Module 6-Elbow, Wrist, Hand Flashcards
What two joints make up the elbow?
Humeroulnar and Humeroradial Joints
What actions happen at the elbow?
Flexion and Extension
What makes the wrist?
Radias
Where do the wrist flexors and wrist extensors attach too?
Wrist flexors-Medial Epicondyle
Wrist Extensors-Lateral Epiconydle
What ligament is considered the “Seatbelt” holding the head of the radius in against the Ulna?
Annular Ligament
Is the Olecranon burse deep or superficial to the olecranon process?
Superficial
What is the only blood supply to the hand?
Brachial Artery
What joint makes the wrist?
Radiocarpal Joint ( Radias and Proximal row of Carpals)
Acronyms for carpal bones (Lateral to Medial)
Some- Scaphoid
Lovers-Lunate
Try-Triquetrum
Positions- pisiform
That-Trapezium
They-Trapezoid
Can’t-Capitate
Handle-Hamate
What is another term for elbow?
Cubital
What is the normal “Carrying Angle” in the elbow, for women and men?
Women-10-15 Degrees
Men-5-10 Degrees
What condition is identical to carpal tunnel syndrome?
Pronator Teres Syndrome
What conditions compresses the median nerve?
Pronator Teres Syndrome and carpal tunnel syndrome
What runs through the carpal tunnel?
9 flexor tendons and median nerve
Capsular pattern of the elbow
Flexion more than extension
Capsular pattern of the wrist
Pronation more than supination
Which side of the forearm do the wrist extensors attach too?
Posterior/Lateral Side
What side of the forearm do the wrist flexors attach to?
Anterior/Medial Side
Brachialis Origin and Insertion
Origin: The distal half of the anterior surface of the humerus
Insertion: Tuberosity and Coronoid process of the ulna
Pronator Teres Origin and Insertion
Origin: Common Flexor tendon of the medial epicondyle of the humerus and the coronoid process of the ulna
Insertion: Middle of lateral surface of the radius
Actions of the Pronator Teres
1.Assist to flex the elbow humeroulnar joint
2.Pronates the wrist at the radioulnar joint.
Innervated: Median Nerve
What is the Mill’s Test testing for?
Wrist Extensor tendonitis/Tendonosis, or lateral epicondylitis (tennis elbow).
What actions happen at the proximal and distal radioulnar joints?
Pronation and Supination
What is the only blood supply to the hand?
Brachial Artery
What does the brachial artery split into?
radial and ulnar arteries
What type of joint is the Humeroulnar joint?
Synovial Hinge Joint
What type of joint is the proximal Radioulnar Joint?
Synovial Pivot Joint
What type of joint is the proximal Radiocarpal Joint?
synovial ellipsoid (condyloid)
What’s another word for “Upper Arm”?
Brachium
What is Elbow Hypomobility?
Loss or decrease of motion at a joint
What is Elbow Hypermobility?
Increased motion available at a joint
Joint laxity within joint capsule or ligaments
What is hypermobility of joints also called?
Double Jointed or Loose Joints
Lateral Epicondylitis is also called what?
Tennis Elbow
What is Lateral Epicondylitis?
Chronic Collagen degeneration in extensor tendons at the lateral epicondyle of the humerus.
What muscle does Lateral Epicondylitis affect the most?
Extensor Carpi Radialis brevis- Microtearing- because it is the most common due to line of pull-no pain at night.
Treatment techniques for Lateral Epicondylitis
- Warm up tissues- MFR, TRPS, lengthening
- identify adhesions in common flexor tendons and only treat 1-2 per session
- Cross Fiber Friction small section per session, 6 or more deep strokes
- Stretch Extensors
- Ice-Immediately - teach self massage
What is Medial Epicondylitis?
Chronic Collagen degeneration in wrist flexors at the medial epicondyle of the humerus.
What muscle does Medial Epicondylitis affect the most?
Pronator Teres-Due to coordinated effort with the wrist flexors and the proximity of the attachment site
What is medial Epicondylitis also referred as?
Golfer’s Elbow
What is Pronator Teres Syndrome?
Compression of the median nerve as the median nerve passes between the two heads of the pronator Teres- Identical to carpal Tunnel Syndrome
Treatment for Pronator Teres Syndrome?
- Treat HT in flexor group
-pin and stretch pronator Teres
-Deep stripping, active engagement, compression broadening
-Treat for both pronator teres and carpal tunnel
Explain the cubital tunnel
The cubital tunnel is the space between the two heads of the flexor Carpi Ulnaris.
What is cubital tunnel syndrome?
The compression of the ulnar nerve between the heads of the flexor carpi ulnaris (FCU) or aponeurotic band hat connects the two heads.
Treatment of cubital tunnel syndrome
-Reduce Hypertonicity in FCU and wrist flexors
-treat tissue along nerve pathway
-Stretch and mobilize ulnar nerve (same as ULTT4 Position)
-Stretch wrist flexors
-heat to reduce pain and hypertonicity
What contraindications are for Cubital Tunnel Syndrome?
ice- may damage ulnar nerve
no increased deep work on cubital tunnel syndrome
Treatment of carpal tunnel:
- Warm up- MFR, TRIGGER POINTS
- Treatment of trigger points in subscapularis and scalenes
- treatment of swelling- ice therapy, lymph drainage
- Deep stripping flexor group, brachioradialis, pronator teres
- treatment of flexor retinaculum
- Stretch
What does radial tunnel syndrome affect?
Terminal motor branch called the posterior interosseous nerve (PIN)
aka, resistant tennis elbow, often mistaken for lateral epicondylitis.
Treatment of Radial Tunnel Syndrome
-Reduce nerve compression: pin and stretch supinator
-Reduce Hypertonicity in muscles compressing nerves- stripping and broadening on wrist and finger extensors and supinator
-Stretch extensors and supinator
What is Guyon’s Canal Syndrome also called?
Ulnar Tunnel Syndrome- Compression of Ulnar nerve
True or False: There are no tendons in the Guyon’s Canal
True- No tendons run through Guyon’s Canal
What is a treatment for Guyon’s Canal?
Reduce Activity, surgical, wrist splints, compression broadening on the wrist flexors, deep stripping, ice to reduce inflammation
What is De Quwevain’s Tenosynovitis?
Tenosynovitis of two tendons and their sheth in the anatomical snuff box of wrist.
What muscles are affected in De Quervain’s Tenosynovitis?
Abductor pollicis longus and Extensor Pollicis brevis.
A client with swan neck deformity can most likey not do what?
Make a fist- Severe loss of function caused by contracture of intrinsic muscles of hand.
What fingers are mostly commonly affected with Dupuytrens Constracture?
MCP and IP joints of the fourth through fifth fingers
What is Dupuytren’s Contracture?
Contracture affected palmar surface of the hand resulting in a deformity of the fingers, where they are in a flexed state. Nodules appear, no inflammation present. slow progression. tends to be bilateral
What are the different types of Polio?
Spinal Polio
Bulbar Polio: rare and most serious
Non-Paralytic polio: flu like symptoms, meningeal irritation
Capsular pattern for the elbow and forearm:
-Flexion more than extension
-Pronation more than supination
Reflex Testing for elbow and forearm:
Biceps Reflex
Brachioradialis Reflex
Triceps Reflex
