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Ortho II 2009
Elbow, Wrist, Hand
| Question | Answer |
|---|---|
| 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
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