MSK Conditions of the UE Joints Flashcards
What are common complaints for pain with lateral elbow tendinopathy?
What are the risk factors for lateral elbow tendinopathy?
- Pain over lateral epicondyle with wrist extensor load
- pain w/ resisted wrist 2nd or 3rd digit extension
- pain with wrist extensor stretch
- pain w/ grip
Risk Factors:
- 35-54 yrs old
- manual labor
- smoking
- tennis players
What is the pathophysiology for lateral elbow tendinopathy?
How do you treat reactive and degenerative tendon pathology for lat. elbow tendinopathy?
Ext. Carpi Radialis brevis degeneration- merges with LCL and annular ligament and is not inflammatory
Reactive (due to unusual or increased activity load) is treated with reducing or modifying the load on the tendon
Degenerative (more chronic symptoms) is treated with eccentric exercised
If there is a tear in tendon or LCL tear surgery may be indicated, also may be indicated if conservative care fails after 6 months
True or False: Corticosteroids combined with PT have been shown to have better benefit then with PT or injection by themselves
False, corticosteroid shots give very short term benefit as far as pain but actually do not address the tendinopathy and has no added benefit when combined with PT
and PT w/o steroids injection has the lowest 1 yr recurrence and has a 100% complete or much improvement rate
What PT interventions have been shown to be beneficial for Lat. elbow tendinopathy?
- mobilization w/ movement
- strengthening of wrist extensors (con and eccentric)
- wrist manipulation
- treat the impairments
- regional interdependence (shoulder and c-t spine)
What is radial tunnel syndrome?
What are the signs and symptoms?
What is the recommended treatment for RTS?
Compression of the deep branch of the radial nerve via compression at proximal border of supinator/ arcade of frohse
- pain lateral forearm (ro consider C6/7 radicular pain)
- pain w/ wrist, 2nd or 3rd digit extension
- no overt weakness, if weakness is present then consider posterior interosseus nerve entrapment (r/o C6/7 radiculopathy) ((PIN is purely motor)
consider radial nerve mobilization, in addition to addressing lateral elbow pain w/ treatment
What is posterolateral rotary instability?
What are common MOI for this condition?
What are the signs and symptoms?
Varus instability or Lateral UCL complex disruption
- acute trauma
- result of chronic corticosteroid injections
- chronic UE weight bearing
- connective tissue disorders
SxS
- unrestrained supination (radial head dislocates posterior with full/excessive supination)
- clicking, snapping; instability sensation in extension and supinated position
What is the pathology for radiocapitellar injuries?
How do you evaluate and manage this injury?
radiocapitellar compression injury that is associated with throwing injuries secondary to medial instability and usually effects children and adolescents
evaluate for valgus stress and address medial instability
What is the pathology of medial elbow instability?
injury to the UCL, primarily the anterior band from throwing/valgus stresses
- rarely assoc. w/ ADLs
- pop followed by sudden pain, tearing, change in throwing velocity or accuracy
What exam findings would indicate medial elbow instability?
What is typical treatment for this instability?
What population must be aware of epicondylar apophysitis with medial elbow instability?
- positive valgus tests, possibly loss of elbow extension
- positive tenderness along UCL
- possible ulnar nerve involvement
usually reqiures surgery
adolescents due to skeletal immaturity
What are the signs for an Ulnar nerve/ cubital tunnel injury?
- sensory deficits in medial palmar/dorsal hand
- weakness of FDP and lumbricals (D4, D5) and interossei
- positive tinel’s test
- positive hyperflexion test
- r/o C8/T1 radiculopathy
What are the signs of an acute fracture of the elbow?
- loss of extension
- occurs due to rapid hemarthrosis
- inability to extend elbow very shortly after injury (suspect fracture)
(very sensitive test to rule out fracture if no loss of extension is present)
What MOI commonly leads to a radial head fracture?
What is common treatment for this injury?
FOOSH
immobilization if non-displaced
What is a nightstick fracture?
What is a monteggia fracture?
fracture at the midshaft of the ulna
fracture of the proximal ulna with a dislocation of the radial head
What is the cause of myositis ossificans in the elbow?
What muscles are most at risk with MO?
What are the different types of rehab for MO?
contusion, fracture or too aggressive of rehab
brachialis and triceps brachii
conservative: Gentle ROM, ice (no heating agents)
surgical: if ROM remains restricted after conservative care, however high recurrence
What is Dupuytren’s contracture?
What can it progress into?
Where does it occasionally present besides the hand?
-palmar fascia dimpling/puckering the skin with visible raised cord or nodules along the flexor tendons
progresses to causing flexion contractures
plantar fascia and in the penis
How can you clinically assess for Dupuytren’s contracture?
What are the treatment options for this contracture?
- palpation to the cords or nodules for pain assessment
- AROM/PROM measurements to assess contractures vs. lag
- sensory testing- digital nerve involvement
Medical-surgical dermofasciectomy, xiaflex injection, or needle aponuerotomy
PT- soft tissue mobilization and stretching, night resting orthosis, post-op care (wound, orthosis and movement)
What is trigger finger?
How would you clinically assess trigger finger?
- stenosing flexor tenosynovitis
- flexor tendon enlarged at the A1 pulley
- locking or popping occurs upon finger flexion/extension
Clinical assessment:
- palpation to the flexor tendon at the A1 pulley
- AROM and PROM of the finger
- test for functional limitations
What are the treatment options for trigger finger?
Orthosis-single joint immobilization (MPjt or PIPjt) used full time for 6-12 wks
Movement- stretching, AROM, and tendon gliding
Medical Intervention- Injection and/or surgical release
What type of injury is gamekeeper’s thumb/skier’s thumb?
What trauma is associated with this injury?
Injury to the UCL at the MPjt and instability at MPjt upon lateral stress
Stenor lesion or avulsion fracture
How can you clinically assess for a UCl injury to the thumb?
- palpation to the UCL
- assess tip pinch strength and integrity
- imaging such as MRI, diagnostic US, and radiographs
What tests would indicate a complete tear of the UCL of the thumb?
What treatment options are there for a UCL injury?
when during a UCL stress test:
- Valgus motion is greater than 35 degress or 15 deg. greater than contralateral side
- Absense of a firm endpoint with valgus testing
Conservative PT:
- weeks 0-4=immobilization
- week 4 AROM of MP joint
- week 6 light use without orthosis
- week 10-12 no forceful pinching
- week 12 begin heavy use
Surgical repair: rehab protocol
What are some signs of OA at the base of the thumb?
How can you clinically assess for OA of the thumb?
- pinching is painful
- ligament laxity
- deformity
Clinical Assessment:
- Palpation of volar and dorsal CMC joint
- AROM of the thumb
- Pinch-lateral and tip pinch
- observation/movement
- radiographs do not correlate with pain!
What are treatment options for OA at the base of the thumb?
- Orthosis management for stabilization (effective for reducing pain but only slightly improves function)
- adaptive devices and joint protection
- stabilization exercises
- restore motion
- surgical joint replacement
What is de Quervain’s Tenosynovitis?
What is the common MOI?
Stenosis of the EPB and APL at the first dorsal compartment
MOI:
- maintaining static ulnar deviation while engaging the thumb extrinsic tendons
- repetitive thumb CMC joint flexion and extension, or wrist radial and ulnar deviation
How can you clinically assess for de Quervain’s Tenosynovitis?
- TTP at the 1st dorsal compartment
- Wrist RD/UD AROM limitations
- Thumb flex/ext AROM limits
- localized inflammation
- radial nerve mobility
- Finkelstein’s Test
- Eichhoff’s test
What are the treatment options for de Quervain’s Tenosynovitis?
- thumb spica orthosis
- activity analysis and modification
- manual therapy
- AROM, PROM, resistance
- modalities for pain and edema
- cortisone injections
- surgical release of the 1st dorsal compartment
What are the two types of TFCC injuries?
How can you clinically assess for a TFCC injury?
Type 1- injury from trauma such as FOOSH
Type 2- repetitive wear and tear
Clinical Assessment:
- localized pain complaints in the ulnar side of the wrist
- ulnar deviation provokes symptoms
- assess integrity of the DRUJ
- TFCC compression test
- Weight bearing test
What are the treatment options for a TFCC injury?
- rigid orthosis to restrict wrist and forearm (DRUJ)
- rest for 4-6 wks then begin AROM
- strengthens at 8 wks
- wrist widget
- surgical arthroscopy/debridement
What is a scapholunate dissociation injury?
What are common causes for this injury?
How might this injury present on medical imaging?
a ligamentous injury between the scaphoid and the lunate
MOI:
- acute FOOSH injury
- degenerative OA
imaging shows a gap at the S-L ligament
How can you clinically asses for a scapholunate dissociation injury?
- palpate the S-L ligament
- Wrist AROM
- test grip strength
- reproducible click in the wrist
- symptoms increase with pushing off the palm
- positive shift test (pain w/ the scaphoid shift is significant to diagnose scaphoid instability)
What are the treatment options for scapholunate dissociation injuries? (for full or partial tears)
If partial tear:
- immobilization
- FCR isometrics
- delay grip strengthening
- regain AROM with ‘dart thrower’s motion’
- proprioception
If complete tear:
- repair of S-L lig
- reconstruction
