Ferril's UE DSA

Question 1

ddx of elbow pain in children

Answer 1

1. buckle or greenstick fracture of distal humerus
2. growth plate injury of distal humerus or proximal radius (Salter-Harris)
3. elbow dislocation
4. avulsion fracture
5. nursemaid’s elbow

Question 2

radiocapitellar line on XR indicates

Answer 2

radial dislocation

Question 3

anterior humeral line on XR indicates

Answer 3

supracondylate fractures

Question 4

fat pad sign on XR indicates

Answer 4

sign of effusion and occult fracture

Question 5

define greenstick fracture of distal humerus

Answer 5

fracture w/o cortical bone disruption, most common type of fracture in children

Question 6

is imaging needed for elbow pain?

Answer 6

not indicated if diagnosis is clear. If diagnosis is not clear, then AP and lateral films to rule out fracture or discloation

Question 7

nursemaid’s elbow pathology

Answer 7

subluxation and entrapment of annular ligament over the radial head

Question 8

SD for elbow pain

Answer 8

look for fascial strain in the UE, upper ribs, upper thoracic, and cervicals

Question 9

OMT tx for elbow pain

Answer 9

1. rib BLT
2. thoracic myofascial release
3. clavicle BLT
4. cervical FPR
5. extremity Still technique

Question 10

reciprocal tension ligaments

Answer 10

role of ligaments in joints - throughout the physio range of motion of any given joint, the associated ligament maintains a constant level of tension

Question 11

reciprocal tension mechanism

Answer 11

shared tension within the ligamentous articular mechanism of any given joint remains constant as long as the ligament is not damaged

Question 12

dx in BLT

Answer 12

determine the restriction of the joint

Question 13

principle of tx of BLT

Answer 13

the point in the ROM of an articulation where the ligaments and membranes are poised between the normal tension present throughout the free ROM and increased tension preceding the strain

Question 14

humerus BLT dx

Answer 14

1. have arm at 45-90 degrees laterally from body and elbow flexed
2. compare external and internal rotation
3. restriction in on direction indicates lesion in the opposite position

Question 15

humerus BLT tx

Answer 15

1. physicians’ hands reach around the humerus with the fingers as superior a contact on the humerus into the axilla as possible (caution about placement as brachial plexus is vulnerable to compression)
2. patient reaches the hand of the involved side across chest to opposite clavicle and hold shoulder
3. patient move uninvolved shoulder posteriorly, carrying with it the hand of the lesioned side
4. BLT established by gently internally or externally rotateing the humerus with a slight superior motion to help engage the entire joint capsule

Question 16

scapulothoracic BLT dx

Answer 16

1. physician assesses position of scapula on thorax

2. hypertonic serratus anterior will produce elevation and lateral displacement of scapula

Question 17

scapulothoracic BLT tx

Answer 17

1. physician places pad of thumb on the ribs at the mid-axillary line as superior as possible, and then slides the thumb posteriorly along the patient’s ribs until it is under the scapula
2. patient lean towards the physician so the physician’s thumb slides further under the scapula until reach the resistance of serratus anterior
3. physician place other hand on top of the scapula, grasping the spine of the scapula with her fingers
4. inferior traction is placed on the scapula to achieve balance between the serratus anterior, rhomboids, and teres mm
5. position held until serratus anterior relaxes

Question 18

mechanism of Still technique

Answer 18

1. move restricted joint or tissue into position of ease and exaggerate position of ease until tissue relax
2. introduce vector of force (compression or traction) through the affected tissue
3. using the force vector as level, tissue is taken through its ROM towards and through the initial restriction
4. force vector is released an tissue is passively returns to neutral

Question 19

posterior radial head restriction dx

Answer 19

radial head resists anterior motion and supination

Question 20

posterior radial head restriction tx

Answer 20

initial position: forearm is brought into pronation until tissue balance is sensed at radial head

final position: gentle axial force is put through the distal radius to the radial head. Maintaining that compression, the forearm is brought into supination. Release the compression

Question 21

anterior radial head restriction dx

Answer 21

radial head resists posterior motion and pronation

Question 22

anterior radial head restriction tx

Answer 22

initial position: forearm is brought into supination until tissue balance is sensed at the radial head

final position: gentle axial force is put through the distal radius to the radial head. Maintaining that compression, the forearm is brought into pronation. Release the compression

Question 23

nursemaid’s elbow PE

Answer 23

1. anxious child who is protective of affected arm
2. anxiety > pain
3. forearm flexed 15-20 degrees and partially pronated
4. resistance to move digits or wrists to prevent pain
5. tenderness at head of radius
6. patient resists supination/pronation and flexion/extension of the forearm