Didactics Weeks 1

Question 1

Three signs for testing Tendonitis

Answer 1

Three things to test:

1. Pain on activation
   - perform the mechanical action and give resistance
2. Focal tenderness
   - palpate the tendon (distal or proximal area)
3. Pain on stretch
   - lengthen the muscle bed by performing the opposite action

Question 2

Example of testing for Bicep Tendonitis

Answer 2

1. Give resistance to elbow flexion and supination
2. Palpate the bicep tendon
3. Pain on stretch- have the person extend and pronate the elbow

Question 3

Example of testing for Lateral Epicondilits

Answer 3

1. Give resistance to wrist extension
2. Palpate the tendon distal to the lateral epicondyle
3. Pain on stretch- have them wrist flexion and see if there is pain

Question 4

Treatment for MSK- Tendonitis

Example- Lateral Epicondilits or Tennis elbow

Answer 4

REST:

1. Immobilization
2. Activity Modulation
   and. ..
3. Corticosteroid shot!
   - work very quickly
4. Needles cause micro-trauma and healing
   i. some studies have found success with saline shots

Question 5

Why can’t you keep giving steroid shots to tendonitis?

Answer 5

1. Will decrease the function of fibroblasts
   
   • will decrease fibroblast activity
2. Will weaken and decrease collagen function–> will break down the collagen
   i. they use steroid shots on Keloid or other abnormal thick tendons
3. Can have Tendon rupture with excessive steroid shot
   i. will degrade that thick collagen
4. Can thin the blood vessels (wear away the endothelium)
5. Local immune suppression- at risk for infection of the skin site
6. Decrease production of melanin
   i. will decrease melanocytes

**7. CHECK their blood glucose
i. Let them know the steroid may increase their blood glucose production
(Remember, cortisol will increase blood sugar)

Question 6

Nerves of Wrist and Hand

Answer 6

1. The Ulnar Nerve
   i. Sensory for the small finger and half of the ring finger
   ii. Motor of Ulnar nerve is intrinsic muscles (interossues and lumbrincals)
   
   • will cause action of intrinsic muscles
     iii. Flexion of proximal metacarpal and extension of distal metacarpal
2. Median
   i. Sensory: Thumb, index, and long finger on the PALMER side
   ii. Extrinsic Flexion -flexion of wrist and fingers
3. Radial
   i. Sensory: Dorsal radial hand
   ii. Motor: extension of elbow, wrist, thumb, and fingers
   
   • Extrinsic Extension

• Test autonomic for each of these nerves
  i. Sweating
  ii. Vaso-motor (appropriate vasodilation and vasocontriction of vessels)
  
  • when nervous- hands get cold and clammy
  • when relaxed- hand is warm and dry

Question 7

When checking the autonomic function for sweat

Answer 7

a. Feel the dorsal portion of the hand
i. More temperature sensitive

b. Also use YOUR dorsal and to feel the dorsal section
c. Palmer side of hand is not very sensitive to temperature
* If Ulnar nerve is damaged–> will feel dry ulnar region in the long term

Question 8

Prune test!

Answer 8

a. If the kid has nerve damage, their skin will NOT wrinkle with water
b. Put them in a bathtube, see where there is NO wrinkles

Question 9

Testing the Ulnar nerve

Answer 9

Look, Feel, and Move

1. Look
   i. look for atrophy of hypothenar eminence
   ii. Look at color and dryness
   iii. Look for claw hand (flexion of the ring and small finger)
   
   • can be entire fingers, or just the last two digits
2. Feel
   i. Feel for tone
   ii. Temperature
   iii. Sweat and dryness
   iv. Strength
3. Move
   i. Strength
   ii. Range of Motion

Question 10

Carpal Tunnel Syndrome

Answer 10

a. Look at the Thenar eminence and the thumb for atrophy
i. Patients will complain of numbness of thenar region (or sometimes the entire hand)
ii. patients will drop things due to thumb weakness

b. Pain often described as burning
i. Nocturnal pain is most common
ii. *Think of pain at night with hand–> Most often Carpal Tunnel syndrome

c. Can perform Phallens and Tenel’s test
i. + test for Tenel is there is tingling
ii. + test for Phallen if there is tingling

• Dirkens test–> press on median nerve
  d. Look for thenar atrophy
  e. Test is adductor pollicis–> try to push thumb down

Question 11

Why do steroid shots help Carpal tunnel syndorme, but Not Cuboidal Syndrome (ulnar nerve)

Answer 11

1. Carpal tunnel will has a ton of synovial sheath around all the median nerve
   i. Steroid shot will decrease synovial sheath size and inflammation
   * Surgery to cut the sheath is also a treatment
2. Cuboidal Syndrome
   i. steroid shot does NOT work
   ii. Just a bony fibrous tunnel
   iii. No sheath to be decreased by steroid