Elbow, Wrist, Hand Flashcards
T or F: you should always assess patient’s activity level during your exam
T: physical activity has significant benefits in MSK management
What movement should you really focus on once patients are in functional brane after UCL repair?
elbow extension! you want full extension by 2 weeks!
how many minutes of moderate intensity cardiovascular exercise recommended per week
150-300
how many days a week of resistance training is recommended
2
T or F: physical activity includes housework and occupation
F
decreased _____ ROM correlated with poor throwing mechanics and shoulder/elbow injury
hip
kinetic link principle
the human body consists of segments linked together… movement of one segment affects the proximal and distal segments
T or F: you should only focus on the injured joint
F: analyze the complete movement pattern
for an overhead athlete what are the proximal and distal segments
hip/core = prox
elbow/hand = distal
** don’t forget about the shoulder
what anatomical feature can lead to GIRD
retroverted humeral head
during the initial phase of a repetitive stres sinjury you want to manage the inflammatory response. how will you do this?
- rest, NSAIDs, ice, splint
- low grade mobs, isometrics
repetitive stress injury may require _____ evaluation
ergonomic
what structure is repaired in a tommy john surgery and how
UCL, uses a palmaris longus graft
T or F: there has been a 22- fold increase in UCL reconstruction from 1994-2010
T
UCL reconstruction is now most common in what age group?
high school level athletes
how to prevent UCL injury
lower pitch counts
correct mechanics
avoid pitching while fatigued
do most athletes return to throwing after UCL reconstruction
yes
the UCL has ____ bundles. what are they and which one is strongest
3 bundles
ant, post, transverse
ant is strongest
the UCL resists ____ stress and slows elbow ______ during throwint
valgus
extersion
*UCL injury caused by repetitive microtrauma to anterior bundle
3 most important structures for elbow stability
anterior UCL
RCL
bony stability
how many grades of UCL injury
3
grade 1 UCL tear
ligament complex strain
non-operative
grade 2 UCL tear
partial tear of UCL
trial of non-operative
for grade 2 UCL tears operative vs. non-operative depends on what? (3)
location of partial tear
level of play
timing
grade 3 UCL tear
complete tear
surgical consultation for throwers
what are some UCL risk factors for throwers?
- increased body weight
- lifting weights during season
- reduced shoulder IR
- supraspinatus weakness
- high pitch velocity
- throwing breaking pitches
- overuse
- fatigue
your patient has a grade 1 ucl injury and asks you when he can start throwing again. what is your response
you will be able to gradually return to throwing, with a pain-free throwing program. if you experience pain or have soreness, stop throwing until it subsides
for grade 2 UCL injuries, there is typically ____ months of restricted throwing
3-4
after this, pain free return to throwing program
after a UCL reconstruction how long does it take to return to play
professional pitcher = 12-18 months
other throwers = 12-15 months
in throwing athletes, UCL injuries are usually ______ while in non-throwing athletes they are usually _____
attritional
traumatic
what are some common ways non-throwers injure the UCL?
- gymnasts = back handspring
- MMA = arm bar
- NFL = block w/ arm extended
= FOOSH w/ valgus
most traumatic UCL injuries are treated with a ______ and are back to sport by ______ weeks
brace
4-6
what is the warning sign of an attritional UCL injury
soreness along medial elbow
T or F: there is minimal guidance for UCL rehab
T: “structured rehab” term commonly used
T or F: most UCL injuries respond to non-operative management
T
what are two associated injuries with UCL injuries
- tendon avulsion of flexor wad
- ulnar nerve - cubital tunnel
what movement to strengthen rotator cuff should you be careful with after UCL injury?
resisted ER because it stresses the medial elbow
T or F: you are likely to perform better than you were before, after rehab of a UCL injury
F: best case scenario is usually return to PLOF
The jobe figure of 8 was the original UCL reconstruction technique. what were the complications
detachment of the flexor pronator and transposition of the ulnar nerve
what technique is now most commonly used for UCL reconstruction
docking technique - graft through ulnar and ME, native ligament sutured over graft and tensioned in varus
there is a lot of variability in post-op rehab for UCL reconstruction. what are two areas on consistancy?
- initial immobilization with plastered splint
- early ROM in function brace
after UCL repair, pts wear a plastered splint for ______ weeks to allow for soft tissue healing. sutures are removed after ____ days
1-2 weeks
10-14 days
after ______ weeks post-op UCL repair, the elbow brace is discontinued
6-8… once they are out of the brace you can really focus on progressing strengthening and initiating pre throwing drills
At _____ months post-op UCL repair you can begin a structured throwing program
4
______ months post-op UCL repair is the expected return to PLOF
18
average return to sport time after UCL reconstruction
12 months
symptoms of cubital tunnel syndrome (3)
- pain along medial elbow
- ulnar distribution sensory changes
- difficulty with gripping
advanced presentation of cubital tunnel (3)
- Froment’s sign
- lumbrical weakness digits 4 and 5
- hypothenar atrophy
what nerve does froment’s test
ulnar (adductor pollicis)
nerve roots and cord for ulnar nerve
C8-T1
medial cord of brachial plexus
the ulnar nerve travels _______ to medial head of the triceps, through the ___ tunnel and divides into forearm between the 2 heads of _______. Then, it goes through ________ canal and terminates in motor and sensory branches
anterior
cubital
flexor carpi ulnaris
guyon’s
T or F: 90% of people with cubital tunnel improve after 3 months
T
when do you refer out with cubital tunnel
if they have motor loss or atrophy
general treatment principles for cubital tunnel
- pt ed to avoid provoking activities
- padding for direct compression
- night splint
- nerve glides
- address c-spine if needed
3 surgical treatments for cubital tunnel
1 - decompression
2 - medial epidondylectomy with decompression
3 - anterior transposition
which procedure for cubital tunnel in the most involved and has more complication
anterior transposition
which procedure for cubital tunnel allows for immediate motion?
decompression
ULTT1
median nerve
- shoulder depression, abd, ER
- forearm supination
- elbow, wrist, and finger ext
- cervical SB
ULTT 2a
median nerve
same as ULTT1 except whole arm is ER and you don’t abduct
ULTT 2b
radial
- shoulder depression, slightly abduct
- elbow ext
- forearm pronation
- shoulder IR
- wrist, finger, thumb flex, ulnar deviation
- cervical sidebend
ULTT 3
ulnar nerve
- shoulder depression, abd, ER
- wrist, finger extension
- elbow flexion
- cervical SB
T or F: ULTT can be used as a stand-alone test
F
ULTT are probably best at ruling out _____
radiculopathy
the elbow is the _____ most common dislocated joint
2nd
simple elbow dislocation
no associated fracture
complex elbow dislocation
w/ associated fracture
80% of elbow dislocations are what direction?
posterolateral
how are elbow dislocations named?
position of the ulna
what is the most common MOI for elbow dislocation
FOOSH
what is critical when it comes to rehab of elbow dislocation
early controlled motion
what are 3 secondary stabilizers of the elbow?
1 - radial head articulation
2 - common flexor pronator tendon
3 - common extensor tendon
terrible triad of the elbow
elbow dislocation, radial head fx, coronoid fx
T or F: terrible triad elbow dislocation requires surgical consultation
T: most are unstable after reduction
what is the primary goal after a complex elbow dislocation
stability
what is disrupted in all elbow dislocations
RCL
*UCL disrupted in some
supination stress the ____ elbow and pronation stresses the _____ elbow
lateral
medial
what movements should you probably avoid after an elbow dislocation?
excessive pronation/supination because these stress the UCL and RCL
simple elbow dislocation rehab approach
- early motion to prevent stiffness
- avoid stressing injured structures
- flex/ext in neutral rotation
- stability predicts rehab approach
who should adjust brace motion after elbow dislocation
ortho
T or F: most patients with elbow dislocations are monitored weekly
T: they have x-rays for the first 3-4 weeks to ensure stability
Golfer’s elbow = ____
epicondylitis
tennis elbow = _____ epicondylitis
country club elbow = ____
medial
lateral
both
T or F: there is limited evidence for many treatments for epicondylitis
T
rehab approach for epicondylitis
- PRICE, pain control
- avoid painful activities
- general exercise
- ergonomics
- mobility/strengthening (possible eccentrics)
T or F: DeQuervain’s Tenosynovitis often a period of splinting/immobilization
T: to control thumb motion
your patient with DeQuervain’s c/o pain on anterior forearm. what kind of splint do they need?
thumb spica
your patient with DeQuervain’s c/o pain on lateral forearm. what kind of splint do they need
wrist splint
DeQuervain’s affects which two muscles the hand
abductor pollicis longus
extensor pollicis brevis
** first extensor compartment
DeQuervain’s and intersection syndrome rehab approach
- avoid painful activities
- relative rest
- promote exercise
- address other impairments
- educate
intersection syndrome affects what two extensor compartments?
1 and 2
what is the 2nd extensor compartment
extensor carpi radialis longus and brevis
what muscle should you test with possible carpal tunnel?
abductor pollicis brevis
rehab approach for carpal tunnel
- PRICE
- NSAIDs
- ergonimics
- address impairments
- educate
carpal tunnel is common during what?
pregnancy
jersey finger
rupture of flexor digitorum profundus
mallet finger
extensor tendon injury
boutonniere deformity
central slip injury
flexion of PIP joint and hyperextension of DIP joint
swan neck deformity
volar plate rupture
hyperextension of PIP joint and flexion of DIP joint
if left untreated, mallet finger can develop into _____
swan neck
what is critical with finger injuries
early passive motion
if your pt comes in with a suspected jersey finger injury what should you do
splint in slight DIP flexion and refer immediately to ortho
what is most important for mallet finger
24/7 splinting in DIP extension for 6 weeks and then 6 weeks night splinting
with boutonniere you splint the PIP in ______ and with swan neck you splint it in _____
extension
flexion
