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MPT 2 > Elbow, Wrist, Hand > Flashcards

Elbow, Wrist, Hand Flashcards

1
Q

T or F: you should always assess patient’s activity level during your exam

A

T: physical activity has significant benefits in MSK management

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2
Q

What movement should you really focus on once patients are in functional brane after UCL repair?

A

elbow extension! you want full extension by 2 weeks!

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3
Q

how many minutes of moderate intensity cardiovascular exercise recommended per week

A

150-300

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4
Q

how many days a week of resistance training is recommended

A

2

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5
Q

T or F: physical activity includes housework and occupation

A

F

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6
Q

decreased _____ ROM correlated with poor throwing mechanics and shoulder/elbow injury

A

hip

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7
Q

kinetic link principle

A

the human body consists of segments linked together… movement of one segment affects the proximal and distal segments

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8
Q

T or F: you should only focus on the injured joint

A

F: analyze the complete movement pattern

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9
Q

for an overhead athlete what are the proximal and distal segments

A

hip/core = prox
elbow/hand = distal
** don’t forget about the shoulder

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10
Q

what anatomical feature can lead to GIRD

A

retroverted humeral head

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11
Q

during the initial phase of a repetitive stres sinjury you want to manage the inflammatory response. how will you do this?

A
  • rest, NSAIDs, ice, splint
  • low grade mobs, isometrics
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12
Q

repetitive stress injury may require _____ evaluation

A

ergonomic

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13
Q

what structure is repaired in a tommy john surgery and how

A

UCL, uses a palmaris longus graft

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14
Q

T or F: there has been a 22- fold increase in UCL reconstruction from 1994-2010

A

T

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15
Q

UCL reconstruction is now most common in what age group?

A

high school level athletes

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16
Q

how to prevent UCL injury

A

lower pitch counts
correct mechanics
avoid pitching while fatigued

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17
Q

do most athletes return to throwing after UCL reconstruction

A

yes

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18
Q

the UCL has ____ bundles. what are they and which one is strongest

A

3 bundles
ant, post, transverse
ant is strongest

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19
Q

the UCL resists ____ stress and slows elbow ______ during throwint

A

valgus
extersion
*UCL injury caused by repetitive microtrauma to anterior bundle

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20
Q

3 most important structures for elbow stability

A

anterior UCL
RCL
bony stability

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21
Q

how many grades of UCL injury

A

3

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22
Q

grade 1 UCL tear

A

ligament complex strain
non-operative

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23
Q

grade 2 UCL tear

A

partial tear of UCL
trial of non-operative

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24
Q

for grade 2 UCL tears operative vs. non-operative depends on what? (3)

A

location of partial tear
level of play
timing

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25
Q

grade 3 UCL tear

A

complete tear
surgical consultation for throwers

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26
Q

what are some UCL risk factors for throwers?

A
  • increased body weight
  • lifting weights during season
  • reduced shoulder IR
  • supraspinatus weakness
  • high pitch velocity
  • throwing breaking pitches
  • overuse
  • fatigue
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27
Q

your patient has a grade 1 ucl injury and asks you when he can start throwing again. what is your response

A

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

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28
Q

for grade 2 UCL injuries, there is typically ____ months of restricted throwing

A

3-4
after this, pain free return to throwing program

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29
Q

after a UCL reconstruction how long does it take to return to play

A

professional pitcher = 12-18 months
other throwers = 12-15 months

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30
Q

in throwing athletes, UCL injuries are usually ______ while in non-throwing athletes they are usually _____

A

attritional
traumatic

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31
Q

what are some common ways non-throwers injure the UCL?

A
  • gymnasts = back handspring
  • MMA = arm bar
  • NFL = block w/ arm extended
    = FOOSH w/ valgus
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32
Q

most traumatic UCL injuries are treated with a ______ and are back to sport by ______ weeks

A

brace
4-6

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33
Q

what is the warning sign of an attritional UCL injury

A

soreness along medial elbow

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34
Q

T or F: there is minimal guidance for UCL rehab

A

T: “structured rehab” term commonly used

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35
Q

T or F: most UCL injuries respond to non-operative management

A

T

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36
Q

what are two associated injuries with UCL injuries

A
  • tendon avulsion of flexor wad
  • ulnar nerve - cubital tunnel
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37
Q

what movement to strengthen rotator cuff should you be careful with after UCL injury?

A

resisted ER because it stresses the medial elbow

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38
Q

T or F: you are likely to perform better than you were before, after rehab of a UCL injury

A

F: best case scenario is usually return to PLOF

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39
Q

The jobe figure of 8 was the original UCL reconstruction technique. what were the complications

A

detachment of the flexor pronator and transposition of the ulnar nerve

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40
Q

what technique is now most commonly used for UCL reconstruction

A

docking technique - graft through ulnar and ME, native ligament sutured over graft and tensioned in varus

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41
Q

there is a lot of variability in post-op rehab for UCL reconstruction. what are two areas on consistancy?

A
  • initial immobilization with plastered splint
  • early ROM in function brace
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42
Q

after UCL repair, pts wear a plastered splint for ______ weeks to allow for soft tissue healing. sutures are removed after ____ days

A

1-2 weeks
10-14 days

43
Q

after ______ weeks post-op UCL repair, the elbow brace is discontinued

A

6-8… once they are out of the brace you can really focus on progressing strengthening and initiating pre throwing drills

44
Q

At _____ months post-op UCL repair you can begin a structured throwing program

A

4

45
Q

______ months post-op UCL repair is the expected return to PLOF

A

18

46
Q

average return to sport time after UCL reconstruction

A

12 months

47
Q

symptoms of cubital tunnel syndrome (3)

A
  • pain along medial elbow
  • ulnar distribution sensory changes
  • difficulty with gripping
48
Q

advanced presentation of cubital tunnel (3)

A
  • Froment’s sign
  • lumbrical weakness digits 4 and 5
  • hypothenar atrophy
49
Q

what nerve does froment’s test

A

ulnar (adductor pollicis)

50
Q

nerve roots and cord for ulnar nerve

A

C8-T1
medial cord of brachial plexus

51
Q

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

A

anterior
cubital
flexor carpi ulnaris
guyon’s

52
Q

T or F: 90% of people with cubital tunnel improve after 3 months

A

T

53
Q

when do you refer out with cubital tunnel

A

if they have motor loss or atrophy

54
Q

general treatment principles for cubital tunnel

A
  • pt ed to avoid provoking activities
  • padding for direct compression
  • night splint
  • nerve glides
  • address c-spine if needed
55
Q

3 surgical treatments for cubital tunnel

A

1 - decompression
2 - medial epidondylectomy with decompression
3 - anterior transposition

56
Q

which procedure for cubital tunnel in the most involved and has more complication

A

anterior transposition

57
Q

which procedure for cubital tunnel allows for immediate motion?

A

decompression

58
Q

ULTT1

A

median nerve
- shoulder depression, abd, ER
- forearm supination
- elbow, wrist, and finger ext
- cervical SB

59
Q

ULTT 2a

A

median nerve
same as ULTT1 except whole arm is ER and you don’t abduct

60
Q

ULTT 2b

A

radial
- shoulder depression, slightly abduct
- elbow ext
- forearm pronation
- shoulder IR
- wrist, finger, thumb flex, ulnar deviation
- cervical sidebend

61
Q

ULTT 3

A

ulnar nerve
- shoulder depression, abd, ER
- wrist, finger extension
- elbow flexion
- cervical SB

62
Q

T or F: ULTT can be used as a stand-alone test

A

F

63
Q

ULTT are probably best at ruling out _____

A

radiculopathy

64
Q

the elbow is the _____ most common dislocated joint

A

2nd

65
Q

simple elbow dislocation

A

no associated fracture

66
Q

complex elbow dislocation

A

w/ associated fracture

67
Q

80% of elbow dislocations are what direction?

A

posterolateral

68
Q

how are elbow dislocations named?

A

position of the ulna

69
Q

what is the most common MOI for elbow dislocation

A

FOOSH

70
Q

what is critical when it comes to rehab of elbow dislocation

A

early controlled motion

71
Q

what are 3 secondary stabilizers of the elbow?

A

1 - radial head articulation
2 - common flexor pronator tendon
3 - common extensor tendon

72
Q

terrible triad of the elbow

A

elbow dislocation, radial head fx, coronoid fx

73
Q

T or F: terrible triad elbow dislocation requires surgical consultation

A

T: most are unstable after reduction

74
Q

what is the primary goal after a complex elbow dislocation

A

stability

75
Q

what is disrupted in all elbow dislocations

A

RCL
*UCL disrupted in some

76
Q

supination stress the ____ elbow and pronation stresses the _____ elbow

A

lateral
medial

77
Q

what movements should you probably avoid after an elbow dislocation?

A

excessive pronation/supination because these stress the UCL and RCL

78
Q

simple elbow dislocation rehab approach

A
  • early motion to prevent stiffness
  • avoid stressing injured structures
  • flex/ext in neutral rotation
  • stability predicts rehab approach
79
Q

who should adjust brace motion after elbow dislocation

A

ortho

80
Q

T or F: most patients with elbow dislocations are monitored weekly

A

T: they have x-rays for the first 3-4 weeks to ensure stability

81
Q

Golfer’s elbow = ____
epicondylitis
tennis elbow = _____ epicondylitis
country club elbow = ____

A

medial
lateral
both

82
Q

T or F: there is limited evidence for many treatments for epicondylitis

A

T

83
Q

rehab approach for epicondylitis

A
  • PRICE, pain control
  • avoid painful activities
  • general exercise
  • ergonomics
  • mobility/strengthening (possible eccentrics)
84
Q

T or F: DeQuervain’s Tenosynovitis often a period of splinting/immobilization

A

T: to control thumb motion

85
Q

your patient with DeQuervain’s c/o pain on anterior forearm. what kind of splint do they need?

A

thumb spica

86
Q

your patient with DeQuervain’s c/o pain on lateral forearm. what kind of splint do they need

A

wrist splint

87
Q

DeQuervain’s affects which two muscles the hand

A

abductor pollicis longus
extensor pollicis brevis
** first extensor compartment

88
Q

DeQuervain’s and intersection syndrome rehab approach

A
  • avoid painful activities
  • relative rest
  • promote exercise
  • address other impairments
  • educate
89
Q

intersection syndrome affects what two extensor compartments?

A

1 and 2

90
Q

what is the 2nd extensor compartment

A

extensor carpi radialis longus and brevis

91
Q

what muscle should you test with possible carpal tunnel?

A

abductor pollicis brevis

92
Q

rehab approach for carpal tunnel

A
  • PRICE
  • NSAIDs
  • ergonimics
  • address impairments
  • educate
93
Q

carpal tunnel is common during what?

A

pregnancy

94
Q

jersey finger

A

rupture of flexor digitorum profundus

95
Q

mallet finger

A

extensor tendon injury

96
Q
A
97
Q

boutonniere deformity

A

central slip injury
flexion of PIP joint and hyperextension of DIP joint

98
Q

swan neck deformity

A

volar plate rupture
hyperextension of PIP joint and flexion of DIP joint

99
Q

if left untreated, mallet finger can develop into _____

A

swan neck

100
Q

what is critical with finger injuries

A

early passive motion

101
Q

if your pt comes in with a suspected jersey finger injury what should you do

A

splint in slight DIP flexion and refer immediately to ortho

102
Q

what is most important for mallet finger

A

24/7 splinting in DIP extension for 6 weeks and then 6 weeks night splinting

103
Q

with boutonniere you splint the PIP in ______ and with swan neck you splint it in _____

A

extension
flexion

MPT 2 (11 decks)

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