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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
MD Rx for lateral elbow tendinitis/tendinosis
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
prognosis for tendinitis and tendinosis at the lateral elbow
prone to recurrent bouts 6-24 months with average of 1 year 89% recover
27
mechanism of abducted elbow
trauma - FOOSH leads to medially fixated olecranon
28
signs of abducted elbow
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
resisted/MMT results for abducted elbow
wrist ext and R dev painful
30
accessory motion and palpation for abducted elbow
limited lateral glide at humeroulnar joint palpation = common extensor tendon TTP
31
complications of abducted elbow
carpal fx or sublux
32
Rx for abducted elbow
correct lateral glide with manipulation stabilization with MET tendinosis parameters
33
conditions that can cause radial nerve entrapment
radial tunnel syndrome posterior interosseous nerve syndrome (PINS) wartenberg syndrome
34
course of the radial nerve
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
describe radial tunnel syndrome
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
symptoms of radial n entrapments
dorsoradial forearm and hand pain/paraesthesias wrist extension is weak and painful
37
what is wartenberg syndrome
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
special tests for radial nerve entrapment
radial nerve dural mobility -ULTT -pro test (aka resisted supination test)
39
terminal nerve branch injury Rx
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
what is medial tendinosis? prevalence/involved structures?
ala throwers, little league, or golfers elbow prevalence = 4% structures involved = pronator teres, FCR, FCU, FDS, FDP
41
complications for medial tendinopathies
medial epicondyle apophysitis in adolescent overhead throwers
42
population/etiology go medial epicondyle apophysitis
aka little league elbow adolescent males > females mostly overhead throwers etiology = growth with high activity
43
pathomechanics of medial epicondyle apophysitis
bone growth exceeds wrist flexor and pronator lengthening increased tendon tension growth plate = weak spot most often inflammation complications = avulsion or premature close
44
symptoms of medial epicondyle apophysitis
gradual onset with overuse a pop may indicate trauma or avulsion possible loss of velocity
45
signs of medial epicondyle apophysitis
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
Rx for medial epicondyle apophysitis
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
prognosis for medial epicondyle apophysitis
1/3 return to sport growth plate typically fuses around 15 years of age can become recurrent/persistent
48
mechanisms/structures involved for valgus stress overload
mechanism = trauma (FOOSH)/repetitive stress like overhead throwing/racquet sports UCL involved
49
special tests for valgus stress overload sprain
valgus stress test at 0 and 90 degrees UCL instability (high sensitivity)
50
describe the ulnar collateral ligament
triangular shaped medial epicondyle to coronoid to olecranon processes provides medial stability/prevents valgus stress
51
structures involved/special test for varus stress overload
RCL involved varus stress test at 0 and 90 degrees
52
describe the radial collateral ligament
triangular shaped lateral epicondyle to annular ligament to lateral radius provides lateral stability and prevents varus stress
53
Rx for sprains
POLICED possible brief immobilization STM/modalities for inflammatory phase bracing/taping PRN MET with optimal stress (emphasis on stabilization)
54
MD Rx for sprains
direct repair vs reconstruction with palmaris longus graft reconstructive sx known as Tommy John sx for UCL 12-18 month recovery
55
describe a "pushed" subluxation of the radius with
mechanism = FOOSH may also cause a fx of distal radius and ulna aka Colles fx
56
describe a pulled subluxation of the radius
radial head is pulled forceful traction through the lateral forearm
57
describe the annular ligament
attaches anteriorly and posteriorly on the radial notch encompasses radial head and holds it against ulna
58
describe the interosseous membrane
broad/flat keeps radius and ulna together serves as a muscle attachment for forearm and wrist muscles
59
radioulnar articulations are held together by
annular ligament interosseous membrane
60
key characteristics of humeroulnar dislocations
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
Rx for subluxation
like ligamentous sprains treat as greater hypermobility/instability

DPT 730: MSK (14 decks)

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