Elbow Orthoses

Question 1

Common Attachment Points

Wrist Flexors

Answer 1

Medial Epicondyle

Question 2

Common Attachment Points

Wrist Extensors

Answer 2

Lateral Epicondyles

Question 3

Joint that allows pronation/supination

Answer 3

Proximal Radioulnar

Question 4

Elbow ROM affects hand position more than wrist or shoulder. (T/F)

Answer 4

True

Question 5

Functional Elbow ROM

Answer 5

30-130 degrees

Question 6

Rarely used elbow ROM

Answer 6

0-30 degrees

Question 7

Lateral Epicondylitis

Etiology

Answer 7

Inflammation of the wrist extensors at common origin point

AKA Tennis Elbow

Question 8

Lateral Epicondylitis

Cause

Answer 8

Overuse

Question 9

Lateral Epicondylitis

Treatment

Answer 9

Goal: decrease inflammation/pain
* immobilize joint (static WHO)
* reduce tension of wrist extensors
* tennis elbow ox only used during activity (usually)

Severe cases may need EWHO

Question 10

Lateral Epicondylitis

Complications with Ox

Answer 10

• edema
• compression of nerves (radial)

Question 11

Brachial Plexus Injury

Etiology/Presentation

Answer 11

• very diverse presentation
• usually C5-7

If C7-T1 are maintained:
* function of hand/wrist
* weakness in elbow and shoulder

Question 12

Brachial Plexus Injury

Ox Management

Answer 12

stabilize shoulder and elbow; leave hand and wrist free
* GH stability
* Step Locks at elbow (user adjustable positioning)

Question 13

Contractures

Typical Causes

Answer 13

• SCI
• Trauma
• Sx
• UMN lesions

Question 14

Contractures

Goals

Answer 14

Fixed:
* accommodate and prevent

Flexible:
* low force, high duration (time)
* inhibit antagonist response
* skin pressure minimized

Ox and Anatomical Joint Congruence is CRUCIAL!!! (lateral portions)

Question 15

Contractures

Primary Comorbidity and Considerations involved

Answer 15

SCI…considerations:
* Elbow ROM - hands to midline (ADLs), wheelchair propulsion, relieving ischial pressure
* Other treatments: PT, serial casting, drop out casts

Question 16

Contractures

Spasticity

Answer 16

Typically CNS dysfunction

Botox:
* promotes temprary paralysis to gain ROM
* best results for first month, but lasts 2-3

After ROM is gained, use Ox to maintain

Question 17

Elbow Sprain Grade III

Etiology

Answer 17

MCL injury

Cause:
* trauma; repetitive stress
* Athletes (pitchers)

AKA Tommy Johns

Question 18

“Tommy John” Sx Protocol

Phase 1

Answer 18

• 0-14 Days
• static posterior splint
• 90 degrees flexion
• in week 2, free ROM during exercises

Question 19

“Tommy John” Sx Protocol

Phase 2

Answer 19

Weeks 3-4
* Expected ROM: 10-120 degrees
* use ox outdoors and to sleep

Weeks 6-12
* full ROM
* Ox used outdoors as needed

Question 20

“Tommy John” Sx Protocol

Phase 3

Answer 20

Weeks 12-24
* remodeling phase
* no Ox

Question 21

“Tommy John” Sx Protocol

Phase 4

Answer 21

Return to activity
(full healing takes 12-18 months)

Question 22

Olecranon Fx

Causes

Answer 22

• Direct Blow
• Indirect Failure (fall on outstrethed arm or triceps avulsion)

Question 23

Olecranon Fx

Treatment Protocols

Answer 23

• Post Op - EO set for 60 degrees flexion
• Week 2 - elbow ext. limited at 90 degrees flexion
• Week 3 - Ox discontinued; PT

Question 24

Elbow Joint Arthoplasty

Causes

Answer 24

RA, OA, severe Fx, osteosarcoma

Question 25

Elbow Joint Arthoplasty | Protocol

Answer 25

Brigham and Woman's Hospital: * heal/restore AROM * decrease pain/edema * EO in 60 degrees flexion * sling (comfort) * no lifting * wean off Ox when ready

Question 26

Elbow Joint Arthoplasty | Main Goals

Answer 26

* Focus on AROM of shoulder, wrist, and hand * Manage edema and pain * Patient education on protection of Px joint

Question 27

Biceps Tendon Repair | Protocol - Brown University (Dr. Green)

Answer 27

Weeks 1-2: * splint at 90 degrees flex. * fix forarm in supination Weeks 2-7: * hinged EO; forearm in supination * ROM 30-135 * worn 24/7; set for static in shower * Ox removed for PT