S2_L2: Elbow & Forearm

Question 1

What part of the humerus articulates to the ulna?

Answer 1

Trochlea

Source: Lecture Formative Quiz

Question 2

What is the type of joint of the humero-ulnar articulation?

Answer 2

Modified hinge joint

Source: Lecture Formative Quiz

Question 3

What ligament provides stabilizing action against varus
forces at the elbow?

Answer 3

Radial collateral ligament

Source: Lecture Formative Quiz

Question 4

Among the elbow flexors, which one contracts actively always regardless of the position of the forearm?

Answer 4

Brachialis

Source: Lecture Formative Quiz

Question 5

Among the elbow flexors, which one is most effective
between 80-100° of flexion?

Answer 5

Biceps brachii

Source: Lecture Formative Quiz

Question 6

Where is the common origin of wrist flexor muscles?

Answer 6

Medial epicondyle

Source: Lecture Formative Quiz

Question 7

What nerve provides sensory supply on the lateral side of the dorsum of wrist and hand and lateral 3 1⁄2 digits?

Answer 7

Radial nerve

Source: Lecture Formative Quiz

Question 8

What nerve may be entrapped between the two heads of the flexor carpi ulnaris?

Answer 8

Ulnar nerve

Source: Lecture Formative Quiz

Question 9

What is the endfeel for elbow flexion?

Answer 9

Soft

Source: Lecture Formative Quiz

Question 10

What is the dermatome assigned at the level of the lateral epicondyle?

Answer 10

C5

Source: Lecture Formative Quiz

Question 11

Regeneration rate of nerves when immobilized

Answer 11

1 mm per day (range 0.5-0.9mm)

Question 12

Match the following techniques to the nerve it is associated with.

1. ULTT 1
2. ULTT 4
3. ULTT 3

A. Radial nerve
B. Median nerve
C. Ulnar nerve

Answer 12

1. B
2. C
3. A

Question 13

This condition is known as the Little League’s Elbow

Answer 13

Medial Elbow Tendinopathy

Question 14

How long is the period of immobilization of Total Elbow Arthroplasty (TEA)?

Answer 14

8-12 days to weeks

Question 15

TRUE OR FALSE: A patient may already try to perform push-ups 4 weeks after TEA to facilitate healing.

Answer 15

False.

The patient must avoid this activity for 6 weeks.

Question 16

What peripheral nerve injury is associated with the ulnar nerve?

Answer 16

cubital tunnel syndrome

Question 17

____ is a cumulative trauma disorder, not from a sudden injury.

Answer 17

overuse syndrome

Question 18

Enumerate the 5 possible etiology of joint hypomobility

Answer 18

Fracture
Dislocation
Arthritic conditions
Burns
Myositis ossificans

Question 19

Determine what is the intervention scenario done in each condition?

1. Total Elbow Arthroplasty
2. Elbow Tendinopathy
3. Peripheral Nerve Injury (Acute Phase)
4. Peripheral Nerve Injury (Recovery Phase)
5. Peripheral Nerve Injury (Chronic Phase)

A. to restore & to compensate
B. to compensate & prevent
C. to restore only

Answer 19

1. B
2. C
3. A
4. C
5. B

Question 20

What is the ROM necessary for function of the elbow? Answer for flexion, extension, pronation, and supination.

Answer 20

flexion-extension: 30-130*
supination-pronation: 50* each

Source: Chegg Elbow Evaluation

Question 21

4 possible etiology of lateral epicondylalgia?

Answer 21

1. overuse phenomenon
2. gripping activities with repetition or sustained force
3. tennis players, factory workers
4. potential for degenerative changes at tendon

Source: Chegg Elbow Evaluation

Question 22

2 possible etiology of medial epicondylalgia?

Answer 22

1. overuse of wrist flexion or pronation
2. overhead throwers and golfers

Source: Chegg Elbow Evaluation

Question 23

What is the intervention for simple dislocations?

Answer 23

Closed reduction and splint in flexion for 7-10 days

Source: Chegg Elbow Evaluation

Question 24

Determine the sensory loss if entrapment of median nerve at ligament of struthers occurs?

Answer 24

1. palmar fingers 2, 3, and1/2 of 4
2. thumb
3. radial palm

Source: Chegg Elbow Evaluation

Question 25

Determine which activity elicit symptoms of the elbow tendinopathy: 1. Shuffling papers 2. Backhand stroke 3. Pulling weeds 4. Lifting heavy objects 5. Computer keyboarding A. Lateral Elbow Tendinopathy B. Medial Elbow Tendinopathy

Answer 25

1. B 2. A 3. A 4. B 5. A

Question 26

In tennis elbow the wrist ____ are strained.

Answer 26

extensors

Question 27

To develop soft tissue & joint mobility in overuse syndrome, a PT must provide ____ resistance for 6 seconds x 10 times.

Answer 27

isometric

Question 28

Wrist position progression of wrist flexor muscles for tendinopathies

Answer 28

Flexion → Neutral → Extension

Question 29

Residual stiffness are common in (1)_____ and may present with (2)____ degrees loss of terminal (3)____.

Answer 29

1. joint hypomobility 2. 10-15 3. extension

Question 30

What bone is usually dislocated in the elbow?

Answer 30

ulna

Question 31

Heterotopic ossification is common to develop in elbow (1)____, (2)____ muscle, & (3)____.

Answer 31

1. trauma 2. brachialis 3. burns

Question 32

To fix a nursemaid's elbow, a PT must apply (1)___ perform (2)____ to return the radial head into position.

Answer 32

1. compression 2. supination

Question 33

For a pushed elbow, a PT must perform ____.

Answer 33

Gr. III distraction

Question 34

When there is an ulnar dislocation present, it's best to place the elbow in _____ to prevent ulnar neuropathy.

Answer 34

20-30 degrees flexion

Question 35

Determine where the following nerves might be impinged: 1. Cubital tunnel 2. Musculospiral groove 3. Supinator 4. Pronator Teres 5. 2 heads of the flexor carpi ulnaris A. Median Nerve B. Radial Nerve C. Ulnar Nerve D. None

Answer 35

1. C 2. B 3. B 4. A 5. C

Question 36

Determine where the following nerves might be impinged: 6. flexor digitorum superficialis 7. Arcade of Fröhse 8. Ligament of Struthers 9. extensor carpi radialis brevis 10. bicipital aponeurosis A. Median Nerve B. Radial Nerve C. Ulnar Nerve D. None

Answer 36

6. A 7. B 8. A 9. B 10. A

Question 37

Determine where the following nerves might be impinged: 1. Median Nerve 2. Radial Nerve 3. Ulnar Nerve A. Cubital tunnel B. Musculospiral groove C. Supinator D. Pronator Teres

Answer 37

1. D 2. B and C 3. A

Question 38

Determine what body movements is seen in the following peripheral nerve mobilization technique: 1. Wrist Extension and radial deviation 2. Elbow & FA extension & pronation 3. Finger Flexion 4. Wrist Extension 5. 10° shoulder abduction and medial rotation A. Radial nerve B. Median nerve C. Ulnar nerve

Answer 38

1. C 2. A 3. A 4. B 5. A

Question 39

What is the position for immobilization the radial head when excised?

Answer 39

90 degrees flexion

Question 40

Return to play activities for athletes are only prescribed if pt reaches ____% of the strength of the other UE.

Answer 40

90

Question 41

Progression of strengthening muscles & improving endurance for overuse syndrome intervention.

Answer 41

Isometric → isotonic → eccentric resistive exercises

Question 42

What are the 2 approaches for TEA ? Explain their procedure.

Answer 42

1. Triceps-reflecting: triceps tendon which inserts in the olecranon process is removed to expose more of the elbow during operation and is later placed back after the operation 2. Triceps-splitting: surgeon only a creates split in the middle of the triceps tendon

Question 43

What is the correct sequence of movements for peripheral nerve mobilization?

Answer 43

Cervical spine → shoulder → elbow & forearm → wrist → fingers

Question 44

TRUE OR FALSE: Loss of terminal flexion of the elbow contributes to greater limitation of function than loss of terminal extension

Answer 44

True Source: Kisner& Colby 7th ed., page 623

Question 45

What are the 2 major ligaments that supports the elbow?

Answer 45

Medial and Lateral Collateral Ligament Source: Kisner& Colby 7th ed., page 623

Question 46

TRUE OR FALSE: The brachioradialis is unaffected by the position of the forearm or the shoulder.

Answer 46

False. It is the brachialis. Source: Kisner& Colby 7th ed., page 625

Question 47

The ____ muscle acts as a pronator when the forearm is in supination and a supinator when the forearm is in pronation

Answer 47

Brachioradialis Source: Kisner& Colby 7th ed., page 625

Question 48

The ____ muscle is capable of generating significant force regardless of the elbow position, speed, or power of the motion.

Answer 48

Supinator Source: Kisner& Colby 7th ed., page 626

Question 49

_____ is the most active and consistently used pronator muscle.

Answer 49

Pronator quadratus Source: Kisner & Colby 7th ed., page 627

Question 50

Radicular symptoms from the C5 and C6 nerve roots will present pain in the (1)_____, while C6 and C7 nerve roots in the (2)____.

Answer 50

1. lateral elbow 2. medial elbow Source: Kisner & Colby 7th ed., page 627

Question 51

How do you perform joint tracking of the elbow to improve elbow flexion?

Answer 51

Apply a gentle lateral glide to the proximal ulna with the belt while having pt perform flexion & extension of elbow. Source: Kisner & Colby 7th ed., page 629

Question 52

In adults, the most common fracture in the elbow region is a fracture of the ____.

Answer 52

head and neck of the radius Source: Kisner & Colby 7th ed., page 630

Question 53

Radial head excision is contraindicated in ____

Answer 53

a growing child Source: Kisner & Colby 7th ed., page 631

Question 54

Arthroplasty is contraindicated in the presence of ____

Answer 54

an active infection Source: Kisner & Colby 7th ed., page 631

Question 55

2 approaches that may be performed for radial head incision:

Answer 55

1. Posterolateral (kocher) approach - between the extensor carpi ulnaris and anconeus muscles 2. Kaplan approach - between the extensor digitorum and the extensor carpi radialis brevis Source: Kisner & Colby 7th ed., page 631

Question 56

Active ROM is generally allowed within (1)____ postoperatively and begins no longer than (2) ____ postoperatively if there was an unstable fracture or dislocation requiring immobilization.

Answer 56

1. 1 week 2. 3 weeks Source: Kisner & Colby 7th ed., page 632

Question 57

If a triceps-reflecting approach was used for a linked TEA, in what position should the elbow & forearm be?

Answer 57

full elbow extension and a neutral position of the forearm Source: Kisner & Colby 7th ed., page 636

Question 58

Primary structures involved in lateral epicondylalgia?

Answer 58

extensor carpi radialis brevis & extensor digitorum Source: Kisner & Colby 7th ed., page 642

Question 59

What activities or movements are not allowed after TEA?

Answer 59

1. High-load progressive resistive exercise (PRE) 2. heavy lifting 3. high-impact recreational activities with high impact on the upper extremities Source: Kisner & Colby 7th ed., page 640

Question 60

To improve pain-free grip strength in patients with lateral epicondylitis, use an ____ to help reduce the load on the musculotendinous unit

Answer 60

elbow orthosis Source: Kisner & Colby 7th ed., page 644

Question 61

Add _____ to the program if the patient’s goals include returning to sports or occupational activities that require elbow and forearm ____

Answer 61

1. plyometrics 2. power Source: Kisner & Colby 7th ed., page 644