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Ortho > Lecture Exam 2 > Flashcards

Lecture Exam 2 Flashcards

1
Q

ROM norm for flexion of shoulder

A

0-180

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2
Q

ROM norm for extension of shoulder

A

180-0

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3
Q

ROM norm for hyperextension of shoulder

A

0-60

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4
Q

ROM norm for abduction of shoulder

A

0-180

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5
Q

ROM norm for adduction of shoulder

A

180-0

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6
Q

ROM norm for MR of shoulder

A

0-70

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7
Q

ROM norm for LR of shoulder

A

0-90

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8
Q

the goniometer placement for which shoulder movement is being described?

axis: over the LATERAL aspect of the greater tubercle

stationary arm: parallel to midaxillary line of the thorax

moving arm: aligned with LATERAL midline of the humerus

A

shoulder flexion

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9
Q

the goniometer placement for which shoulder movement is being described?

axis: over the LATERAL aspect of the greater tubercle

proximal arm: parallel to midaxillary line of the thorax

distal arm: aligned with the LATERAL midline of the humerus

A

shoulder extension

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10
Q

the goniometer placement for which shoulder movement is being described?

axis: close to the ANTERIOR aspect of the acromial process

stationary arm: aligned so that it’s parallel to the midline of the ANTERIOR aspect of the sternum

moving arm: aligned with the ANTERIOR midline of the humerus

A

shoulder abduction

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11
Q

the goniometer placement for which shoulder movement is being described?

not usually measured or recorded because its the return to 0 from its opposing action

A

shoulder adduction

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12
Q

the goniometer placement for which shoulder movement is being described?

axis: over the olecranon process

stationary arm: perpendicular to or parallel with the floor

moving arm: aligned with the ulna

A

shoulder MR

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13
Q

the goniometer placement for which shoulder movement is being described?

axis: over the olecranon process

proximal arm: perpendicular to or parallel with the floor

distal arm: aligned with the ulna

A

shoulder LR

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14
Q

name the 3 synovial joints of the shoulder

A

glenohumeral joint (GH)
acromioclavicular (AC)
sternoclavicular (SC)

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15
Q

which synovial joint of the shoulder is being described?

made up of the humeral head & glenoid fossa

A

GH

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16
Q

which synovial joint of the shoulder is being described?

  • triaxial plane joint
  • weak capsule supported by superior & inferior AC ligaments
A

AC

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17
Q

which synovial joint of the shoulder is being described?

  • triaxial with disk
  • supported by anterior/posterior ligaments AND interclavicular/costoclavicular ligaments
A

SC

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18
Q

what is the capsular pattern of the shoulder?

A

ER&raquo_space;> abduction&raquo_space;> IR

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19
Q

which peripheral joint’s open pack position is being described?

55-70 degrees of abduction with 30 degrees of horizontal adduction

A

shoulder joint

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20
Q

which peripheral joint’s closed pack position is being described?

mac abduction & ER

A

shoulder joint

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21
Q

what’s the end feel of the shoulder joint?

A

firm (joint capsule)

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22
Q

which special test of the shoulder is being described?

PURPOSE: tests for bicep tondenitis & assesses the integrity of the bicep tendon

HAND PLACEMENT: stabilize same side shoulder

FORCE: resisted shoulder extension

+ SIGN: pain in bicipital groove is reproduced

A

speeds test

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23
Q

which special test of the shoulder is being described?

PURPOSE: tests for full thickness RC tear

HAND PLACEMENT: passively raise arm to 90 degrees of abduction

FORCE: slowly lower arm

+ SIGN: can’t slowly control downward descent

A

drop arm test

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24
Q

which special test of the shoulder is being described?

PURPOSE: tests for supraspinatus weakness

HAND PLACEMENT: patient is in caption (thumbs down/IR)

FORCE: downward pressure

+ SIGN: pain is reproduced

A

empty can test

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25
Q

which special test of the shoulder is being described?

PURPOSE: general shoulder impingement test

HAND PLACEMENT: (patient is standing or sitting) depress or stabilize scapula

FORCE: passive IR of shoulder & then passively range into maximal flexion

+ SIGN: pain is reproduced

A

neer’s test

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26
Q

which special test of the shoulder is being described?

PURPOSE: subacromial impingement test

HAND PLACEMENT: shoulder & elbows are flexed 90 degrees

FORCE: passively MR shoulder

+ SIGN: pain is reproduced

A

kennedy hawkins test

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27
Q

which special test of the shoulder is being described?

PURPOSE: tests for subscapularis tear

HAND PLACEMENT: arm is behind the back with the dorsal surface of hand against the back

FORCE: ask patient to lift hand from back

+ SIGN: unable to lift hand off of back/away from body

A

lift off sign

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28
Q

which special test of the shoulder is being described?

PURPOSE: tests for anterior instability of GH joint

HAND PLACEMENT: (patient is in supine) shoulder in 90 degrees of abduction & elbow in 90 degrees of flexion

FORCE: slowly ER patient’s shoulder

+ SIGN: patient is apprehensive & feels like their is instability

A

anterior apprehension test

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29
Q

which muscle does this action & nerve innervation belong to?

action: scapular elevation & UR

nerve: spinal accessory cranial nerve XI/C3 & C4 sensory component

A

upper trap

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30
Q

which muscle does this action & nerve innervation belong to?

action: scapular retraction

nerve: spinal accessory cranial nerve Xl/C3 & C4 sensory component

A

middle trap

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31
Q

which muscle does this action & nerve innervation belong to?

action: scapular depression & UR

nerve: spinal accessory cranial nerve Xl/C3 & C4 sensory component

A

lower trap

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32
Q

which muscle does this action & nerve innervation belong to?

action: scapular elevation & DR

nerve: C3, C4, & dorsal scapular C5

A

levator scapula

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33
Q

which muscle does this action & nerve innervation belong to?

action: scapular retraction, elevation, & DR

nerve: dorsal scapular C5

A

rhomboids

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34
Q

which muscle does this action & nerve innervation belong to?

action: scapular protraction & UR

nerve: long thoracic C5, C6, C7

A

serratus anterior

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35
Q

which muscle does this action & nerve innervation belong to?

action: scapular protraction, depression, DR, & tilt

nerve: medial pectoral nerve C8-T1

A

pectoralis minor

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36
Q

which muscle does this action & nerve innervation belong to?

action: shoulder flexion, MR, abduction, & horizontal adduction

nerve: axillary C5 & C6

A

anterior deltoid

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37
Q

which muscle does this action & nerve innervation belong to?

action: shoulder abduction

nerve: axillary C5 & C6

A

middle deltoid

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38
Q

which muscle does this action & nerve innervation belong to?

action: shoulder extension, hyperextension, LR, & horizontal abduction

nerve: axillary C5 & C6

A

posterior deltoid

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39
Q

which muscle does this action & nerve innervation belong to?

action: shoulder abduction

nerve: suprascapular C5 & C6

A

supraspinatus

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40
Q

which muscle does this action & nerve innervation belong to?

action: shoulder LR & horizontal abduction

nerve: suprascapular C5 & C6

A

infraspinatus

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41
Q

which muscle does this action & nerve innervation belong to?

action: shoulder LR & horizontal abduction

nerve: axillary C5 & C6

A

teres minor

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42
Q

which muscle does this action & nerve innervation belong to?

action: shoulder MR

nerve: subscapular C5 & C6

A

subscapularis

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43
Q

which muscle does this action & nerve innervation belong to?

action: first 60 degrees of flexion

nerve: lateral & medial pectoral C5 -T1

A

pec major (clavicular portion)

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44
Q

which muscle does this action & nerve innervation belong to?

action: first 60 degrees of extension (180-120)

nerve: lateral & medial pectoral C5-T1

A

pec major (sternal portion)

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45
Q

which muscle does this action & nerve innervation belong to?

action: shoulder MR, adduction, & horizontal adduction

nerve: lateral & medial pectoral C5-T1

A

pec major (both portions)

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46
Q

which muscle does this action & nerve innervation belong to?

action: shoulder extension, hyperextension, MR, & adduction

nerve: thoracodorsal C6, C7, C8

A

latissimus dorsi

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47
Q

which muscle does this action & nerve innervation belong to?

action: shoulder extension, MR, & adduction

nerve: lower sub scapular C5, C6, C7

A

teres major

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48
Q

which muscle does this action & nerve innervation belong to?

action: stabilizes shoulder joint

nerve: musculocutaneous C5, C6, C7

A

coracobrachialis

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49
Q

which pathology is being described?

  • tendons of the RC (usually supraspinatus) are compressed/crowded under the coracoacromial arch
  • over time repetitive movements, pain, stress, & friction can cause the tendons to wear & tear
  • poor limited blood supply
A

impingement syndromes

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50
Q

what are the 3 types of acromion processes?

A

type 1: flat
type 2: curved
type 3: crooked

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51
Q

when treating an impingement syndrome with conservative treatment, which phase is being described?

  • Decrease/modify pain
  • Meds for pain/inflammation
  • Rest
  • Stretching/strengthening
  • Scapular strengthening & stabilization exercises
  • Pendulum exercises
  • Isometrics
  • Patient education
  • Modalities
A

protection phase

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52
Q

when treating an impingement syndrome with conservative treatment, which phase is being described?

  • Increased use of injured area
  • Increased intensity of isometrics
  • Stretch & strengthen RC muscles
  • Scapular stabilization
  • Open & closed chain endurance exercises
A

controlled motion phase

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53
Q

when treating an impingement syndrome with conservative treatment, which phase is being described?

  • Functional training
  • Increased duration & intensity of exercises
  • plyometrics
A

return to function phase

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54
Q

when treating an impingement syndrome with non-conservative treatment, which phase is being described?

  • Lasts 3-4 weeks
  • Control pain & inflammation
  • Almost ALWAYS address mobility
  • Pendulum
  • Posture
  • About 1-week post-op: pain-free, low intensity isometrics
  • Submax isometrics
  • AAROM of shoulder & AROM of wrist, hand & elbow
A

maximum protection phase

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55
Q

when treating an impingement syndrome with non-conservative treatment, which phase is being described?

  • restore & maintain full/pain-free ROM
  • self-stretching
  • postural exercise
  • develop dynamic stability, strength (low-load with a slow increase in reps), endurance, & control of GH joint & scapulothoracic joint
  • stabilization exercises
  • functional activities
A

moderate protection phase

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56
Q

when treating an impingement syndrome with non-conservative treatment, which phase is being described?

  • Begins ~8 weeks post-op & lasts 12-16 weeks
  • Strength
  • Endurance
  • Functional activities
A

minimum protection phase

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57
Q

what does SAD stand for & what is it a treatment option for?

A

Subacromial Decompression

  • used to eliminate/decrease the abnormality causing an impingement
  • allows increased movement of tendons with pain/compression
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58
Q

describe these components of SAD:
release
acromioplasty
distal clavicle excision
removal of osteophytes
removal of subacromial bursa

A

release: of coracoacromial ligament

acromioplasty: shaving the end of the acromion to create more room in the shoulder joint

distal clavicle excision: removal of distal end of the clavicle to increase joint space

removal of osteophytes: at AC joint

removal of subacromial bursa

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59
Q

name the 4 types of tendonitis of the shoulder

A

supraspinatus tendonitis
infraspinatus tendonitis
bicipital tendonitis
bursitis

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60
Q

are the following treatments of tendonitis conservative or non-conservative?

  • NSAIDS (anti-inflammatory meds)
  • Avoid activities that place a load on the tendon
  • Isometric exercise
  • Once pain decreases, work on building strength
A

conservative

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61
Q

what are the size classifications of the following RC tears?

1cm or less
1-3cm or less
3-5cm or less
5cm+

A

1cm or less: small
1-3cm or less: medium
3-5cm or less: large
5cm+: massive

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62
Q

what are the 2 classifications of thickness for an RC tear?

A

partial thickness tear
full thickness tear

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63
Q

when treating an RC tear with non-conservative treatment, which phase is being described?

  • Prevent loss of ROM of peripheral joints
  • Prevent shoulder stiffness
  • PROM (as allowed)
  • Self-assisted/wand exercise
  • Postural training
  • Scapular stabilization
A

maximum protection phase

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64
Q

when treating an RC tear with non-conservative treatment, which phase is being described?

  • Self or AAROM with end range hold
  • Pain-free AROM
  • Look for substitution motions
  • Isometric & dynamic scapulothoracic stabilizers
  • Gradually increase resistance with submax isometrics
  • Scar mobilization
  • Use of UE for light, functional activities
A

moderate protection phase

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65
Q

when treating an RC tear with non-conservative treatment, which phase is being described?

  • Full ROM of shoulder
  • Strengthening continues
  • Return to functional activities
  • Task specific training
  • No high demand activities for 6 months – 1 year
  • Endurance training
  • Phase may begin 12-16 weeks post op
A

minimum protection phase

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66
Q

which pathology are these signs & symptoms for?

chronic
intermittent
activity dependent

A

glenohumeral joint instability & dislocation

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67
Q

loss of articulation between humeral head & glenoid fossa

A

dislocation

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68
Q

partial disloaction

A

subluxation

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69
Q

which type of dislocation is being described?

  • common
  • posteriorly directed force while humerus is in elevation, ER & horizontal abduction
A

anterior dislocation

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70
Q

which type of dislocation is being described?

  • less common
  • force applied while humerus is in flexion, adduction & IR
A

posterior dislocation

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71
Q

which type of hypermobility is being described?

  • when shoulder starts to slip from the joint with no significant injury
  • can be unidirectional or multidirectional
A

atraumatic hypermobility

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72
Q

which type of hypermobility is being described?

occurs with anterior dislocation of the shoulder

A

traumatic hypermobility

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73
Q

when treating GH joint instability/dislocation with conservative treatment, which phase is being described?

  • Compression fracture of the posterolateral aspect of the humeral head because of anterior shoulder instability
  • Pain control
  • Avoid any position that reproduces the mechanism of dislocation of the arm
  • Maintain range/strength in joints below that are non-compromising to shoulder
  • Once immobilization is over, gradually return to ROM (still protecting shoulder from abduction/ER)
A

protection phase

74
Q

when treating GH joint instability/dislocation with conservative treatment, which phase is being described?

Submax isometrics
* Pain free
* Neutral position: add,abd/ IR, ER/ elevation, extension
* Partial WB & stabilization exercises
* Limited ER from neutral to 50 degrees
* Avoid dislocation positions
* Work up to full IR & 90-degree flexion
* DO NOT PUT IN 90 DEGREES ABDUCTION
* AVOID COMBINATION OF ABDUCTION & ER

A

controlled motion phase

75
Q

when treating GH joint instability/dislocation with conservative treatment, which phase is being described?

  • Scapular & RC strengthening
  • Anterior shoulder strengthening
  • Look at scapulohumeral rhythm: focus on normal scapular motion & stabilization
  • Avoid prohibited motions for up to 3 months after original injury
  • Full, pain free ROM
  • No palpable tenderness
  • Machine, CKC, OKC, cable systems
  • Progress from easy to hard
  • Discuss with PT when progression is appropriate
  • Endurance activities
  • May take up to 4 months for patient to be able to return to full activity
A

return to function phase

76
Q

which injury associated with GH instability/dislocation is being described?

may be associated with bicep long head tear & anterior instability

A

SLAP lesion

77
Q

which injury associated with GH instability/dislocation is being described?

avulsion (separation) of the capsule & glenoid off of the anterior rim of the glenoid labrum due to traumatic anterior dislocation

A

Bankhart lesion

78
Q

which injury associated with GH instability/dislocation is being described?

compression fracture of the posterolateral aspect of the humeral head because of anterior shoulder instability

A

Hill-Sach’s lesion

79
Q

name and describe the 2 types of adhesive capsulitis

A

primary: spontaneous/more common
secondary: occurs after immobilization/trauma

80
Q

which of the 4 stages of adhesive capsulitis is being described?

  • Gradual onset of pain that increases with movement
  • Night pain
  • Loss of ER ROM
  • BL RC strength
  • Lasts less than 3 months
A

stage 1

81
Q

which of the 4 stages of adhesive capsulitis is being described?

  • Continual pain & intense pain at rest
  • Motion is limited in all directions
  • Lasts 3-9 months
A

stage 2 (freezing)

82
Q

which of the 4 stages of adhesive capsulitis is being described?

  • Pain only with movement
  • Limited GH joint motions
  • Scapular substitutions patterns
  • Weakness
  • Lasts 9-15 months
A

stage 3 (frozen)

83
Q

which of the 4 stages of adhesive capsulitis is being described?

  • Minimal pain
  • Significant capsular restrictions due to adhesions
  • Gradual improvement of ROM
  • Lasts 15-24 months
  • May never get ROM back
A

stage 4 (thawing)

84
Q

when treating adhesive capsulitis with conservative treatment, which phase is being described?

  • Educate pt
  • Activity modification
  • Passive or assisted ROM in pain free range available
  • Joint mobs
  • Isometrics
  • Grip ball squeezes
A

protection phase

85
Q

when treating adhesive capsulitis with conservative treatment, which phase is being described?

  • Progress ROM to point of pain for shoulder & scapula
  • Wand exercise, table stretches, pulleys
  • Self-mobs
  • Stretching (manual & self)
  • Postural changes
  • Modalities as needed
A

controlled motion phase

86
Q

when treating adhesive capsulitis with conservative treatment, which phase is being described?

  • Stretching
  • Strengthening
  • Posture
  • Prepare for real life
A

return to function phase

87
Q

what are the degrees of the sprains?

A

1st degree
2nd degree
3rd degree

88
Q

what is the goal of ORIF (Open Reduction Internal Fixation) when treating AC joint sprains/dislocations

A

immobilization with the goal of regaining functional strength & ROM of the joint

89
Q

what procedure is being described?

  • Incisions is 17cm long&raquo_space; deltoid is retracted
  • Surgery takes 1 ½ - 2 ½ hours
  • Post op ROM for abduction: 143 degrees
A

TSA (Total Shoulder Arthroplasty)

90
Q

when treating an AC joint sprain/dislocation with non-conservative treatment (after a TSA), which phase is being described?

  • Control pain
  • PROM: surgical guidelines
  • AROM: scapula
  • Supine self-assisted ROM
  • Codman’s (NO CIRCLES)
  • Functional activity with elbow at waist level
  • Maintain above/below joint integrity
A

maximum protection phase

91
Q

when treating an AC joint sprain/dislocation with non-conservative treatment (after a TSA), which phase is being described?

  • Avoid aggressive stretching or resistance exercises or overuse of involved shoulder with ADLs
  • AAROM
  • Transition gradually to AROM
  • Wand exercises behind back
  • Low intensity, pain-free stretching
  • Pain-free submax isometrics
  • Dynamic scapular strengthening
A

moderate protection phase

92
Q

when treating an AC joint sprain/dislocation with non-conservative treatment (after a TSA), which phase is being described?

  • End range of self-stretching
  • Strengthening: pain-free, low load, high rep
  • Functional activity training
A

minimum protection phase

93
Q

after an rTSA, which post op date(s) do the following rules apply to?
(day 1, days 2-21, weeks 3-8, weeks 4-5, or weeks 9-12)?

  • No passive ER until week 2
  • No circular pendulums
A

day 1

94
Q

after an rTSA, which post op date(s) do the following rules apply to?
(day 1, days 2-21, weeks 3-8, weeks 4-5, or weeks 9-12)?

  • Do not exceed PROM 120 degrees of flexion, 30 degrees of ER, & 45 degrees of scaption
  • Avoid pulleys unless it’s pure flexion
A

days 2-21

95
Q

after an rTSA, which post op date(s) do the following rules apply to?
(day 1, days 2-21, weeks 3-8, weeks 4-5, or weeks 9-12)?

  • No passive adduction or horizontal adduction beyond neutral
  • No combined ER & abduction
  • No passive flexion over 140 degrees
A

weeks 3-8

96
Q

after an rTSA, which post op date(s) do the following rules apply to?
(day 1, days 2-21, weeks 3-8, weeks 4-5, or weeks 9-12)?

  • NO active ER more than 45 degrees
  • NO IR behind back
A

weeks 4-5

97
Q

after an rTSA, which post op date(s) do the following rules apply to?
(day 1, days 2-21, weeks 3-8, weeks 4-5, or weeks 9-12)?

  • No lifting more than 5lbs if painful
  • Should have 90 degrees of active abduction
  • Should have 45 degrees of active ER
  • Should have 70 degrees of active IR
A

weeks 9-12

98
Q

normal ROM for elbow flexion

A

0-150 degrees

99
Q

normal ROM for elbow extension

A

0 degrees

100
Q

normal ROM for elbow pronation

A

0-80 degrees

101
Q

normal ROM for elbow supination

A

0-80 degrees

102
Q

the goniometer placement for which elbow motion is being described?

o Axis: over the lateral epicondyle of the humerus

o Stationary arm: aligned with the LATERAL midline of the humerus (using acromion process for reference)

o Moving arm: aligned with the LATERAL midline of the radius (using the radial head & radial styloid process for reference)

A

elbow flexion

103
Q

the goniometer placement for which elbow motion is being described?

o Axis: center it LATERALLY & PROXIMALLY to the ulnar styloid process

o Stationary arm: align parallel to the ANTERIOR midline of the humerus

o Moving arm: place across the DORSAL surface of the forearm, just PROXIMAL to the radius & ulna

A

elbow pronation

104
Q

the goniometer placement for which elbow motion is being described?

o Axis: place it MEDIALLY & just PROXIMALLY to the ulnar styloid process

o Stationary arm: align parallel to the ANTERIOR midline of the humerus

o Moving arm: place across the VENTRAL surface of the forearm, just PROXIMAL to the styloid process

A

elbow supination

105
Q

what is the capsular pattern of the humeroulnar joint?

A

flexion loss > extension loss

106
Q

what is the capsular pattern of the humeroradialis joint?

A

flexion loss > extension loss

107
Q

what is the capsular pattern of the proximal & distal radioulnar joint?

A

pronation loss = supination loss

108
Q

what is the open pack position of the humeroulnar joint?

A

70 degrees flexion & 10 degrees of supination

109
Q

what is the open pack position of the radiohumeral joint?

A

full extension & supination

110
Q

what is the closed pack position of the humeroulnar joint?

A

full extension & supination

111
Q

what is the closed pack position of the radiohumeral joint?

A

90 degrees of flexion & 5 degrees of supination

112
Q

which special test of the elbow is being described?

o PURPOSE: looks at integrity of MCL of the elbow (is it intact?)
o POSITION: supine with elbow flexed at 20 degrees (clinician stands towards feet)
o HAND PLACEMENT: stabilize above joint line
o FORCE: abduction of the FA
o + SIGN: pain or excessive movement

A

valgus stress test

113
Q

which special test of the elbow is being described?

o PURPOSE: looks at integrity of LCL at the elbow
o POSITION: supine with elbow flexed at 20 degrees (clinician stands towards head)
o HAND PLACEMENT: stabilize above joint line
o FORCE: adduction of the FA
o + SIGN: pain or excessive movement

A

varus stress test

114
Q

which special test of the elbow is being described?

o PURPOSE: Tests for ulnar entrapment (provocation/tapping nerve test)
o POSITION:
o HAND PLACEMENT: support FA
o FORCE: Tapping the groove between the olecranon process & medial epicondyle
o + SIGN: pain, numbness, tingling

A

tinel’s sign

115
Q

which special test of the elbow is being described?

o PURPOSE: tests for medial epicondylitis
o POSITION: elbow fully extended & supinated; then passively extend wrist
o HAND PLACEMENT: stabilize UE
o FORCE: push hand back into further extension
o + SIGN: reproduce pain/symptoms

A

golfer’s elbow test

116
Q

which special test of the elbow is being described?

o PURPOSE: tests for lateral epicondylitis
o POSITION: extend elbow & pronate FA
o HAND PLACEMENT: on dorsum of wrist
o FORCE: resist further extension against clinician’s hand
o + SIGN: reproduces pain/symptoms

A

tennis elbow test

117
Q

which special test of the elbow is being described?

o PURPOSE: tests for lateral epicondylitis
o POSITION:
o HAND PLACEMENT:
o FORCE: resists middle finger extension
o + SIGN: reproduces pain/symptoms

A

lateral epicondylitis test

118
Q

which muscle does this action & nerve innervation belong to?

action: elbow flexion

nerve: musculocutaneous C5, C6

A

brachialis

119
Q

which muscle does this action & nerve innervation belong to?

action: elbow flexion & forearm supination

nerve: musculocutaneous C5, C6

A

biceps brachii

120
Q

which muscle does this action & nerve innervation belong to?

action: elbow flexion

nerve: radial C5, C6

A

brachioradialis

121
Q

which muscle does this action & nerve innervation belong to?

action: elbow extension

nerve: radial C6, C7, C8

A

triceps

122
Q

which muscle does this action & nerve innervation belong to?

action: assistes in elbow extension (not a prime mover)

nerve: radial C6, C7, C8

A

aconeus

123
Q

which muscle does this action & nerve innervation belong to?

action: forearm pronation

nerve: median C6, C7

A

pronator teres

124
Q

which muscle does this action & nerve innervation belong to?

action: forearm pronation

nerve: median C8, T1

A

pronator quadratus

125
Q

which muscle does this action & nerve innervation belong to?

action: forearm supination

nerve: radial C6

A

supinator muscle

126
Q

which pathology is being described?

  • associated with repetitive (overusing) wrist extension
  • commonly involved ECRB
  • pain/weakness in common wrist extensor tendon & humeroradial joint with gripping activities or activities that require firm wrist stability
  • also known as “tennis elbow”
A

lateral epicondylitis

127
Q

which pathology is being described?

  • associated with repetitive (overusing) wrist flexion
  • commonly involves common flexor tendon
  • pain in common flexor/pronator tendon at the medial epicondyle
  • also know as “golfer’s elbow”
A

medial epicondylitis

128
Q

what are some functional limitations of medial & lateral epicondylitis?

A

keyboarding
throwing
sports (golf & tennis)
hammering
using hand tools

129
Q

when treating lateral/medial epicondylitis with conservative treatment, which phase is being described?

o Decrease pain
- Immobilization
- Avoid aggravating activities
- Ice

o Develop soft tissue & joint mobility
- Cross friction massage
- If nn symptoms are present: implement nn gliding/mobilizations
- Soft tissue mobilization: decrease tightness
- Isometrics in pain-free ranges
- Gentle passive stretching

o Maintain UE function
- Active ROM: to all joints to maintain integrity of the UE
- Resistive exercises: to shoulder & scapular stabilization exercises

A

protection phase

130
Q

when treating lateral/medial epicondylitis with conservative treatment, which phase is being described?

o Manual stretching
o Continue with cross friction massage
o Joint mobs by PT
o Force dispersing strap/brace
o Increased strengthening
o Initiate concentric & eccentric exercise with caution
o Make sure they are appropriate & don’t “flare up” the pt
o Activity modification
o Promote gradual return to all functional activities
o Plyometric if appropriate

A

controlled motion/return to function phase

131
Q

which pathology is being described?

  • onset: transverse fx of distal 1/3 of the humerus
  • 2 types
A

supracondylar fracture

132
Q

is the following a type l or type ll supracondylar fx?

fall onto an outstretched, extended arm&raquo_space; fragment is displaced posteriorly

A

type l

133
Q

is the following a type l or type ll supracondylar fx?

flexion injury with direct trauma to the posterior elbow&raquo_space; fragment lies anterior to humerus

A

type ll

134
Q

the following treatment parameters are for what pathology?

  • focus on gentle active motion that doesn’t stress the fracture site
  • Typically immobilized 4-6 weeks
  • Gentle AROM after cast is removed
  • no resistance exercise or progressive ROM allowed until x-ray shows healing
  • above/below joints are maintained
  • passive stretching is contraindicated during early healing phase
    o DO NOT PUT STRESS OVER HEALING FX SITE
A

supracondylar fracture

135
Q

the following are potential complications what kind of surgery?

  • Intraoperative fracture
    o Component malpositioning
    o Ulnar damage
  • Postoperative
    o Deep infection
    o Joint instability
    o Wound healing insufficiency
    o Triceps insufficiency
  • Months/years later
    o Loosening of components
    o Periprosthetic fracture
    o Mechanical failure
    o Premature wear if components
A

TEA (Total Elbow Arthroplasty)

136
Q

when recovering from a TEA, which phase is being described?

  • Control pain, inflammation, & edema
  • Maintain careful inspection of wound
  • Protect soft tissue as it begins to heal
  • Maintain mobility of shoulder, wrist & hand
  • Regain motion of FA & elbow (if permitted by procedure used)
  • Goals can include maintaining mobility of shoulder, wrist & hand (if allowed ROM to elbow & FA)
  • Minimize atrophy of UE musculature
    o Isometrics may be used to achieve this
  • first 4 weeks
A

maximum protection phase

137
Q

when recovering from a TEA, which phase is being described?

4-6 weeks postoperatively
- Soft tissue has healed sufficiently to increase stress

12 weeks
- (Barring complications) only minimum protection is needed
- Increase ROM
- Regain functional strength & muscular endurance

A

moderate/minimum protection phase

138
Q

ulnar entrapment (ulnar nerve C8, T1) at the medial aspect of the elbow is the cause of

A

CTS (Cubital Tunnel Syndrome)

139
Q

the following directions are for which test?

  • Sequentially add
    o Wrist extension & forearm supination
    o Full elbow flexion
    o Shoulder girdle depression
    o Hold this position, then add shoulder LR & abduction
    o Hands end near ear with fingers posteriorly
  • SB (side bend) neck to opposite side
A

ulnar nerve tension test

140
Q

normal ROM for wrist flexion

A

0-80 degrees

141
Q

normal ROM for wrist extension

A

0-70 degrees

142
Q

normal ROM for radial deviation

A

0-20 degrees

143
Q

normal ROM for ulnar deviation

A

0-30 degrees

144
Q

the goniometer placement of which wrist motion is being described?

A

wrist flexion/extension

145
Q

the goniometer placement of which wrist motion is being described?

A

radial/ulnar deviation

146
Q

what is the capsular pattern of the wrist?

A
  • equal flexion & extension
    slight loss of UD & RD
147
Q

what is the open pack position of the wrist?

A

10 degrees of flexion & slight UD

148
Q

what is the closed pack position of the wrist?

A

full extension

149
Q

which special test of the wrist is being described?

o PURPOSE: tests for inflammation of APL & EPB
o POSITION: pronation; make a fist with the thumb tucked
o HAND PLACEMENT:
o FORCE: passively ulnar deviate
o + SIGN: reproduce symptoms

A

finkelstein’s test

150
Q

which special test of the wrist is being described?

o PURPOSE: puts pressure on median nerve
o POSITION: fully flex both wrists
o HAND PLACEMENT:
o FORCE: press opposite dorsums of hands together & hold for 1 minute
o + SIGN: reproduce symptoms

A

phalen’s

151
Q

which special test of the wrist is being described?

o PURPOSE: tests for CTS
o POSITION: wrists are fully extended with both palms together (prayer)
o HAND PLACEMENT:
o FORCE: lower hands & throw elbows out
o + SIGN: reproduce symptoms

A

reverse phalen’s

152
Q

which special test of the wrist is being described?

o PURPOSE: tests for CTS
o POSITION: sitting with FA fully supinated
o HAND PLACEMENT: hand & wrist are held in neutral position
o FORCE: tap at midpoint of carpal tunnel
o + SIGN: pain, numbness, or tingling

A

tinel’s sign

153
Q

which special test of the wrist is being described?

  • squeeze a dynamometer
A

grip strength

154
Q

which muscle does this action & nerve innervation belong to?

action: wrist flexion & UD

nerve: ulnar C8, T1

A

FCU (Flexor Carpi Ulnaris)

155
Q

which muscle does this action & nerve innervation belong to?

action: wrist flexion & RD

nerve: median C6, C7

A

FCR (Flexor Carpi Radialis)

156
Q

which muscle does this action & nerve innervation belong to?

action: wrist extension & RD

nerve: radial C6, C7

A

ECRL (Extensor Carpi Radialis Longus)

157
Q

which muscle does this action & nerve innervation belong to?

action: wrist extension

nerve: radial C6, C7

A

ECRB (Extensor Carpi Radialis Brevis)

158
Q

which muscle does this action & nerve innervation belong to?

action: wrist extension & UD

nerve: radial nerve C6, C7, C8

A

ECU (Extensor Carpi Ulnaris)

159
Q

what pathology is being described?

  • Entrapment/compression of median nerve is caused by:
    • Repetitive motions
    • Genetic link
    • Race
    • Canal size
    • Occupation
A

carpal tunnel syndrome

160
Q

the following are associated conditions of which pathology?

o DM
o Obesity
o Hypothyroidism
o Inflammatory arthritis
o Pregnancy
o Alcohol abuse

(& may also see)
o Thenar mm atrophy
o + Phalen’s test
o Loss of 2-point discrimination
o + Tinel’s at the wrist
o Sensory changes over median nerve distribution

A

carpal tunnel syndrome

161
Q

the following is non-operative management of what pathology?

o Modify activity: home & work
o Educate patient & HEP
o MD prescribe medication:
o Possibly injections
o Splint wrist in neutral
o Allow inflammation to subside before starting resistance training
o Gentle ROM/gripping exercise that do not flare symptoms
o Postural exercises needed
o Joint mobs by PT if needed
o Tendon gliding exercises for extrinsic tendons
o Median nerve glides/mobilization
o EMG ordered for cases where compression may be coming from cervical root/BP issue

A

carpal tunnel syndrome

162
Q

the following is operative management of what pathology?

o Surgical release of transverse carpal ligaments/removal of scar tissue
- Can be open or endoscopic
- Open is a safer alternative
- Decreases risk that median nn or ulnar area will be damaged
- 80-90% of board-certified hand surgeons use open technique
- Surgery has a 90-93% success rate & is cost-effective to manage CTS
- Usually performed as an outpatient procedure with local sedation

A

carpal tunnel syndrome

163
Q

when treating carpal tunnel syndrome with non-conservative treatment, which phase is being described?

o Immobilization for 7-10 days
o Patient education
o Avoid active wrist flexion & extension past neutral
o Avoid active finger flexion with wrist flexion
o Pain/edema/wound management
o Active tendon gliding
o Maintain integrity of FA, elbow, & shoulder

A

maximum protection phase

164
Q

when treating carpal tunnel syndrome with non-conservative treatment, which phase is being described?

o AROM initiated as tissue heals & sutures are removed ( ~ day 10-12)
o Scar mobilization: to prevent scar tissue from forming
o Nerve glides
o Isometrics being around 4 weeks
o Grip/pinch around week 6
o Dexterity exercises & sensory stimulation
o Overall, CTS can return
o May see an increase in incidence of this 10-15 years after CT release

A

moderate protection phase

165
Q

which pathology is being described?

  • involvement of the ulnar nerve in the tunnel between the hook of hamate & the pisiform
  • sensory symptoms in:
    • little finger
    • ulnar side of hand
    • fatigue & weakness in the hand with repetitive motions
  • provoking activities
    • knitting
    • biking
    • tying knots
    • falling onto ulnar side of hand
    • prolonged handwriting
A

compression in tunnel of guyon

166
Q

the following is non-operative management of what pathology?

o Similar to that of CTS
o Avoid pressure to the base of the hand
o Possible use of hand-based ulnar orthosis to provide rest
o Ulnar nerve mobilization

A

compression in tunnel of guyon

167
Q

the follow is operative management of what pathology?

o Release of ulnar tunnel
o Immobilization of wrist for 3-5 days
o Gentle ROM
o Guidelines similar to CTS surgery (except use ulnar nn mob techniques)

A

compression in tunnel of guyon

168
Q

what pathology is being described?

o caused by repetitive tension or a sudden increase of repetitive activities
o thickening/swelling of sheath & tunnel of the tendons of the
 abductor pollicis longus
 extensor pollicis brevis
o 3-5x greater in women during pregnancy or menopause

o signs & symptoms
o repetitive ulnar deviation
 increased pain
o pain & swelling at radial styloid process
o pain & decreased ROM at the thumb
o pain when making a fist
o + Finkelstein’s test

A

De Quervain’s Tenosynovitis

169
Q

the following is conservative management of what pathology?

o NSAIDS
o Wrist/thumb immobilization
o Eliminate any activity that causes pain
o Ice
o Ionto/phono
o PROM progressing to AROM when pain free
 Emphasize concentric & eccentric
o PT for joint mobs if indicated
o Surgical decompression for chronic cases
o Post-op mobilization for 1 week
o If conservative tx fails
 Injection of the 1st dorsal compartment

A

De Quervain’s Tenosynovitis

170
Q

which pathology is being described?

o Most common fx at the wrist (FOOSH fall)
o Fall on the palmar side of hand & bone gets pushed to dorsal side of wrist

o Rehab
- Gentle, active PAIN-FREE ROM after immobilization with x-ray confirmation of secure bone healing
- Control edema
- Encourage soft tissue extensibility
- No resistive exercise until secure bone union (may be up to 8 weeks)
- Rehab may last up to 1 year

A

colles fracture

171
Q

which pathology is being described?

o Reverse colles fracture
o Fall on the dorsal side of hand & bone gets pushed to palmar side of wrist
o Rehab is similar to colles fx

A

smith’s fracture

172
Q
  • most common fracture in carpal bones
  • injury due to wrist extension
  • Rehab
    o Displaced: ORIF with rigid immobilization
    o Length of time to heal is LONG (be cautious with rehab)
    o Gliding of the wrist & finer muscle
    o DO NOT STRESS motions that cause pain
    o Light strengthening
    o Gradual return to closed chain exercise
    o May have patient in Spica splint between exercise session
    o Return to activities 12 weeks after cast is removed
A

scaphoid fractures

173
Q

is the following a stable/non-displaced or proximal pole scaphoid fracture?

closed reduction with cast for 6 weeks

A

stable/non-displaced fracture

174
Q

is the following a stable/non-displaced or proximal pole scaphoid fracture?

closed reduction with cast for 12-24 weeks

A

proximal pole fracture

175
Q

what pathology is being described?

o Affects the palmar fascia
o Affect is bilateral (45% involve the ulnar digits)
o Not usually painful
o 20–30-degree contracture at MCP joint (indication for surgical intervention)
o Unable to flatten hand onto table

o Surgical approaches
o Fasciotomy
o Regional fasciectomy
o Extensive fasciectomy
o Dermofasciectomy

o Patient treatments
o Wound care
o Splinting to allow flexion (limits full extension at the MP)
o CHT designs/makes splints during rehab process
o Watch for signs of CRPS

A

Dupuytren’s Contractures

176
Q

what pathology is being described?

o Gradual onset usually after some type of injury/painful lesion
o Most often seen in women 30-55
o Higher incidence in smokers
o Most commonly occurs after fx of distal radius & ulna

  • 2 types
  • 3 stages
  • Signs & symptoms
    o Pain: out of proportion to injury
    o Trophic skin changes
    o Autonomic disturbances
    o Loss of mobility & function
    o Edema
A

CRPS (Complex Regional Pain Syndrome)

177
Q

is the following type l or type ll CRPS?

o Develops after an initiating noxious event
o Spontaneous pain or allodynia/hyperalgesia
o Edema/vascular changes
o Non-nerve origin
o Abnormal sudomotor activity

A

type l

178
Q

is the following type l or type ll CRPS?

o Develops after nerve injury
o Not limited to territory of nerve injury
o Edema/skin blood flow abnormality
o Abnormal sudomotor activity

A

type ll

179
Q

which stage of CRPS is being described?

o Acute/reversible
o Lasting 3 weeks- 6 months
o Pain
o Edema
o Excessive sweating
o Discoloration (red)
o Temperature changes
o Rapid nail growth

A

stage l

180
Q

which stage of CRPS is being described?

o Dystrophic/vasoconstriction
o Lasts 3-6 months
o Pain/edema increase
o Burning pain
o Skin dries
o Atrophy
o Sympathetic hyperactivity
o OP may develop
o Skin mottling & coldness

A

stage ll

181
Q

which stage of CRPS is being described?

o Begins 6months – 1 year post injury
o Atrophic stage
o Severe atrophy
o Inelastic fibrous tissue
o Pain can decrease or become worse
o Overall condition can last for months or years
o Spontaneous recovery can occur between 18-24 months

A

stage lll

182
Q

the following treatment parameters are for what pathology?

o Initiate Rx as soon as Dx is made
o Reduce pain/swelling
o Eliminate pain-producing things
o TENS, massage, heat
o Protection of area
o Patient education
o Compression wraps (if tolerable)
o Active exercised as long as it doesn’t increase pain
o Desensitization (brief periods 5x a day)
o Address psychological component

A

CRPS (Complex Regional Pain Syndrome)

Ortho (5 decks)

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