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therex test 2
210: elbow, wrist, hand
| Question | Answer |
|---|---|
| •Trochlea articulates with ___ (medial) | ulna |
| •Capitulum articulates with ____ (lateral) | radius |
| where do flexion and extension of elbow occur? | at distal end of humerus where trochlea articulates with ulna and capitulum articulates with radius |
| Radius and ulna articulate at the ____ | radial notch of the ulna (forms radio-ulnar joint) |
| where do pronation and supination occur? | radioulnar joint |
| •Ulna fossa is _____ (concave/convex) | concave |
| •Fossa slides in ____ (opposite or same) direction as ulna moves | same |
| There is also some lateral sliding which results in ____ angle in extension and ____ in flexion (varus or valgus) | valgus, varus |
| in Flexion fossa slides ___ and ___ | anterior and distal |
| in extension fossa slides ____ and ____ | posterior and proximal |
| •Concave radial head slides in _____(same/opposite) direction of bone motion (on the convex capitulum) | same |
| in flexion, radial head slides ____ | anterior |
| in extension, radial head slides ____ | posterior |
| •Radial head spins on ____ | capitulum |
| radial head is ____ on ____ motion | concave, convex |
| purpose of Medial (ulnar) collateral ligament | Provides stability against valgus stresses; Approximates joint surfaces |
| when is medial collateral ligament taut? | different parts of ROM |
| purpose of Lateral (radial) collateral ligament | Lateral collateral ligament and annular ligament; Provides stability against varus forces; Prevents anterior translation of radius |
| what motion occurs at radioulnar joint | pronation and supination |
| ____ rim of radial head articulates with ___ notch of ulna and annular ligament | Convex, concave |
| Annular ligament purpose | encircles rim of radial head and stabilizes against ulna |
| Rim of radius slides____ of bone motion | opposite |
| in Pronation the rim of radius slides ____ | posteriorly (dorsally) |
| in supination the rim of radius slides ____ | anteriorly (volarly) |
| protection phase therex for elbow hypomobility | Educate Patient; Teach joint protection; Avoid lifting, pushing, pulling and push off; Limit Immobilization; Controlled pain free movement; Gentle joint mobilization; ROM for uninvolved joints such as shoulder, hand, wrist |
| controlled motion phase therex for elbow hypomobility | Increase soft tissue mobility |
| return to function phase therex for elbow hypomobility | •Self Stretching; Progress Strengthening; Mimic functional activities |
| most common elbow fx | radial head and neck; typically result of FOOSH |
| what often accompanies elbow fx? | dislocation |
| what may be required in severe comminuted fx? | excision of radial head, will be filled with implant |
| Difficult to get full ROM for ____ and ____ after elbow fx | extension , supination |
| lateral epicondylitis | Pain at common wrist extensor tendons at lat. epicondyle |
| where is highest incidence of lateral epicondylitis | extensor carpi radialis brevis musculotendinous junction |
| what causes pain in lateral epicondylitis? | Pain with palpation, resisted wrist ext. with elbow extension, resisted middle finger ext. with elbow extension |
| what strength is decreased in lateral epicondylitis? | grip |
| what commonly causes lateral epicondylitis? | repetitive eccentric strain |
| colles fx common cause | FOOSH; More often older than 60 if not high energy injury; Often osteoporotic |
| what is the most commonly fx bone in the arm? | radius |
| what sometimes occurs with colles fx? | unlar styloid fx, can also have triangular fibrocartilage complex injury |
| treatment for colles fx | Immobilized if not displaced; ORIF volar plating rather than OREF |
| how long will pt be in cast/brace after colles fx? | 6 weeks, if brace can do gentle ROM |
| how long does pt need to wait before vigorous activity after colles fx? | 3 months |
| PT for colles FX | ROM; Stretching; Progress to strengthening |
| lateral epicondylalgia tx | Ice and NSAIDS, Rest/Immobilization, activity adjustment, ergonomic assessment, soft tissue mobilization of wrist extensors and |
| ergonomics for lateral epicondylalgia | keep wrist neutral and decrease gripping |
| lateral epicondylalgia therex | low intensity isometrics; cross friction fiber massage, manual and self stretching techniques. progress strengthening to PRE's (t-band, weights, wrist rolls) |
| what position puts least strain on wrist extensors | extension - extenders are in shortened position, progress to neutral and then flexed position |
| how should you progress isometrics for lateral epicondylalgia | Progress to isometrics in wrist flexion position --> Progress to elbow in extended position and repeat isometric progression --> include resisted supination |
| what other dysfunctions should you look for in lateral epicondylalgia | Posture, Shoulder, Cervical, Radial tunnel syndrome |
| other tx for lateral epicondylalgia | Graston/Astym; Autologous blood injection; steroid injection |
| purpose of autologous blood injection | Trigger stem cell recruitment and Fibroblast stimulation |
| what structure is affected by medial epicondylalgia | Common flexor/pronator tendon |
| what causes medial epicondylalgia | repetitive movements into flexion, eccentric strain of wrist and forearm mm |
| symptoms of medial epicondylalgia | may have ulnar neuropathy; Pain on palpation of medial epicondyle; Pain with resisted flexion with elbow extended; Pain with passive wrist extension with elbow extended |
| medial epicondylalgia tx | Ice, NSAIDS, rest, immobilization, activity adjustment, ergonomic adjustment, soft tissue mobilization |
| therex for medial epicondlyalgia | low intensity isometrics, cross friction fiber massage, manual and self stretching techniques, progress strengthening to PRE (t-band, weights, wrist rolls) |
| how should isometrics be progressed for medial epicondylalgia | Start isometrics in wrist flexion position, progress to extended position-- .Progress to elbow in extended position and repeat isometric progression--> Progress to resisted pronation |
| what other dysfunctions should you look for in medial epicondylalgia | Posture, Shoulder, Cervical, Radial tunnel syndrome |
| Myositis Ossificans (HO) | Bone formation most often in brachialis or joint capsule |
| what pts are prone to myositis ossificans (HO) | TBI patients, burn patients |
| what can HO develop from? | aggressive stretching too early following fracture |
| tx for myositis ossificans | rest in splint, active pain free ROM |
| carpal tunnel syndrome | sensory loss and motor weakness that occurs when the median nerve is compromised in the carpal tunnel |
| common impairments/limitations in carpal tunnel syndrome | pain in hand; atrophy in the thenar muscles and first 2 lumbricals; sensory loss in the median nerve distribution; tightness in the adductor pollicis and extrinsic thumb extensors; decreased thumb opposition; inability to perform repetitive wrist motion |
| non operative tx of carpal tunnel | splinting, joint mobs, tendon gliding exercises, median nerve mobilization, pt education, multi angle isometrics, progress to dynamic strengthening exercises |
| therex in max protection phase post op CTS | pain and edema control, active tendon and nerve gliding exercise, active finger /thumb motions, active wrist extension, active radial and ulnar deviation and pronation/supination |
| therex in moderate protection phase post op CTS | scar tissue mobilization; progressive stretching; joint mobilizations; isometrics at 4 weeks post op; grip and pinch exercises at 6 weeks; dexterity exercises; sensory stimulation and re education |
| DeQuervain's Syndrome | •Inflammation of extensor pollicis brevis, abductor pollicis longus |
| tx for DeQuervain's Syndrome | Immobilization, Rest, Ice, Gentle Stretching, Joint mobilization, Progressive Strengthening, Ultrasound, iontophoresis, steroid injection |
| OA of hand in acute stage | Achiness, Stiffness which decreases with movement, Joint swelling, warmth, Restricted, painful motion |
| OA of hand in advanced stage | Capsular laxity, Hypermobility or instability progressing to contractures, Weakness |
| OA tx | educate to protect joints, pain management, splinting, activity modification, PROM ->AAROM -> AROM, tendon gliding |
| pain management for hand OA | NSAIDS; Modalities (paraffin); Joint mob oscillations, fluidotherapy, ergonomics |
| what does hook or claw fist tendon glide position do? | intrinsic stretch, glide of flexor digitorum profundus and superficialis |
| what does straight fist tendon glide postion do? | flexor digitorum superificialis glide |
| what does full fist tendon glide position do? | flexor digitorum profundus glide |
| progression for tendon gliding exercises | wrist in neutral --> once gain full finger ROM go to wrist in flexion --> reverse the motion |
| Tendon blocking exercises | progression of tendon gliding exercises, require neuromuscular control of individual jt motions, can progress to manual resistance as tissues heal |
| what position achieves max elongation of the median nerve? | shoulder ABD to 110, elbow ext, shoulder ER and supination of forearm, wrist finger and thumb extension and cervical flexion to contralateral side |
Created by:
bdavis53102
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