Orthopedic Conditions of UE part 2 Flashcards

1
Q

Orthopedics Conditions of the Elbow

  1. Lateral Epicondylitis
  2. Medial Epicondylitis
  3. Little League Elbow
  4. Osteochondritis
    Dissecans
  5. Myositis Ossificans
  6. Heterotrophic Ossification
  7. Olecranon Bursitis
  8. Elbow Dislocation
  9. Pulled Elbow
  10. Volkmann’s Ischemic
    Contracture
  11. Ulnar and Radial Nerve
    Injuries
A

Orthopedics Conditions of the Elbow

  1. Lateral Epicondylitis
  2. Medial Epicondylitis
  3. Little League Elbow
  4. Osteochondritis
    Dissecans
  5. Myositis Ossificans
  6. Heterotrophic Ossification
  7. Olecranon Bursitis
  8. Elbow Dislocation
  9. Pulled Elbow
  10. Volkmann’s Ischemic
    Contracture
  11. Ulnar and Radial Nerve
    Injuries
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2
Q

Lateral Epicondylitis

Caused by: ___________________________
Aka: ___________________________
MOI: ___________________________
Muscles involved: ____>____>____>____>____

S/sx: ___________________________

: ____________
: pain with ____________ & ____________
: ____________

Orthosis: ____________
DDx: ____________ v.s. ____________

A

Caused by: repetitive microtrauma to the origin of wrist extensor muscles
Aka: Tennis Elbow
MOI: inexperienced backstroke
Muscles involved: ECRB>EDC>Brachiorads>ECRL>ECU

S/sx: aching pain at lateral epicondyle

: ↓ elbow ROM
: pain with AROM & PROM
: Pain & weakness in wrist & hand may develop

Orthosis: FA band
DDx: Lat Epi v.s. Radial Tunnel Syndrome

  1. Lateral Epicondylitis
    - DDx: Lat Epi vs Rad Tunnel Synd
    Apply pressure at Lat Epicondyle
    If decreased pain = Tennis elbow – de-loading technique
    De-loading the tendon
    If increased pain = Radial syndrome – impinging
    Special Test
    Method 2 (Mill’s) Will You Marry Meills
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3
Q

Special tests for Lateral Epicondylitis

  1. 2.
    3.
A
  1. Method 1 (Cozen’s)
  2. Method 2 (Mill’s)
  3. Method 3 (Maudsley’s)
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4
Q

Method 1 (Cozen’s)

Procedure:
(+):
Indication:

A

❑ Stabilize at lat epi
❑ Px FA pronation, wrist ext
& RD while PT resists
❑ Active
❑ (+): pain at lat epi

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5
Q

Method 2 (Mill’s)

Procedure:
(+):
Indication:

A

❑ Palpate lat epi
❑ Elbow ext, FA pronation,
Wrist flex
❑ Passive
❑ (+): pain at lat epi

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6
Q

Method 3 (Maudsley’s)

Procedure:
(+):
Indication:

A

❑ PT resist ext of 3rd distal
phalanx
❑ Test: EDC ms & tendon

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7
Q

Medial Epicondylitis

Aka: ____________
MOI: ____________
Muscles involved: ____________
Signs and symptoms:
Pain with ____________& ____________
Pain with ____________ as well in severe injuries
Point tenderness and mild swelling at the ____________
Tx: ____________

A

Aka: Golfer’s/ Medial Tennis/ Swimmer’s Elbow
MOI: repeated wrist flex c valgus force on the elbow
Muscles involved: wrist flexors & FA pronators
Signs and symptoms:
Pain with AROM & PROM
Pain with wrist flexion as well in severe injuries
Point tenderness and mild swelling at the medial epicondyle
Tx: Curvilinear brace below the elbow to reduce stress at the elbow jt

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8
Q

Little League Elbow/Pitcher’s Elbow

D/t repetitive valgus stress (young): microtrauma from
throwing motions
Presentation: ____________
Onset: ____________
Other s/sx: ____________,
____________, ____________ or ____________, ____________
esp in FA ____________ & ____________

MNEMONIC: CAVSMCL

Throwing activities: postpone for ____________
May lead to: ____________

A

D/t repetitive valgus stress (young): microtrauma from
throwing motions
Presentation: pain at medial epicondyle
Onset: slow/gradual
Other s/sx: slight flexion contracture, tight ant capsule,
weakness in triceps, locking or catching sensation, ↓ ROM
esp in FA pronation & supination

MNEMONIC: CAVSMCL

Throwing activities: postpone for 1 year
May lead to: OCD → AVN

Little League Elbow/Pitcher’s Elbow
“CAVS MCL”
Compression fracture HR jt.
Avulsion fracture medial epi
Valgus stress of the elbow
Stressed epicondylar growth plate
MCL stretched/tear

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9
Q

Osteochondritis Dissecans

____________ → ____________ → ____________ & ____________
MOI: ____________
MC: ____________ – If AVN = ____________

A

Impaired blood supply at bone underneath the cartilage → articular
cartilage degeneration → formation of loose bodies & AVN
MOI:repetitive trauma
MC: Capitulum – If AVN = Panner’s Dse

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10
Q

Myositis Ossificans

Cause: ____________
____________ & ____________
(+): ____________
MC involved: ____________
Usually occurs after injury: ____________, ____________, ____________

S/sx: ____________ & ____________, ____________, ____________

CI: ____________
Best Mx: ____________ = allow ____________ before ____________

A

D/t aggressive mobilization of elbow ff
dislocation (post) & supracondylar Fx
(+): Ca deposits in ms belly
MC involved: Brachialis
Usually occurs after injury: post elbow
disloc, brachialis tear, lower humerus Fx
S/sx: painful stretch & resistance, palpable
mass, flex contracture

CI: vigorous PT (massage & strenuous exercise)
Best Mx: just IMMOB (splint in pain free ROM) bec NO SURGERY in early
stage = allow 6-12 mos before aspiration

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11
Q

Heterotopic Ossification

Ectopic bone formation
MOI: ____________ (____________)

MC affects: ____________

CI: ____________ (____________& ____________)
Mgt: ____________
Meds: ____________

A

Ectopic bone formation
MOI: formed ff trauma (Fx, disloc, burn, or head
trauma)

MC affects: elbow>hip>Sh in burn px
“bony block” -> LOM

CI:vigorous PT (massage & strenuous exercise)
Mgt: Just IMMOB (splint in pain free ROM)
Meds: Disodium Etidronate

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12
Q

Olecranon Bursitis

Aka: Student’s, Miner’s, Draftsman
Caused by: ____________
Pt c/o: ____________
S/Sx: “____________”
____________

Mgt: ____________, ____________, ____________

Acute: ____________
Chronic: ____________
If conservative mgt fails - ____________

A

Aka: Student’s, Miner’s, Draftsman
Caused by: infection, prolonged repetitive trauma
Pt c/o: post elbow pain
S/Sx: “Goose Egg Appearance”
Pain, swelling, & point tenderness
Swelling will appear almost spontaneously s the pain & heat

Mgt: compression, US, FES

Acute: compression for at least 1 hr
Chronic: compression + therapy
If conservative mgt fails - aspiration

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13
Q

Elbow Dislocation

MOI: ____________
MC direction: ____________ and ____________, ____________, ____________, ____________
____________& ____________ nerves may be compromised
Blood vessels may be compromised
Terrible Triad:
1. ____________
2. ____________
3. ____________
Tx: ____________
____________

A

MOI:FOOSH or severe twisting of a flexed elbow
MC direction: Posterolateral
Signs and Symptoms
Swelling, severe pain, disability
Median & radial nerves may be compromised
Blood vessels may be compromised
Terrible Triad:
1. Radial head Fx (often involved)
2. Coronoid process Fx
3. Ruptured collateral ligaments
Tx: repair ligaments, ORIF of Fxc plates & screws,
NO elbow extbeyond 30 deg for 1 mos

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14
Q

Pulled Elbow

Aka: ____________
MOI: ____________ &____________
LOM: ____________

____________ disloc of ____________
Assoc c ____________Fx d/t ____________

A

Aka: Nursemaid’s elbow
MOI: forceful pull on child’s extended
&_pronated arm causing Inf subluxation
of the radial head from the annular
ligament
LOM: supination d/t pain & mechanical
locking

Proximal disloc of radial head
Assoc c Colle’s Fx d/t FOOSH

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15
Q

Volkmann’s Ischemic Contracture

MOI: ____________, which compromises the ____________
and inhibits circulation to ____________

Most important Sx: ____________
S&Sx:
1. ____________
2. ____________
3. ____________
4. ____________

Dx: ____________

N = ____________
(+) = ____________

Tx: decompressive fasciotomy, immediate reduction of Fx, cast
must allow swelling

A

MOI: impaired circulation or ischemia
Supracondylar Fx, which compromises the brachial artery
and inhibits circulation to forearm
Most important Sx:severe pain accentuated by stretch
S&Sx:
1. Pain in FA which ↑ c PROM finger ext
2. Cessation of brachial and radial pulses
3. Coldness in arm
4. Decreased ROM

Dx: Manometer (intercompartmental pressure)

N = <15mmHg
(+) = 30-40mmHg

Tx:decompressive fasciotomy, immediate reduction of Fx, cast
must allow swelling

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16
Q

Ulnar Nerve Injury

  1. 2.
A
  1. CUBITAL TUNNELSYNDROME
  2. Tardy Ulnar Palsy
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17
Q

CUBITAL TUNNELSYNDROME
* ____________
* Compressed at: ____________,
____________, or ____________
* S&Sx:
o ____________
o ____________
o ____________
o ____________

A
  • Highest point where the ulnar nn can be injured
  • Compressed at: Arcade of Struthers,
    Osborne Fascia, or 2 heads of FCU
  • S&Sx:
    o Pain on medial aspect of elbow
    o Point tenderness in cubital tunnel
    o Pain with hyperflexion
    o Intermittent paresthesia in 4th and 5th fingers
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18
Q

Tardy Ulnar Palsy
* ____________
onset of ulnar neuropathy
* ____________

A
  • Chronic condition characterized by delayed
    onset of ulnar neuropathy
  • Injury from olecranon Fx
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19
Q

CUBITAL TUNNELSYNDROME
Special Test:

  1. Elbow Flexion Test
  2. Tinel’s
  3. Wartenbergs
A
  1. Elbow Flexion Test:(most sensitive)
    Px actively holds elbow in full flex for 3-5 mins
    (+): tingling
  2. Tinel’s – tapping bet the olecranon process
    & medial epicondyle
    (+): tingling → regeneration
  3. Wartenbergs – passively spread fingers apart
    & ask px to bring fingers together
    (+) inability to squeeze little finger
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20
Q

Check Drive Ulnar Nerve Injury

A

Check Drive Ulnar Nerve Injury

21
Q

Radial Nerve Injury

Radial Nerve Levels of Entrapments

  1. Axilla
    ❑________ Crutch Palsy
    ❑Too much weight ____________
    ❑____________ are affected
    ❑(+) ____________
  2. Spiral Groove
    ❑Aka: Honeymoon’s/ Saturday’s Night/ Tourniquet
    ❑Spared: ____________& ____________
    ❑____________
  3. Arcade of Frohse
    ❑ Aka: ____________/ ____________/
    ❑ Deep branch of ____________
    ❑ Pure v
    ❑ (+): ____________
    ❑ If no wrist drop ____________
  4. Superficial Branch
    ❑ Aka: Cheiralgia Paresthetica/ Wartenburg
    ❑ Under the ____________
    ❑ Pure sensory deficit at ____________
    thumb, dorsal 1st WS
    ❑ Wrist level: ____________
A

Radial Nerve Injury

Radial Nerve Levels of Entrapments

  1. Axilla
    ❑ Chronic Crutch Palsy
    ❑Too much weight bearing on the crutch
    ❑All innervations are affected
    ❑(+) weakness of triceps, loss of sensation in post arm,
    FA, & hand
  2. Spiral Groove
    ❑Aka: Honeymoon’s/ Saturday’s Night/ Tourniquet
    ❑Spared: Triceps & Anconeus
    ❑↓ sensation starting at post FA down to hand
  3. Arcade of Frohse
    ❑ Aka: Radial Tunnel/ Supinator/ PIN Syndrome
    ❑ Deep branch of radial nn
    ❑ Pure motor deficit
    ❑ (+): weakness of the hand
    ❑ If no wrist drop (ERCB intact) – PIN “Palsy”
  4. Superficial Branch
    ❑ Aka: Cheiralgia Paresthetica/ Wartenburg
    ❑ Under the brachiorads
    ❑ Pure sensory deficit at dorsal wrist, dorsal
    thumb, dorsal 1st WS
    ❑ Wrist level: NO weakness
22
Q

Active Papal
Procedure: ____________
(+): Papal sign - ____________lat half of FDS, FDP cannot flex = ____________

Passive Papal
Procedure: ____________
(+): Papal sign - ____________
med half of intrinsic cannot ext = ____________

A

Active Papal
Procedure: Ask px to close hand
(+): Papal sign - Cannot close lat side of hand
lat half of FDS, FDP cannot flex = median nn patho

Passive Papal
Procedure: Ask px to open hand (relax hand)
(+): Papal sign - Cannot open med side of hand
med half of intrinsic cannot ext = ulnar nn patho

23
Q

Carpal Tunnel Syndrome

Compressed Nerve: ____________ d/t ____________
____________
____________; If unilateral = ____________
CAUSE: ____________

____________ may
increase risk of sustaining CTS

Diagnostic test: ____________
Sensory affectation: ____________
Motor affectation: ____________, ____________
Spared: ____________
(____________)

A

Compressed Nerve: median nerve at the carpal tunnel of wrist d/t inflammation
of flexor tendons and/or median nerve
F>M; If unilateral = dominant hand first, can be bilateral
CAUSE: idiopathic

Overuse (computer), edema & connective tissue diseases may
increase risk of sustaining CTS

Diagnostic test: EMG NCV
Sensory affectation: Lat 3 & 1⁄2 fingers
Motor affectation: Thenar ms (AFO), Lat half of lumbricals
Spared: sensation thenar eminence (superficial palmar branch med nn)

24
Q

Orthopedic Conditions of the Wrist and Hand

  1. CTS
  2. Pronator Teres Syndrome
  3. Wrist Fractures
  4. Madelung’s Deformity
  5. Boxer’s Fx
  6. Scaphoid Fx
  7. DQT
  8. Dupuytren’s Contractures
  9. Trigger Finger
  10. Gamekeeper’s Thumb
  11. Boutonniere Deformity
  12. Swan Neck Deformity
  13. Mallet Finger
A
  1. CTS
  2. Pronator Teres Syndrome
  3. Wrist Fractures
  4. Madelung’s Deformity
  5. Boxer’s Fx
  6. Scaphoid Fx
  7. DQT
  8. Dupuytren’s Contractures
  9. Trigger Finger
  10. Gamekeeper’s Thumb
  11. Boutonniere Deformity
  12. Swan Neck Deformity
  13. Mallet Finger
25
1. Carpal Tunnel Syndrome Compressed Nerve: ____________ nerve at the carpal tunnel of wrist d/t ____________ of ____________ and/or ____________ F>M; If unilateral = ____________ CAUSE: ____________ ____________, ____________& ____________ may increase risk of sustaining CTS Diagnostic test: ____________ Sensory affectation: ____________ Motor affectation: ____________ Spared: ____________
Compressed Nerve: median nerve at the carpal tunnel of wrist d/t inflammation of flexor tendons and/or median nerve F>M; If unilateral = dominant hand first, can be bilateral CAUSE: idiopathic Overuse (computer), edema & connective tissue diseases may increase risk of sustaining CTS Diagnostic test: EMG NCV Sensory affectation: Lat 3 & 1⁄2 fingers Motor affectation: Thenar ms (AFO), Lat half of lumbricals Spared: sensation thenar eminence (superficial palmar branch med nn)
26
1. Carpal Tunnel Syndrome Clinical findings: ____________, ____________, ____________, ____________ (+) Tinel’s sign and/or Phalen’s test/ Reverse Phalens Long term compression: causes ____________& ____________. Median nn mob: ____________ Tx: ____________ = ____________ degrees ____________ ____________ > ____________
Clinical findings: Burning, tingling, pins and needles, Numbness into median nerve distribution at night (+) Tinel’s sign and/or Phalen’s test/ Reverse Phalens Long term compression: causes atrophy & weakness of thenar muscles & 2 lumbricals. Median nn mob: 5-30SH, 3-4x/day Tx: night wrist splint = 0-5 degrees ext Local corticosteroid injection > surgical decompression
27
2. Pronator Teres Syndrome Aka: ____________ ____________ SPARED MOI: ____________ Nn involved: ____________ Affectation: ____________> ____________ Motor: ____________ Sensory: ____________ (palmar cutaneous branch)
Aka: Grocery Bag Syndrome Pronator SPARED MOI: entrapped by 2 head of pronator teres (hypertrophy) Nn involved: Median nn Affectation: Motor > Sensory Motor: Thenar ms, AIN Sensory: Thenar eminence (palmar cutaneous branch)
28
3. Wrist Fractures COLLE’S FRACTURE Aka: ____________ MOI: ____________ Displacement: ____________ MC Fx in hand esp in ____________ d/t ____________ Dx Test: ____________ Tx: ____________
COLLE’S FRACTURE Aka: Dinner fork deformity MOI: FOOSH Displacement: Radial Fx c dorsal displacement of its fragments MC Fx in hand esp in elderly d/t osteoporosis Dx Test: Plain films Tx: Immob 5-8 wks
29
SMITH’S FRACTURE Aka: ____________ or ____________ MOI: ____________(____________) Displacement: ____________ Dx: ____________
Aka: Reverse Colle’s or Garden Spade deformity MOI: FOBOTH (back of the hand) Displacement: distal fragments in a volar direction Dx: Xray
30
4. Madelung’s deformity ____________, ____________ ____________ - ____________ Pushes the wrist into ____________→ LOM: ____________
Congenital, develops during puberty D/t retarded & asymmetric growth of epiphyseal plate at distal end of radius Ulna dislocates dorsally & distally, articulating c the lateral side of pisiform - Prominent Ulna, Retarded growth of Radius Pushes the wrist into ext → LOM: wrist flexion
31
Madelung’s deformity picture gdrive
32
5. Boxer’s Fracture Aka: ____________ Fx of the ____________ MOI: ____________/____________or ____________ Tx: ____________ Dx Test: ____________
Aka: Street Fighter Fx Fx of the 5th MC neck MOI: fighting/punching a wall in anger or frustration Tx:Cast for 2-4 wks Dx Test:Xray
33
6. Scaphoid Fracture MOI: ____________ MOST commonly fractured carpal bone Can affect: ____________ & ____________ Diagnostic test: ____________ CC: tenderness @ ____________ Complication: AVN – ____________ Tx: Immob ____________
MOI: FOOSH MOST commonly fractured carpal bone Can affect: median nn & radial artery Diagnostic test: Plain film CC: tenderness @ anatomic snuffbox Complication: AVN – Preisser’s Dse Tx: Immob 4-8 wks
34
7. De Quervain’s Tenosynovitis Aka: ____________/ ____________ MC ____________ F>M; ____ y/o MOI: ____________ Presentation: ____________ Most difficult activity: ____________ Muscles involved: Special test: (+) ____________ Test (procedure of test) Tx: thumb spica splint (FA based)
Aka: Washerwoman’s/ Hoffman’s Thumb MC tendinitis of hand F>M; 30-50 y/o MOI: overuse or repetitive microtrauma Presentation: pain at radial styloid/anatomic snuffbox; swelling; ↓ grip & pinch strength Most difficult activity: Hammering Muscles involved: Special test: (+) Finkelstein Test (make a fist c thumb inside then passive UD) Tx: thumb spica splint (FA based)
35
8. Dupuytren’s Contracture ____________. M>F Non-DM: ____________ DM is a possible risk factor: ____________ Tx: Release of ____________ fascia
Banding on palm/digit flexors d/t contracture/ thickening of palmar fascia. M>F Non-DM: contracture of MCP & PIP of 4th & 5 th digit DM is a possible risk factor: 3rd & 4th digits Tx: Release of palmar fascia
36
Trigger Finger Aka: ____________ Cause: ____________ Result to: ____________ F>M; ____________y/o Presentation: ____________; passive ext produces ____________ MC involved: A1 pulley = Children: ____________ Adult: ____________
Aka: Digital Tenovaginitis Stenosans, Snapping finger Cause: Idiopathic Result to: thickening of flexor tendon sheath F>M; 40 y/o Presentation: painless; passive ext produces snapping sensation MC involved: A1 pulley = Children: FPL of thumb Adult: FDS of 3rd & 4th finger
37
Game Keeper’s Thumb Aka: ____________ MOI: ____________ Fall while skiing when increasing forces are placed on thumb through the ski pole Pathophysiology: ____________ Tx: Immob ____ wks Dx Test: ____________ Special Test:
Aka: Skier’s Thumb MOI: Fall on abducted hand Fall while skiing when increasing forces are placed on thumb through the ski pole Pathophysiology: Valgus >35 degrees → sprain/ rupture of thumb UCL Tx: Immob 6 wks Dx Test: MRI Special Test:
38
Thumb UCL laxity or instability test ❑ Stabilize ____________bone ❑ Apply ____________force ❑ N = ______degrees ❑ <______ = ____________ tear of UCL ❑ >______ = ____________tear
❑ Stabilize MC bone ❑ Apply valgus force ❑ N = 15 degrees ❑ <30-35 = partial tear of UCL ❑ >30-35 = complete tear
39
Boutonniere Deformity Rupture of: ____________ Deformity: ____________ MOI: ____________or ____________ Swan Neck Deformity ____________ Deformity: ____________
Boutonniere Deformity Rupture of: central tendinous slip rupture Deformity: EFE MOI: trauma or RAc degen of central band Swan Neck Deformity Contracture of intrinsic muscle/ dorsal subluxation of lateral extensor tendon Deformity: FEF real deformity: extension of the proximal interphalangeal joint. Common with RA
40
Bunnel-Littler (Finochietto-Bunnel) Test ❑ Aka: Intrinsic (+) Test – test for intrinsic contracture/tightness ❑ Tests structures around the MCP jt ❑ 1. Yes – No – ❑ 2. Yes – No –
- 1. Passively ext MCP, PIP flex Yes - NORMAL No – either tight intrinsic or tight capsule - DDx - 2. Passively flex MCP: PIP flex Yes - tight intrinsic No – tight capsule
41
Hanes Zancolli Test p471 Figure 7-64, Magee 6th ed ❑ Aka: Test for retinacular ligament ❑ Tests structures around the PIP jt ❑ 1. Yes – No – ❑ 2. Yes – No –
- 1. Passively ext PIP, DIP flex Yes - NORMAL No – either tight retinacular ligament or tight capsule - DDx - 2. Passively flex PIP: DIP flex Yes - tight retinacular ligament No – tight capsule
42
Mallet Finger Aka: ____________ MOI: ____________ Terminal slip Rupture or avulsion of ____________ at its ____________. Deformity: ____________
Aka: Baseball finger MOI: trauma forcing DIP flexion Terminal slip Rupture or avulsion of extensor tendon at its insertion into distal phalanx of digit. Deformity: EEF
43
FLEXOR TENDON ZONES I. - ____________ II.– ____________ III.– ____________ IV – ____________ V – ____________ TI – ______joint TII – ______joint TIII – ______joint
I. - DIP joint II.– NO MANs LAND III.– Metacarpals IV – Carpal Tunnel V – Distal Forearm TI – IP joint TII – MCP joint TIII – CMC joint
44
EXTENSOR TENDON ZONES I.– ______joint II.– middle phalanx III –______joint IV.– proximal phalanx V.– ______joint VI.– dorsum of hand VII – dorsal wrist
I.– DIPjoint II.– middle phalanx III –PIPjoint IV.– proximal phalanx V.– MCP joint VI.– dorsum of hand VII – dorsal wrist
45
Upper Limb Neurodynamic (Tension) Test Reference: OPA Magee 7th Ed. Page 205 Other Names: ULTT, ULNT, Elvey Test ❑ Supine, passive ❑ Start c Sh, FA, wrist, finger, elbow ❑ **Sh depression ❑ C/L neck SB (sensitizing test) ❑ Hold position 6-10 secs ❑ (+): reproduction of sx
46
Drill A physical therapist performs the test shown in the photo. Upon examination, the patient felt deep stretch in the cubital fossa. What structure is most likely affected: a. Median nerve b. Anterior Interosseus nerve c. Musculocutaneous nerve d. None of the above
47
OA & Gastrectasis: (HD Blue Picture) - Heberden nodes – dorsal surface of ______ - Bouchard nodes - dorsal surface of ______
48
Flexor Tendon Zone (structures involved) I – II–NOMANSLAND:FDPandFDS(poorprognosis,needssurgery) III - + lumbricals IV – FDP, FDS, FPL V – median and ulnar nn; ulnar and radial arteries TI-II – FPL and FPB TIII – thenar mm
49
Extensor Tendon Zone I-II: inability to actively extend DIP - mallet finger & swan neck III-IV: inability to actively extend the PIP - boutonniere