Elbow and Wrist Exercises and Stretches Flashcards
how can we stretch the biceps for elbow extension?
low load long duration stretch
biceps stretch in the doorway
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
true
how can we do a low load, long duration stretch of the biceps for elbow extension?
by putting a bolster under the elbow and cuff weight around the wrist to let gravity and weight stretch the arm into extension
what can we add to a low load, long duration stretch?
heat, like US, on the muscle to promote relaxation
what are the parameters for a low load, long duration stretch?
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
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?
in neutral
with low load, long duration stretching, should we increase weight or time first?
time
how can we stretch the triceps for elbow flexion?
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
how can we do a low load, long duration stretch of the triceps for elbow flexion?
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
how can we get a greater stretch of the triceps in an OH stretch with a strap pull it down?
face a wall and push the elbow against it to increase shoulder flexion
what is an Empi advance splint for the elbow?
a dial brace (DME) that allows flexion but pulls them back into extension with varying amount of tension in the spring mechanism
the Empi advance splint provides a constant ___ tension
extension
how is the Empi advance splint different from a dynasplint?
the dynasplint has a medial medial splint and lateral splint while the Empi advance brance just has the lateral splint
where should the axis of the Empi advance splint be?
at the axis of the elbow allowing the olecranon process to be in the open space
the Empi advance splint is not a good options for what pts?
pts with lots of tone
what are the parameters for wearing the Empi advance splint?
start wearing about 3-5 hours with low tension and increase tension on the dial as tolerated
once the Empi brace is tolerated in waking hours, what should happen?
they should wear the brace at night
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
30 minutes
how can we stretch pronation/supination?
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
what is something we have to look for when using a weight to stretch into pronation/supination?
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
how can we stretch wrist flexion?
phallen sign stretch-backs of hands pressed together starting low and bringing them up towards the face
what pts would we not stretch flexion of the wrists?
pts with carpal tunnel syndrome bc it will elicit their symptoms
how can we stretch wrist extension?
prayer hands starting up high and bring them down
is the prayer hands stretch an isometric exercise?
no bc the pt should not be pushing their wrists together, just bringing them down until they feel a stretch
how can we stretch a pt with lateral epicondylalgia?
stretch wrist extensors into elbow extension, wrist flexion (Mills sign position) with full pronation
if a pt with lateral epicondylalgia is really painful and reactive with the Mills stretch, how can we adjust the stretch?
start with elbow flexion until it doesn’t hurt, then progress to more elbow extension with time
how can we stretch the extensor digitorum?
same as the Mills position but make a fist with it
why do we want to strengthen eccentrics?
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
what is the influence of thoracic spine on lateral epicondylalgia?
not enough trunk rotation = compensation with overexerting at the elbow
no hip/trunk to get explosive motion from recoil-elbow takes all the stress
how can we stretch the elbow for medial epicondylalgia?
stretch wrist flexors into elbow extension, wrist extension with full supination
flatten hand on table or wall and push body weight into it
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?
start with less elbow extension or don’t involve the fingers
what is DQ (DeQuarveins tenosynovitis)?
irritation of the lining of the tendons of the EPB and APL over the radial styloid process
what actions often cause DQ?
picking up a baby frequently
people counting money
what bracing can we use for DQ?
a thumb spica brace to keep the thumb abducted and extended to prevent the motions causing pain
how can we stretch the wrist for a pt with DQ?
start with an easy UD stretch, then add thumb extension in, then wrap the thumb in last (BE VERY CAREFUL)
how do we perform tendon glides of the digits?
have the pt perform a hook, straight, lumbrical, and flat fist, and opposition
when are tendon glides on the digits performed?
day 1 for trigger finger
what are blocking exercises?
exercises to get isolated movts of a jt
how do we perform blocking exercises?
isolate motion of the MCP, PIP and DIP joints for flexion and extension
t/f: blocking exercises are good to teach in an HEP
true
when are blocking exercises used?
often after fx or tendon injuries or sprains/strains or long term casting
what are the bracing options for the wrist and hand?
spica
resting wrist splint
finger jacks
trigger finger splint
what does a resting wrist splint do?
keep in neutral amount of flexion and extension
what is a finger jack?
extension based splint that puts pressure at finger jts
low load long duration for extension
what are some exercises for the triceps?
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
what is the progression for pushups for the triceps?
start on a wall and increase the angle closer to horizontal or do in quadruped then full plank push up
what are some exercises for pronation and supination?
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
how can we strengthen wrist flexion/extension?
Wrist curls for flex/ext (easier with elbow flexion)
ring out wash clothes or the theraband stick
how can we strengthen RD with a TB?
bring the TB behind the back and grab with the hand over head and moving wrist up to ceiling (RD)?????
when using the hand web for strengthening the digits in flexion, where should the wrist be positioned?
start in wrist extension and move towards wrist flexion
what wrist position can the finger flexors create the most force?
in neutral
what are some dexterity exercises?
Purdue peg board
nuts and bolts
what elbow position does the wrist ranger work the forearm more?
at 90 deg elbow flexion
in what arm position does the wrist ranger work the shoulder too?
in shoulder flexion
how many weeks out from onset of symptoms are we usually seeing pts with DQ?
usually 3 weeks out
during the first 2 weeks seeing a pt with DQ, what kinds of things would we be doing?
spica splint
PROM–>AAROM–>AROM
can use thermal US, but be careful bc it is very close to bone
when do we think about discontinuing the spica splint?
when there is adequate ROM with minimal to no pain
during what phase of DQ would we consider using thermal US?
subacute phase
with carpal tunnel syndrome, are we working into flexion or extension first? why?
extension first bc flexion is the aggravating motion as carpal tunnel syndrome is a flexor tendon problem
what nerve glides can be done for carpal tunnel syndrome?
median nerve glides
