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DPT 616 : MSK > Elbow Pathology > Flashcards

Elbow Pathology Flashcards

1
Q

in what plane does most elbow motion occur?

A

sagittal

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2
Q

there is some degree of frontal plane motion at the elbow with _____ accompanying elbow flexion and _____ accompanying elbow extension

A

adduction, abduction

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3
Q

how does limited elbow fxn limit fxn?

A

limited ability to bring arm up for eating/drinking or self care

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4
Q

what is lateral epicondylalgia?

A

irritation of the lateral epicondyle and the extensors, radial deviators, and sometimes supinators

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5
Q

what muscles are primarily effected in lateral epicondylalgia?

A

extensor carpi radialis brevis

1/3 extensor digitorum communis

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6
Q

what is tennis elbow?

A

lateral epicondylalgia

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7
Q

what age group is most effected by lateral epicondylalgia?

A

those 35-50 y/o

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8
Q

what extremity is usually effected by lateral epicondylalgia?

A

the dominant arm

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9
Q

what is the usual MOI of lateral epicondylalgia?

A

overuse, but can be traumatic too

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10
Q

what is the difference in treatment of inflammatory vs degenerative/fibrotic disease?

A

inflammatory disease is treated with US and is very protective

degenerative/fibrotic disease is not likely to focus on US treatment, but rather uses IASTM, TFM, stretching, and eccentrics

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11
Q

describe stage 1 lateral epicondylalgia

A

inflammatory

often resolves

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12
Q

describe stage 2 lateral epicondylalgia

A

fibroblastic and vascular response within tendon

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13
Q

describe stage 3 lateral epicondylalgia

A

pathologic changes (tendinosis) or rupture

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14
Q

describe stage 4 lateral epicondylalgia

A

fibrosis, calcification

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15
Q

when do symptoms occur in lateral epicondylalgia?

A

with active wrist extension or grasping

morning/night

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16
Q

does pro/sup tend to be more painful in elbow flexion or extension with lateral epicondylalgia?

A

elbow extension

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17
Q

t/f: pts with lateral epicondylalgia may frequently drop things

A

true

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18
Q

where is a pt with lateral epicondylalgia TTT?

A

over the lateral epicondyle

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19
Q

what tests would we expect to be positive in lateral epicondylalgia?

A

Cozen

Mills

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20
Q

what are some treatment options for lateral epicondylalgia?

A

US

iontophoresis

TFM

modify techniques

injections

mobilizations (wrist, elbow, cervical)

stretching

PREs (conc and ecc)

counterforce bracing

dry needling

Tenex

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21
Q

are PREs for concentric or eccentric contractions more important?

A

eccentric

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22
Q

what does counterforce bracing do?

A

applies pressure to the epicondyle just distal to the muscles insertion dispersing force and making the muscle think it inserts more distally than it does

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23
Q

is lateral or medial epicondylalgia more common?

A

lateral epicondylalgia

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24
Q

what is Golfer’s elbow?

A

medial epicondylalgia

25
Q

what is medial epicondylalgia?

A

tendonopathy of the common flexor tendons, primarily the FCR and pronator teres with increased valgus stress and failure of the UCL

26
Q

where is there pain and TTT in medial epicondylalgia?

A

over the medial epicondyle

27
Q

what is the common MOI of medial epicondylalgia?

A

overuse due to repeated stress to the flexor-pronator tendons, increased valgus stress, and failure of the UCL

28
Q

what motions cause pain with medial epicondylalgia?

A

resisted wrist flexion, pronation

passive wrist extension, supination

29
Q

what are some treatment options for medial epicondylalgia?

A

RICE

modalities

avoid immobilization

stretching

PREs (conc and ecc)

bracing

30
Q

what are the 5 criteria for classification of instability?

A

1) acute, chronic, recurrent
2) articulations involved
3) direction of displacement (valgus, varus, ant/post rotatory)
4) degree of displacement (sublux or disloc)
5) presence of fx

31
Q

what causes an ulnar collateral sprain?

A

chronic valgus and ER forces (ie tennis and throwing)

32
Q

what are some other common MOIs, other than throwing for ulnar collateral sprain?

A

FOOSH

chronic medial epicondylalgia

33
Q

what tests would we expect to be positive with ulnar collateral sprain?

A

valgus stress test

moving valgus stress test

34
Q

what are some treatment options for ulnar collateral sprain?

A

RICE 2-4 weeks

modalities

PREs for FCU, pronator teres, FDS, and shoulder

35
Q

what types of forces are responsible for contributing to UCL sprain/instability?

A

valgus stress occuring with throwing

cooking phase of throwing puts a lot of medial stress of the elbow

36
Q

what causes radial collateral sprain?

A

a combo of compression, ER, and varus forces, or secondary to chronic LE

can be caused by dislocation too

37
Q

what can radial collateral sprain result in?

A

posterolateral rotatory instability

38
Q

what are the interventions for radial collateral sprain?

A

RICE 2-4 weeks

modalities

PREs

39
Q

what functional losses are associated with median nerve injury?

A

loss of pronation

loss of wrist flexion, RD

loss of thumb flexion, abduction, opposition

loss of gripping

ape hand deformity (loss of pinch)

closing hand of benediction

40
Q

what functional losses are associated with ulnar nerve injury?

A

loss of wrist flexion, UD

loss of 5th digit PIP flexion

loss of finger adb/add

opening hand of benediction (loss of ext of PIP and DIP of digits 4-5)

41
Q

what functional losses are associated with radial nerve injury?

A

loss of supination

loss of wrist extension

loss of gripping

loss of wrist stabilization

loss of finger extension

loss of thumb abduction

42
Q

why is there a weaker grip in wrist flexion?

A

bc of active insufficiency do the finger and wrist flexors

43
Q

what is cubital tunnel syndrome?

A

entrapment of the ulnar nerve at the medial intermuscular septum which slopes from a thick wide base at the medial epicondyle to a thin edge on the humeral shaft

44
Q

t/f: cubital tunnel syndrome is caused by traction in flexion

A

true

45
Q

t/f: the anconeus can cause entrapment of the ulnar nerve causing cubital tunnel syndrome

A

true

46
Q

what are the s/s of cubital tunnel syndrome?

A

pain/paresthesia in digits 4-5

worse at night

reduced sensation in ulnar nerve distribution

inability to abd/add fingers

loss of grip

atrophy of intrinsics

contracture of digits 4-5

(+) Tinel over the medial elbow

47
Q

what are some interventions for cubital tunnel syndrome?

A

ADL modification

night splinting 40-60 deg

padding

ulnar nerve transposition in severe cases

48
Q

what should be avoided with cubital tunnel syndrome?

A

leaning on the elbow

elbow flexion while sleeping

49
Q

what is pronator teres syndrome?

A

median nerve most commonly entrapped at the ligament of Struthers

50
Q

what condition can look similar to carpal tunnel syndrome?

A

pronator teres syndrome

51
Q

where is there pain in pronator teres syndrome?

A

wrist and medial forearm

52
Q

pain in pronator teres syndrome is increased with what motions?

A

extension and pronation

53
Q

where do we expect to see paresthesias in pronator teres syndrome?

A

digits 2-3

54
Q

what are the 3 sites of entrapment for pronator teres syndrome?

A

Lacertus fibrosis

pronator teres

FDS

55
Q

there can be reproduction of symptoms of pronators teres syndrome with palpation over what muscles?

A

pronators 4cm distal to the cubital crease

56
Q

what is a unique spot we may perform a Tinel test at for pronator teres syndrome?

A

4cm distal to the cubital crease

57
Q

what motions may cause reproduction of symptoms in pronator teres syndrome?

A

resisted pronation

supination

long finger flexion

elbow and Wrist flexion

58
Q

t/f: pronator teres syndrome responds well to conservative measures

A

true

DPT 616 : MSK (23 decks)

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