Exam 3: Elbow Flashcards
most common tendon involved with lateral epicondylagia
ECRB
is ERCB pure tendon or mix of muscle and tendon at the insertion
pure tendon (the other extensor muscles are a mix of muscle and tendon)
For tennis elbow, do advice and home programs appear to be as effective as clinical visit?
Yes
is there evidence for scapulothroacic impairment with lateral elbow pain
Yes
do treatments for lateral elbow pain have a long term, short term, or both effect
short term
commonly provided tx for lateral elbow pain
- stretching
- eccentric exercise
- concentric exercise
- high velocity ecc exercise
- low level laser over trigger points
- Extracorporal shock wave shows promise
- short term relief with splinting
true or false lateral elbow pain may be self limiting for 12-18 months
true
what is muscle is commonly involved with medial elbow pain
pronator teres
finding with medial elbow pain
Weak wrist flex, forearm pronation, or forceful grip
what kinds of other problems do people with medial elbow pain have
- carpal tunnel
- lateral elbow pain
- RTC issues
what condition starts as medial elbow pain then goes laterally?
medial elbow instability
what type of force causes medial elbow instability
valgus/lateral force to the elbow
what can medial epicondyalgia progress to
ulnar nerve involvement and instability
if excessive valgus motion with elbow in full extension what should you suspect
fracture or capsular rupture and tendon avulsion
most medial stability comes from what bundle of the MCL
anterior
as a group, bundles of the MCL are most slack in what position
70 degrees of flex
loose packed position of humero-ulnar joint
70 degrees of flexion, 10 degrees of supination
loose packed position of humero–radial joint
elbow extension and supination
loose packed position of the superior radio-ulnar joint
35 degrees supination and 70 degrees of elbow flexion
closed packed position of humero-ulnar joint
elbow extended and forearm supinated
closed packed position of the humero-radial joint
90 degrees of flexion adn forearm supinated
closed packed position of the superior radio-ulnar joint
5 degrees of supination
capsular pattern for OA at the elbow
flexion is more restrictive than extension AND pronation and supinaton equally involved
what is epiphysitis or lesion of the growth plate at the elbow
little league elbow
instablity at the medial elbow indicates what
avulsion of the medial epicondyle
pivot shift test at the elbow will be positive for what
posterolateral instability
is AROM or PROM better for instability
AROM
treatment for elbow instability early on?
AROM
how long should you protect a grade I UCL sprain
6 weeks
Treatment for grade 1 UCL sprain
- ) protection for 6 weeks
- ) bracing (no good evidence for taping though)
- ) exercise to strengthen wrist flexors, elbow flexors, and elbow extensors
- ) AROM
- ) address scapular and GH function
true or false: grade II UCL sprain can be done surgically or non-op?
True
what motion should you avoid when rehabbing a UCL sprain
shoulder IR (this places valgus stress to the elbow
occurs when the subchondral bone at the elbow degeneragtes and fragments of cartilage break off
Panner’s Diseease
what other structure besides the ECRB can be involved with lateral elbow pain
LUCL
is there a correlation between degree of injury and involvement of LUCL with lateral elbow pain
yes
is using cold hyperalgesia a good idea for someone with lateral elbow pain
no
should you do a cortisone injection/sterioid for lateral elbow pain
no
is a wrist extension splint or forearm strap better for someone with lateral elbow pain
wrist extension splint
true or false: medial elbow pain is a precursor to medial instability
true
is lateral or medial elbow instability more common
medial
what should you suspect if someone is losing elbow flexion more than elbow extension
arthritis
split of the growth plate at the medial epicondyle
little league elbow
why should you NOT do a valgus stress test on a teenager that you suspect may have medial instability
they may have little league elbow and this could cause further damage
with surgery for elbow instability when can resisted exercise begin
8 weeks post op
is Panner’s dz seen medial or lateral on elbow
lateral (sometimes posterior)
Radial collateral ligament restrains ______forces
varus
3 MOI for lateral elbow ligament injury
- Elbow dislocation
- Varus elbow stress
- Iatrogenic (adverse effect related to a treatment for another pathology…..like a fracture)
what test is positive for a lateral elbow ligament injury
Pivot shift
how long should someone be in a hinged elbow brace following a lateral ligament injury
4-6 wks
what types of motions should you avoid with lateal ligament injury
adduction and IR of the shoulder
what nerve is commonly involved with post dislocation
median nerve
in what condition will you see a sulcus at the distal triceps
posterior elbow dislocation
if there is a fracture or unstable before 60 degrees of flexion coming from full extension then what will be needed
surgical stabilization
when rehabbing non-op elbow dislocation what are motion limitations at the elbow
- no AROM beyond 30 degrees of flexion toward ext
- do not go beyond 90 degrees of flex
- Avoid valgus stress to the elbow
after _____weeks following non-op dislocation you can increase elbow extension and elbow flexion
2 weeks
what should progress faster getting back elbow flexion or ext
flexion
following non-op dislocation how many weeks until full flexion and close to full ext
6 weeks
after elbow dislocation how long until someone can consider returning to usual activity
8 weeks
ectopic bone growth
myositis ossificans
should heat be used for someone with myositis ossificans
no
is ultrasound ok for someone with myositis ossificans
yes (but pulse it)
what muscle commonly develops myositis ossificans
brachialis
which nerve is commonly damaged with supracondylar and epicondylar fx
ulnar
froment’s sign is what
adductor pollicis is weak
what “sign” is it when adductor pollicus is weak
froments sign
what “sign” is it when 5th finger adduction is weak
wartenburgs sign
what is wartenburg’s sign
when 5th finger adduction is weak
if the adductor pollicis and the 5th finger adduction are weak then what nerve is involved
ulnar
nerve that is commonly injured with posterior elbow dislocation
median
what nerve can be entrapped in the lig of struthers
median
if someone has issues with closing fist what nerve is involved
median
anterior interosseous nerve is a branch of what nerve
median
is the deficit with anterior interosseous nerve motor or sensory or both
just motor
what nerve passes thru the two heads of pronator teres
anterior interosseous nerve
posterior interosseous nerve is a branch of what nerve
radial
direct trauma to the brachioradialis, extensor carpi radialis can cause damage to what nerve
radial/posterior interosseous nerve
what nerve passses under supinator
radial
what nerve goes thru the arcade of frohse between the two heads of the supinator
posterior interosseous nerve
radial tunnel syndrome presents similar to what
lateral elbow pain
how to differntiate between tennis elbow and radial tunnel syndrome
weakness in the hand will be seen with radial tunnel syndrome but not tennis elbow
3 things that could cause elbow bursitis
- infection
- gout
- bumped into something and bursa is just swollen
what 2 tendon injuries are most common
- biceps
- triceps
—> triceps will usually avulse on elbow side an biceps will avulse on shoulder side
what injury will lead to a popeye deformity
biceps avulsion
caused by sudden snapping of elbow towards ext/moving the elbow too fast toward ext
triceps tendinitis
how to differentitate posterior impingement and triceps tendintis??
with triceps tendonitis it will hurt only hurt actively but with posterior impingement it will hurt passively
what type of fractures are common in kids
supracondylar
what is a fat pad sign, what does it mean?
darkness off the distal humerus at the back and front. this measn that bone has bled under the periosteum….indicates a fx
does the radius or ulna rotate with pronation/supination
rotate
under what conditions should a radial head resection be done
- more than 30% of the radial head is invovled
2. 30 degrees of ROM lost
what conditon will the olecranon be palpated up in the tricpes
olecranon fx
after a supracondular fx in a child what deformity can be seen
gunstock defromity (cubitus varus)
management around a supracondylar fx focuses around what
regaining ROm
major concerns with a supracondylar fx
ROM loss, varus defromitu, and return to function
what is usually not acheived with a supracondylar fx
full ext
best exercise for rhomboids
prone row with arms down at side and at 90 degrees
what muscle does adduction and downward rotation of scapula
rhomboids
best place to put a pt. if you don’t want to have activity of upper trap
prone
best exercise for lower trap
prone horizontal abduction at 135 degrees abduction with ER
best exercise for middle trap
prone horizontal abduction at 135 degrees abduction w
what type of impingement is caused by the deltoid contraction being unopposed by the rotator cuff muscles
Posterior impingement
impingement that occurs in the 90-90 postion and is most common in throwers
posterior impingement
type of impingement that presents with scapular dyskinesia
subacromial (external)
type of impingement that presents with hypermobility
posterior (internal)
best exercise for infraspinatus
sidelying ER at 0 degrees of abduction
best exercise for teres minor
sidelying ER at 0 degrees of abduction
best exercise for supraspinatus
full can
best exercise for middle deltoid
prone horizontal abduction at 100 degrees with full ER
best exercise for posterior deltoid
prone horizontal abduction at 100 degrees with full ER
can eliminating pain improve results with FS?
yes
capsular pattern at the shoulder
ER>elevation(flex)>IR
is laser good for FS?
yes
when should sterioid injections be done for FS?
stage 1 (freezing)
when is prolonged stress for remodling best for FS?
stage 2 (frozen)
how is the glenoid oriented on the scapula
anterior and superior 30 degrees angerior
if levator is tight then what will we see
lack of elevation of the scapula
how much of UE elevation comes from the scapulothroacic region
1/3 (60 degrees)
where should the resting position of the scapula be
Between T2 and T7
Internally rotated scapula occurs in what plane
transverse plane
tipping and tilting of the scapula occur in what plane
sagittal
tight levator can cause what
downwardly rotated scapula
weak serratus anterior can lead to what
downwardly rotated scapula
inferior angle pulling off the scapula is called what
tipping
tipping scapula is caused by what
tight pec minor
winging of the scapula is also known as what
internally rotated scapula
winged scapula usually indicates what
weak serratus anterior
serratus anterior does upward rotation above what
90 degrees elevation
2 muscles that do downward rotation
- ) rhoomboids
2. ) levator scapulae
what causes scapular depression
weak upper trap
if scapula moves first with IR then what is the issue
ERs or post capsule is tight
if resisting ER and the scapula adducts to produce motion then what is the issue
rhomboid dominance. The ERs are weak and the rhomboids are substututing and causing the scapula to adduct
What is the flip sign and what does it mean?
when ER is resisted and the scapula wings and pulls away from the thorax. This means the serratus is weak most likely
tipping scapula is caused by what two things
- ACJ dysfunction
2. tight pec minor
true or false: thoracic flexion leading to excessive kyphosis can cause winging scapula
true
deltoid dominance means what
weak infraspiantus
2 functions of levator
- elevation of scapula
2. downward rotation of scapula
clavicle and acromion will be high on distal end if what is tight
upper trap
what two parts are there for the coracoclavicular ligament
conoid and trapezoid
what muscles should be worked for someone who has a sprained ACJ?
- ) Upper Trap
2. ) Deltoid
MOI for ACJ injury
Fall onto shoulder or direct blow to lateral aspect of shoulder
main finding with a ACJ injury
tendernessof the ACJ
what two tests will be positive for an ACJ injury
- ) O’Brien’s
2. ) Cross chest adduction
which tears first the AC or CC ligament with ACJ pathology
AC ligament sprains first
What position will someone be immoblized in with ACJ pathlogy
IR
What motion should you avoid with ACJ pathlogy
ER
True or false: non-sugical is adequate for most with a grade III ACJ injury
True
what motions should be avoided with Sternoclavicular joint pathology
Punching, serratus anterior activity, and bench pressing
Ehlers Danlos is an issue with what two types of collagen synthesis
type 1 and 3
Ligament that prevents inferior translation/displacement of the humerus
superior glenohumeral ligament
Ligament that resists anterior translation of humerus with up to 45 degrees of abduction with ER
middle glenohumeral ligament
strongest of the GHJ ligaments
inferior
Ligament that restrains ER and anterior translation with humerus abduction at 90 degreees
inferior glenohumeral ligament
what ligament reinforces the supraspinatus
coracohumeral ligament
Borders of the rotator interval
Base = coracoid process
Superior= supraspinatus
Inferior=subscapularis
Roof= SGHL + CHL
what passes thru the rotator interval
long head of biceps
a large rotator interval allows for what
increased humeral head translation
posterior GHJ capsule is a primary restraint against what
posterior instability
True or false: with anterior instability people will complain of posterior shoulder pain
true
excessive inferior glide / sulcus sign means what
AMBRII (systemic hypermobility)
polar type 1
trauma (Bankart)
polar type 2
lax capsule
polar type 3
poor RTC muscles
posterior lateral humeral head impression fractrue
Hill-Sachs Lesion
coracoid process appear prominent with what type of dislocation
posterior
If posterior dislocation how will person hold their arm
adduction and IR
If anteriorly dislocated how will person hold their arm
ER and abduction
what muscle is most important to rehab for an anterior dislocation
posterior deltoid
what motions should you avoid with anterior dislocation and for how long
avoid end range ER and abduction for at least 3 months
what is a contributing factor for shoulder OA
instability
is there a lot of evidence that shoulder pain with shoulder OA can improve with PT
no; just treat the dysfunctions you find
is the glenoid or the humeral head not replaced with hemi shoulder (hemiarthroplasty)
glenoid is not replaced
Early TSA precautions
- ) No AROM
- ) No lifting
- ) No ext past neutral
- ) No excessive ER
- ) No movement behind back
function of what muscle is key with rTSA?
deltoid
at what weak can you start IR and ER submax isometrics after rTSA
week 8
what type of sling is someone in for 3-6 weeks following a rTSA
abduction type sling in 30 degrees of elevation
type of labral lesion that is usually traumatic
bankart
type of labral lesion that is usually a chronic MOI
SLAP
how long should you wait to do biceps exercise following a SLAP lesion
6 weeks
how long should you wait to do submax isometrics for IR, ER, scaption, and adduction following a SLAP lesion
3 weeks
major sx with bankart lesion
feeling of instability
what should be limited to 30 degrees for 4-6 weeks followingg a bankart lesion
ER
