Quiz 2 Flashcards
Identify the anatomical structures of the elbow capsule and their functions
ulnar collateral ligament, radial collateral ligament complex (annular, lateral ulnar collateral, radial collateral, and accessory lateral collateral ligaments)
functions:
•Resists joint distraction, hyper-extension and valgus stress. (Safran & Baillargeon, 2005)
•Most lax at 80 degrees of flexion
•Position of comfort after injury
•Risk of flexion contracture
•Ligaments inter-digitate with the capsule and contribute to reinforcing the capsule.
•Wrist and hand muscles contribute to reinforcing the capsule.
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functional elbow motion and forearm
-30 to 130
50 to 50
common areas for elbow tendinitis
lateral tendinosis: poor quality tendon
failed tendon healing, pain with resisted wrist extension
medial: pain with resisted wrist flexion
contents of the mobile wad of three
brachioradialis, extensor carpi radialis longus and brevis
elbow mobilization devices such as orthosis and continuous passive motion machines
hinged elbow splint
treatment for lateral epicondylitis
- ice, heat, ionto
- anti-inflammatories
- stretch and strengthen wrist extensors
- counterforce brace
- soft tissue techniques
treatment for medial epicondylitis
- ice, heat, ionto
- anti-inflammatories
- stretch and strengthen wrist extensors
- counterforce brace
- soft tissue techniques
treatment for MCL
- hinged elbow orthosis to prevent vagus deformity
- tommy john surgery for
severe - strengthen elbow mx and flexors
treatment for LCL
- hinged or static orthosis to prevent varus deformity
- strengthen elbow mx and extensors
treatment for posterior dislocations
- elbow and wrist orthosis with forearm in neutral
- remove 3-5x day for safe motion (unstable at 0-20 deg extension)
- edema control
possible causes for frozen shoulder
Underlying pathology of Frozen shoulder: adhesive capsulitis, impingement syndrome, peri arthritis
Determine the contributions of the sternoclavicular and acromioclavicular joints
*Functional motions of the shoulder girdle:
scapulothoracic joint not a true synovial joint, provides rotation of the scapula on the chest wall
sternoclavicular joint acts as a radius of limb-girdle motion
acromioclavicular joint: provides adaptive motion between the clavicle and scapula
scapular motion realistic to A-C joint:
Phase I: SC elevation and AC posterior tilt = 16° scapula upward rotation
Phase II & III: SC elevation & posterior rotation = 2° scapula posterior tilt
Phase II & III:SC retraction and AC internal rotation = 2° scapula external rotation.
scapular force coupling
upward rotation, posterior tilt, and external rotation
scapular force couple muscles: all fibers of trapezius and serratus anterior
shoulder sequential evaluation
history
- insidious (sleeping, sports, working)
- traumatic (mechanism, surgery)
- upper quarter screen –> AROM –> PROM –> palpation, mobilization, special tests –> treatment plan
capsular restrictions and ROM lost in individuals with adhesive capsulitis
Recognize capsular restrictions and ROM lost in individuals with adhesive capsulitis.
Underlying pathology of Frozen shoulder: adhesive capsulitis, impingement syndrome, peri arthritis
clinical phases of adhesive capsulitis
Freezing/inflammatory: 3-9 mo, pain worse at night, starts as dull ache and becomes more severe over time
Frozen: loss of motion, dull achy pain, capsular fibrosis
Thawing: regained motion, decreased pain, increased ADLs, capsular hypovascularity
client presentations of adhesive capsulitis
thickening capsule with contracture obliteration of inferior recess chronic inflammation fibrosis of synovial layer synovial adhesions decreased synovial fluid
post-op interventions for clients with a rotator cuff repair
Protection phase: 0-2 weeks post op
patient education
no exercise
Protection phase: 2-6 weeks post op
protected PROM (avoid passive or active extension and internal rotation)
Protection to Mobilization phase: 6-12 weeks
AAROM-AROM and protected PROM
Mobilization phase: 8-12 weeks and 12-120 weeks
exercises with increased EMG supraspinatus activity
Strengthening phase: 20 weeks
intrinsic and extrinsic factors of shoulder impingement
Intrinsic: degeneration of rotator cuff, tears bursa inflammation mal union fractures anatomic variations of acromion from trauma (type II or III) Extrinsic: poor posture glenohumeral muscle imbalance (weak RC) tightness in glenohumeral joint capsule encroachment of greater tuberosity on subacromial tissue periscapular muscular imbalance
Determine intervention progressions for shoulder impingement (early, intermediate and late phases of healing)
For extrinsic (bursal or articular sided tears)
stage I: edema/hemorrhage
stage II: fibrosis/tendinosis
stage III: permanent thickening of tendon
stage IV: tendon tears/ruptures, bone spurs
For intrinsic:
degenerative tendon, muscle dysfunction, chronic inflammation, avascular tendon
Early goals: reduce pain (modify activities, patient education, maintain motion, promote blood flow, mobilization, stretching)
Intermediate goals: strengthening/endurance of shoulder girdle stabilizers (initiate stabilization exercises with low/upper trap to serratus/low trap ratios)
Late phase goals: strengthening and endurance in functional positions
anatomical locations of upper extremity amputations
ratio of arm to leg amputations is 1:3 primary cause of arm amputation: trauma Transhumeral: above elbow Transradial: below elbow primary cause of leg amputations: vascular disease and diabetes
Explain varying types of prosthesis and how they operate
No prosthesis
Passive prosthesis: systems that do not possess the ability to actively position/grasp/release; functions to protect limb, support/stabilize objects, social acceptance
Conventional body-powered prosthesis: uses motions from the proximal body to operate the device)
simple, low cost, reliable, may restrict some movement, patient exerts effort
voluntary opening: colitional force and excursion of the cable, prehension force is dictated by number of rubberbands
voluntary closing: allows for graded prehensile force, higher forces can be applied through cabling system
Externally powered prosthesis/myoelectric: uses power external to the body; muscle contractions to operate
wrist units: hook and hand, ball and socket
no harness, can get more types of motions, frequently prescribed for transradial amputations, electrode alignment
Hybrid prosthesis: combination of body powered and myoelectric
electrically powered elbow with a body powered terminal device; use proprioceptive feedback from the cable system and inputs from electromechanical stimulation
Activity specific prosthesis
Determine the best methods for wrapping a residual limb with elastic bandages
Goals: shrink and shape residual limb so that it is tapered at the distal end; want rounded end
Rigid dressings: protects limb from trauma, early prosthetic fit, effective in controlling edema, requires skill to put on and off
Shrinkers: easily applied, more consistent pressure, easier to maintain, loses elasticity when washed, more expensive
Elastic wraps: pressure can be customized and graded to reduce edema, adjustable compression, inexpensive, cannot self apply with UE, needs frequent reapplying
treatment interventions to address phantom limb pain
OT treatment: patient education, management of residual limb, strengthening and ROM, prosthetic specifics, ADL training, psychosocial adjustment
UE Pre-Prosthetic Program: 1) wash limb daily with mild soap and dry; 2) provide wound cleansing; 3) use appropriate creams to massage at the suture line to loosen crust
TENS, acupuncture, psychotherapy/hypnosis, mirror therapy, desensitization, edema management, positioning for ROM
