Elbow, Wrist, Hand
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| Elbow ROM | 0-135
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| forearm pronation | 0-80
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| forearm supination | 0-90
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| carrying angle | men 10 deg, women 15 deg
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| cause of lateral epicondylitis | overuse, poor technique, muscle imbalance, repetitive activity, TIGHTNESS CAUSES RADIAL HEAD TO RUB AGAINST TENDON WHEN GOING INTO EXTENSION
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| Max phase lateral epicondylitis | ice, rest, anti-inflam, gentle stretching, AROM, McConnel taping, NO STRENGTHENING!!!
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| MOD phase lateral epicondylitis | stretching of extensor group, strengthening (pain free!), slow, eccentric a must!, theraband, free wts (emphasize extensors), grip, consider shoulder strg, jt mobs of radial head
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| MIN phase lateral epicondylitis | wrist stg (pain free) & stretching, ECCENTRIC, ECCENTRIC!, wrist ext & radial/ulnar deviation, cross friction massage, may need to work thru some of pain but try to avoid this method if possible
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| what muscle is primarily being stretched in tennis elbow? | extensor carpi radialis brevis
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| Patient ED for lateral epicondylitis | grip size, lift w/bicep-not wrist, tool modification
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| External Wrist Extension Force wrap/strap..FOREARM SUPPORT BAND helps what? | lateral epicondyliti/tennis elbow....reduces electromyographic activity or wrist extensor muscles during gripping
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| Medial epicondylitis emphasis on ______? also known as? | strengthening wrist flexors (incl pronation & supination)...GOLFER'S ELBOW
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| what is 2nd most dislocated joint in body? | Elbow
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| what is the most common complication of elbow dislocation? | loss of elbow extension
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| what to avoid for 2-8 wks? and why | No PROM, can develop myositis ossificans (unique prob to elbow)
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| what is important in tx of elbow dislocation? | avoid contractures of capsule, low load/long duration stretch
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| characteristics of myositis ossificans | heterotopic, ectopic bone formation, brachialis mm, palpation of distal tendon is painful
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| contraindication w/myositis ossificans if brachialis is involved | massage, passive stretching, resistive exercises
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| Colles Fracture | extension fracture of the distal radius, fall on outstretched arm
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| Smith's fracture | flexion fracture of the radius
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| clinical manifistations of Colle's or Smith's fracture? | severe pain, swelling, deformity (depression)
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| management of wrist fracture | casted 6 wks, external fixator 6-8 wks
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| Scaphoid fracture | bones of the right wrist, palm up
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| swelling, tenderness over snuffbox, pain w/pronation, indicative of ? | scaphoid fx
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| tx of scaphoid fx | casted, can take long time to heal, 60% of all carpal fractures
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| Navicular fracture | distal pole, non displaced, immob 6 wks, prox pole non displ immob 12-24 wks (less blood supply), displaced - ORIF
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| Navicular fracture - tx after cast removed | begin active thumb/wrist motion, NO PASSIVE STRETCHING OR MOBS
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| Carpal Tunnel Syndrome | MEDIAN NERVE ENTRAPMENT w/in wrist, inflammation from overuse, genetically determined narrow tunnel
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| what mm's involved in carpal tunnel? (tenosynovitis) | flex dig prof, flex digit sup, flex pollicis longus (go thru tunnel)
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| symptoms numbness, tingling, pain, clumsiness, weakness in hand grip all point to? | Carpal Tunnel
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| Tx for carpal tunnel | identify & modify ADL & occupational risks causing the greatest effect & work on reducing symptoms
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| NCV | nerve conduction test for Carpal tunnel
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| conservative PT tx for carpal tunnel | splint (neutral), ice (ice massage), gentle exercise, NSAIDS, tendon gliding exercise nerve gliding exercise, jt mobs, ERGONOMIC ASSESSMENT VERY IMPORTANT! (pt ed)
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| exercise routine for carpal tunnel, when to add strengthening exercises | don't do strengthening before nerve gliding, once nerve glides are pain free add strengthening
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| effect of cortizone shot for carpal tunnel | 77% relief of symptoms at 30 days post injection
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| post op carpal tunnel surgery | division of transverse carpal lig. splint 10 days, incisional pain 3-6 mo, scar massage, loss of strength should improve 3-6 mo
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| MAX phase carpal tunnel post op | ice, elevation, AROM to surrounding joints, tendon/nerve gliding, after suture removal, scar desensitization w/wound closed, modalities to dec pain
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| what to avoid MAX phase carpal tunnel | AROM wrist flexion, finger flexion w/wrist flexion fist 10 days, cautious first 3 wks due to BOWSTRING effect
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| MOD phase carpal tunnel surgery | MH, scar desensitization (cross friction), tendon/nerve gliding, AROM wrist flexion (after 21 days), strengthening (post 4 weeks), rice gripping/paper crunchs, resistive gripping & pinching ex,
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| MOD phase carpal tunnel avoid______ | radial deviation stg ex
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| MOD phase carpal tunnel exercise | wrist & grip isometrics, light PRE's, ergonomic principles & recommendations
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| MIN phase carpel tunnel | strengthening, normal flexibility of mm & tendons, function
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| Dequervain's syndrome | tenosynovitis, cumulative trauma disorder, extensor pollicis brevis, abductor pollicis longus, pass thru the 1st dorsal compartment
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| clinical manifistations of Dequervain's syndrome | pain & swelling at the radial styloid region
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| tx for Dequervain's syndrome | reduce symptoms of the thumb, splinting 3-6 wks, NSAIDS, wrist & thumb immob, ice, phono, ionto, injection if conservative fails
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| causes of Dequervain's syndrome | inflammatory & repetitive stress, new baby care, hammering, florist
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| test for Dequervain's syndrome | Finkelstein's test
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| purpose of Finkelstein's test | see if there is tenosynovitis of the abductor pollicus longus & extensor pollicis brevis, pain w/wrist ulnar devation (thumb in fist) + (stenosis & inflammation)
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| RSD | Reflex sympathetic dystrophy
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| what is RSD | an exaggerated & unpredictable response of the body to trauma or post-surgical procedures
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| etiology of RSD | unknown, abnormal autonomic reflex, prolonged symapthetic outflow, increase local circulatory disturbances, muscle spasm, pain, INCREASED SENSITIVITY
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| clinical manifistation of RSD | PAIN, touch & weight bearing almost intolerable, night pain, ROM increases pain, edema, heat, redness, hyperesthesia of skin, hyperhydrosis (profuse sweating), thickened, stiff feeling in jt, trophic chgs in skin
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| tx for RSD | BEST IF RECOGNIZED EARLY, pain & swelling mngt, MH, massage, estim, PROM/AROM in warm WPL, topical stimulation (rubbing towel across the area), TENS, ES, neuroprobe, light wt bearing, mobilize & desensitize (add lots of sensory input, suitcase protocol
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| TX for RSD | EARLY ROM, ROM, ROM!! active muscle contractions, analgesics, NSAIDS, steroids, intermittent pneumatic pressure, treat AGGRESSIVELY, DESPITE THE PATIENT NOT LIKING IT!
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| contraindication for tx of RSD | NO RESISTIVE & MANIPULATIVE EXERCISES
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| Skier's thumb | acute sprain of ulnar collateral ligament, partially or completely torn
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| cause of skier's thumb | sudden valgus force, hyperextenion of thumb
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| acute sprain of ulnar collateral ligament is ? | skier's thumb
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| tx for skier's thumb, partial tear | thumb spica cast or immob 3-6 wks, gentle ROM of thumb motion,
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| avoid........with partial tear skier's thumb | avoid end range of abduction (valgus) & hyperextension, avoid resistive exercise to thumb for 2 months
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| tx .....torn ligament, skier's thumb | ORIF, casted 4-6 wks
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| skier's thumb/gamekeeper's thumb test | to test for integrity of ulnar (medial) collarteral ligament, pain &/or laxity are present when an abduction force is applied to the MCP, indicates hypermobility or instability of MCP
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| Mallet finger | avulsion fx or ext tendon rupture results in distal interphalangeal joint flexion contracture
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| tx for Mallet finger | 6-10 wks of extension splinting is a must!!! DO NOT REMOVE THE SPLINT!!
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| contraindication for Mallet finger | PASSIVE FLEXION EXERCISES OF THE DIP ARE CONTRAINDICATED TO PROTECT THE HEALING TENDON/BONE
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| Swan neck deformity | inflammation from injury or disease ( such as RA) may cause pain & swelling of the PIP jt, , it will go too far into extension, the DIP is bent downward into flexion
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| tx for swan neck | PIP jt must be supple ( not stiff), aligning the PIP jt & preventing hyperextension should help restore DIP extension, stretching, massage, jt mobs are used to try & restore finger alignment & function
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| post op swan neck | splinting 3 wks, stretching as needed, strengthening exercises are started 8-10 wks after surgery
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| contraindication of mallet finger? | PASSIVE FLEXION EXERCISES OF THE DIP ARE CONTRAINDICATED TO PROTECT THE HEALING TENDON/BONE
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