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Extremity Clet > IRAT 2 > Flashcards

IRAT 2 Flashcards

1
Q

Elbow joint type

A

Hinge

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2
Q

The elbow is far less commonly injured than the knee due in part to teh face that it is a

A

Non-weight bearing structure

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3
Q

Due to teh elbows link to the shoulder and wrist, it is more susceptible to

A

Wear and tear, repetitive stress, and micro trauma.

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4
Q

Overuse, misuse, overstrain, and trauma are the

A

Most common presentatiosn

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5
Q

Always distinguish between

A 
Pain
Stiffness
Looseness
Crepitus
Locking 
Combination of above
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6
Q

Olecranon fractures will more likely result from

A

A fall on the tip of the elbow

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7
Q

A hyperextension injury will result in

A

A dislocation or supracondylar fracture

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8
Q

In overstretch or sudden stretch injuries,

A

Medial or collateral ligaments will be involved

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9
Q

Compressive injuries can occur to the

A

Radial head or capitellum in overstretch or sudden stretch injuries

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10
Q

Traction to the elbow can result in

A

Radial head subluxation (nursemaid’s elbow)

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11
Q

Repetitive or overuse injury is common where the patient performs supination or pronation excessively

A

Supination - radial nerve

Pronation - median nerve

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12
Q

Repetitive or overuse, soft tissue injury is more common with

A

Trigger poitns
Muscle strain
Nerve compression

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13
Q

Cocking or medial stretch to elbow is common

A

Medial collateral ligament sprain
Flexor muscle strain
Ulnar nerve entrapment

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14
Q

Dislocation and fracture are common following

A

Hyperextension injury to the elbow

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15
Q

Hyperextension injuries leading ot supracondylar fractures account for

A

2/3 of fractures in children

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16
Q

Dislocations at the elbow are usually posterior due to

A

Structures of the elbow

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17
Q

Valgus stress is more common from

A

Overuse

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18
Q

Acute cases of valgus trauma

A

Avulsion fracture to the medial epicondyle, medial collateral ligament sprain and capitellum fracture

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19
Q

Repetitive sports activities are probably the most common cause of

A

Persistent elbow pain

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20
Q

Elbow weakness

A

Biceps tendon rupture

Follows sudden flexion contration with proximal migration of biceps muscle belly

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21
Q

Instability will probably follow a past history of

A

Trauma to the elbow
Dislocation or
Constant valgus overload in immature atheletes

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22
Q

Restricted ROM will be as a result of

A

Joint effusion or fracture

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23
Q

Non-traumatic reasons for restricted ROM could follow

A

Tight muscles or

Capsular ligament sprains/adhesions

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24
Q

Locking/crepitus in young patients

A

Osteochondritis dissecans

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25
Q

Locking/crepitus in older patients

A

More suggestive of degenerative changes

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26
Q

Grinding during supination/pronation will be as a result of

A

Radial head-capitellum articular changes

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27
Q

In flexion and extension grinding or locking,

A

Medial epicondyle or olecranon degenerative changes are likely

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28
Q

Superficial complaints commonly involve

A

Skin such as psoriasis

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29
Q

Swelling indicates

A

Gout or

Olecranon bursitis

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30
Q

Numbness and tingling can be from

A

Nerve entrapment at the site, distal or proximal

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31
Q

Elbow assessment look for

A 
Weakness
Instability
Pain
Fracture
Decreased ROM
Swelling
Spasm
Tenderness
Nerve entrapment
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32
Q

Little league elbow and panner’s disease will be diagnosed

A

Radiographically

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33
Q

Patients with ulnar nerve involvement can be evaluated with

A

Cubital tunnel view (15 degrees external rotation adn maximal flexion

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34
Q

Fractures and dislocations require

A

Referral

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35
Q

Tendinitis will respond to

A

PT and
Cross friction massage
Trigger point therapy
Myofascial release

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36
Q

Little league elbow without radiographic damage can be treated with

A

Ice and rest and modification of activity

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37
Q

LLE with x-ray damage evident should be

A

Referred for evaluation

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38
Q

Valgus overload will respond to

A

Taping
Bracing
Other support to prevent overextension of the elbow

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39
Q

Elbow joint 3 articulations

A

Humeroulnar
Humeroradioulnar
Proximal radioulnar

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40
Q

Elbow joint articulates

A

Trochlea of humerus with trochlear notch of ulna

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41
Q

Articulates captiulum of humerus with

A

Superior surface of radial head

42
Q

Q3 main nerves of the forearm

A

Radial
Median
Ulnar

43
Q

Innervate prime mover muslces

A

Brachial plexus

44
Q

ROM elbow

A 
Flexion 150
Extension 0
Valgus angle 15
Supination 90
Pronation 80-90
45
Q

Prime movers in flexion

A

Biceps brachii

Brachioradialis

46
Q

Prime movers in extension are

A

Triceps brachii

Anconeus is accessory

47
Q

Prime supinators

A

Biceps brachii

Supinator

48
Q

Pronation activated by

A

Pronator teres

Pronator quadratus

49
Q

Complex movements that occur simultaneously around an axis

A

Pronation

Supination

50
Q

Common elbow joint disorders

A 
Lateral epicondylitis (tennis elbow)
Medial epicondylitis (golfer’s elbow)
Triceps tendinitis (posterior tennis elbow)
Posterior impingement syndrome
Nursemaid’s elbow
Little league elbow
Osteochondrosis
Olecranon bursitis
51
Q

Lateral epicondylitis presentations

A

Lateral elbow pain assocaited with repetitive sports or occupationalactivity

52
Q

Anatomy and structures in lateral epicondylitis

A

Tearing of the extensor carpi radialis brevis origin.

Somtimes this may extend to the extensor-digitorum-communis

53
Q

Cause/etiology lateral epicondylitis

A

Referred to histologically as an angiofibroblastic hyperplasia. Repetitive and forceful wrist extension, radial deviation and supination are most common causes. Seen often with tennis players, weavers, plumbers, and meat cutters.

54
Q

Evaluation/assessment lateral epicondylitis

A

Tenderness on the lateral aspect of the epicondyle at the origin of the ECRB on palpation

Positive cozen and mill maneuvers. Chair lift test.

X-ray may show calcification in 25% of cases

55
Q

Management lateral epicondylitis

A

Acute phase responds well to ice while splinting and myofascial release techniques are also indicated

Chiro adjustments, cross friction massage and mobilization are recommended in subacute phase. Rehab to include stretching adn strengthening.

Bracing during the sub-acute phase while playing tennis helps and modification of equipment is recommended

Co-manage approaches might recommend topical nitric-oxide application

56
Q

Medial epicondylitis presentation

A

Medial elbow pain after repetitive activity such as hammering or using a screwdriver. Golfing or throwing can also cause symptoms and weakness on gripping is common

57
Q

Anatomy/structures medial epicondylitis

A

Medial epicondyle pain with an accompanying tendinopathy of the wrist flexors adn pronator teres. Ulnar nerve neuropathy may coexist with medial epicondylitis.

58
Q

Cause/etiology of medial epicondyltis

A

Pain on wrist flexion and pronation from overuse, repetitive motions or athletic pursuits like golf. Tendinitis of the wrist flexors adn pronator teres results

59
Q

Evaluation medial epicondyltisi

A

During activity from teh sub-acute phase onwards

Mills and cozen are positive for lateral

Golfer and reverse mill test positive for medial epicondylitis

Tinel might be positive if ulnar nerve is involved

Elbow flexion contractures can occur in chronic cases, leading to restricted motion in extenstion and supination

X-ray may reveal calcifications over teh medial epicondyle in 20-30% of patients.

60
Q

Management medial epicondylitis

A

Acute phase - ice and rest - if flexor group involved, splinting in 10 degeres of flexion may relieve tension. If flexor carpi radialis is involved splinting in 10 degrees of radial deviation is recommended.

Myofascial release of flexor muscle mass and pronator teres is very effective

Cross friciton massage and mobilization is good for sub-acute phase

Chiro adjustments during subacute phase

Elbow braces will be effective

61
Q

Cubital tunnel syndrome caused

A

Traction forces,
cubitus valgus, subluxating ulnar nerve
Elbow synovitis (edema)

Anconeus muscle has also been implicated

62
Q

Clinical signs cubital tunnel syndrome

A

Pain and paresthesia’s in 4-5 digit, pain worse at night, inability to adduct/abduct fingers (wartenberg’s sign), loss of power grip, atrophy over teh hypothenar eminence with benediction or claw hand noticeable, positive flexion provocative test, positive tinel’s sign, positive froment’s sign, positive maximum elbow flexion/compression test

63
Q

Triceps tendinitis presentation

A

Pain at the tip of the elbow after forceful elbow extension or repetitive extension motion

64
Q

Anatomy/structures triceps tendinitis

A

Olecranon process tenderness with accompanying bursitis. Strain injury to the triceps insertion on the olecranon

65
Q

Cause/etiology triceps tendinitis

A

Repetitive atheltic activity/motion/exertion that strains the tendinous insertion of the triceps to the olecranon process.

Common in boxers, weight lifters, pitchers, shot-putters and sometimes tennis players

66
Q

Triceps tenditinitis evaluation

A

Pain elicited with resisted elbow extension from a starting point of elbow flexion

67
Q

Triceps tendinitis management

A

Myofascial release/cross friction to the insertion point of the triceps. Ice, rest and modification of activity

Chiro adjustments to improve functional proprioception

68
Q

Usually atheletes complaining of posterior elbow pain following quick/sudden extension of the elbow.

CLlicking, popping and locking on elbow extension are occasionally reported.

A

Posterior impingement syndrome

69
Q

Anatomy/structures posterior impingement syndrome

A

Olecranon trochlea and olecranon fossa compression

70
Q

Cause/etiology posterior impingement syndrome

A

Repetitive extension between the olecranon trochlear and fossa which causes reactive synovitis and which can progress to degeneration.

Osteophytes and loose bodies will form in some cases

71
Q

Evaluation posterior impingement syndrome

A

Active and passive extension displays an end range blockage with pain

Valgus extension overload test will be positive with crepitus and grinding

X-ray shows cartilaginous loose bodies on axial or cubital tunnel views

72
Q

Management posterior impingement syndrome

A

Loose bodies will need to be surgically removed

Pain managment program should include ice, rest and activity modificaiton

Chiro adjustments to improve functional proprioception/ROM

Extension-block bracing or taping will be recommended

73
Q

Child between 2 and 4 years old with lateral elbow pain after being swung or jerked aggressively by a parent or a caregiver

A

Nursemaid’s elbow

74
Q

Anatomy/structures involved nursemaid’s elbow

A

Damage to the annular ligament with radial head tenderness. The radial head is not fully formed

75
Q

Cause/etiology nursemaid’s elbow

A

Entrapment/rupture of the annular ligament by a forceful distraction/rotation. Radial head under-formation predisposes annular ligament damage.

76
Q

Evaluation nursemaid’s elbow

A

Immense pain without an obvious trauma such as a fall or blow to the elbow is indicative. Palpation will reveal a misplaced or mal-positioned radial head.

77
Q

Managemnet nursemaid’s elbow

A

Elbow flexion and rotation will be accomplished by reduction

Chiro extremity assessment and adjustment

78
Q

Adolescent baseball pitcher complaining of medial or lateral elbow pain

A

Little league elbow

79
Q

Anatomy/structure little league elbow

A

Medial pain is due to injury of the medial anterior oblique ligament and fragmentation of the medial epicondylar epiphysis. Lateral pain is associated with degrees of radial head injury and growth plate immaturity. An osteochondritis dessicans of the capitellum is indicative of a lateral elbow injury.

80
Q

Cause/etiology little league elbow

A

Actually a syndrome

Repetitive valgus stress incurred while pitching causes a stretch injury to the medial elbow and compression injury to the lateral elbow

81
Q

Tenderness at both medial and lateral aspects of the elbow. Supination and pronation alternatively whether performed actively or passively can cause a palpable click or audible crepitus at the head of the radius (osteochondritis dissecans)

A

Little league elbow

82
Q

Little league elbow evaluation

A

Flexion contracture evident on passive ROM. Popping, clicking, and locking might occur on full-range active movment.

X-ray special views are required to see proper structures. Would order radial head-capitellum and valgus stress view

83
Q

Little league elbow management

A

Modification of activity is highly recommended if x-ray appears normal while clinical signs confirm. This would include proper mechanics training and teaching while avoidance of certain types of throws.

Acute pain modalities during the initial phase and proper warm up and stretching before resuming activity

Chiro adjustments to assist in resotring proper bio-mechanical fucntion.

84
Q

Young male complaining of one sided (dominant) arm pain and stiffness. Usually a sports related injury with a history of excessive throwing. Clicking and locking is associated

A

Osteochondrosis (panner’s disease)

85
Q

Anatomy/structures involved osteochondrosis/panner’s

A

Involves the capitellum of the elbow, more exactly the chondro-epiphysis. There is a decrease of blood supply to the structures causing avascular necrosis.

86
Q

Cause/etiology osteochondrosis/panner’s disease

A

Trauma or repetitive strenuous motion results in a disturbance of blood circulation to the cartilaginous epiphysis of the capitellum. Avascular necrosis results leading to deformity.

87
Q

Evaluation osteochondrosis

A

Elbow pain in children should often indicate necessity for x-rays following history of repeated weight bearing or excessive throwing.

Diagnosis for panner’s is largely radiographic - radial head capitellum and oblique views are essential. Fragmentation or loose bodies will be a clear indicator

88
Q

Management osteochondrosis (panner’s disease)

A

Best prognosis is with an open epiphysis
Rest and elimination of activity is required with splinting indicated
Stretchign and strengthening after acute phases subsides
Loose bodies and fragments if evident might need surgical removal if elbow locks
Chiro adjustments to help recuperation/recovery

89
Q

Swelling and redness just distal tot eh point of elbow. Following fall/trauma/repetitive activity injury such as wrestling

A

Olecranon bursitis

90
Q

Anatomy/structures involved olecranon bursitis

A

Olecranon bursa is injured/inflamed

91
Q

Cause/etiology olecranon bursitis

A

Olecranon bursa is injured following dragging or fall on the elbow resulting in the cushion like structure becoming inflamed, irritated, or infected.

92
Q

Evalutation olecranon bursitis

A

The large, egg sized swelling on the point of the elbow is hard to miss. Gout associated with kidney disease must be ruled out on history. Infection is distinguished if a visible wound is noticeable or if the site is warm and more tender than traditional bursitis.

93
Q

Management olecranon bursitis

A

Protection with a donut shaped support

Ice and pulsed US are indicated and very effective espeicially when chrnoic

Medical aspiration and excision might at times be necessary and if infectied would require immediate referral.

94
Q

Medial collateral ligament test (abduction stress test)

A

Pt seated, examiner stabilizes the lateral asepct of the arm and places an abduction/valgus pressure on the emdial forearm

Excessive gapping and pain indicates medial collateral ligament tear and/or instability

95
Q

Lateral collateral ligament test (adduction stress test)

A

Pt seated, examiner stabilizes teh medial aspect of the arm and places an adduction (varus) pressure on pt;s lateral forearm

Excessive gapping and pain indicates lateral collateral ligament tear and/or instability

96
Q

Tinel elbow sign

A

Pt seated, reflex hammer taps over ulnar groove

Pain and/or tenderness at the site being tapped and paresthesia in the ulnar nerve distribution area (fingers 4,5) indicates neuroma of the ulnar nerve

97
Q

Cozen test

A

Pt seated examiner instructs pt to make a fist and place wrist into extension. Examiner instructs pt to resist as ex tries to push extended wrist into flexion.

Pain over the lateral epicondyle indicates lateral epicondylitis (tennis elbow)

98
Q

Mills test/maneuver/Evans

A

Pt seated arms supinated. Dr. Passively maximally flexes pts fingers and wrist and then extends the elbow to pronation

Pain over the lateral epicondyle indicates lateral epicondylitis (tennis elbow)

99
Q

Golfer elbow test

A

Pt seated, extends elbow and supinate hand, ex instructs pt to flex wrist against resistance

Pain over medial epicondyle indicates medial epicondylitis

100
Q

Maximum elbow flexion test/compression test

A

Pt asked to place elbows in maximum elbow flexion for up to 3 minutes to close down the cubital tunnel

Reproduction of parasthesia’s into the ulnar nerve distribution with possible weakness on handshake (power grip) indicates cubital tunnel syndrome (ulnar nerve entrapment at the cubital tunnel)

101
Q

Valgus overload test of the elbow

A

Elbow is placed into 90 degress flexion. Ex places valgus stress into elbow while passively extending the elbow fully

Pain in the posterior elbow with a reproduction of a locking or catching sensation of an inability to fully extend the elbow due to pain indicates posterior elbow impingement syndrome

102
Q

Reverse mills test

A

Elbow is extended and forearm supinated. Wrist then passively extended fully. Designed to confirm golfers elbow test

Reproduction of pain in the medial elbow indicates medial epicondylitis or golfers elbow

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