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Ortho II 2009

Elbow, Wrist, Hand

QuestionAnswer
Elbow ROM 0-135
forearm pronation 0-80
forearm supination 0-90
carrying angle men 10 deg, women 15 deg
cause of lateral epicondylitis overuse, poor technique, muscle imbalance, repetitive activity, TIGHTNESS CAUSES RADIAL HEAD TO RUB AGAINST TENDON WHEN GOING INTO EXTENSION
Max phase lateral epicondylitis ice, rest, anti-inflam, gentle stretching, AROM, McConnel taping, NO STRENGTHENING!!!
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
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
what muscle is primarily being stretched in tennis elbow? extensor carpi radialis brevis
Patient ED for lateral epicondylitis grip size, lift w/bicep-not wrist, tool modification
External Wrist Extension Force wrap/strap..FOREARM SUPPORT BAND helps what? lateral epicondyliti/tennis elbow....reduces electromyographic activity or wrist extensor muscles during gripping
Medial epicondylitis emphasis on ______? also known as? strengthening wrist flexors (incl pronation & supination)...GOLFER'S ELBOW
what is 2nd most dislocated joint in body? Elbow
what is the most common complication of elbow dislocation? loss of elbow extension
what to avoid for 2-8 wks? and why No PROM, can develop myositis ossificans (unique prob to elbow)
what is important in tx of elbow dislocation? avoid contractures of capsule, low load/long duration stretch
characteristics of myositis ossificans heterotopic, ectopic bone formation, brachialis mm, palpation of distal tendon is painful
contraindication w/myositis ossificans if brachialis is involved massage, passive stretching, resistive exercises
Colles Fracture extension fracture of the distal radius, fall on outstretched arm
Smith's fracture flexion fracture of the radius
clinical manifistations of Colle's or Smith's fracture? severe pain, swelling, deformity (depression)
management of wrist fracture casted 6 wks, external fixator 6-8 wks
Scaphoid fracture bones of the right wrist, palm up
swelling, tenderness over snuffbox, pain w/pronation, indicative of ? scaphoid fx
tx of scaphoid fx casted, can take long time to heal, 60% of all carpal fractures
Navicular fracture distal pole, non displaced, immob 6 wks, prox pole non displ immob 12-24 wks (less blood supply), displaced - ORIF
Navicular fracture - tx after cast removed begin active thumb/wrist motion, NO PASSIVE STRETCHING OR MOBS
Carpal Tunnel Syndrome MEDIAN NERVE ENTRAPMENT w/in wrist, inflammation from overuse, genetically determined narrow tunnel
what mm's involved in carpal tunnel? (tenosynovitis) flex dig prof, flex digit sup, flex pollicis longus (go thru tunnel)
symptoms numbness, tingling, pain, clumsiness, weakness in hand grip all point to? Carpal Tunnel
Tx for carpal tunnel identify & modify ADL & occupational risks causing the greatest effect & work on reducing symptoms
NCV nerve conduction test for Carpal tunnel
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)
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
effect of cortizone shot for carpal tunnel 77% relief of symptoms at 30 days post injection
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
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
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
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,
MOD phase carpal tunnel avoid______ radial deviation stg ex
MOD phase carpal tunnel exercise wrist & grip isometrics, light PRE's, ergonomic principles & recommendations
MIN phase carpel tunnel strengthening, normal flexibility of mm & tendons, function
Dequervain's syndrome tenosynovitis, cumulative trauma disorder, extensor pollicis brevis, abductor pollicis longus, pass thru the 1st dorsal compartment
clinical manifistations of Dequervain's syndrome pain & swelling at the radial styloid region
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
causes of Dequervain's syndrome inflammatory & repetitive stress, new baby care, hammering, florist
test for Dequervain's syndrome Finkelstein's test
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)
RSD Reflex sympathetic dystrophy
what is RSD an exaggerated & unpredictable response of the body to trauma or post-surgical procedures
etiology of RSD unknown, abnormal autonomic reflex, prolonged symapthetic outflow, increase local circulatory disturbances, muscle spasm, pain, INCREASED SENSITIVITY
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
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
TX for RSD EARLY ROM, ROM, ROM!! active muscle contractions, analgesics, NSAIDS, steroids, intermittent pneumatic pressure, treat AGGRESSIVELY, DESPITE THE PATIENT NOT LIKING IT!
contraindication for tx of RSD NO RESISTIVE & MANIPULATIVE EXERCISES
Skier's thumb acute sprain of ulnar collateral ligament, partially or completely torn
cause of skier's thumb sudden valgus force, hyperextenion of thumb
acute sprain of ulnar collateral ligament is ? skier's thumb
tx for skier's thumb, partial tear thumb spica cast or immob 3-6 wks, gentle ROM of thumb motion,
avoid........with partial tear skier's thumb avoid end range of abduction (valgus) & hyperextension, avoid resistive exercise to thumb for 2 months
tx .....torn ligament, skier's thumb ORIF, casted 4-6 wks
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
Mallet finger avulsion fx or ext tendon rupture results in distal interphalangeal joint flexion contracture
tx for Mallet finger 6-10 wks of extension splinting is a must!!! DO NOT REMOVE THE SPLINT!!
contraindication for Mallet finger PASSIVE FLEXION EXERCISES OF THE DIP ARE CONTRAINDICATED TO PROTECT THE HEALING TENDON/BONE
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
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
post op swan neck splinting 3 wks, stretching as needed, strengthening exercises are started 8-10 wks after surgery
contraindication of mallet finger? PASSIVE FLEXION EXERCISES OF THE DIP ARE CONTRAINDICATED TO PROTECT THE HEALING TENDON/BONE
Created by: djbari