockwave

TENS and micro current not recommended

weak evidence for LASER and US

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18
Q

STM effectiveness for tendinosis and tendinitis

A

not as effective as exercise or injections

TFM and IASTM not supported

more evidence needed for stretching

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19
Q

cercial JM effectiveness for tendinosis and tendinitis

A

manipulation effective with pain and grip strength

fewer visits and equal success when compared to elbow Rx

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20
Q

elbow and wrist JM effectiveness for tendinitis/tendinosis

A

effective

mills manipulation for P! and function and pulling apart scarring

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21
Q

effectiveness of thoracic JM for tendinitis/tendinosis

A

not effective with pain but increases grip strength

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22
Q

effectiveness of trigger point dry needling for tendinopathies

A

short term pain relief

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23
Q

MET for tendinitis/tendinosis

A

tissue proliferation and possible cervical stabilization

tendinosis Rx

eccentrics&raquo_space;

isometrics = additive benefit

greater weakly frequency = better pain control

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24
Q

specific parameters to keep in mind with lateral elbow tendinopathies

A
  1. isometrics loading without compression from lengthening
  2. isotonic loading without compression from lengthening
  3. isotonic loading with compression from lengthening
  4. possible isometric loading in weight bearing
  5. plyometric loading
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25
Q

MD Rx for lateral elbow tendinitis/tendinosis

A

cortisone injections = associated with poorer outcomes and higher recurrence rates vs wait and see approach; more effective than TFM and STM

sx=5-10%; arthroscopic procedure to promote inflammation with tendinosis not responding to PT

26
Q

prognosis for tendinitis and tendinosis at the lateral elbow

A

prone to recurrent bouts

6-24 months with average of 1 year

89% recover

27
Q

mechanism of abducted elbow

A

trauma - FOOSH

leads to medially fixated olecranon

28
Q

signs of abducted elbow

A

increased carrying angle

limits with elbow flex and FA supination due to lack of lateral ulnar guide

limits with wrist flex/R dev due to radius shifting distally from contact with capitulum

29
Q

resisted/MMT results for abducted elbow

A

wrist ext and R dev painful

30
Q

accessory motion and palpation for abducted elbow

A

limited lateral glide at humeroulnar joint

palpation = common extensor tendon TTP

31
Q

complications of abducted elbow

A

carpal fx or sublux

32
Q

Rx for abducted elbow

A

correct lateral glide with manipulation

stabilization with MET

tendinosis parameters

33
Q

conditions that can cause radial nerve entrapment

A

radial tunnel syndrome

posterior interosseous nerve syndrome (PINS)

wartenberg syndrome

34
Q

course of the radial nerve

A

off posterior cord of brachial plexus

passes inferior to teres major

posterior to brachial artery in posterior arm

travels just anterior to lateral epicondyle before entering posterior forearm

35
Q

describe radial tunnel syndrome

A

rare neuropathy of posterior interosseous n

begins where radial n courses over radiohumeral joint and ends at distal edge of supinator

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

36
Q

symptoms of radial n entrapments

A

dorsoradial forearm and hand pain/paraesthesias

wrist extension is weak and painful

37
Q

what is wartenberg syndrome

A

compression of superficial SENSORY radial n between brachioradialis and ECRL

since there is no motor innervation, only sensory symptoms or paraesthesias over dorsoradial HAND and 1st 3 and a half digits (radial nerve path)

38
Q

special tests for radial nerve entrapment

A

radial nerve dural mobility

-ULTT
-pro test (aka resisted supination test)

39
Q

terminal nerve branch injury Rx

A

POLI ED (NO COMPRESSION B/C THIS IS THE CAUSE)

bracing/splinting to assist with eliminating compression

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

40
Q

what is medial tendinosis? prevalence/involved structures?

A

ala throwers, little league, or golfers elbow

prevalence = 4%

structures involved = pronator teres, FCR, FCU, FDS, FDP

41
Q

complications for medial tendinopathies

A

medial epicondyle apophysitis in adolescent overhead throwers

42
Q

population/etiology go medial epicondyle apophysitis

A

aka little league elbow

adolescent males > females

mostly overhead throwers

etiology = growth with high activity

43
Q

pathomechanics of medial epicondyle apophysitis

A

bone growth exceeds wrist flexor and pronator lengthening

increased tendon tension

growth plate = weak spot

most often inflammation

complications = avulsion or premature close

44
Q

symptoms of medial epicondyle apophysitis

A

gradual onset with overuse

a pop may indicate trauma or avulsion

possible loss of velocity

45
Q

signs of medial epicondyle apophysitis

A

ROM = possible loss of ect

Resisted/MMT = possibly weak or painful muscles that attach to CFT

palpation = TTP over medial epicondyle

special tests for UCL sprain possibly +

46
Q

Rx for medial epicondyle apophysitis

A

POLICED

pt edu on:
-soreness rule
-load management
-movement cues

careful prolonged stretching due to vulnerable growth plate

throwing progression program

MET for trunk, cuff, scap, and LE impairements

caution with muscles/tendons attached to growth plate

47
Q

prognosis for medial epicondyle apophysitis

A

1/3 return to sport

growth plate typically fuses around 15 years of age

can become recurrent/persistent

48
Q

mechanisms/structures involved for valgus stress overload

A

mechanism = trauma (FOOSH)/repetitive stress like overhead throwing/racquet sports

UCL involved

49
Q

special tests for valgus stress overload sprain

A

valgus stress test at 0 and 90 degrees

UCL instability (high sensitivity)

50
Q

describe the ulnar collateral ligament

A

triangular shaped

medial epicondyle to coronoid to olecranon processes

provides medial stability/prevents valgus stress

51
Q

structures involved/special test for varus stress overload

A

RCL involved

varus stress test at 0 and 90 degrees

52
Q

describe the radial collateral ligament

A

triangular shaped

lateral epicondyle to annular ligament to lateral radius

provides lateral stability and prevents varus stress

53
Q

Rx for sprains

A

POLICED

possible brief immobilization

STM/modalities for inflammatory phase

bracing/taping PRN

MET with optimal stress (emphasis on stabilization)

54
Q

MD Rx for sprains

A

direct repair vs reconstruction with palmaris longus graft

reconstructive sx known as Tommy John sx for UCL

12-18 month recovery

55
Q

describe a “pushed” subluxation of the radius with

A

mechanism = FOOSH

may also cause a fx of distal radius and ulna aka Colles fx

56
Q

describe a pulled subluxation of the radius

A

radial head is pulled

forceful traction through the lateral forearm

57
Q

describe the annular ligament

A

attaches anteriorly and posteriorly on the radial notch

encompasses radial head and holds it against ulna

58
Q

describe the interosseous membrane

A

broad/flat

keeps radius and ulna together

serves as a muscle attachment for forearm and wrist muscles

59
Q

radioulnar articulations are held together by

A

annular ligament

interosseous membrane

60
Q

key characteristics of humeroulnar dislocations

A

primarily in males and usually on the non-dominant side

can injury any of the 3 major nerves or the brachial artery

frequent loss of terminal extension

61
Q

Rx for subluxation

A

like ligamentous sprains

treat as greater hypermobility/instability

DPT 730: MSK (14 decks)

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