elbow wrist and hand Flashcards
differential diagnosis star points
visceral, osseous, muscular, articular, neuro
supraconylar fracture MOI
most common age 12 from FOOSH from height
olecranon fracture MOI
FOOSH w direct elbow trauma
Radial head fracture MOI
FOOSH
most common of elbow in athletes
Coronoid fracture occurs with ?
terrible triad
- radial head fracture
- elbow dislocation
- coronoid fracture
Most serious elbow injury
posterior dislocation
dislocation MOI
sports / FOOSH
Radial head sublation MOI
common in children under 5 with sudden pull on lower arm
Good test to rule out a fracture?
Elbow extension test
Lateral elbow aka
tennis elbow
Does tennis elbow hurt with flexion or extension
ext
ext carpi radialis brevis
signs its lateral elbow tendinopathy
hurts with grip n wrist ext
ULNT (radial)
decreased cervical ROM
Treatment of tennis elbow
isometric exercise at mid range
isotonic loading
strength / end /flexibilty of forearm mm
manual therapy
what manual therapy would you do to tennis elbow
lateral glide of radial and ulna on humerus
trigger points
lateral ligament sprain MOI
elbow dislocation
varus stress
symptoms of lateral ligament sprain
pain
clicking, catching
Acute treatment of lateral ligament sprain
rest, dec swelling
AROM to surrounding joints
After acute stage, treatment for lateral ligament sprain
ROM
strengthen around the joint
proprioception
radial tunnel syndrome aka
posterior interosseous nerve entrapment
Who gets radial tunnel syndrome
those who do lots of pronation/supination
symptoms of radial tunnel syndrome
parasthesia in hand/lateral forearm
pain in forearm extensors
tender supinator
positive ULNT (radial)
treatment for radial tunnel syndrome
soft tissue techs over supinator
radial nerve glides
strength forearm mm
flexor / pronator tendinopathy aka
golfers elbow
golfers elbow is from wrist ext or flex
f
medial collateral ligament MOI
Throwing
valgus
treatment medial collateral ligament
modify activity
throwing technique
soft tissue techs on medial ligament
strengthen flexors and pronators
ulnar nerve entrapment MOI
throwing
compressions
recurrent subluxations
Froments sign
paper pull
adductor pollicis
wartenburg sign
hand flat, can you bring the thumb in
5th finger add
treatment of ulnar nerve entrapment
consider cause
valgus - treat the instability
adhesions - soft tissue
padding the elbow
olecranon bursitis MOI
single trauma or repeated trauma
resting elbow on hard surface (students elbow)
treatment olecranon bursitis
ice rest compress
anti inflams
posterior impingement in elbow MOI
youth athletes doing receptive hyperextension
osteophyte growth
treatment for posterior impingement
taping
manual therapy
strength / flexibly
pronator teres syndrome
median nerve trapped in pronator terres
what mm get weak if pronator teres syndrome
median nerve distribution - thenar mm
MOI pronator teres syndrome
forceful pronation (throwing)
pronator teres aka
median nerve entrapment
treatment pronator teres syndrome
soft tissue on pronator teres
median nerve mobilization
most common type of distal radial fracture
colles (fork looking)
is colles fracture anterior or posterior displacement of radial
posterior
how long do you cast colles fracture
6 weeks, may need to change it 2-3 weeks in as swelling goes down
management of distal radius fracture
AROM at surrounding joints
reduce edema
after cast is removed what could you do with distal radius fracture
edema mangement retrograde massage wrapping techniques (Cuban) compression glove active ROM
once fracture is healed what can you do
joint mobilization modalities for pain/circ stretching resistive exercises isokinetic at 8 weeks functional activities
complications of colles fracture
malunion median nerve damage complex regional pain syndrome carpal tunnel late rupture of extensor pollicis
most common carpal fracture
scaphoid fracture
signs its a scaphoid fractures
tender snuffbox
loss of grip strength
pain with wrist extension loaded
direct pain at scaphoid
is scaphoid fracture sugerical
if its unstable or displaced yes because of avascular necrosis risk
treatment of scaphoid fracture
immobilization (8-12wks)
or surgical
good test to rule out wrist fracture
Amsterdam wrist rules
7 features of Amsterdam wrist rules
distal radius fracture
age sweling deformation tender distal radius pain on palmar flexion pain on supination pain on radioulnar tests
7 features of Amsterdam wrist rules
any wrist fracture
age male swelling swell at snuffbox deformation distal radius tender pain on radial deviation
whats de quervain effect
abd pollicis longs and ext poll brevis
what test for de quervain
finkelstein
treatment of de quervain
ergonomics
splinting
stretch /strengthen
radial sensory nerve compression due to
radial styloid fracture
tight cast
trauma/sports
compression of brachioradialis and ext carpi radials longs
T/F de quervains has sensory changes
false
which fracture has more pain initially but after 12 months no significant difference
ulnar styloid fracture
fracture of hook of hamate cause
direct blow
checking bat
sensory or motor changes during fracture of hook of hamate
both because ulnar nerve
symptoms of hook of hamate fracture
decreased grip strength
ulnar wrist pain
tender hook of hamate
MOI fracture of triquetrum
FOOSH
where is TFCC
between distal end of ulnar and proximal carpal row
can TFCC heal
central portion is avascular and can’t
TFCC tear symptoms
ulnar side wrist pain
worse with grip, rotation and wb
assessing TFCC
swelling on dorsal wrist
pain in resisted ext / ulnar deviation
wrist click
reduced grip
press test
TFCC management
brace for 4-6 wks NSAAIDs AAROM resisted strength sport specific
could be surgical if these fail
borders of carpal tunnel
scaphoid
trapezium
hamate
pisiform
roof is flexor retinaculum
whats in the carpal tunnel
median nerve
flexor dig profundus (4 tendons)
flexor dig superficial ( tendons)
flexor pollicis longus tendon
who gets carpal tunnel
middle age
women
diabetes
pregnant
how does carpal tunnel develop
tenosynovium (irritation / inflammation)
clinical features of carpal tunnel
tingling, numbness in median area (first 3 fingers) nocturnal pain pain in forearm / wrist wrist flexion activites weakness of hand
is palm effected during carpal tunnel
no because the superficial sensory branch of median doesn’t go through carpal tunnel
n
special tests carpal tunnel
tinel tap
phalens/ reverse phalens
carpal compression test
ULTT (median)
objective findings for carpal tunnel
thenar atrophy / mm weakness
difficulty manipulating small objects
loss of 2 point discrimination
