MSK Flashcards
Ulnar Collateral Ligament (medial) tear elbow
restricts valgus stress
MOI: excessive valgus force
s/s: pain, TOP, effusion, < ROM, instability, “pop”
special test: valgus stress test
intervention: reduce pain/swelling, bracing, strengthen forearm flexors/pronators, restore ROM
Nursemaids elbow
subluxation of radial head children 1-4, annular ligament tear
MOI: longitudinal traction with wrist pronation
s/s: refusal to move arm, held against body in slight flexion
Olecranon bursitis
inflammation of bursa
MOI: trauma, pressure, infection
s/s: swelling, redness
interventions: ice, compression, NSAIDS, cortisone injection, aspiration, antibiotics, bursectomy
lateral epicondylitis (tennis elbow)
degenerative changes/inflammation commonly at ECRB tendon of lateral epicondyle (common extensor tendon)
MOI: repetitive use, heavy ball/racquet, load > capacity for recovery
s/s: aching pain lateral epicondyle to proximal forearm extensor muscle mass, insidious, TOP, pain resisted wrist extn/gripping, pain wrist extn stretch
special tests:
cozens - resisted wrist extn with pronation + radial deviation
mills - passive wrist flexion + pronation with elbow extension
maudsleys - 3rd finger extn
interventions: eccentric wrist extn strengthening, stretching, counterforce brace, cross-frictions, mobilizations, pain modalities, reduce inflammation (cortisone, NSAIDS)
medial epicondylitis (golfers elbow)
degenerative/inflammation to wrist flexor tendons at medial epicondyle (common flexor tendon), PRONATOR TERES, FCR tendon
MOI: repetition, load > capacity
s/s: aching pain medial epicondyle to proximal forearm flexor muscle mass, insidious, TOP, pain resisted wrist flexion/forearm pronation/gripping, flexion stretching
special tests:
med epic. (reverse mills): passive wrist extension stretch, resisted pronation/flexion at wrist
interventions: eccentric wrist flexion strength, stretching, counterforce brace, cross-frictions, mobilizations, pain modalities, reduce inflammation (cortisone, NSAIDS)
anterior interosseous nerve syndrome
median nerve branch entrapment between two heads of pronator teres muscle
MOI: forearm fracture
s/s: pinch deformity (motor nerve injury)
interventions: nerve mobilizations, NSAIDS, cortisone
cubital tunnel syndrome (elbow)
entrapment of ulnar nerve at cubital tunnel between two heads of the flexor carpi ulnaris
special tests:
cubital tunnel compression test, tinnels tap at elbow (cubital tunnel), elbow flexion test (90/90 at elbow + hold like ULTT)
interventions: nerve mobilizations, NSAIDS, cortisone
radial tunnel syndrome
entrapment of posterior interosseous nerve
interventions: nerve mobilizations, NSAIDS, cortisone
Colles fracture
distal radial fracture with dorsal displacement
complications: median nerve compression, CRPS, arthritis
MOI: FOOSH injury, osteoporotic women
s/s: dinner fork deformity
interventions: spica brace, mobilization above/below, strengthening
**no pronation/supination ROM
CRPS
chronic pain disorder by SNS malfunction pain>stimulus
s/s: allodynia, hyperalgesia, burning pain, abnormal blood flow, abnormal sweating, stiffness (hallmark sign), edema, mottled skin, nail/hair growth, shiny tight skin, osteoporosis
days/weeks after injury
pain, hyperhydrosis, warmth, erythemia, rapid nail growth, edema distal extremity
stage 1 (acute/reversible)
3 to 6 months after injury
burning pain, sympathetic hyperactivity, hyperesthesia to cold weather, mottling and coldness, brittle nails, osteoporosis
stage 2 (dystrophic or vasoconstriction (ischemic) stage)
6 months to 1 year after injury
pain decreasing or increasing, severe osteoporosis, muscle wasting, contractures
stage 3 (atrophic stage)
CRPS interventions
education, TENS, mobility, ADL encouragement, desensitization. RICE, mirror therapy, avoid passive treatments
de quervains tenosynovitis
painful inflammation of sheath around tendons of thumb (abductor pollicis longus + extensor pollicis brevis)
MOI: chronic overuse, repetitive use wrist/thumb movements - golfing, carpentry, gripping, pinching
s/s: radial sided wrist pain, tenderness, swelling, pain stretching/contraction of EPB+APL
special tests: finkelstein test
interventions: activity modification, cryotherapy, thumb spica, gradual stretching/strengthening, NSAIDS, cortisone
Muscle innervation of median nerve
Lumbricals 1 + 2
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Radial nerve muscle innervation
Brachioradialis
Extensors of wrist
Supinators
Triceps (anconeus)
Ulnar nerve muscle innervation
Adductor pollicis
lumbricals 3 + 4
hypothenar muscles - flexor digiti minimi, opponens digiti minimi, palmaris brevis
interossei muscles - PAD (palmar adductors), DAB (dorsal abductors)
median nerve palsies
APE hand (low level lesion - carpal tunnel)
inability to abduct thumb - opposed muscles
HAND OF BENEDICTION (high level lesion)
inability to flex D1-D3 - will remain in extn when making a fist
ulnar nerve palsy
CLAW HAND
hyperextension of MCP and flexion of IP joints D4-5
unopposed muscles
radial nerve palsy
WRIST DROP
inability to extend the wrist or MCP joints
muscles are unopposed (BEST)
what makes up the carpal tunnel
carpal bones (floor)
flexor retinaculum (roof)
*9 tendons: flexor pollicis longus, 4 tendons of the flexor digitorum profundus, 4 tendons of flexor digitorum superficialis
median nerve
carpal tunnel risk factors/populations
insidious onset, repetitive stress, associated conditions (RA + inflammatory conditions), colles #, lunate subluxation, pregnancy, hypothyroidism, DM, obesity
carpal tunnel s/s
paresthesia median nerve distribution (palmar - 1, 2, 3, half ring finger)
increasing pain with repetitive hand movements, nocturnal pain/numbness, relieved by “flicking wrist”, weakness in grip strength, severe = atrophy of thenar eminence + 1/2 lumbicals