Lecture 12 Flashcards
What type of joint is the elbow joint
-hinge joint
What is the 3 joints of the elbow joint
-ulnohumeral joint
-radiohumeral joint
-proximal radioulnar joint
What are the elbow ligaments
-ulnar (medial) collateral ligament
-radial (lateral) collateral ligament
Joints of the wrist and hand
-radioulnar joint
-midcarpal joints
-carpometacarpal joint
-metacarpalphalangeal joint
-proximal interphalangeal joint
-distal interphalangeal joint
Ligaments of the wrist and hand
-collateral ligaments of wrist and fingers
-collateral ligaments of fingers
-intercarpal ligament
-triangular fibrocartilage complex (TFCC)
What are the intercarpal ligaments
-dorsal
-palmar
What is the triangular fibrocartilage complex (TFCC)
-complex made up of load beaing triangular fibrocartilage artciular disc and ligaments on medial aspect of wrist
What does the TFCC do
-disperses axial load from carpals to ulna
What is TFCC thickened by
-ulnar collateral ligament medially
What is the TFCC a major stabilizer of
-ulnocarpal joint
-distal radioulnar joint
Nerves of the elbow and wrist to note
-ulnar nerve
-median nerve
What are the elbow flexors
-biceps brachii
-brachialis
-brachioradialis
What are the heads of the biceps
-long head
-short head
What is another movement of the long head of biceps other than elbow flexion
-shoulder flexion
What are the elbow extensors
-triceps brachii
-anconeus
Where does the common flexor tendon originate
-medial epicondyle
Where does the common extensor tendon originate
-lateral epicondyle
What are the major structures that run through the carpal tunnel
-flexor tendons
-median nerve
What are the ROM of elbow
-flexion
-extension
-pronation
-supination
What are the ROM of the wrist
-flexion
-extension
-radial deviation
-ulnar deviation
What are the ROM of the digits
-flexion
-extension
-adduction
-abduction
-1-5th opposition/reposition
What is lateral epicondylitis known as
-tennis elbow
MOI tennis elbow
-overuse of forearm extensors
What sports are tennis elbow common in
-tennis
-squash
-badminton
What muscles are tennis elbow common in
-extensor carpi radialis longus
-extensor carpi radialis brevis
What are the signs and symptoms of tennis elbow
-TOP common extensor origin
-pain and weakness with wrist extension
Acute management of tennis elbow
-stretch wrist extensors in elbow extension and flexion
-PIER
-tennis elbow brace
-eccentric strengthened program for forearm extensors
What is medial epicondylitis known as
-golfers elbow
MOI golfers elbow
-overuse of wrist flexors
What sports are golfers elbow common in
-golfers
-pitchers
What muscles are most commonly affected by golfers elbow
-flexor carpi radialis
-pronator teres
Signs and symptoms of golfers elbow
-TOP common flexor origin
-pain and weakness with wrist flexion
Acute care of golfers elbow
-stretch forearm flexors
-PIER
MOI ruptured biceps
-sudden lengthening of contracting muscle (eccentric)
-sudden load when lifting or catching a heavy load
Where is ruptured biceps most common
-distal tendon
Signs and symptoms of ruptured biceps
-popeyes muscle balled up
-bruising
-pain near insertion of biceps into radial tuberosity
-pain and weakness with elbow flexion and supination
Acute management of ruptured biceps
-PIER
-pressure pad to approximate ends
-shorten biceps in sling to remove tension
-surgical repair
MOI dequervains syndrome tenosynovitis
-overuse of thumb due to gripping/wringing
What is dequervains syndrome tenosynovitis
-inflammation of the tendons and sheath around the thumb tendons
Signs and symptoms of dequervains syndrome tenosynovitis
-pain over tendons of thumb
-weakness in thumb
-abduction or extension
-pain with gripping
What sport is dequarvains syndrome tenosynovitis common in
-golf
Special test for dequarvains syndrome tenosynovitis
-finkelstein test
Acute management of dequarvains tenosynovitis
-PIER
-thumb spica brace
What can happen to dequarvains tenosynovitis if left untreated
-can progress to thickening/scarring
-reduced ROM
MOI elbow hyperextension injuries
-FOOSH
-sometimes with an added external force
Signs and symptoms of elbow hyperextension injuries
-anterior elbow pain
-swelling from ligament/capsule sprain and/or muscle sprain
-posterior elbow pain from osteochondral lesion
What do you need to rule out in an elbow hyperextension injury
-olecranon fracture
Acute management of elbow hyperextension injury
-PIER
-shorten injured tissues
-sling
-tape job
MOI ulnar collateral ligament sprains of elbow
-FOOSH
-overuse by repeat valgus force on the elbow
Signs and symptoms of ulnar collateral ligament sprains of elbow
-pain and laxity in medial elbow joint
-can include ulnar nerve symptoms
Special test for ulnar collateral ligament sprains of elbow
-valgus stress test
Who is ulnar collateral ligament sprains of elbow common in
-pitchers due to repeat high velocity force
What surgery is used for ulnar collateral ligament sprains of elbow
-tommy john surgery
What does tommy john surgery do
-reconstructs UCL using a graft tendon from palmaris longus, semitendonosus or gracilis
MOI collateral ligament sprains of the wrist
-FOOSh
-forced forearm rotation
What ligament is affected with valgus force
-ulnar collateral ligament
What ligament is affected with varus force
-radial collateral ligament
Signs and symptoms of collateral ligament sprains of the wrist
-pain
-swelling and instability of medial (UCL) or lateral (RCL) aspect of wrist
Special test for UCL
-valgus stress test
Special test for RCL
-varus stress test
Acute management of collateral ligament sprains of the wrist
-PIER
-wrist wrap
What is UCL sprain of the thumb known as
-skiers thumb
-gamekeepers thumb
MOI UCL sprain thumb
-traumatic or overuse hyperabduction of the thumb
Traumatic MOI UCL sprain thumb
-skiers thumb
-thumb gets caught
-FOOSH
-catching ball
Overuse MOI UCL sprain thumb
-gamekeepers thumb
-repeat gripping/twisting
What can UCL sprain thumb also result in
-avulsion fracture
Signs and symptoms of UCL sprain thumb
-pain
-swelling and instability at 1st MCP joint
When is surgery recommended for UCL sprain thumb
-for instability to stabilize joint
-prevents osteoarthritis longer term
Acute management for UCL sprain thumb
-PIER
-possible x ray to rule out avulsion
-brace for healing
-tape for RTP
What ROM do you want to limit with a thumb tape job
-hyperextension
-abduction
Acute MOI TFCC tear
-FOOSH
-forced forearm rotation
Overuse MOI TFCC tear
-repetitive wrist motions
Signs and symptoms of TFCC tear
-medial wrist pain
-pain with ulnar deviation and loading through wrist
-popping/clicking
-wrist weakness
Special test for TFCC tear
-TFCC compression test
Acute management of TFCC tear
-PIER
-brace as heals
-anti-inflam injections if needed
-surgery for persistent instability
MOI elbow dislocations
-FOOSH
Signs and symptoms of elbow dislocations
-deformity
-pain
-holding elbow
-tingling/numbness
-shock
Acute care for elbow dislocations
-stabilize
-splint
-monitor/treat for shock
-ER/EMS
-reduction under sedation
MOI elbow fractures
-direct trauma
-fall
Signs and symptoms of elbow fractures
-pain
-unable or unwilling to move elbow
Acute care for elbow fractures
-splint
-monitor for shock
-ER for xrays/surgery
MOI colles fracture
-FOOSH
What happens with a colles fracture
-distal radius gets displaced posteriorly
Signs and symptoms of colles fracture
-dinner fork deformity
-pain
-numbness
Acute management of colles fracture
-splint
-monitor for shock
-emerge for xrays
-surgery if unable to align
MOI scaphoid fracture
-FOOSH
Signs and symptoms of scaphoid fracture
-TOP of anatomical snuffbox
Why does scaphoid have a reduced ability to heal
-scaphoid has poor blood supply
MOI metacarpal and finger fractures
-axial compression (jammed)
-direct trauma
-being stepped on
Signs and symptoms of metacarpal and finger fractures
-localized pain
-swelling
-unable to grip
Acute care of metacarpal and finger fractures
-buddy tape to stabilize
-SAM splint
What may happen with metacarpal and finger fractures
-avulsion fractures (tendon pulls off piece of bone)
MOI cyclist palsy
-compression from handlebars
Signs and symptoms of cyclist palsy
-tingling/numbness/nerve pain
-decreased muscle strength of 5th digit
-hand cramping
Who is cyclist palsy common in
-new cyclists
-distance cyclists
Prevention of cyclist palsy
-avoid hyperextension of wrist on handlebars
-proper bike fit
Acute care of cyclist palsy
-PIER
-splint
-may require NSAIDS
MOI carpal tunnel syndrome
-overuse of wrist flexor tendons causing pressure on median nerve within carpal tunnel
Signs and symptoms of carpal tunnel syndrome
-burning/tingling/numbness in anterior wrist and hand (along median nerve distribution- digits 1-3 and 1/2 of 4)
-decreased grip strength
Acute care for carpal tunnel syndrome
-bracing
-PIER
-anti-inflam treatment
-proper ergonomic set up
-steroid injection sometimes
-surgery
What does surgery for carpal tunnel syndrome do
-open up tunnel if conservative treatment unsuccessful
