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MSK 2 > Exam 3: Elbow > Flashcards

Exam 3: Elbow Flashcards

1
Q

most common tendon involved with lateral epicondylagia

A

ECRB

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2
Q

is ERCB pure tendon or mix of muscle and tendon at the insertion

A

pure tendon (the other extensor muscles are a mix of muscle and tendon)

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3
Q

For tennis elbow, do advice and home programs appear to be as effective as clinical visit?

A

Yes

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4
Q

is there evidence for scapulothroacic impairment with lateral elbow pain

A

Yes

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5
Q

do treatments for lateral elbow pain have a long term, short term, or both effect

A

short term

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6
Q

commonly provided tx for lateral elbow pain

A
  1. stretching
  2. eccentric exercise
  3. concentric exercise
  4. high velocity ecc exercise
  5. low level laser over trigger points
  6. Extracorporal shock wave shows promise
  7. short term relief with splinting
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7
Q

true or false lateral elbow pain may be self limiting for 12-18 months

A

true

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8
Q

what is muscle is commonly involved with medial elbow pain

A

pronator teres

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9
Q

finding with medial elbow pain

A

Weak wrist flex, forearm pronation, or forceful grip

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10
Q

what kinds of other problems do people with medial elbow pain have

A
  1. carpal tunnel
  2. lateral elbow pain
  3. RTC issues
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11
Q

what condition starts as medial elbow pain then goes laterally?

A

medial elbow instability

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12
Q

what type of force causes medial elbow instability

A

valgus/lateral force to the elbow

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13
Q

what can medial epicondyalgia progress to

A

ulnar nerve involvement and instability

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14
Q

if excessive valgus motion with elbow in full extension what should you suspect

A

fracture or capsular rupture and tendon avulsion

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15
Q

most medial stability comes from what bundle of the MCL

A

anterior

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16
Q

as a group, bundles of the MCL are most slack in what position

A

70 degrees of flex

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17
Q

loose packed position of humero-ulnar joint

A

70 degrees of flexion, 10 degrees of supination

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18
Q

loose packed position of humero–radial joint

A

elbow extension and supination

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19
Q

loose packed position of the superior radio-ulnar joint

A

35 degrees supination and 70 degrees of elbow flexion

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20
Q

closed packed position of humero-ulnar joint

A

elbow extended and forearm supinated

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21
Q

closed packed position of the humero-radial joint

A

90 degrees of flexion adn forearm supinated

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22
Q

closed packed position of the superior radio-ulnar joint

A

5 degrees of supination

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23
Q

capsular pattern for OA at the elbow

A

flexion is more restrictive than extension AND pronation and supinaton equally involved

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24
Q

what is epiphysitis or lesion of the growth plate at the elbow

A

little league elbow

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25
Q

instablity at the medial elbow indicates what

A

avulsion of the medial epicondyle

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26
Q

pivot shift test at the elbow will be positive for what

A

posterolateral instability

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27
Q

is AROM or PROM better for instability

A

AROM

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28
Q

treatment for elbow instability early on?

A

AROM

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29
Q

how long should you protect a grade I UCL sprain

A

6 weeks

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30
Q

Treatment for grade 1 UCL sprain

A
  1. ) protection for 6 weeks
  2. ) bracing (no good evidence for taping though)
  3. ) exercise to strengthen wrist flexors, elbow flexors, and elbow extensors
  4. ) AROM
  5. ) address scapular and GH function
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31
Q

true or false: grade II UCL sprain can be done surgically or non-op?

A

True

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32
Q

what motion should you avoid when rehabbing a UCL sprain

A

shoulder IR (this places valgus stress to the elbow

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33
Q

occurs when the subchondral bone at the elbow degeneragtes and fragments of cartilage break off

A

Panner’s Diseease

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34
Q

what other structure besides the ECRB can be involved with lateral elbow pain

A

LUCL

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35
Q

is there a correlation between degree of injury and involvement of LUCL with lateral elbow pain

A

yes

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36
Q

is using cold hyperalgesia a good idea for someone with lateral elbow pain

A

no

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37
Q

should you do a cortisone injection/sterioid for lateral elbow pain

A

no

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38
Q

is a wrist extension splint or forearm strap better for someone with lateral elbow pain

A

wrist extension splint

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39
Q

true or false: medial elbow pain is a precursor to medial instability

A

true

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40
Q

is lateral or medial elbow instability more common

A

medial

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41
Q

what should you suspect if someone is losing elbow flexion more than elbow extension

A

arthritis

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42
Q

split of the growth plate at the medial epicondyle

A

little league elbow

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43
Q

why should you NOT do a valgus stress test on a teenager that you suspect may have medial instability

A

they may have little league elbow and this could cause further damage

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44
Q

with surgery for elbow instability when can resisted exercise begin

A

8 weeks post op

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45
Q

is Panner’s dz seen medial or lateral on elbow

A

lateral (sometimes posterior)

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46
Q

Radial collateral ligament restrains ______forces

A

varus

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47
Q

3 MOI for lateral elbow ligament injury

A
  1. Elbow dislocation
  2. Varus elbow stress
  3. Iatrogenic (adverse effect related to a treatment for another pathology…..like a fracture)
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48
Q

what test is positive for a lateral elbow ligament injury

A

Pivot shift

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49
Q

how long should someone be in a hinged elbow brace following a lateral ligament injury

A

4-6 wks

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50
Q

what types of motions should you avoid with lateal ligament injury

A

adduction and IR of the shoulder

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51
Q

what nerve is commonly involved with post dislocation

A

median nerve

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52
Q

in what condition will you see a sulcus at the distal triceps

A

posterior elbow dislocation

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53
Q

if there is a fracture or unstable before 60 degrees of flexion coming from full extension then what will be needed

A

surgical stabilization

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54
Q

when rehabbing non-op elbow dislocation what are motion limitations at the elbow

A
  1. no AROM beyond 30 degrees of flexion toward ext
  2. do not go beyond 90 degrees of flex
  3. Avoid valgus stress to the elbow
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55
Q

after _____weeks following non-op dislocation you can increase elbow extension and elbow flexion

A

2 weeks

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56
Q

what should progress faster getting back elbow flexion or ext

A

flexion

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57
Q

following non-op dislocation how many weeks until full flexion and close to full ext

A

6 weeks

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58
Q

after elbow dislocation how long until someone can consider returning to usual activity

A

8 weeks

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59
Q

ectopic bone growth

A

myositis ossificans

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60
Q

should heat be used for someone with myositis ossificans

A

no

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61
Q

is ultrasound ok for someone with myositis ossificans

A

yes (but pulse it)

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62
Q

what muscle commonly develops myositis ossificans

A

brachialis

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63
Q

which nerve is commonly damaged with supracondylar and epicondylar fx

A

ulnar

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64
Q

froment’s sign is what

A

adductor pollicis is weak

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65
Q

what “sign” is it when adductor pollicus is weak

A

froments sign

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66
Q

what “sign” is it when 5th finger adduction is weak

A

wartenburgs sign

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67
Q

what is wartenburg’s sign

A

when 5th finger adduction is weak

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68
Q

if the adductor pollicis and the 5th finger adduction are weak then what nerve is involved

A

ulnar

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69
Q

nerve that is commonly injured with posterior elbow dislocation

A

median

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70
Q

what nerve can be entrapped in the lig of struthers

A

median

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71
Q

if someone has issues with closing fist what nerve is involved

A

median

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72
Q

anterior interosseous nerve is a branch of what nerve

A

median

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73
Q

is the deficit with anterior interosseous nerve motor or sensory or both

A

just motor

74
Q

what nerve passes thru the two heads of pronator teres

A

anterior interosseous nerve

75
Q

posterior interosseous nerve is a branch of what nerve

A

radial

76
Q

direct trauma to the brachioradialis, extensor carpi radialis can cause damage to what nerve

A

radial/posterior interosseous nerve

77
Q

what nerve passses under supinator

A

radial

78
Q

what nerve goes thru the arcade of frohse between the two heads of the supinator

A

posterior interosseous nerve

79
Q

radial tunnel syndrome presents similar to what

A

lateral elbow pain

80
Q

how to differntiate between tennis elbow and radial tunnel syndrome

A

weakness in the hand will be seen with radial tunnel syndrome but not tennis elbow

81
Q

3 things that could cause elbow bursitis

A
  1. infection
  2. gout
  3. bumped into something and bursa is just swollen
82
Q

what 2 tendon injuries are most common

A
  1. biceps
  2. triceps

—> triceps will usually avulse on elbow side an biceps will avulse on shoulder side

83
Q

what injury will lead to a popeye deformity

A

biceps avulsion

84
Q

caused by sudden snapping of elbow towards ext/moving the elbow too fast toward ext

A

triceps tendinitis

85
Q

how to differentitate posterior impingement and triceps tendintis??

A

with triceps tendonitis it will hurt only hurt actively but with posterior impingement it will hurt passively

86
Q

what type of fractures are common in kids

A

supracondylar

87
Q

what is a fat pad sign, what does it mean?

A

darkness off the distal humerus at the back and front. this measn that bone has bled under the periosteum….indicates a fx

88
Q

does the radius or ulna rotate with pronation/supination

A

rotate

89
Q

under what conditions should a radial head resection be done

A
  1. more than 30% of the radial head is invovled

2. 30 degrees of ROM lost

90
Q

what conditon will the olecranon be palpated up in the tricpes

A

olecranon fx

91
Q

after a supracondular fx in a child what deformity can be seen

A

gunstock defromity (cubitus varus)

92
Q

management around a supracondylar fx focuses around what

A

regaining ROm

93
Q

major concerns with a supracondylar fx

A

ROM loss, varus defromitu, and return to function

94
Q

what is usually not acheived with a supracondylar fx

A

full ext

95
Q

best exercise for rhomboids

A

prone row with arms down at side and at 90 degrees

96
Q

what muscle does adduction and downward rotation of scapula

A

rhomboids

97
Q

best place to put a pt. if you don’t want to have activity of upper trap

A

prone

98
Q

best exercise for lower trap

A

prone horizontal abduction at 135 degrees abduction with ER

99
Q

best exercise for middle trap

A

prone horizontal abduction at 135 degrees abduction w

100
Q

what type of impingement is caused by the deltoid contraction being unopposed by the rotator cuff muscles

A

Posterior impingement

101
Q

impingement that occurs in the 90-90 postion and is most common in throwers

A

posterior impingement

102
Q

type of impingement that presents with scapular dyskinesia

A

subacromial (external)

103
Q

type of impingement that presents with hypermobility

A

posterior (internal)

104
Q

best exercise for infraspinatus

A

sidelying ER at 0 degrees of abduction

105
Q

best exercise for teres minor

A

sidelying ER at 0 degrees of abduction

106
Q

best exercise for supraspinatus

A

full can

107
Q

best exercise for middle deltoid

A

prone horizontal abduction at 100 degrees with full ER

108
Q

best exercise for posterior deltoid

A

prone horizontal abduction at 100 degrees with full ER

109
Q

can eliminating pain improve results with FS?

A

yes

110
Q

capsular pattern at the shoulder

A

ER>elevation(flex)>IR

111
Q

is laser good for FS?

A

yes

112
Q

when should sterioid injections be done for FS?

A

stage 1 (freezing)

113
Q

when is prolonged stress for remodling best for FS?

A

stage 2 (frozen)

114
Q

how is the glenoid oriented on the scapula

A

anterior and superior 30 degrees angerior

115
Q

if levator is tight then what will we see

A

lack of elevation of the scapula

116
Q

how much of UE elevation comes from the scapulothroacic region

A

1/3 (60 degrees)

117
Q

where should the resting position of the scapula be

A

Between T2 and T7

118
Q

Internally rotated scapula occurs in what plane

A

transverse plane

119
Q

tipping and tilting of the scapula occur in what plane

A

sagittal

120
Q

tight levator can cause what

A

downwardly rotated scapula

121
Q

weak serratus anterior can lead to what

A

downwardly rotated scapula

122
Q

inferior angle pulling off the scapula is called what

A

tipping

123
Q

tipping scapula is caused by what

A

tight pec minor

124
Q

winging of the scapula is also known as what

A

internally rotated scapula

125
Q

winged scapula usually indicates what

A

weak serratus anterior

126
Q

serratus anterior does upward rotation above what

A

90 degrees elevation

127
Q

2 muscles that do downward rotation

A
  1. ) rhoomboids

2. ) levator scapulae

128
Q

what causes scapular depression

A

weak upper trap

129
Q

if scapula moves first with IR then what is the issue

A

ERs or post capsule is tight

130
Q

if resisting ER and the scapula adducts to produce motion then what is the issue

A

rhomboid dominance. The ERs are weak and the rhomboids are substututing and causing the scapula to adduct

131
Q

What is the flip sign and what does it mean?

A

when ER is resisted and the scapula wings and pulls away from the thorax. This means the serratus is weak most likely

132
Q

tipping scapula is caused by what two things

A
  1. ACJ dysfunction

2. tight pec minor

133
Q

true or false: thoracic flexion leading to excessive kyphosis can cause winging scapula

A

true

134
Q

deltoid dominance means what

A

weak infraspiantus

135
Q

2 functions of levator

A
  1. elevation of scapula

2. downward rotation of scapula

136
Q

clavicle and acromion will be high on distal end if what is tight

A

upper trap

137
Q

what two parts are there for the coracoclavicular ligament

A

conoid and trapezoid

138
Q

what muscles should be worked for someone who has a sprained ACJ?

A
  1. ) Upper Trap

2. ) Deltoid

139
Q

MOI for ACJ injury

A

Fall onto shoulder or direct blow to lateral aspect of shoulder

140
Q

main finding with a ACJ injury

A

tendernessof the ACJ

141
Q

what two tests will be positive for an ACJ injury

A
  1. ) O’Brien’s

2. ) Cross chest adduction

142
Q

which tears first the AC or CC ligament with ACJ pathology

A

AC ligament sprains first

143
Q

What position will someone be immoblized in with ACJ pathlogy

A

IR

144
Q

What motion should you avoid with ACJ pathlogy

A

ER

145
Q

True or false: non-sugical is adequate for most with a grade III ACJ injury

A

True

146
Q

what motions should be avoided with Sternoclavicular joint pathology

A

Punching, serratus anterior activity, and bench pressing

147
Q

Ehlers Danlos is an issue with what two types of collagen synthesis

A

type 1 and 3

148
Q

Ligament that prevents inferior translation/displacement of the humerus

A

superior glenohumeral ligament

149
Q

Ligament that resists anterior translation of humerus with up to 45 degrees of abduction with ER

A

middle glenohumeral ligament

150
Q

strongest of the GHJ ligaments

A

inferior

151
Q

Ligament that restrains ER and anterior translation with humerus abduction at 90 degreees

A

inferior glenohumeral ligament

152
Q

what ligament reinforces the supraspinatus

A

coracohumeral ligament

153
Q

Borders of the rotator interval

A

Base = coracoid process
Superior= supraspinatus
Inferior=subscapularis
Roof= SGHL + CHL

154
Q

what passes thru the rotator interval

A

long head of biceps

155
Q

a large rotator interval allows for what

A

increased humeral head translation

156
Q

posterior GHJ capsule is a primary restraint against what

A

posterior instability

157
Q

True or false: with anterior instability people will complain of posterior shoulder pain

A

true

158
Q

excessive inferior glide / sulcus sign means what

A

AMBRII (systemic hypermobility)

159
Q

polar type 1

A

trauma (Bankart)

160
Q

polar type 2

A

lax capsule

161
Q

polar type 3

A

poor RTC muscles

162
Q

posterior lateral humeral head impression fractrue

A

Hill-Sachs Lesion

163
Q

coracoid process appear prominent with what type of dislocation

A

posterior

164
Q

If posterior dislocation how will person hold their arm

A

adduction and IR

165
Q

If anteriorly dislocated how will person hold their arm

A

ER and abduction

166
Q

what muscle is most important to rehab for an anterior dislocation

A

posterior deltoid

167
Q

what motions should you avoid with anterior dislocation and for how long

A

avoid end range ER and abduction for at least 3 months

168
Q

what is a contributing factor for shoulder OA

A

instability

169
Q

is there a lot of evidence that shoulder pain with shoulder OA can improve with PT

A

no; just treat the dysfunctions you find

170
Q

is the glenoid or the humeral head not replaced with hemi shoulder (hemiarthroplasty)

A

glenoid is not replaced

171
Q

Early TSA precautions

A
  1. ) No AROM
  2. ) No lifting
  3. ) No ext past neutral
  4. ) No excessive ER
  5. ) No movement behind back
172
Q

function of what muscle is key with rTSA?

A

deltoid

173
Q

at what weak can you start IR and ER submax isometrics after rTSA

A

week 8

174
Q

what type of sling is someone in for 3-6 weeks following a rTSA

A

abduction type sling in 30 degrees of elevation

175
Q

type of labral lesion that is usually traumatic

A

bankart

176
Q

type of labral lesion that is usually a chronic MOI

A

SLAP

177
Q

how long should you wait to do biceps exercise following a SLAP lesion

A

6 weeks

178
Q

how long should you wait to do submax isometrics for IR, ER, scaption, and adduction following a SLAP lesion

A

3 weeks

179
Q

major sx with bankart lesion

A

feeling of instability

180
Q

what should be limited to 30 degrees for 4-6 weeks followingg a bankart lesion

A

ER

MSK 2 (3 decks)

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