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NPTE The Elbow
Notes for NPTE
| Question | Answer |
|---|---|
| What is the Resting position, Close packed position Close packed position of the ULNOHUMERAL OR TROCHLEAR JOINT ? | RP: 70 elbow flexion, 10 supination CloseP: Extension with supination CAPP: Flexion more limited than extension |
| What is the Resting position, Close packed position, Capsular pattern of RADIOHUMERAL JOINT? | RP: Full extension and full supination, CloseP: Elbow flexed to 900, forearm supinated to 5, CAPP: Flexion more limited than extension, supination, pronation |
| If I want to increase the Flexion mortion of the RADIOHUMERAL JOINT which mobilization should I use? | Anterior |
| If I want to increase the Extension mortion of the RADIOHUMERAL JOINT which mobilization should I use? | Posterior |
| What is the Resting position, Close packed position, Capsular pattern of SUPERIOR RADIOULNAR JOINT? | RP: 35 supination, 70 elbow flexion, CloseP: 50supination, CAPP: Equal limitation of supination and pronation. |
| If I want to increase the pronation mortion of the SUPERIOR RADIOULNAR JOINT which mobilization should I use? | Posterior |
| If I want to increase the supination motion of the SUPERIOR RADIOULNAR JOINT which mobilization should I use? | Anterior |
| Which muscles flex the elbow? | BRACHIALIS, BICEPS brachii, BRACHIORADIALLIS; the FLEXOR CARPI ULNARIS and PRONATOR TERES |
| Which muscles extend the elbow? | TRICEPS BRACHII,ACONEUs,PECTORALIS MAJOR and ANTERIROR DELTOID muscles facilitate elbow extension in closed chain movements (push-ups or pushing heavy objects). |
| Which muscles causes pronation/supination of the forearm? | Supinator muscle:the BICEPS BRACHIIand the PRONATOR QUADRATUS is active during low loads, the PRONATOR TERES is used for pronation and stabilizing elbow flexion and the FLEXOR CARPI RADIALIS may help pronate. |
| Which muscles requires to Pulling objects toward body? | Requires the biceps brachii to flex the elbow while the shoulder extends, the triceps aids shoulder extension and controls elbow flexion. |
| Which muscles requires to Pushing away from the body? | Requires that the triceps extends elbow while biceps controls extension and helps with shoulder flexion. |
| Which muscles requires to Turning doorknobs or screwdrivers clockwise? | Requires the biceps to supine while the flexion action is countered by the triceps. |
| Which muscles requires to Using a fork? | Requires the biceps to supinate and flex elbow to bring fork to mouth and works eccentrically to control putting the fork down. |
| What is the Ligament instability tests (medial and lateral stability)? Describe it? | Identifies ligament laxity or restriction. Patient is sitt or supine. Entire UE is supported and stabilized and elbow 20-30 of fle. Valgus force placed tests ulnar collateral ligament. Varus force placed through elbow tests radial collateral ligame |
| What is the Lateral epicondylitis (tennis elbow)? Describe it? | Identifies lateral epicondylitis. Patients sitting with elbow in 90o flexion and supported/stabilized. Resist wrist extension, radial deviation, and forearm pronation with fingers fully flexed (first) simultaneously. +Pain at medial epicondyle. |
| What is the Medial epicondylitis (golfer’s elbow)?Describe it? | Identifies medial epicondylitis. Patient sitting with elbow in 90o flexion and supported/stabilized. Passively supinate forearm, extend elbow, and extend wrist. |
| What is the Lateral Tinel’s sign? Describe it? | Identifies dysfunction of ulnar nerve ate olecranon. Tap region where the ulnar nerve passes through cubital tunnel. +Reproduces a tingling sensation in ulnar distribution. |
| What is the Pronator teres syndrome test? Describe it? | Median nerve entrapment within pronator teres. Patient sitting with elbow in 90o flexion and supported/stabilized. Resist forearm pronation and elbow extension simultaneously. +Reproduces a tingling or paresthesia within medial nerve distribution. |
| What are the signs and symptoms of Elbow contractures? | Loss of motion in capsular pattern (loss of flexion greater than extension). Loss of motion in noncapsular pattern as the result of a loose body in joint, ligamentous sprain, and/or complex regional pain syndrome. |
| What is the diagnostic and medication of Elbow contractures? | Comparing results of AROM, PROM, resistive tests, and palpation. Acetaminophen and NSAIDS |
| What is the Physical therapy treatment of Elbow contractures? | Joint mobilization. Soft tissue/massage techniques, flexibility exercises, and functional exercises including strengthening, endurance, and coordination. Splinting in regaining loss of motion for capsular restrictions. |
| What are the signs and symptoms of Lateral epicondylitis (“tennis elbow”)? | A chronic inflammation of the extensor carpi radialis brevis tendon (ECRB) at its proximal attachment to the lateral epicondyle of the humerus. |
| How is the Onset of Lateral epicondylitis (“tennis elbow”)? | Is gradual, usually the result of sports activities or occupations that require repetitive wrist extension or strong grip with the wrist extended, resulting in overloading the ECRB. Must rule out involvement or relationship to cervical spine condition. |
| What is the Chief complaint of Lateral epicondylitis (“tennis elbow”)? | dull or sharp lateral pain. What are the Symptoms of Lateral epicondylitis (“tennis elbow”)? |
| What is the diagnostic and medication of Lateral epicondylitis (“tennis elbow”)? | Lateral epicondylitis test. Acetaminophen and NSAIDS |
| What is the Physical therapy treatment of Lateral epicondylitis (“tennis elbow”)? | strengthening, endurance, coordination, and flexibility exercises to gain restoration of normal function. Joint mobilization. Cryo, thermo, hydrotherapy, sound agents, and TENS. Counterforce bracing is frequently used to reduce forces along the ECRB. |
| What are the signs and symptoms of Medial epicondylitis (“gofer’s elbow? | Inflammation of the prontor teres and flexor carpi radialis tendons. As a result of chronic overuse in sports: baseball pitching, driving golf swings, swimming, or occupations that require a strong hand grip and excessive pronation of the forearm. |
| What is the diagnostic and medication of Medial epicondylitis (“gofer’s elbow)? | Medial epicondylitis test. |
| What is the Physical therapy treatment of Medial epicondylitis (“gofer’s elbow)? | Strengthening, endurance, coordination, and flexibility exercises to gain restoration of normal function.Joint mobilizatio. Cryo, thermo, hydrotherapy, sound agents, and TENS Counterforce bracing is frequently used to reduce forces along the ECRB. |
| What is the Physical therapy treatment of Distal humeral fractures? | Pain reduction and limiting the inflammatory response following trauma and/or surgery. Improving flexibility of shortened structures, strengthening, and training to restore functional use of UE. |
| What are the signs and symptoms of Osteochondrosis of humeral capitellum? | An osteochondral bone fragment becomes detached from articular surface, forming a loose body in joint. Caused by repetitive compressive forces between radial head and humeral capitellum. Occours 12-15 year of age. |
| What is Panner’s disease? | Is a localized vascular necrosis of capitellum leading to loss of subchondral bone with fissuring and softening of articular surfaces of radiocapitelar joint. Etiology is unknown but occurs in children age 10 or younger. |
| What is the diagnostic and medication of Osteochondrosis of humeral capitellum? | PFI Acetaminophen and NSAIDS. |
| What is the Physical therapy treatment of Osteochondrosis of humeral capitellum? | Rest with avoidance of any throwing or upper extremity loading activities. When pain free initiate flexibility and strengthening/endurance/coordination exercises.Late phases:a program to slowly increase load on joint is initiated. |
| What is the PT for Osteochondrosis of humeral capitellum If symptoms persist? | After surgery: minimize pain and swelling. Flexibility exercises are begun immediately following surgery. Thereafter, a progressive strengthening program is initiated. Joint mobilization to the specific restrictions identified during the examination. |
| What are the signs and symptoms of Ulnar collateral ligament injuries? | Repetitive valgus stresses to medial elbow with overhead throwing. Clinical signs include pain along medial elbow at distal insertion of ligament. In some cases paresthesias are reported in ulnar nerve distribution with positive Tinel’s sign. |
| What is the diagnostic and medication of Ulnar collateral ligament injuries? | MRI |
| Medial ligament instability test. Acetaminophen and NSAIDS. | |
| What is the Physical therapy treatment of Ulnar collateral ligament injuries? | Initial intervention includes rest and pain management. After resolution of pain and inflammation, strengthening exercises that focus on elbow flexors are initiated. Taping can also be used for protection during return to activities. |
| What are the signs and symptoms of Ulnar Nerve entrapments? | Direct trauma and cubital tunnel, traction due to laxity at medial aspect of elbow, compression due to a thickened retinaculum or hypertrophy of flexor carpi ulnaris muscle, recurrent subluxation or dislocation and DJD that affects the cubital tunnel. |
| What are the signs and symptoms of Ulnar Nerve entrapments? | medial elbow pain, and paresthesias in ulnar distribution, and a positive Tinel’s sign. |
| What are the signs and symptoms of Median Nerve entrapments? | Occurs within pronator teres muscle and under superficial head of flexor digitorum superficialis with repetitive gripping activities required in occupations and with leisure time activities. |
| What are the signs and symptoms of Median Nerve entrapments? | An aching pain with weakness of forearm muscles, positive Tinel’s sign with paresthesias in median nerve distribution. |
| What are the signs and symptoms of Radial nerve entrapment? | entrapment of distal branches (posterior or interrosseous nerve) occurs within radial tunnel (radial tunnel syndrome) as result of overhead activities and throwing. |
| What are the signs and symptoms of Radial nerve entrapment? | Lateral elbow pain that can be confused with lateral epicondylitis, pain over supinator muscle and paresthesias in radial nerve distribution. Tinel’s sign may be positive. |
| What is the diagnostic and medication of Nerve entrapments? | Electrodiagnostic tests. Acetaminophen, NSAIDS and Neurotin for neuropathic pain |
| What is the Physical therapy treatment of Nerve entrapments? | Early intervention includes rest, avoiding exacerbating activities, use of NSAIDs, modalities and soft tissue/massage techniques to reduce inflammation and pain. Protective padding, and night splints to maintain slackened position of involved nerves. |
| What is the Physical therapy treatment of Nerve entrapments with reduction in pain and paresthesias? | strengthening/endurance/coordination exercise of involved muscles to achieve nuscle, normal flexibility of shortened structures. Intervention should also includes functional training, patient education, and self-management techniques. |
| What are the signs and symptoms of Posterior Elbow dislocation? | most dislocations occurring at elbow:defined by position of olecranon relative to the humerus. Posterior dislocations frequently cause avulsion fracture of medial epicondyle secondary to traction pull of medial collateral ligament. |
| What are the signs and symptoms of Posterolateral Elbow dislocation? | Are most common and occur as the result of elbow hyperextension from a fall on the outstretched upper extremity. |
| What are the signs and symptoms of Anterior and radial head Elbow dislocation? | account for only 1 to 2 percent of all elbow dislocations. |
| What happen with a complete dislocation? | Ulnar collateral lig will rupture with rupture of anterior capsule, lateral collateral ligament, brachialis muscle, and/or wrist flexor and extensor muscles.Rapid swelling, severe pain at the elbow and a deformity with olecranon pushed posteriorly. |
| What is the diagnostic and medication of Elbow dislocation? | PFI. Acetaminophen, NSAIDS |
| What is the Physical therapy treatment of Elbow dislocation? | Initial:reduction of the dislocation. If is stable: there is an initial phase of immobilization followed by rehabilitation focusing on regaining flexibility within limits of stability, and strengthening. If elbow is not stable, surgery is indicated. |
| Which muscles is innervated by the Radial Nerve (C6, C7, C8, T1)? | Triceps, anconeus, brachioradialis, supinator, wirst and finger extensors and thumb extensors |
| Where is the sensory loss of Radial Nerve (C6, C7, C8, T1)? | posterior arm and forearm, and radial side of posterior hand |
| What is the function loss of Radial Nerve (C6, C7, C8, T1)? | loss of elbow, wrist, finger, and thumb extension |
| Which muscles is innervated by the Median (C6, C7, C8, T1)? | Pronators, wrist and fingers flexor on radial side, most thumb muscles. |
| Where is the sensory loss of Radial Median (C6, C7, C8, T1)? | Palmar aspects of tumb, 2 , 3 and 4 (radial half) fingers |
| What is the function loss of Radial Median (C6, C7, C8, T1)? | loss of forearm pronation, thumb opposition, flexion, and abduction. |
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