Elbow and Wrist Exercises and Stretches

Question 1

how can we stretch the biceps for elbow extension?

Answer 1

low load long duration stretch

biceps stretch in the doorway

Question 2

t/f: supine is a better position for low load long duration biceps stretch in the clinic, but can have them do it in sitting on the couch at home

Answer 2

true

Question 3

how can we do a low load, long duration stretch of the biceps for elbow extension?

Answer 3

by putting a bolster under the elbow and cuff weight around the wrist to let gravity and weight stretch the arm into extension

Question 4

what can we add to a low load, long duration stretch?

Answer 4

heat, like US, on the muscle to promote relaxation

Question 5

what are the parameters for a low load, long duration stretch?

Answer 5

start with 10 minutes and work up to 15 minutes with no weight then add weight as tolerated and when adding the weight, keep it proximal then move it distal

may want to start with 5 minute intervals up 3x then work up to 15 consecutive minutes

Question 6

when an elbow is super tight and reactive, what position should the wrist/forearm be in to start for low load long duration stretch of the biceps?

Answer 6

in neutral

Question 7

with low load, long duration stretching, should we increase weight or time first?

Answer 7

time

Question 8

how can we stretch the triceps for elbow flexion?

Answer 8

low load long duration stretch

lean body weight into elbow flexion with forearms on the table or wall

use a strap to pull OH hand down in OH stretch

prayer stretch on the table with trunk flexion

Question 9

how can we do a low load, long duration stretch of the triceps for elbow flexion?

Answer 9

put a weight around their wrist (can put a wedge and pillow under the arm to support it) and let gravity pull them into more flexion

Question 10

how can we get a greater stretch of the triceps in an OH stretch with a strap pull it down?

Answer 10

face a wall and push the elbow against it to increase shoulder flexion

Question 11

what is an Empi advance splint for the elbow?

Answer 11

a dial brace (DME) that allows flexion but pulls them back into extension with varying amount of tension in the spring mechanism

Question 12

the Empi advance splint provides a constant ___ tension

Answer 12

extension

Question 13

how is the Empi advance splint different from a dynasplint?

Answer 13

the dynasplint has a medial medial splint and lateral splint while the Empi advance brance just has the lateral splint

Question 14

where should the axis of the Empi advance splint be?

Answer 14

at the axis of the elbow allowing the olecranon process to be in the open space

Question 15

the Empi advance splint is not a good options for what pts?

Answer 15

pts with lots of tone

Question 16

what are the parameters for wearing the Empi advance splint?

Answer 16

start wearing about 3-5 hours with low tension and increase tension on the dial as tolerated

Question 17

once the Empi brace is tolerated in waking hours, what should happen?

Answer 17

they should wear the brace at night

Question 18

more than ____ of soreness in the morning after wearing the Empi advance splint over night tells us that we should decrease the tension of the brace

Answer 18

30 minutes

Question 19

how can we stretch pronation/supination?

Answer 19

with a hammer like weight in the hand allowing the weight and gravity to push them into either pronation or supination with a good amount of elbow flexion

TB around the wrist and stepping on the other end of it on the floor to promote pronation or supination

self stretch with the other hand giving overpressure into pronation or supination

Question 20

what is something we have to look for when using a weight to stretch into pronation/supination?

Answer 20

make sure the pt is keeping a good grip on the weight bc if they loose their grip a bit it may look like the weight is going further into pronation/supination but is not actually

Question 21

how can we stretch wrist flexion?

Answer 21

phallen sign stretch-backs of hands pressed together starting low and bringing them up towards the face

Question 22

what pts would we not stretch flexion of the wrists?

Answer 22

pts with carpal tunnel syndrome bc it will elicit their symptoms

Question 23

how can we stretch wrist extension?

Answer 23

prayer hands starting up high and bring them down

Question 24

is the prayer hands stretch an isometric exercise?

Answer 24

no bc the pt should not be pushing their wrists together, just bringing them down until they feel a stretch

Question 25

how can we stretch a pt with lateral epicondylalgia?

Answer 25

stretch wrist extensors into elbow extension, wrist flexion (Mills sign position) with full pronation

Question 26

if a pt with lateral epicondylalgia is really painful and reactive with the Mills stretch, how can we adjust the stretch?

Answer 26

start with elbow flexion until it doesn’t hurt, then progress to more elbow extension with time

Question 27

how can we stretch the extensor digitorum?

Answer 27

same as the Mills position but make a fist with it

Question 28

why do we want to strengthen eccentrics?

Answer 28

it encroaches on (cuts off) neovascularization (too much vascularization that causes pain) and adds tensile stretch to healing collagen to get good collagen formation greater stretch

Question 29

what is the influence of thoracic spine on lateral epicondylalgia?

Answer 29

not enough trunk rotation = compensation with overexerting at the elbow no hip/trunk to get explosive motion from recoil-elbow takes all the stress

Question 30

how can we stretch the elbow for medial epicondylalgia?

Answer 30

stretch wrist flexors into elbow extension, wrist extension with full supination flatten hand on table or wall and push body weight into it

Question 31

if stretching the wrist flexors with full elbow extension and wrist flexion, is too painful for someone with medial epicondylalgia, how can we adjust the stretch?

Answer 31

start with less elbow extension or don’t involve the fingers

Question 32

what is DQ (DeQuarveins tenosynovitis)?

Answer 32

irritation of the lining of the tendons of the EPB and APL over the radial styloid process

Question 33

what actions often cause DQ?

Answer 33

picking up a baby frequently people counting money

Question 34

what bracing can we use for DQ?

Answer 34

a thumb spica brace to keep the thumb abducted and extended to prevent the motions causing pain

Question 35

how can we stretch the wrist for a pt with DQ?

Answer 35

start with an easy UD stretch, then add thumb extension in, then wrap the thumb in last (BE VERY CAREFUL)

Question 36

how do we perform tendon glides of the digits?

Answer 36

have the pt perform a hook, straight, lumbrical, and flat fist, and opposition

Question 37

when are tendon glides on the digits performed?

Answer 37

day 1 for trigger finger

Question 38

what are blocking exercises?

Answer 38

exercises to get isolated movts of a jt

Question 39

how do we perform blocking exercises?

Answer 39

isolate motion of the MCP, PIP and DIP joints for flexion and extension

Question 40

t/f: blocking exercises are good to teach in an HEP

Answer 40

true

Question 41

when are blocking exercises used?

Answer 41

often after fx or tendon injuries or sprains/strains or long term casting

Question 42

what are the bracing options for the wrist and hand?

Answer 42

spica resting wrist splint finger jacks trigger finger splint

Question 43

what does a resting wrist splint do?

Answer 43

keep in neutral amount of flexion and extension

Question 44

what is a finger jack?

Answer 44

extension based splint that puts pressure at finger jts low load long duration for extension

Question 45

what are some exercises for the triceps?

Answer 45

skull crushers pushups with hands close together and shoulders in triceps extensions tricep dips EOB or in sitting pushing up butt off table cable column triceps extension straight row backs (paddle exercise) with TB lean on table and do kickbacks with the arm going into elbow extension behind the back D1 extension

Question 46

what is the progression for pushups for the triceps?

Answer 46

start on a wall and increase the angle closer to horizontal or do in quadruped then full plank push up

Question 47

what are some exercises for pronation and supination?

Answer 47

smiles and frowns with the theraband sticks hammer weights into pro/sup rice bucket scooping to find a hidden object hold a piece of TB with it over hands to work supination or under the thumbs for pronation play with putty into pro/sup pro/sup with grabbing a dowel velcrow board activities all with elbow flexion for better exercise of the pronators and supinators

Question 48

how can we strengthen wrist flexion/extension?

Answer 48

Wrist curls for flex/ext (easier with elbow flexion) ring out wash clothes or the theraband stick

Question 49

how can we strengthen RD with a TB?

Answer 49

bring the TB behind the back and grab with the hand over head and moving wrist up to ceiling (RD)?????

Question 50

when using the hand web for strengthening the digits in flexion, where should the wrist be positioned?

Answer 50

start in wrist extension and move towards wrist flexion

Question 51

what wrist position can the finger flexors create the most force?

Answer 51

in neutral

Question 52

what are some dexterity exercises?

Answer 52

Purdue peg board nuts and bolts

Question 53

what elbow position does the wrist ranger work the forearm more?

Answer 53

at 90 deg elbow flexion

Question 54

in what arm position does the wrist ranger work the shoulder too?

Answer 54

in shoulder flexion

Question 55

how many weeks out from onset of symptoms are we usually seeing pts with DQ?

Answer 55

usually 3 weeks out

Question 56

during the first 2 weeks seeing a pt with DQ, what kinds of things would we be doing?

Answer 56

spica splint PROM-->AAROM-->AROM can use thermal US, but be careful bc it is very close to bone

Question 57

when do we think about discontinuing the spica splint?

Answer 57

when there is adequate ROM with minimal to no pain

Question 58

during what phase of DQ would we consider using thermal US?

Answer 58

subacute phase

Question 59

with carpal tunnel syndrome, are we working into flexion or extension first? why?

Answer 59

extension first bc flexion is the aggravating motion as carpal tunnel syndrome is a flexor tendon problem

Question 60

what nerve glides can be done for carpal tunnel syndrome?

Answer 60

median nerve glides