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Ortho - Elbow, hand
| Question | Answer |
|---|---|
| 4 considerations unique to hand therapy | 1) Cosmesis and expression 2) Fine motor and dexterity abilities 3) Strength and power 4) Sensory abilities |
| Review anatomical features of the elbow | |
| 3 joints of elbow | 1) humeroulnar 2) humeroradial 3) radioulnar |
| 3 descripitions of the humeroulnar joint | 1) Trochlea 2) Trochlear Notch 3) Minimal contact in extension, Contact increases with flexion |
| 2 anatomical features involved in the humeroradial joint | 1) capitulum 2) head of the radius |
| 2 motions at the proximal radioular joint (describe motion) | pronation and supination (radius spins around the ulna) |
| 4 passive stabilizers of the elbow | 1) Structural geometry of articulating surfaces 2) Joint capsule 3) Reinforcing ligaments 4) Interosseus membrane |
| Review anatomy of joint capsule (slide 11) | |
| 3 bands/fiber directions of the MCL (Ulnar collateral ligament) | 1) Anterior band 2) Posterior band 3) Oblique (transverse) band |
| What is the origin of the MCL at the elbow? | anteroinferior medial condyle |
| What is the insertion of the MCL at the elbow? | anteromedial coronoid |
| What is the primary function of the anterior band of the MCL? | Primary restraint against valgus stresses in extension through midrange flexion |
| The anterior band is further divided into how many sections? | 3 |
| When is the MCL posterior band taut? | in flexion |
| Purpose of oblique MCL fibers | no sig contribution |
| Lateral (radial) collateral lig of elbow blends with what? | joint capsule and superficial extensor tendons |
| eral (radial) collateral lig of elbow is the primary constraint for what? | posterolateral rotatory instability |
| Fibers of interosseus membrane of the Lateral (radial) collateral lig run in what direction? | obliquely from the radius distally to the ulna |
| Purpose of the Interosseus membrane in the forearm? (transmits what forces) | Transmits compression forces through the wrist from radius to ulna |
| What is the MOI of lateral epicondylitis? | repetitive activity involving gripping (tennis) |
| What muscle is commonly involved in lateral epicondylitis? | ECRB |
| What is the clinical presentation of lateral epi? (3) | 1) lateral elbow & forearm pn 2) ECRB and ECRL weak and pnfl (above lat. epi) 3) decreased grip strength & grasp (with elbow ext?) |
| How to treat lat. epi? (3) | 1) stretch wrist extensors and common ext. tendon 2) Eccentric based wrist ext. exercises 3) taping |
| What 4 manual treatments can you use for lat. epi? | 1) Elbow M/L glide 2) Ulnar distraction 3) Elbow extension MWM 4) Radial anterior glide |
| What is the MOI for Med. Epi? | 1) repetitive activity involving gripping objects (golf) 2) commonly caused by valgus stresses on elbow 3) MC involves FCR & Pronator teres |
| Clinical presentation of med. epi? (5) | 1) med. elbow and forearm pn with increased activity 2) Tenderness on medial epi 3) pn with resisted wrist flexion and pronation 4) Ulnar n sx often co-exist |
| Is grip strength affected by med epi? | no |
| 3 tx methods to treat medial epi? | 1) stretch wrist flexors 2) Eccetric based exercises for wrist flexion 3) taping |
| 2 manual therapy treatments for med epi? | 1) elbow m/l glide 2) radial POSTERIOR glide |
| MOI of intersection syndrome | inflammation due to friction at the intersection of the 1st and 2nd dorsal compartments |
| Clinical presentation of intersection syndrome? (3) | 1) Pn & swelling 4-6 cm prox to lister's tubercle 2) crepitus 3) Pn w/: 1) passive wrist flexion 2) Resisted wrist ext 3) Palp of intersection site 4) (+) finkelstein's @ intersectionsite (not the snuff box!) |
| 4 treatment options for intersection syndrome | 1) thumb spica 2) modalities 3) patient edu 4) stretching |
| 4 compression sites of median nerve | 1) Struther's ligament 2) pronator teres muscle 3) FDS 4) carpal tunnel |
| 2 compression sites for the ulnar nerve | 1) cubital tunnel 2) ulnar tunnel @ wrist |
| 3 compression sites for the radial nerve | 1) high compression in arm 2) Radial tunnel at the arcade de frosche 3) wrist |
| How are AINS and Pronator teres syndrome different? | ant. interosseus nerve syndrome is a pure motor impairment unlike the pronator teres syndrome which is a sensory impairment |
| 2 MOIs of pronator teres syndrome | 1) median N. compression btn heads of pronator teres 2) repetitive flexion and pronation (golf) |
| Clinical presentation of pronator teres syndrome (4) | 1) pn in medial elbow 2) sensory loss 3) forearm and hand parathesias in 1-3rd digits increased with activity 4) wkness in forearm & hand ms. innervated by median n. |
| 3 treatments for pronator teres syndrome | 1) splint 4-6 weeks 2) modalities 3) nerve gliding |
| What is the MOI of AINS? | entrapment of the AIN branch btn two heads of the pronator teres |
| Clinical presentation of AINS (3) | 1) weakness/paralysis: FDL, FDP (lat.), Pronator quadratus 2) pinch deformity (pad to pad rather than tip to tip) 3) Extension deformity at IP of thumb & DIP at index finger secondary to weakness of FDP and FPL |
| How do you treat AINS? | Adress compression site PROM of 1st - 3rd digits |
| MOI of supinator syndrome | unaccustomed repetitive activity involving gripping or manipulating objects |
| Clinical presentation of supinator syndrome (5) | 1) Lat. elbow & forearm ⓟ 2) Parasthesia in forearm & hand 3) Sx reprod with: o Radial n. stretch test o Palpation of post. interossesus branch of radial n. in supinator ms (arcade of frohse) o nRepeated resisted mvmt tests • Deep, burning and achin |
| Supinator syndrome seems the same as what other elbow path? | lateral epi |
| 5 potential areas of entrapment causing radial tunnel entrapment | 1) Thickned fascial tissue sup. to the radiohumeral jt 2) Leash of henry 3) Fibrous orign of ECRB or fibrous bands within ECRB 4) Prox. border of the supinator (arcade de frohse)Distal edge of the supinator 5) Entrapment can be coming from elbow or ne |
| What should you check when you find clinical presentation of radial tunnel syndrome? | Entrapment can be coming from elbow or neck o Check if the pain is coming from neck rotation |
| 4 treatment options for radial tunnel syndrome | 1) Splinting during provocative activity 2) Modalities 3) Stretching/nerve glides 4) Ergonomic intervention |
| What is the MOI of cubital tunnel syndrome? | 2nd most common compressive neuropathy (after carpal tunnel syndrome) |
| Clinical presentation of cubital tunnel syndrome (5) | 1) Med. elbow ⓟ 2) Parathesia in ulnar dist. of forearm & hand (Ulnar neuropathy at elbow) 3) Sx reprod. w/ulnar n. stretch test 4) Palp. of ulnar n. in cubital tunnel incl. the arcade of struthers 5) Tinel’s sign |
| How do you know when cubital tunnel syndrome has become a chronic problem? | There is atrophy of intrinsic ms of hand |
| 3 tests for cubital tunnel syndrome | 1) (+) elbow flexion test 2) (+) wartenberg's sign 3) (+) Froment's sign (tip-tip) |
| 4 treatments for cubital tunnel syndrome | 1) Rest 2) Avoid elbow flexion during ADL’s 3) Night splinting (30˚flexion) 4-6 wks 4) May require decompression/transposition (nerve flossing & ROM following procedure) |
| What is the clinical presentation for RTS? (5) | 1) Deep aching distal to lateral epi 2) ⓟ at belly of brachioradialis 3) ⓟ w/resisted supination 4) ⓟ w/repetitive wrist flexion, pronation, or both 5) No motor or sensation loss |
| What is the clinical presentation for PINS? (5) | 1) Lateral forearm or elbow ⓟ 2) Wrist ext. w/radial deviation 3) Weakness of finger extensors 4) Thumb ext. elicits ⓟ at lat. epi 5) No sensation loss, pure motor |
| What is the MOI of a UCL strain? (3) | 1) blunt trauma or strain to the medial elbow 2) valgus stress 3) repetitive overuse poor throwing mech. |
| Clinical presenation of UCL strain? (2) | 1) Medial elbow pain 2) Sx reprod w/valgus stress test & ulnar collateral ligament palpation |
| Manual treatment for UCL strain? - | 1) Elbow Valgus stress test o Symptom response and mobility compared to uninvolved elbow Clear Tinels sign at elbow |
| MOI of RCL strain (2) | 1) Blunt trauma or strain to lateral elbow 2) Varus stress |
| Clinical presentation of RCL strain (2) | 1) Lateral elbow pain 2) Sx reprod w/varus stress test & lateral collateral ligament palpation |
| Describe the manual treatment for RCL strain | Elbow varus stress test o Symptom response and mobility compared to uninvolved elbow |
| MCL is comprised of how many bands? Name them | 3 Anterior, posterior and oblique |
| What forces does the anterior band restrain against? | valgus stresses in ext thru midrange flex |
| When is the MCL posterior band taut? | in flexion |
| The LCL complex blends with what? | joint capsule and superficial extensor tendons |
| The LCL is the primary constraint to what instability? | posterolateral rotatory |
| 2 fun facts about the interosseus membrane | 1) Fibers run obliquely from radius distally to the ulna 2) Transmits compression forces thru wrist from radius to ulna |
| Nursemaids elbow is common in what pop? | Common in children < 5 years |
| What is nursemaids elbow? | Radial head subluxation or dislocation caused by longitudinal tractioning of child’s arm |
| What is the clinical presentation of nursemaid's elbow? (2) | 1) Vague description of ⓟ 2) Avoidance of use |
| Tx for nursemaid's elbow? | reduction of dislocation |
| Radial head fx are mc seen in what pop? | 30-40 yrs old females > men |
| Radial head fx usually caused by what? | FOOSH |
| Approximately what % of all elbow dislocations involve a fx of the radial head | 10% |
| How do you treat radial head fx? (when they are less complicated w/o displacement) (3) | 1) Edema mgmt 2) AROM 3) App of sling to support fx |
| What manual therapy can you use for a radial head fx? (1) | elbow flexion MWM |
| How do you treat radial head fracture treated with an ORIF? (2) | 1) AROM (also crucial for a radial head replacement) 2) Strengthening initiated at 6wks |
| How do you treat a radial head fracture that had a radial head replacement? (1) | AROM ASAP-limit bleeding to decrease likeliness of Heterotrophic Ossification (HO) |
| Describe the 4 types of radial head fractures | Type I: undisplaced Type II: large, displaced fragment Type III: comminuted Type IV: associated w/elbow dislocation |
| Moi for ulnohumeral capsulitis? (2) | 1) Trauma (ex: fx) 2) Stiffness following immobilization & healing |
| Clinical presentation for ulnohumeral capsulitis? (3) | 1) ⓟ at end-range of and/or extension 2) Limited elbow or extension ROM (usually elbow > extension) 3) Limited ulnohumeral accessory motions (do ulnar distraction to test) |
| 4 types of manual treatments that can be used for ulnohumeral capsulitis | 1) Lateral/medial glide 2) Ulnar distraction 3) Elbow flexion MWM 4) Elbow extension MWM |
| MOI for radioulnar capsulitis | 1) Trauma (ex: contusion, dislocation) 2) Stiffness following immobilization & healing |
| Clinical presentation for prox. radioulnar capsulitis | 1) ⓟ at end-range of supination and/or pronation 2) Limited radioulnar accessory movements (do radial posterior & anterior glides & radial distraction to test) |
| 5 types of manual therapy for proximal radioulnar capsulitis | 1) Forearm pronation MWM 2) Supination MWM 3) Radial Distraction 4) Radial Posterior Glide 5) Radial Anterior Glide |
Created by:
jnorthcutt