Exam 4: Elbow Flashcards
What are the four outcome measures used for examination of the elbow
- Patient specific functional scale
- DASH
- Quick Dash
- Patient-rated forearm evaluation questionnaire
Which of the functional outcome measures is more specific for epicondylitis
quick dash
Describe the PSFS
An outcome measure that identifies up to 5 important activities that patients are having difficulty with on an eleven point scale
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
DASH
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
hard; not applicable
(reliability/validity) are results that can be repeated
reliable
(reliability/validity) ensures the information is the right information and isn’t fabricated
validity
The ___ ___ is a shortened version of the DASH and (still/doesn’t) has the same issues as the DASH
quick DASH; still
The patient rated forearm evaluation questionnaire is found to be reliable, reproducible, and sensitive for the assessment of _____ _____
lateral epicondylitis
When it comes to outcome measures, what does sensitivity mean
sensitive to change
What are the different ROMs that should be tested during the examination of the elbow
flexion
extension
supination
pronation
What type of end feel will elbow flexion have
soft end feel
What type of end feel will elbow extension have
hard end feel
what type of end feel will forearm supination and pronation have
skin stretch
What are the three general strength test categories that should be done during the examination of the elbow
isometric MMT
dynamometry
grip strength testing
When performing isometric MMT for the elbow, which four tests should be done
flexion, extension, supination, pronation
When performing dynamometry strength testing, which two tests should be done
flexion and extension
What are the 6 areas of special testing to consider when examining the elbow
- Cubital tunnel/ulnar neuropathy
- Bony or joint injury
- Radial head fracture
- Stability/ ligamentous testing
- Neural tension testing
- Reflex testing about the elbow
Yellow and red flags are determined via the ____ ____ ____ and allow you to formulate the ____ ____
medical screening form; initial hypothesis
A patient has pain over the lateral elbow during gripping activities, what is your initial hypothesis
lateral epicondylitis, radial tunnel syndrome
A patient reports pain over the medial elbow during wrist flexion and pronation
medial epicondylitis
A patient reports numbness and tingling in the ulnar nerve distribution distal to the elbow, what is your initial hypothesis
cubital tunnel syndrome
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
pronator syndrome
A patient reports pain during movement with sensations of catching or instability, what is your initial hypothesis
rotatory instability
A patient reports posterior elbow pain during elbow hyperextension, what is your initial hypothesis
valgus extension overload syndrome
When should a patient get an x ray of the elbow
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
What are the 7 areas of the elbows to observe and or palpate during examination
- contours
- carrying angles
- swelling
- olecranon fossa and bursa
- Radial head
- Epicondyles
- Tissue texture
What are then normal carrying angle values for men and women
M: 5-10
FM: 10-15
What are the norms for elbow flexion ROM
140-150
What are the norms for elbow extension
0-10
What are the norms for forearm supination
90
What are the norms for forearm pronation
80-90
The intra and inter examiner reliability for ROM is (good/poor). The ICCs range is __-__ for both.
good; 0.85-0.99
Isometric MMT is done in (mid range/end range)
mid range between flexion and extension 90-100 degrees
Grip strength testing using dynamometers has (poor/good) reliability with an ICCs range of __-__
good; 0.84-0.99
A patient with lateral epicondylitis or radial tunnel syndrome will have pain with what movements
gripping activities
A patient with medial epicondylitis will have pain with what movements
wrist flexion and pronation
A patient with cubital tunnel syndrome will have what type of symptoms
numbness and tingling in the ulnar distribution below the elbow
A patient with pronator syndrome will have pain with what type of movements
wrist flexion combined with elbow flexion and forearm pronation
A patient with rotary instability will have what symptoms
pain with movements with other feelings of the elbow being caught or instable
A patient with valgus extension overload syndrome will have pain with what movements
posterior pain with elbow hyperextension
What are the three ligaments that should be tested for elbow stability
lateral collateral ligament
medial collateral ligament
annular ligament
The lateral collateral ligament relates to the (radial/ulnar) side
radial
The medial collateral ligament relates to the (radial/ulnar) side
ulnar
What does ULNT stand for
upper limb neurodynamic tests
What are the three major nerves that are involved with ULNT
median, ulnar, and radial
Why are deep tendon reflexes done
To detect the possibility of cervical nerve root involvement or other abnormalities
What does a DTR with a grade of 0 mean
absent
What does a DTR with a grade of 1+ mean
trace, or seen only with reinforcement
What does a DTR with a grade of 2+ mean
normal
What does a DTR with a grade of 3+
brisk
What does a DTR with a grade of 4+ mean
Non sustained clonus
What does a DTR with a grade of 5+ mean
sustained clonus
What level does the biceps DTR test
C5 and C6 but more C5
What level does the brachioradialis DTR test
C5 and C6
What level does the triceps DTR tetst
C7 and C8
What level does the finger flexors DTR test
C8
What are four common lesions often seen at the elbow
- Ligamentous instability
- Cubital tunnel syndrome
- Post immobilization capsular tightness
- Epicondylalgia
How is elbow ligamentous instability tested
via radial and ulnar collateral ligament stability tests and moving valgus stress test
Cubital tunnel syndrome often presents with pain due to prolonged ____ of the elbow
flexion
Cubital tunnel syndrome is common in _____ athletes. It can also be caused by ____ or excessive ____ on the elbow
throwing; trauma; leaning
Besides trauma, repetitive throwing and leaning on the elbow, what are other causes of cubital tunnel syndrome
UCL laxity, recurrent dislocations, or flipping the nerve out of the groove
What is the second most common cause of nerve entrapment
cubital tunnel syndrome
What are the signs and symptoms of cubital tunnel syndrome
Weakness, hyperesthesia, clumsiness, wasting of hypothenar, and tingling in the ulnar nerve distribution distal to the tunnel
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
cubital tunnel syndrome
What are some management options for cubital tunnel syndrome
- Use a soft elbow pad at night
- Increase flexibility of the forearm muscles (flexor carpi ulnaris)
- Check the neck
- Surgery
- Regional interdependence treatment
How would surgical intervention treat cubital tunnel syndrome
The ulnar nerve is taken from behind the elbow and placed in front of the elbow under muscle
What muscle should be stretched with cubital tunnel syndrome
flexor carpi ulnaris
What four things could cause post immobilization capsular tightness
Casting
surgery
protection of the extremity
prolonged use of a sling
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 _____.
limitation; tightness; musculature
What are a few management options for post immobilization capsular tightness
modalities
stretching
joint mobs
What are the four different joint mobilizations that can be done for post immobilization capsular tightness
humeroradial
humeroulnar
radial head
proximal radial/ulnar mobs
What is the difference between epicondylalgia and epicondylitis
epicondylalgia has been there for 3-4 months, itis is acute
(medial/lateral) epicondylalgia refers to golfers elbow
medial
(medial/lateral) epicondylalgia refers to tennis elbow
later
Pain due to epicondylalgia is usually of a ____ onset and may be related to _____ activities
gradual; gripping
Why would gripping activities irritate epicondyles
they are the point of muscle attachment
What muscle is the most involved when it comes to epicondylalgia
extensor carpi radialis brevis
True or False:
A patient with epicondylalgia will have a pain free PROM
true
What is the best way to treat epicondylalgia according to the BMJ research article
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
