Elbow

Question 1

humeroulnar and humeroradial arthrokinematics

Answer 1

flex: ant roll and glide, ext: post roll and glide

Question 2

Proximal RU joint arthrokinematics

Answer 2

pron: ant roll, post glide; sup: post roll, ant glide

Question 3

distal RU joint arthrokinematics

Answer 3

pron: ant roll and glide; sup: post roll and glide

Question 4

Normal elbow ROM

Answer 4

ext-flex: 0-140, Pro-Sup 0-85

Question 5

functional movement elbow ROM

Answer 5

ext-flex: 30-130, pro-sup: 0-50 each

Question 6

revised functional motion at elbow

Answer 6

full flex and pron needed for contemporary tasks

Question 7

elbow joint hypo mobility is due to? (3)

Answer 7

OA/RA, post immob (sprain/strain), Trauma

Question 8

protection phase of joint hypo mobility for elbow (4)

Answer 8

pt ed, reduce effects of inflammation, maintain soft tissue/joint mobility and integrity/function of related areas

Question 9

controlled motion phase of hypo mobility for elbow (4)

Answer 9

increase soft tissue/joint mobility, improve joint tracking, performance, functional abilities

Question 10

how to progress joint mobility of the elbow?

Answer 10

Emphasize the accessory motions of varus and valgus at end range

Question 11

ulnar glide (2)

Answer 11

increases ext, apply force against distal humerus in a radial direction

Question 12

radial glide (2)

Answer 12

increase flex, lat glide is applied to prox ulna while pt actively flexes their elbow

Question 13

return to function phase of joint hypomobility for elbow (3)

Answer 13

improve muscle performance, restore functional mobility of soft tissues/joints, promote joint protection

Question 14

stress on the elbow from throwing athletes (5)

Answer 14

post compartment is subject to tensile, compressive, and torsional forces during the acc/dec phases, which may result in valgus extension overload

Question 15

valgus extension overload could lead to?

Answer 15

stress fx of olecranon or physeal injury

Question 16

surgical options for displaced fractures of radial head include? (4)

Answer 16

ORIF, low profile fixation, excision of radial head/fragments, arthroplasty of radial head

Question 17

immobilization following surgery on elbow

Answer 17

orthosis in 45-90 elbow flex for up to 3 wks

Question 18

protection phase post-elbow surgery (4)

Answer 18

pt ed (wound care, pain control, edema), manage edema, AROM of shoulder/wrist/hand, gentle protected elbow ROM can be initiated within 2-3 days post op (LIMIT EXTENSION)

Question 19

controlled motion phase post-elbow surgery (3)

Answer 19

2-3 wks post op to about 8 wks post op, restoring ROM is primary focus (avoid grade IV), exercises to improve UE strength/endurance

Question 20

return to function phase post-elbow surgery (4)

Answer 20

2-6 months after surgery, initiate more aggressive techniques (avoid overstretching), manual stretching/hold relax techniques at end range, restore strength/endurance

Question 21

myositis ossificans symptoms (2)

Answer 21

Hard end feel where there shouldn’t be, Pain at end range

Question 22

normal tendon is primary composed of (2)

Answer 22

type I collagen (parallel arrangement) fibers and cells embedded in a matrix of PGs, glycosaminoglycans, and water

Question 23

etiology of lateral epicondylitis (2)

Answer 23

Activities that require forceful repetitive wrist ext and/or flex (against resistance), often combined with sup/pro

Question 24

other causes of lateral epicondylitis include? (4)

Answer 24

Direct trauma to lateral elbow, Relative hypovascularity of the region, Fluoroquinolone antibiotics (Cipro), Long standing corticosteroid use

Question 25

biomechanical analysis of lateral epicondylitis has shown that

Answer 25

ecc contractions of ECRB during backhand tennis swings leads to tears of the origin (EDC also involved)

Question 26

angiofibroblastic tendinosis (3)

Answer 26

ECRB tendon is invaded by immature fibroblasts and nonfunctional vascular buds with adj tissue being disorganized and hypercellular

Question 27

S/s of angiofibroblastic tendinosis (6)

Answer 27

gradual or sudden onset, pain at night, difficulty with grasping, minimal swelling, NO weakness of elbow or neurologic signs

Question 28

MRI of angiofibroblastic tendinosis (3)

Answer 28

will show micro tears, fibrovascular proliferation and degeneration, and edema

Question 29

ultrasound of angiofibroblastic tendinosis

Answer 29

calcification of the common extensor tendon

Question 30

Diff Dx for lateral elbow tendinopathy (6)

Answer 30

local arthritis, intra-articular or radiocapitellar patho, Radial tunnel/PIN, C/s referral, posterolateral rotatory intability

Question 31

initial treatment for TRUE lateral epicondylitis (5)

Answer 31

reduce pain/inflammation, STM depending on tissue irritability, ROM (pain free), look at shoulder, counterforce bracing (compression)

Question 32

eccentrics for lateral epicondylitis (2)

Answer 32

may counteract the failed healing response by promoting collagen cross-linkage formation within tendon

Question 33

exercises for lateral epicondylitis

Answer 33

wrist/elbow ROM/stretch/strengthen

Question 34

low load BFR and lateral epicondylitis helps to

Answer 34

produce endorphins to help with pain and GH

Question 35

protection phase for lateral epicondylitis (3)

Answer 35

Decrease pain, Develop soft tissue/joint mobility, Maintain UE function

Question 36

controlled motion phase for lateral epicondylitis (5)

Answer 36

Increase flexibility, Restore tracking of RU joint, Improve muscle performance/function, Initiate progressive pain-free resistive strengthening (3 sets of 15, twice a day), Resume previously aggravating activities

Question 37

return to function phase for lateral epicondylitis (4)

Answer 37

Continue stretch/strength (maintenance 3x/wk), Functional training (correct mechanics), Ice (IF NEEDED), Gradual return to sport

Question 38

extracorporeal shock wave therapy (ESWT)

Answer 38

shock waves are believed to activate the inflammation cycle (there is contradicting evidence)

Question 39

PRP and lateral epicondylitis (2)

Answer 39

cytokines such as vascular endothelial GF and platelet-derived GF important in tendon healing

Question 40

Prolotherapy

Answer 40

injecting an irritant substance (hyperosmolar dextrose, sodium morrhuate) into a ligament/tendon to promote the growth of new tissue

Question 41

Nitroglycerin patches (theory)

Answer 41

nitric oxide enhances extracellular matrix production, improving mechanical properties

Question 42

surgical intervention for lateral epicondylitis (3)

Answer 42

excision of non healing tissue, synovectomy, TEA

Question 43

healing time for lateral epicondylitis

Answer 43

Most people will get better in 8-12 months

Question 44

medial epicondylitis (3)

Answer 44

repetitive trauma to wrist flexors (FCR) or pronator (golfers elbow), may have avulsion of medial epiphysis or see ulnar compression

Question 45

S/s of medial epicondylitis (3)

Answer 45

Insidious onset, Medial elbow pain, Sx increase with wrist flex

Question 46

treatment progression of medial epicondylitis (2)

Answer 46

similar to lateral epicondylitis, want to eccentrically load tissue going into flexion

Question 47

medial athletic elbow injuries

Answer 47

Valgus stress applied to the elbow during the acceleration phase of throwing exceeds the ultimate tensile strength of the UCL

Question 48

medial athletic elbow injuries (pt 2)

Answer 48

medial aspect undergoes tremendous tension forces, while the lateral aspect is forcefully compressed during the throw causing repetitive stress

Question 49

anterior capsule has a tendency to

Answer 49

develop adhesions following injury leading to loss of ext

Question 50

little league elbow

Answer 50

Medial epicondyle epiphysis avulsion due to constant snapping at the elbow joint

Question 51

ulnar nerve entrapment

Answer 51

repetitive stress can lead to ulnar nerve transposition (lat more common)

Question 52

progression in rehab (2)

Answer 52

staging of injury should guide progression, consider irritability of the tissue

Question 53

Throwers 10

Answer 53

D2 Ext/Flex, ER/IR at 0 and 90 abd, abd to 90, scaption/ER, sidelying ER, prone T/Y/W/rows, seated press ups, push ups, elbow flex/overhead ext, wrist flex/ext

Question 54

D2 ext

Answer 54

start with involved hand overhead (ER/flex) and bring to opposite pocket (IR/ext)

Question 55

D2 flex

Answer 55

start with involved hand by opposite pocket (IR/ext) and bring overhead of involved side (ER/flex)