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MSPT > The Elbow and Forearm > Flashcards

The Elbow and Forearm Flashcards

1
Q

What are 2 relevant medical history/conditions to ask about in patients experience elbow/forearm pain?

A
  1. Congenital anomalies

2. known elbow OA

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2
Q

What 2 general physical activities can contribute to elbow/forearm pain?

A
  1. Gripping activities

2. Repetitive UE activity

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3
Q

What 4 questions should a PT ask if the patient relates there pain to a sport activity or playing a musical instrument?

A
  1. If the patient is learning the game/instrument
  2. If the patient has recently changed a training regimen or style of performing the activity that is giving the patient problems
  3. If the patient has recently changed equipment/musical instrument
  4. In the case of racket sports, if the patient changed the grip on the racket or has been mishitting the ball a lot
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4
Q

What position is the forearm in when testing biceps strength?

A

Forearm is in full supination

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5
Q

What position is the forearm in when testing brachialis strength?

A

Forearm is in full pronation

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6
Q

What position is the forearm in when testing Brachioradialis strength?

A

Forearm is in mid pronation

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7
Q

Tennis elbow is also referred to as ________.

A

Lateral Epicondylalgia

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8
Q

Golfer’s elbow is also referred to as ________.

A

Medial Epicondylalgia

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9
Q

What are 3 symptoms associated with tendinopathy at the elbow?

A
  1. painful response when performing RI testing to the involved musculotendinous unit
  2. Pain when performing PROM to the involved musculotendinous unit
  3. Tenderness to palpation at the site of the disorder
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10
Q

What are 3 ways tendinopathies are typically treated?

A
  1. Manual therapy including friction massage, progressive strengthening exercises and activity progression.
  2. If the muscle of the affected tendon is tight, exercise to stretch the tight muscle is also recommended
  3. Eccentric exercises
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11
Q

_______ exercises are generally believed to be most effective in strengthening the musculotendinous unit and decreasing the recurrence of the tendinopathy.

A

ECCENTRIC

Slow loading regimes are also very effective

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12
Q

True or False: Histopathologic examination frequently reveals a noninflammatory process underlying tendinosis.

A

TRUE

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13
Q

An inflammatory infiltrate has been demonstrated in what 3 tendons?

A
  1. Supraspinatus
  2. Subscapularis
  3. Achilles tendons
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14
Q

True or False: Anti-inflammatory medication may have a role in the late stages of tendinosis

A

FALSE

Effective in the early stages of tendinosis

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15
Q

What are 3 deleterious effects of anti-inflammatory medications?

A

increased risk of:
1 .rupture
2. Adipogenesis
3. Chondrogenesis

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16
Q

What are 2 basic mechanisms that influence tendon adaptations?

A
  1. Tendon load

2. Strain magnitude and duration

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17
Q

Eccentric exercises should incorporate a ______ load and _____ speed.

A
  1. Heavy load

2. Low speed

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18
Q

What muscle is most commonly effected by lateral epicondylalgia?

A

Extensor carpi radialis brevis

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19
Q

What population is typically affected by lateral epicondylalgia? What are 2 common causes?

A
  1. Population: Tennis Players

2. Cause: Faulty backhand/increased age

20
Q

Aside from overuse, what else may be the likely cause of lateral epicondylalgia?

A

Degenerative changes

21
Q

What 3 impairments are associated with lateral epicondylalgia?

A
  1. Decreased shoulder, wrist, elbow extension/flexion strength
  2. Decrease in pain pressure threshold
  3. Humeroradial/proximal radioulnar joint hypomobility
22
Q

What is the consensus regarding strength training for treating medial/lateral epicondylalgia?

A

Strength training decreases sxs in tendinosis

23
Q

What is the consensus regarding mobilizations for treating medial/lateral epicondylalgia?

A

Short term analgesic effect of manipulation allows for more stretching/strengthening exercises leading to faster recovery

24
Q

What is the consensus regarding resistance exercises for treating medial/lateral epicondylalgia?

A
  1. Resistance exercises improve pain and grip strength
25
Q

What mediates manipulation induced analgesia?

A

Non-opioid, descending pain inhibitory mechanisms

26
Q

What 2 forms of soft tissue manipulations have been advocated for targeting local tendon pathology? Are they supported by RCTs in comparison to exercise/corticosteroids?

A
  1. Transverse Friction
  2. Mill’s manipulations
  3. No, not supported by clinical trials
27
Q

As per regional interdependence, manipulation of what 3 areas may decrease pain at the elbow?

A
  1. Cervical and/or thoracic spine manipulation
  2. Mobilization with movement of the elbow lateral glide
  3. Wrist manipulation
28
Q

Is orthotic use recommended for treating lateral epicondylalgia?

A

No, consensus is unclear.

29
Q

What are the acute and chronic mechanisms of injury leading to ulnar collateral ligament instability?

A
  1. Acute: fall or traumatic incidence

2. Chronic: overuse, especially if overhead throwing athlete

30
Q

True or False: There is little to no evidence to guide treatment for ulnar collateral ligament instability.

A

TRUE

31
Q

_______ treatment is recommended for the non-athlete with ulnar collateral ligament instability.

A

CONSERVATIVE

32
Q

What diagnosis may occur in conjunction with ulnar collateral ligament instability? What structure should be examined?

A
  1. Cubital tunnel syndrome is common due to increase valgus force
  2. Evaluate for ulnar nerve impairments
33
Q

What treatment is typical for competitive athletes/throwers with ulnar collateral ligament instability?

A

May require surgery - reconstruction of the anterior band of UCL (Tommy Jones Surgery)

Sometimes with palmaris longus or ulnar nerve transposition

34
Q

What 2 areas may be weak in patients with an ulnar nerve lesion/cubital tunnel syndrome at the elbow?

A
  1. Weakness of 4th/5th digits

2. Hypothenar eminence

35
Q

What 3 areas may be weak in patients with anterior interossesous syndrome (branch of median nerve)?

A
  1. FDP 2nd/3rd digits
  2. FPL
  3. Pronator Quadratus
36
Q

What 2 areas may be weak in patients with posterior interossesous syndrome (branch of radial nerve)? What 2 muscles are typically spared?

A
  1. Wrist extensors
  2. Finger extensors
  3. ECRB and brachioradialis are usually spared
37
Q

What area may be weak in patients with pronator teres syndrome (median nerve)?

A
  1. Thenar atrophy and weakness
38
Q

What are 3 characteristics of an elbow dislocation? What can a dislocation also effect?

A
  1. exaggerated bony prominence
  2. effusion
  3. appearance of elongation of forearm;
  4. Dislocation could also affect neurovascular status
39
Q

What are 2 characteristics of an elbow fracture? What movement will the patient be unable to perform?

A
  1. history of trauma
  2. Pain could be delayed or remote from injury
  3. Pt. will be unable to fully extend the elbow
40
Q

What is the etiology of osteochondritis Dessicans (OCD)? What structure is most commonly affected?

A
  1. Etiology: increased lateral compression

2. Most commonly affecting capitulum of the humerus

41
Q

what 2 populations are at risk for developing osteochondritis Dessicans?

A
  1. Teen male baseball pitchers

2. Young female gymnasts

42
Q

Osteochondritis Dessicans: Male vs female? Dominant vs Non-dominant arm? Age?

A
  1. 90% male
  2. Dominate arm
  3. 12-17 years of age
43
Q

What 2 signs and symptoms are associated with osteochondritis Dessicans?

A
  1. Vague lateral elbow pain

2. Extension range of motion loss

44
Q

List 4 strengthening exercise options for the elbow/forearm.

A
  1. Resisted elbow extension / flexion with weights
  2. Resisted forearm pronation / supination with asymmetrical bell bar
  3. Resisted wrist extension / flexion with weights
  4. Wrist roller exercises using dowel and weights
45
Q

What is the normal carrying angle at the elbow? Is it larger in males or females?

A

Normal: 5-10 deg

Larger in women

MSPT (12 decks)

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