Quiz 4 Flashcards
what do we want to see within the elbow outcome measures?
10 point change
what are some questions we would ask within the examination part specifically the history section?
- age
- occupational demands
- MOI
- aggravating or easing positions
- impaired motion and function
- neurological symptoms
- past medical history
- general health
- medications
- personal goals
if a patient has pain over the lateral elbow during gripping activities what could this possibly be?
lateral epicondylitis
if a patient has pain over the medial elbow with wrist flexion and pronation, what could this possibly be?
medial epicondylyits
if a patient has numbness and tingling along the ulnar nerve distribution distal to the elbow, what could this possibly be?
cubital tunnel syndrome
if a patient has pain with elbow movement with sensation of catching or instability, what could this possibly be?
UCL instability
if a patient has posterior elbow pain with elbow hyperextension, what could this possibly be?
extension overload
what is the normal carrying angle for males and females?
males= 5 to 10 degrees
females= 10 to 15 degrees
what is the one objective examination we shouldn’t see?
a cubitus varus look= which is when the arm is completely straight and there is no carrying angle
what does the triangle sign detect?
a screen for a fracture
- limited extension
describe the objective examination for someone who has olecranon bursitis?
presence of edema, effusion and ecchymosis
- check the tissue temperature!!
what must we rule out within the elbow examination?
- C spine
- shoulder
- upper t spine (specifically T7 and up)
what is the inclusion criteria for the elbow extension test?
- acute elbow injury
- adults > 15 yrs
- children 3-15 years old
what is the exclusions criteria for the elbow extension test?
- previous limited extension
- no history of trauma
- occurred 72 hours after
- neuromuscular disease
what is the flexion degrees for the elbow?
150
what is the extension degrees for the elbow?
10
what is the functional ROM for AROM flexion and extension?
30 to 130 degrees
what is elbows flexion end feel?
soft
what is the elbows extension end feel?
hard
what is the difference between the flexion limitation and extension limitation?
5% difference
can we see the presence of a capsular pattern?
after an injury
what is the AAOS value for elbow pronation?
80 degrees
what is the AAOS value for elbow supination?
80 degrees
what is the PROM end feel for pronation at the elbow?
firm
what is the PROM end feel for supination at the elbow?
firm
what is the most limited joint in the elbow?
the radiohumeral
what is the least limited joint in the elbow?
the distalradioulnar
name the common direction preferences for elbow extension repeated movements:
- open chain
- open chain with flick
- loaded (closed chain)
- loaded with pt generated overpressure
what special test is associated with the PLRI?
pivot shift test
what special test is paired with PLRI?
pivot shift test
what special test goes with a RCL sprain/tear?
varus stress test
what special test goes with an UCL sprain/tear?
1- valgus stress test
2- moving valgus stress test
what are the special tests for the radial nerve?
ULTT2b and TTP
the median nerve is associated with what syndrome and special test?
pronator teres syndrome and the pronator teres test
the ulnar nerve is associated with what syndrome and special tests?
cubital tunnel syndrome and the elbow flexion test and the tinel’s test
the radial nerve is associated with what syndrome and special tests?
PIN and the ULTT palpation
what is the diagnostic cluster for lateral epicondylitis?
- cozens test
- mills test
- maudsley test
- pain palpation
what is the diagnostic cluster for medial epicondylitis?
- pain with resisted wrist flexion
- Pain with stretch of wrist flexors
- golfers elbow test
- pain with palpation of medial epicondyle
describe the grip strength within muscle performance testing:
- we assess this bilaterally
- with lateral elbow pain we assess this in elbow extension
what order does muscle performance occur in for the elbow?
- resisted break testing
- elbow flexion
- elbow extension
- pronation
- supination
- grip strength
what structures resist varus in the elbow?
- RCL
- anterior capsule
- bony articulation (mainly) 75%
what structures resist valgus in the elbow?
- UCL (mainly) 54%
- anterior capsule
- bony articulation
the humeroulnar joint Play P-A Is what type of glide?
anterior glide
the humeroradial joint play P-A is what type of glide?
anterior glide
the humeroulnar A-P is what type of glide?
posterior glide
the humeroradial A-P is what type of glide?
posterior glide
the radioulnar A-P is what type of glide?
medial glide of the radial head
the radioulnar A-P is what type of glide?
lateral glide of the radial head
the ULTT2a is associated with what nerve?
median nerve
the ULTT2b is associated with what nerve?
radial nerve
the ULTT3 is associated with what nerve?
ulnar nerve
what are we specifically testing during the Cozen’s test?
extensor carpi radialis brevis muscle
what are we specifically doing during the Mills test?
stretching the wrist extensors
what are we specifically doing during the Maudsley test?
lifting the 3rd digit aka the extensor digitorum
what are we specifically doing during the golfers elbow test?
passively supinating the patients forearm, extending the patients wrist and elbow
what are interventions for epicondylitis?
- rest from aggravating activities
- mobility
- strength and conditioning
- bracing or taping
what are the interventions for a UCL elbow sprain?
- rest/ immobilization
- modalities for pain/swelling- NSAIDS
- gain pain free ROM
- general conditioning with shoulder and scapular mobility
- core stability, balance, strength
- throwing progression
what are the interventions for someone who has cubital tunnel syndrome?
- splinting at 45 degree flexion and full supination for 4-6 weeks
- elbow pad over medial epicondyle
- mobilization
List the common causes of radial sided wrist pain?
De quervains tenosynovitis
Thumb UCL
Ganglion cyst
Radial neuritis
C6 Radial
CTS/ Median Nerve
Scapulonate instability
what are some interventions for someone who has PIN syndrome/radial tunnel syndrome?
- immobilization
- relative rest
- modalities
- neural glides
what are some interventions for someone who has pronator syndrome that involved the median nerve?
- splinting at 90 degrees flexion and gentle ROM for 2 weeks
- modalities
- treat the underlying cause of irritation to nerve
- soft tissue mobilization TATSM
- neural glides
List the common causes of ulnar side?
Instability
TFCC tear
FCU tendonitis
Arthritis
Fracture
hypothenar hammer syndrome
Cervical redic (C8)
Ulnar tunnel/ Guyon’s canal
what are some interventions for someone who has a distal biceps tendon rupture following a surgical repair?
- posterior splint at 90 degrees for 1-2 weeks
- gentle ROM following splint
- full AROM at week 4
- strengthening begins at week 6
- unrestricted activity at week 8
what are some interventions for someone who has osteoarthritis in the elbow?
- modalities for pain
- maximize flexibility of surrounding tissues
- distraction mobilization
- muscle performance specifically proximal strength/stability
Types of fractures in the wrist and hand?
Colles fracture
Smiths Fracture
Scaphoid fracture
Signs of infection?
Temperature >100
BP> 160/95
Resting pulse >100 bpm
Resting respiration> 25 bpm
Fatigue
inflammation
what are some interventions for someone who has elbow instability?
- reduction and placement in a padded splint
- can begin rehab with no restrictions if stable
what is ascending lymphangitis?
Inflammation of lymphatic channels
Medical emergency can lead to sepsis and death
Will present with rash on dorsum of hand and arm
what are some interventions for someone who had a fracture and is looking for post operative management?
- limb is elevated 24 hours and in a resting splint for 1 week
- modalities that can reduce swelling/pain
- early controlled motion and AAROM
- isotonics at week 8
4 signs of flexor shealth infection?
Finger/hand held in flexion
swelling
Tenderness over tendon sheath
Pain on passive extension
Earliest sign of flexor sheath infectIion?
pain with passive extension
What is a colles fracture? MOI
Distal radius fracture with posterior displacement
FOOSH
Common findings with a colles fracture?
dinner fork deformity
distal + dorsal wrist pain
swelling
increased distal radius angulation
inability to grasp
What is a smiths fracture? MOI
Distal radius fracture with anterior displacement
Garden spade deformity
Fall on flexed hand
Treatment options for a distal radius fracture?
reduction of the fracture
Casting
What motion is usually limited after distal radius fracture?
rotation of the forearm
What is the most commonly fractured carpal bone/
scaphoid
Common findings of a scaphoid fracture?
Ache in snuff box
pain made worse with pinching/gripping
Swelling/ bruising
Who is at risk for scaphoid fracture?
males
sports flayers
pain with thumb-index finger pinching
Criteria for moderate suspicion of scaphoid fracture?
Snuff box tenderness
painful resisted supination
painful compression of thumb
ST tenderness
Treatment options for scaphoid fracture?
non-displaced: splint
AROM/PROM
Joint mobs
MOI for a metacarpal fracture?
Boxers fracture
from punching
Clinical presentation for metacarpal fracture?
pain
swelling, bruising
limited AROM/PROM
Deformity/assymetry
Compression of finger–> reproduces pain
treatment for metacarpal fracture?
casting for 2-4 weeks
MOI for a lunate dislocation?
wrist hyperextension
Spilled t-cup
Common findings for lunate dislocation?
swelling
deformity
Decreased ROM
Spilled t-cup xray
murphys sign
Treatment for lunate dislocation?
surgical repair
casting
Gentle stretch-> gentle strengthening
MOI for a scapholunate dislocation?
FOOSH
Terry thomas sign
What nerve is involved for carpal tunnel syndrome?
median neuropathy
Risk factors for developing Carpal tunnel syndrome?
Obesity, >50, female
DM
OA
Estrogen therapy
hypothyroid
family history
Wrist ratio> .70
Symptoms of carpal tunnel syndrome?
Pain in palmar aspect of 1,2,3,4 digits
pain at wrist
Weakness of thenar muscles
thenar waisting (ape-hand)
What reflexes are affected in someone with carpal tunnel syndrome?
Reflex normal
What do you use to do sensation testing for carpal tunnel syndrome?
Semmes weinstein monofilament
What test helps differentiate between AIN and Cubital tunnel syndrome?
okay sign/tear drop sign
Clinical prediction rule for carpal tunnel syndrome?
positive flick signs
wrist ration>.67
Symptom severity> 1.9
Reduced median sensation to D1
Age> 45 y/o
What is a positive sign for tinels test?
tingiling in median nerve distrubtion
what is phalens test
hold wrists flexed together for 1minute
positive if median nerve distribution tingles
What is reverse phalens test?
hold wrist extended together for 1 minute
positive is median nerve distribution tingles
What is carpal compression test?
PT applies pressure at transverse carpal lig for 30 seconds
positive is median nerve distribution tingles
What is a positive sign for ULNTT-A?
reproduction of symptoms
difference in elbow extension>10 degrees
Treatment options for carpal tunnel syndrome?
Surgery (CTR)
Very effective
Splinting, mobilization, nerve gliding, exercise
Night splints have what kind of impact on CTS?
Strong if used in early CTD
Prevent symptoms
How does nerve gliding treat CTS?
improve healing of nerve tissue, reduce pain
how does carpal bone mobilization treat CTS?
Improves blood flow, gate pain, increases mobility
How does activity modification treat CTS?
prevents symptoms and reduces risk factors
What is wartenberg syndrome?
entrapment of the superfiical radial nerve
wrist watch/handcuff neuropathy
MOI for wartenberg syndrome?
trauma
prolonged compression
operative complication during fracture reduction
Is wartenbergs syndrome common or rare?
rare
Symptoms associated with wartenbergs syndrome?
paraesthesia along anatomical snuff box, thumb, dorsum 2-3
may be worse with gripping
no motor issues
sensation decreased in radial n. distrubtion in hand
What special tests can you use for wartenbergs syndrome?
Tinels test @ snuff box
Radial N. ULTT
If you have sensation lose in dorsum of hand what nerve is affected and where?
Radial nerve @wrist
If you have wrist drop + weakness of wrist and finger extensors + weak triceps what nerve is affected and where?
radial nerve above the elbow
What reflex is affected with radial n. impingement?
brachioradialis
Symptoms associated with ulnar n. entrapment at guyons canal?
Weakness and atrophy of ulnar intrinsic hand muscles
Numbness in palmar aspect and dorsum digits 4,5
Ulnar claw hand
wattenbergs sign
What reflex would be affected with ulnar nerve entrapement?
none babe
What is wartenbergs sign?
difficulty adducting the fifth digit bc of weakness in 3rd palmar interosseoi
What is froments test and what nerve does it target?
paper test
ulnar n.
What is de quervains tenosynovitis?
inflammation of synovial fluid tendon of 1st dorsal compartment
pain and edema
EPB, APL
MOI for de-quervains tenosynovitis?
repitive trauma w/ thumb
What test can you use for de-quervains tenosynovitis?
finkelstein’s test
Thumb in wrist, ulnarly deviate
Treatments for dequervains tenosynovitis?
Splinting 2-3 weeks
stretching
joint mobs of thumb and wrist
strengthening grip strength
Resisted thumb extension and abduction
What is gamekeepers’ thumb?
distrubtion of ulnar collateral ligament
occurs with trauma (valgus force)
Clinical presentation of gatekeepers thumb?
pain
tenderness, bruising, swelling near MCP of thumb
instability/ trouble grasping
Treatment for gatekeepers thumb?
surgery
immbolization for 6 weeks
what position should the thumb splint be in ?
20* of wrist extension
MCP in slight flexion
what position should the thumb splint be in ?
20* of wrist extension
MCP in slight flexion
Symptoms of wrist and hand osteoarthritis?
pain
swelling
morning stiffness
weakness griping
Reduced ROM
What are heberdens nodes?
Osteoarthritic enlargement of DIP
what are bouchard’s nodes?
osteoarthritic enlargement of PIP
What are deformities associates with rheumatoid arthritis at wrist and hand
Ulnar drigs at MCP, radial drift at wrist
Bouchards nodes
What test can you use for arthritis of MCP?
CMC grind test
How do you treat a ganglion cyst?
nothing
aspiration
surgical excision
MOI for TFCC?
trauma
degeneration
symptoms of TFCC?
Ulnar sided wrist pain
TTPL distal to ulnar styloid
Click with ulnar deviation
Ulnar grind test positive
Special tests for TFCC?
Shear/load
Supination lift test
Fovea sign
Treatment for TFCC?
Bracing
Therapeutic exercise: wrist circles
MOI of wrist sprain?
Trauma
dislocation
Simple v.s complex sprain?
Simple: pain with function
complex: dislocation occurs with activity
Treatment for a simple wrist sprain?
protect, tape/splint
Keep fingers moving
What is the most common static instability in the wrist?
scapholunate instability
What does the terry thomas sign indicate?
Scapholunate instability
Symptoms of scapholunate instability?
point tenderness over ligament
dorsal wrist swelling
pain
Click/clunck with radial dev
pinch weakness
Tests used for scapholunate instability?
Scapholunate ballotment test
watson test
Treatment for scapholunate instability?
> grade 1: surgical canidate
ROM: dart throws
Strengthen ECRL, FCR, ABP (10 s, 10 reps, 3x /day_
What is the most commmon dynamic wrist instability?
midcarpal
Symptoms of a midcarpal instability?
TTP @triquetrohamate hunction
lichtman test
x-rays normal
Signs and symptoms of ligamentous injury of the wrist/hand?
TTP and swelling over joint
MCP joints stress collateral ligs in flexion
IP joints: stress collateral ligs in extension
What tests can you use for ligamentous instability?
shuck test
Lunotriquetral ballotment test
