1
Q
Loss of ROM in a non capsular pattern may be the result of what?
A
loose both in the joint, ligamentous sprain, and.or complex regional pain syndrome
2
Q
Elbow contracture - loss of ROM
A
typically in capsular pattern (loss of flex > ext)
3
Q
diagnosis for elbow contracture
A
- AROM
- PROM
- resistive test
- palpation
4
Q
PT goals for elbow contracture
A
- address joint movement restrictions through manual therapy and exercise
- soft tissue/massage, modalities, flexibility exercises, functional exercises
- splinting may be effective adjunct
5
Q
What is lateral epicondylagia/epicondylitis/tennis elbow
A
chronic degenerative condition of the ECRB at its proximal attach meant to the lat epicondyle of humerus
6
Q
onset of lateral epicondylitis
A
gradual
- usually result of sports activities or occupations that require repetitive wrist extension or string grip with wrist extended, resulting in overload of ECRB
7
Q
when examining lateral epicondylitis, what do you need to rule out?
A
- involvement of c spine or radial nerve entrapment
8
Q
what is normal range of motion of the elbow?
A
0-140 degrees flexion
- 80-90 degrees supination
- 75-85 degrees pronation
9
Q
PT goals, outcomes, interventions for lateral epicondylitis
A
- resistance training to improve strength and endurance are the cornerstone of treatment
- address joint movement restrictions
- education on preventions
- ed to avoid gripping or lifting with palm down
- hot, cold, hydrotherapy, sound agents, TENS
- counterforce bracing is frequently used to reduce forces along ECRB
10
Q
What is medial epicondylitis/ golfers elbow
A
- degenerative condition of the printer tires and flexor carpi radials at their attachment to medial epicondyle of humerus
11
Q
How does medial epicondylitis occur
A
overuse in sports, such as baseball pitching, driving golf swings, swimming, or occupations that require a strong hand grip and excessive pronation of the forearm
12
Q
PT goals, outcomes, interventions for medial epicondylitis
A
- similar to lateral epicondylitis
- educate to avoid gripping or living with palm down
13
Q
complications of distal humerus fractures
A
- loss of motion, myositis ossificans, malalignment, neuromuscular compromise, ligamentous injury, CRPS
14
Q
Supracondylar humeral fracture
A
- typically due to FOOSH
- distal fragment often displaces posteriorly
- must be caught quickly due to radial nerve and vascular structures –> may lead to Volkmann’s ischemia
- must assess growth plate –> high incidence of malunion
15
Q
Intra-articular distal humerus fractures
A
- “T or Y” fractures
- due to blow to flexed elbow or longitudinal loading of an extended elbow
- joint surface disrupted –> more challenging to regain full ROM
16
Q
Lateral epicondyle fracture
A
- common in long people and typically require an ORIF to ensure alignment (typically allowed to WB early with ORIF)
17
Q
PT for Humeral fractures
A
- pain reduction and limiting inflammatory response following trauma and/or surgery
- improve flexibility of shortened structures, strengthening and training to report functional use of UE
18
Q
Olecranon Fracture
A
- due to direct trauma or triceps avulsion
19
Q
Radial head fracture
A
- typically due to axial loading on a pronated forearm or due to values compression (FOOSH)
- may or may not involve annular ligament
- radial head dislocation: typically in kids from their arms being yanked –> can cause stretching of annular lig
20
Q
Osteochonritis dessecans of humeral capitulum can affect…
A
- central and/or lateral aspect of capitulum or radial head
- osteochondral bone fragment can become detached from articular surface, forming loose body in joint
21
Q
Osteochonritis dessecans of humeral capitulum is caused by
A
- repetitive compressive forces between the radial head and the humeral capitulum
- occurs in adolescents between 12-15 yo
22
Q
what is Panner’s disease
A
a localized avascular necrosis of the capitulum leading to loss of subchondral bone with fissuring and softening of articular surfaces of RC joint
- etiology unknown
- occurs in kids under 10
23
Q
PT interventions for osteochondrosis of humeral capitulum
A
- rest with abidance of any throwing or UE loading activities
- when pain free: initiate flexibility and strengthening
- during late phases of rehab: initiate program to slowly increase load on joint –> if symptoms persist, surgery is indicated
24
Q
PT interventions for post op osteochrondrosis of humeral capitulum
A
- initial focus is to minimize pain and swelling
- flexibility exercises are begun immediately following sx
- then progressive strength program
- joint restrictions then addressed
25
what causes UCL injuries
- repetitive valgus stresses to medial elbow with overhead throwing
26
clinical signs of UCL injury
- pain along medial elbow at distal insertion of ligament
- sometimes paresthesias are reported in Ulnar nerve distribution w/ + Tinel's
27
diagnostic test for UCL injury
MRI
28
PT goals, outcomes, interventions for UCL injury
- rest and pain management
- strengthening exercises that focus on elbow flexors are initiated
- taping can be used for protection during return to sport
29
what is Cubital Tunnel Syndrome
- entrapment of ulnar nerve by aponeurosis of FCU, 2-3 cm below medial epicondyle
30
What can cause Cubital Tunnel Syndrome
- direct trauma at cubical tunnel, traction due to laxity, compression due to thickened retinaculum or hypertrophy of FCU, recurrent subluxation, DJD that affects cubital tunnel
- increased carrying angle = increased risk of entrapment
- leaning on elbow, over use, valves deformity
31
what is Prontator Teres Syndrome
- compression of median n between heads of the pronator teres muscle
- similar to carpal tunnel, but also forearm mm involvement (PT, wrist flexors, finger flexors)
32
how does Pronator teres syndrome occur
- repetitive gripping activities required in occupations and with leisure activities (tennis)
33
clinical findings of pronator teres syndrome
- aching pain with weakness of forearm muscles and positive Tinel's with paresthesias in median nerve distribution
34
Radial n entrapment
- entrapment of distal branches (post interosseous n) occurs within radial tunnel as a result of overhead activities and throwing
35
clinical signs of radial nerve entrapment
- lateral elbow pain tat can be consumed with lateral epicondylitis and epicondylopathy, pain over supinator muscle, and paresthesias in a radial nerve distribution
- Tinel's may be +
36
diagnostic tests used for nerve entrapment
- electrodiagnostic test
37
medications for nerve entrapment
- acetaminophen
- NSAIDs
- Neurontin for neuropathic pain
38
PT for nerve entrapment
- early intervention: rest, avoiding exacerbating activities, use of NSAIDs, modalities, soft tissue
- neurodynamic mobilization may be indicated if abnormal neurotension is present
- protective padding and night splints
- with reduction in pain and n/t, focus on strengthening exercise of involved muscles to achieve muscle balance between agonist and antagonist. normal flexibility, normal strength/endurance/coordination
- functional training, pt ed, self management
39
posterolateral dislocations at elbow
- most common
- occurs as the result of elbow hyperextension or FOOSH
40
posterior dislocations of elbow are defined by..
positing of olecranon relative to the humerus
41
posterior dislocations of elbow frequently cause...
avulsion fractures of medial epicondyle secondary to traction pull of MCL
42
what occurs with complete dislocation of radial head
UCL will rupture with possible rupture if anterior capsule, LCL, brachialis, wrist flexor/extensor muscles
43
clinical signs of elbow dislocation
- rapid welling, severe pain at elbow and deformity with the olecranon pushed posteriorly
44
PT goals outcomes, interventions for elbow dislocation
- initial intervention is reduction of dislocation
- if elbow is stable, there is initial phase of immobilization followed by rehab focusing on regaining flexibility within limits of stability and strengthening
- if elbow is not stable --> surgery
45
Capsular pattern
loss of flexion > loss of ext
46
radio ulnar convex/concave rule
proximal: convex on concave
distal: concave on convex
47
humeroradial convex/concave rule
concave on convex
48
humeroulnar convex/concave rule
concave on convex
49
humeroulnar joint OPP
70 degrees flex, 10 degrees supination
50
humeroradial joint OPP
full ext and supination
51
humeroulnar joint CPP
full extension and supination
52
humeroradial joint CPP
90 degrees flexion and 5 degrees supination
53
proximal radio ulnar joint OPP
70 degrees flexion, 35 degrees supination
54
proximal radio ulnar joint CPP
5 degrees supination
55
distal radio ulnar joint OPP
10 degrees supination
56
distal radio ulnar joint CPP
5 degrees supination
57
Boards Prep - MSK
flashcards
Decks in class (29)
# Cards
-
Pathological End Feels5
-
Imaging11
-
Degenerative Disc Disease6
-
Ankylosing Spondylitis8
-
Gout8
-
Psoriatic Arthritis8
-
Rheumatoid Arthritis8
-
Osteoporosis16
-
Osteomalacia7
-
Osteomyelitis9
-
Myofasical Pain Syndrome9
-
Contraindications23
-
Bursitis8
-
Myositis Ossificans6
-
Paget's disease/Osteitis Deformans)11
-
Shoulder27
-
Elbow57
-
Wrist and Hand67
-
Hip64
-
Knee76
-
Foot and Ankle120
-
Spine48
-
Masqueraders of MSK Pain8
-
Peds lifespan development20
-
Peds reflexes19
-
Peds examination tools6
-
pediatric outcome measures and screening tools19
-
Wheelchair/Adaptive Equipemnt30
-
Endocrine9
