Exam 2 Flashcards
Soft Tissue Disorders to Shoulder Complex (Quiz 4 to present)
what nerves are most at risk for entrapment?
long thoracic
axillary
spinal accessory
suprascapular
what muscle does the long thoracic nerve innervate?
serratus anterior
what muscles do the axillary nerve innervate?
deltoid
teres minor
what muscles do the spinal accessory nerve innervate?
trapezius
infraspinatus
what would you see with long thoracic nerve palsy?
scapular winging
does scapular winging occur more in the frontal plane with abduction or with flexion?
with flexion
what weakness is indicated by the flip sign?
serratus anterior
scapular weakness
what would you see with axillary nerve palsy?
deltoid atrophy
weak abduction and flexion
may see compensatory motions
what would you see in spinal accessory nerve palsy?
trapezius atrophy and weakness
may have a flip sign
what is scapular dumping?
scap doesn’t come down from abduction smooth and slow, but rather quickly releases at the end of the motion
form of scapular dyskinesia
which capsule of the elbow is more loose, posterior or anterior?
posterior capsule
does the lateral collateral lig resist valgus or varus forces?
varus forces
are varus or valgus forces more common
valgus forces
do the posterior or anterior fibers of the lateral collateral lig resist varus forces more in extension?
the anterior fibers
do the posterior or anterior fibers of the lateral collateral lig resist varus forces more in flexion?
the posterior fibers
does the medial collateral lig resist varus or valgus forces?
valgus forces
do the posterior or anterior fibers of the medial collateral lig resist valgus forces more in extension?
the anterior fibers
do the posterior or anterior fibers of the medial collateral lig resist valgus forces more in flexion?
the posterior fibers
what is the carrying angle of the elbow?
allows elbows to be at the side without hitting the pelvis
normal is about 15 deg
what is epicondylalgia?
pain of the epicondyles
what is alteral epicondylalgia?
tennis elbow
tendinopathy of the extensors and radial deviators
primarily involves ECRB, 1/3 ext dig communis
usually from overuse but cna be traumatic
overhand lifting (pronated)
what is stage 1 of lateral epicondylalgia?
inflammatory
often resolves
epicondylitis
what is stage 2 of epicondylalgia?
fibroblastic and vascular response w/in tendon
what is stage 3 lateral epicondylalgia?
pathologic changes (tendinosis) or rupture
more chronic
what is stage 4 lateral epicondylalgia?
fibrosis
calcification
what is the primary management of lateral epicondylalgia in stages 1 and 2?
ice
US
compression
e-stim
ionophoresis (drives meds into the area)
what is the primary management of lateral epicondylalgia in stages 3 and 4?
friction massage to break up adhesions and reorganize collagen fibers
eccentrics!!!
t/f: chronic conditions can have an acute overlay
true
when are symptoms of lateral epicondylalgia elicited?
with active wrist extension or grasping
t/f: pts with lateral epicondylalgia may frequently drop items
true
what tests would indicate lateral epicondylalgia?
(+) Cozens
(+) Mills
what is a counterforce brace?
pad puts pressure on the affected muscle and provides some relief bc the muscle thinks it’s pulling more distally
spreads the area of forces to decrease pain
what is a (+) Cozens sign?
resist wrist extension in sitting or standing
(+)=painful at the lateral epicondyle
what is a (+) Mills test?
put pt in full pronation, elbow extension, and wrist flexion
(+)=painful at the lateral epicondyle
what is the 1st sign of improvement of lateral epicondylalgia?
pt can hold elbow at their side without pain
what is the 2nd sign of improvement of lateral epicondylalgia?
decreased pain with the Mills test (elbow flexion will feel better first)
what is medial epicondylalgia?
golfer’s elbow
tendinopathy of the common flexor tendons, primarily FCR, and pronator teres
overuse due to: repeated stress to flexor-pronator tendons, increased valgus stress, failure of the ulnar collateral ligament
which is more painful with resisting wrist flexion: MCL injury or med epicondylalgia?
medial epicondylalgia
which becomes chronic more: lateral or medial epicondylalgia?
lateral epicondylalgia
t/f: pain with med epicondylalgia increases with resisted wrist flexion, pronation and passive wrist extension, supination
true
what is the intervention for medial epicondylalgia?
RICE, modalities, avoid immobilization, stretching, PRE’s (conc and ecc), bracing (counterforce bracing on medial side)
what is little league elbow?
ulnar collateral sprain
chronic valgus and external rotation forces (ie. tennis serve, throwing)
may occur from FOOSH, chronic med epicondylalgia
+valgus stress testing
what is the intervention for medial collateral sprains?
RICE 2-4 wks, modalities, PRE’s for FCU, pronator teres, FDS, and shoulder
surgical repair in athletes only involving palmaris longus graft w/wo ulnar n transposition
what are the common surgical procedures for medial collateral sprains?
Tommy John and docking to reduce valgus stress
what is the docking technique?
cinch up MCL
preserves the ulnar nerve
nerve transpostion-take ulnar nerve and move it in front of medial epicondyle to reduce friction
insutu ulnar nerve transposition-free up the nerve so it slides better due to possible scarring around it
what is the valgus stress test?
move elbow into flexion and extension with valgus stress applied
what is a radial collateral sprain?
posterolateral rotary instability
combination of compression, external rotation and varus forces or secondary to chronic lateral epicondylalgia
is UCL or RCL more common?
UCL
