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DPT MSK - fall 22 > Elbow & Forearm - Final Exam > Flashcards

Elbow & Forearm - Final Exam Flashcards

1
Q

what is the avg. functional ROM for the elbow?

A

130 deg (out of 142 deg)
with flexion & extension

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2
Q

what is the avg. functional ROM for the forearm?

A

103 deg with pronation and supination

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3
Q

what is functional ROM for max pronation? for what activity?
what is functional ROM of max supination? for what activity?

A

65 deg with keyboarding
77 deg with opening a door

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4
Q

what is the most common injury site for lateral elbow pain?

A

common extensor tendon

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5
Q

what are the 3 causes of lateral elbow pain?

A

tendinopathy - tendinitis, tendinosis
trauma - abducted elbow
radial n. entrapment

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6
Q

_______% of population gets lateral elbow pain
______% of laborers with overuse of hand tasks
______% of tennis players/racket sports

A

1-3%
15%
up to 40%

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7
Q

what are risk factors for lateral elbow pain?

A

dominant arm > non-dominant
forceful activities
repetitive activities
smoking (circulatory issue)
poor posture
35-54 years of age

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8
Q

what are the primary tendons/muscles involved in lateral epicondylitis? (4)

which has the highest incidence? why?

A

extensor carpi radialis longus
extensor carpi radialis brevis
extensor digitorum
extensor digiti minimi

highest incidence: ECRB - radially deviates and extends wrist

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9
Q

cause of lateral epicondylitis?

A

overuse

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10
Q

pathogenesis of lateral epicondylitis?

A

tendinitis aka tennis elbow

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11
Q

hallmark signs of tendinitis are:
- TTP
- tendon doesn’t like to be used/resisted
- tendon doesn’t like to be lengthened

what would these signs be at the lateral elbow?

A

P! with gripping
P! with extension
tender at distal lateral epicondyle (ECRB)
- tendon is inflammed

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12
Q

what are hallmark signs of lateral epicondylitis?

ROM?
Resisted/MMT?
Palpation?
nociplastic Pain?

A
  • P! and limitation with lengthening during wrist flexion with/without elbow extension
  • P! w/ wrist ext & possible 3rd finger ext, radial deviation esp. in lengthened position. possible weakness. P! with gripping. abnormal muscle activation patterns, including scapular muscles
  • common extensor tendon TTP –> all come into CET.
  • may become nociplastic p!
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13
Q

Rx for lateral epicondylitis?

A

tendinitis Rx (pt education, POLICED, NSAIDS, bracing)
possible sport specific corrections (i.e. tennis swing or larger grips)
cuff, scapular, trunk, and/or LE muscle coordination, endurance, and strength training to decrease elbow stress

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14
Q

if patient has lateral elbow pain but not from overuse of a laborer or tennis player, what could be some causes?

A

tendinosis etiologies (most common)
– recurrent tendinitis
– regional interdependence
– cervical n. impingement
abducted elbow
radial nerve entrapment

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15
Q

what is the cause of C5,6 regional interdependence?

A

C5, 6 hypermobility/instability
most common segment

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16
Q

Patient has lateral elbow pain and reports they haven’t done anything different to their routine. You suspect C5, 6 regional interdependence led to pain. Why?

A

over recruited wrist extensors created increased common extensor tendon tension and compression

** normally we only recruit the muscle fibers in the tendon needed to pick up the weight of the intended object. If we over recruit, increased tension/compression can cause pain

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17
Q

C6 spinal nerve impingement creates ?

A

decreased activation of wrist extensors and lowers supply –> overuse/lower supply of wrist extensors, even without activity change

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18
Q

S&S of C6 spinal n. impingement?

A

neuro S&S

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19
Q

Rx for C6 spinal n. impingement?

A

tendinosis Rx

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20
Q

in a patient with lateral tendinosis, where does the degeneration most often occur at?

A

musculotendinous junction

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21
Q

Which special test may be positive for lateral tendinosis?

A

Mill’s test for CET scarring

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22
Q

what is PT Rx for lateral tendinosis/tendinitis?

A

patient education (soreness rule, load management)
POLICED
bracing/taping (elbow strap)
modalities (LASER, TENS & shockwave therapy - need more evidence)
stretching - need more evidence
dry needling - short term P!

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23
Q

what would you target with cervical JM for lateral tendinitis/tendinosis?

A

effective with pain and grip strength
fewer visits and equal success compared to elbow Rx

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24
Q

what would you target with elbow & wrist JM for lateral tendinitis/tendinosis?

A

mill’s manipulation for P!/function & pulling apart scarring
*cervical and elbow together better evidence

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25
Q

what does thoracic manipulation increase for lateral tendinitis/tendinosis?

A

grip strength

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26
Q

what is the primary purpose of MET for lateral tendinitis/tendinosis?

A

tendon proliferation
cervical stabilization

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27
Q

what are the 5 loading MET parameters for lateral tendinitis/tendinosis?

A
  1. isometric loading without compression from lengthening i.e. in shortened position
  2. isotonic loading without compression from lengthening i.e. neutral to a shortened position
  3. isotonic loading with compression from lengthening i.e. lengthened position
  4. isometric loading in weight bearing (push ups)
  5. plyometric loading (throwing)

** 4&5 may not apply to everyone

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28
Q

MD Rx for lateral tendinitis/tendinosis?

A

cortisone injections
surgery (5-10%)

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29
Q

prognosis of lateral tendinitis/tendinosis?

A

6-24 months w/ avg of 1 year

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30
Q

how does an abducted elbow happen? leads to?

A

trauma / FOOSH
leads to medially fixated olecranon

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31
Q

what would you observe with someone with an abducted elbow?

A

increased carrying angle

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32
Q

what are ROM limitations of an abducted elbow?

A

elbow flx & FA sup - lack of lateral ulnar glide
wrist flx & R. Dev - radius shifting distally from contact with capitulum

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33
Q

what would a PT find with an abducted elbow?
resisted testing:
accessory motion:
palpation:

A

wrist ext & radial dev painful
limited lateral glide at HU joint
CET TTP

34
Q

what are two complications with an abducted elbow/

A

carpal fx or subluxation

35
Q

how do you treat abducted elbow?

A

correct lateral glide with manipulation
stabilization with MET
treat for tendinosis possibly (if it’s been there a while)

36
Q

what is the course of the radial nerve with radial n. entrapment?

A

off posterior cord of brachial plexus
passes inferior to teres major
posterior to brachial a. in post. arm
travels anterior to lateral epicondyle before entering post. forearm

37
Q

radial tunnel syndrome locations of:

site & TTP:
P!/paresthesia’s:
weak & painful:

A

begins where deep radial n. branch courses over RH jt and ends at distal edge of supinator
dorsoradial forearm & hand
wrist & finger ext

38
Q

what is radial tunnel syndrome often confused with? what is the difference/

A

lateral elbow tendinopathy
provocation more distal than lateral elbow tendinopathy

39
Q

what is Wartenberg syndrome?
where does it experience sensory symptoms?

A

compression of superficial sensory radial n. between brachioradialis and ECRL

** no motor innervation
sensory symptoms or paresthesia’s over dorsoradial hand (first 3.5 digits)

40
Q

what are special tests used to determine radial n. entrapment?

A

radial n. dural mobility (+)
resisted supination test (relieve pressure on nerve)

41
Q

how do you treat a terminal n. branch injury?

A

POLI( no C) ED - don’t create more compression
splinting to assist w/ eliminating compression & motion
MET w/ optimal stresses to create neural motion/flossing and elimination of compression

42
Q

what structures are involved with medial tendinitis/tendinosis? what is this also known as?

A

pronator teres, FCR, FCU, FDS, FDP
thrower’s/little league/golfer’s elbow

43
Q

S&S of medial tendinitis/-osis

A

P! w/ wrist ext
P! at medial epicondyle
P! in flex/sup

44
Q

how do you treat medial tendinitis/-osis

A

like lateral tendinitis/-osis

45
Q

what is the main complication of someone with medial tendinitis/-osis

A

medial epicondyle apophysitis in adolescent overhead throwers

46
Q

who usually gets medial epicondyle apophysitis & how does it grow?

A

male overhead throwers/racquet sports
growth with high activity

47
Q

medial epicondyle apophysitis:
bone growth exceeds:
increased:
growth plate is:
inflammation?
complications:

A

wrist flexor and pronator lengthening
tendon tension
weak spot (as opposed to tendon in adult)
yes
avulsion and/or premature closure & UCL sprain

48
Q

symptoms of medial epicondyle apophysitis

A

gradual onset w/ overuse
pop may indicate trauma or avulsion
possible loss of velocity

49
Q

what would PT see with medial epicondyle apophysitis?
ROM:
resisted:
palpation:
special tests:

A

possible loss of ext
possibly weak and/or P!ful muscles that attach to CFT
TTP over medial epicondyle
those for UCL sprain possible (+)

50
Q

medial epicondyle apophysitis Rx:

A

patient education
– soreness rule, load management, movement cues
POLICED
careful w/ prolonged stretching
MET
– for trunk, cuff, scap & LE impairments
– caution w muscle/tendons attached to growth plate
RTP - throwing progression program

51
Q

what is the prognosis for someone with medial epicondyle apophysitis?

A

1/3 return to sport
growth plate fuses around 15 years old
can become recurrent/persistent

52
Q

how does a valgus stress overload sprain happen?

A

trauma (FOOSH)
repetitive stress like overhead throwing

53
Q

what structure is involved with a valgus stress overload sprain?

A

UCL

54
Q

S&S of elbow sprains?
ROM:
resisted:
stress tests:
special tests:

A

painful w/ lengthening; AROM = PROM
P! in lengthening, strong & painful
P! with distraction, compression relieving
valgus stress test at 0 & 90, UCL instability

55
Q

how can there be differential Dx with medial epicondyle apophysitis?

A

easily misdiagnosed with a growth plate problem because common in children
sprains are more protected due to ligaments

56
Q

MCL/UCL:
shaped?
runs from _____ to ______ to ______
provides:
lengthened w:

A

triangular shaped
medial epicondyle to coronoid to olecranon processes
medial stability/prevents valgus stress
extreme ER

57
Q

what structure is involved with a varus stress overload sprain? (less common)

A

RCL

58
Q

LCL/RCL:
shaped?
runs from _____ to ______ to ______
provides:

A

triangular
lateral epicondyle to annular ligament to lateral radius
lateral stability/prevents varus stress

59
Q

PT Rx for sprains:

A

POLICED
possible brief period of immobilization
bracing/taping prn
MET - emphasis on stabilization & tissue integrity

60
Q

MD Rx for sprains:

A

direct repair vs reconstruction with palmaris longus graft
reconstructive Sx AKA tommy john sx for UCL
12-18 month recovery

61
Q

how does a pushed subluxation/dislocation happen? what happens when this happens?

A

** radial head proximal
FOOSH
fall on radial side & pushes radial head up through annular ligament

62
Q

what is a colles fx? how may it be caused?

A

fx of distal radius and ulna
may be caused from pushed subluxation/dislocation

63
Q

what happens if a pulled subluxation/dislocation occurs? example?

A

forceful traction through lateral forearm
pulls radius distally

** grabbing child’s arm

64
Q

where does the annular ligament attach and what does it encompass?

A

attaches anteriorly and posteriorly on radial notch
encompasses radial head and holds it against ulna

65
Q

what does the interosseous membrane do?

A

keeps radius and ulna together
serves as muscle attachment for forearm and wrist muscles

66
Q

how are RU articulations held together?

A

annular ligament
interosseous membrane

67
Q

what kind of dislocation is most common in males on non-dominant side & can injure any of the 3 major nerves or brachial artery?

A

humeroulnar dislocation

68
Q

Frequent loss of ____________ with HU dislocation?

A

terminal extension

69
Q

how do you treat a subluxation/dislocation?

A

like ligamentous sprains for greater hypermobility/instability
always some period of immobilization

70
Q

where would a fracture be located for a supracondylar fracture?

A

above condyle
distal humeral segment

71
Q

where would a fracture be located for a intercondylar fracture?

A

in between condyles

72
Q

what could be a complication of a condylar fracture? referral type?

A

Volkmann’s ischemic flexion contracture due to possible brachial artery damage
emergency referral

73
Q

why would someone with a olecranon fracture have difficulty regaining extension?

A

immobilized 6-8 weeks
no flexion > 90 for 2 months

74
Q

what would you see with elbow special tests after trauma?

A

lack of ext ROM
other motions restricted
lack of supination
lack of pronation

75
Q

Rx for fractures:

A

POLICED
isometrics when immobilized
STM/JM to improve ROM after prolonged immobilization
MET w/ optimal stresses, focus on consequences from immobilization
pain from bone not typically an issue after bone is healed
regain full extension - can be difficult

76
Q

2nd most common compression neuropathy seen by hand surgeons:

A

ulnar n. entrapment

77
Q

where are the locations we see ulnar n entrapment at?

A

cubital tunnel at elbow
FCU heads in proximal forearm
guyon’s canal in hand

78
Q

how does cubital tunnel syndrome happen?

A

OA/trauma, age related changes

79
Q

symptoms of cubital tunnel syndrome, regarding the hand?

A

medial hand/finger paresthesias (1/2 4th digit & 5th digit)
weak grip

80
Q

what would a PT see w cubital tunnel syndrome?
ROM
resisted testing:
neuro:
special tests:
palpation in cubital tunnel:

A
  • limited elbow flx w possible paresthesias & limited ext
  • weak wrist, 4th&5th digit flx, thumb abd & grip
  • possibly diminished sensation over ulnar cutaneous distribution (start w neck & move to hand/wrist)
  • elbow flx test, Tinel’s, Wartenberg’s sign
  • provocation w ulnar n pressure up to 60 sec, possible ulnar n subluxation
81
Q

Ulnar n entrapment at FCU heads in forearm S&S are same as cubital tunnel syndrome except:

A

ROM elbow WNL
palpation: NO paresthesias or ulnar n. subluxation in cubital tunnel

82
Q

Ulnar n entrapment at Guyon’s canal in hand S&S are same as cubital tunnel syndrome except:
etiology:
ROM:
Resisted testing:
P!/parenthesis:

A
  • cyst/repetitive stress w hand and onto hook of hamate carpal bone
  • elbow WNL
  • hand but no wrist weakness because the entrapment is at the hand & distal
  • no paresthesia’s or ulnar n subluxation in cubital tunnel

DPT MSK - fall 22 (18 decks)

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