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Management of MS Disorders > Exam 4: Elbow > Flashcards

Exam 4: Elbow Flashcards

1
Q

What are the four outcome measures used for examination of the elbow

A
  1. Patient specific functional scale
  2. DASH
  3. Quick Dash
  4. Patient-rated forearm evaluation questionnaire
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2
Q

Which of the functional outcome measures is more specific for epicondylitis

A

quick dash

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3
Q

Describe the PSFS

A

An outcome measure that identifies up to 5 important activities that patients are having difficulty with on an eleven point scale

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4
Q

Which outcome measure is cumbersome for patients bc it can take a longer time to complete but is widely used in the clinic and for research purposes

A

DASH

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5
Q

It is (easy/hard) to answer some questions on the DASH if the affected extremity is not the dominate arm because there is no ___ ___ response questions

A

hard; not applicable

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6
Q

(reliability/validity) are results that can be repeated

A

reliable

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7
Q

(reliability/validity) ensures the information is the right information and isn’t fabricated

A

validity

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8
Q

The ___ ___ is a shortened version of the DASH and (still/doesn’t) has the same issues as the DASH

A

quick DASH; still

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9
Q

The patient rated forearm evaluation questionnaire is found to be reliable, reproducible, and sensitive for the assessment of _____ _____

A

lateral epicondylitis

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10
Q

When it comes to outcome measures, what does sensitivity mean

A

sensitive to change

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11
Q

What are the different ROMs that should be tested during the examination of the elbow

A

flexion
extension
supination
pronation

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12
Q

What type of end feel will elbow flexion have

A

soft end feel

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13
Q

What type of end feel will elbow extension have

A

hard end feel

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14
Q

what type of end feel will forearm supination and pronation have

A

skin stretch

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15
Q

What are the three general strength test categories that should be done during the examination of the elbow

A

isometric MMT
dynamometry
grip strength testing

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16
Q

When performing isometric MMT for the elbow, which four tests should be done

A

flexion, extension, supination, pronation

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17
Q

When performing dynamometry strength testing, which two tests should be done

A

flexion and extension

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18
Q

What are the 6 areas of special testing to consider when examining the elbow

A
  1. Cubital tunnel/ulnar neuropathy
  2. Bony or joint injury
  3. Radial head fracture
  4. Stability/ ligamentous testing
  5. Neural tension testing
  6. Reflex testing about the elbow
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19
Q

Yellow and red flags are determined via the ____ ____ ____ and allow you to formulate the ____ ____

A

medical screening form; initial hypothesis

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20
Q

A patient has pain over the lateral elbow during gripping activities, what is your initial hypothesis

A

lateral epicondylitis, radial tunnel syndrome

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21
Q

A patient reports pain over the medial elbow during wrist flexion and pronation

A

medial epicondylitis

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22
Q

A patient reports numbness and tingling in the ulnar nerve distribution distal to the elbow, what is your initial hypothesis

A

cubital tunnel syndrome

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23
Q

A patient reports pain in the anterior aspect of the elbow and forearm that is exacerbated by wrist flexion combined with elbow flexion and forearm pronation, what is your initial hypothesis

A

pronator syndrome

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24
Q

A patient reports pain during movement with sensations of catching or instability, what is your initial hypothesis

A

rotatory instability

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25
Q

A patient reports posterior elbow pain during elbow hyperextension, what is your initial hypothesis

A

valgus extension overload syndrome

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26
Q

When should a patient get an x ray of the elbow

A

if they are point tender of the epicondyles, if they cannot function with it outside of a sling, or if they cannot load the bone

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27
Q

What are the 7 areas of the elbows to observe and or palpate during examination

A
  1. contours
  2. carrying angles
  3. swelling
  4. olecranon fossa and bursa
  5. Radial head
  6. Epicondyles
  7. Tissue texture
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28
Q

What are then normal carrying angle values for men and women

A

M: 5-10
FM: 10-15

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29
Q

What are the norms for elbow flexion ROM

A

140-150

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30
Q

What are the norms for elbow extension

A

0-10

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31
Q

What are the norms for forearm supination

A

90

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32
Q

What are the norms for forearm pronation

A

80-90

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33
Q

The intra and inter examiner reliability for ROM is (good/poor). The ICCs range is __-__ for both.

A

good; 0.85-0.99

34
Q

Isometric MMT is done in (mid range/end range)

A

mid range between flexion and extension 90-100 degrees

35
Q

Grip strength testing using dynamometers has (poor/good) reliability with an ICCs range of __-__

A

good; 0.84-0.99

36
Q

A patient with lateral epicondylitis or radial tunnel syndrome will have pain with what movements

A

gripping activities

37
Q

A patient with medial epicondylitis will have pain with what movements

A

wrist flexion and pronation

38
Q

A patient with cubital tunnel syndrome will have what type of symptoms

A

numbness and tingling in the ulnar distribution below the elbow

39
Q

A patient with pronator syndrome will have pain with what type of movements

A

wrist flexion combined with elbow flexion and forearm pronation

40
Q

A patient with rotary instability will have what symptoms

A

pain with movements with other feelings of the elbow being caught or instable

41
Q

A patient with valgus extension overload syndrome will have pain with what movements

A

posterior pain with elbow hyperextension

42
Q

What are the three ligaments that should be tested for elbow stability

A

lateral collateral ligament
medial collateral ligament
annular ligament

43
Q

The lateral collateral ligament relates to the (radial/ulnar) side

A

radial

44
Q

The medial collateral ligament relates to the (radial/ulnar) side

A

ulnar

45
Q

What does ULNT stand for

A

upper limb neurodynamic tests

46
Q

What are the three major nerves that are involved with ULNT

A

median, ulnar, and radial

47
Q

Why are deep tendon reflexes done

A

To detect the possibility of cervical nerve root involvement or other abnormalities

48
Q

What does a DTR with a grade of 0 mean

A

absent

49
Q

What does a DTR with a grade of 1+ mean

A

trace, or seen only with reinforcement

50
Q

What does a DTR with a grade of 2+ mean

A

normal

51
Q

What does a DTR with a grade of 3+

A

brisk

52
Q

What does a DTR with a grade of 4+ mean

A

Non sustained clonus

53
Q

What does a DTR with a grade of 5+ mean

A

sustained clonus

54
Q

What level does the biceps DTR test

A

C5 and C6 but more C5

55
Q

What level does the brachioradialis DTR test

A

C5 and C6

56
Q

What level does the triceps DTR tetst

A

C7 and C8

57
Q

What level does the finger flexors DTR test

A

C8

58
Q

What are four common lesions often seen at the elbow

A
  1. Ligamentous instability
  2. Cubital tunnel syndrome
  3. Post immobilization capsular tightness
  4. Epicondylalgia
59
Q

How is elbow ligamentous instability tested

A

via radial and ulnar collateral ligament stability tests and moving valgus stress test

60
Q

Cubital tunnel syndrome often presents with pain due to prolonged ____ of the elbow

A

flexion

61
Q

Cubital tunnel syndrome is common in _____ athletes. It can also be caused by ____ or excessive ____ on the elbow

A

throwing; trauma; leaning

62
Q

Besides trauma, repetitive throwing and leaning on the elbow, what are other causes of cubital tunnel syndrome

A

UCL laxity, recurrent dislocations, or flipping the nerve out of the groove

63
Q

What is the second most common cause of nerve entrapment

A

cubital tunnel syndrome

64
Q

What are the signs and symptoms of cubital tunnel syndrome

A

Weakness, hyperesthesia, clumsiness, wasting of hypothenar, and tingling in the ulnar nerve distribution distal to the tunnel

65
Q

If a patient complains of dropping objects because they don’t seem to have the strength for it, and you discover the hypothenar muscle is smaller and not as developed as normal, what would your hypothesis be

A

cubital tunnel syndrome

66
Q

What are some management options for cubital tunnel syndrome

A
  1. Use a soft elbow pad at night
  2. Increase flexibility of the forearm muscles (flexor carpi ulnaris)
  3. Check the neck
  4. Surgery
  5. Regional interdependence treatment
67
Q

How would surgical intervention treat cubital tunnel syndrome

A

The ulnar nerve is taken from behind the elbow and placed in front of the elbow under muscle

68
Q

What muscle should be stretched with cubital tunnel syndrome

A

flexor carpi ulnaris

69
Q

What four things could cause post immobilization capsular tightness

A

Casting
surgery
protection of the extremity
prolonged use of a sling

70
Q

The greatest finding of post immobilization capsular tightness is limitation of ____. Try to identify if the ROM restriction is due to ____ of the capsule or _____.

A

limitation; tightness; musculature

71
Q

What are a few management options for post immobilization capsular tightness

A

modalities
stretching
joint mobs

72
Q

What are the four different joint mobilizations that can be done for post immobilization capsular tightness

A

humeroradial
humeroulnar
radial head
proximal radial/ulnar mobs

73
Q

What is the difference between epicondylalgia and epicondylitis

A

epicondylalgia has been there for 3-4 months, itis is acute

74
Q

(medial/lateral) epicondylalgia refers to golfers elbow

A

medial

75
Q

(medial/lateral) epicondylalgia refers to tennis elbow

A

later

76
Q

Pain due to epicondylalgia is usually of a ____ onset and may be related to _____ activities

A

gradual; gripping

77
Q

Why would gripping activities irritate epicondyles

A

they are the point of muscle attachment

78
Q

What muscle is the most involved when it comes to epicondylalgia

A

extensor carpi radialis brevis

79
Q

True or False:

A patient with epicondylalgia will have a pain free PROM

A

true

80
Q

What is the best way to treat epicondylalgia according to the BMJ research article

A

Mobilization with movement is the best way, so combining manipulations with exercise is better than just an injection. Or if a patient must get an injection, they will have better results by doing PT after the injection

Management of MS Disorders (18 decks)

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