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211 exam 2
elbow, wrist, hand
| Question | Answer |
|---|---|
| arthrokinematics of the elbow | Flexion Extension Supination Pronation |
| humeroulnar joint | Trochlear notch of the ulna with the trochlea of humerus Motion: Flexion/extension |
| humeroradial joint | Capitulum of the humerus with head of the radius Motion: pronation/supination |
| radioulnar joint | Motion: pronation/supination |
| elbow flexors | Biceps, brachialis |
| elbow extensors | triceps |
| pronators | Pronator teres, pronator quadratus |
| supinators | biceps, supinator |
| Lateral (Radial) Collateral (RCL) | Attaches to the lateral epicondyle to proximal radius Prevents varus forces |
| Medial (Ulnar) Collateral (UCL) | Attaches to medial epicondyle and medial side of the ulna Prevents Valgus forces |
| annular ligament | Attaches around the neck of the radius Quadrate Ligament (radius to ulna) strengthens the borders of the annular ligament |
| elbow joint capsule | Collateral ligaments are a thickening of the capsule |
| ulnar nerve roots | C8, T1 |
| radial nerve roots | C5-C8 |
| median nerve roots | C6- C8 |
| review UE nerve distribution | |
| normal elbow flexion | 0-145 |
| normal elbow extension | 0- (-2) |
| special tests for lateral epicondylitis | Cozen test Tennis Elbow/ Lateral Epicondyle Test Passive Tennis Elbow Test |
| special tests for medial epicondylitis | Resisted Wrist Flexion and Pronation Passive Wrist Extension Medial Epicondyle Test: Supinates and extends wrist and elbow |
| ULC/MCL special tests | valgus stress tests |
| cubital tunnel special tests | tinels |
| LCL special test | varus stress |
| biceps tendinitis special tests | Speeds- resisted flexion distally Yergasons- resisted supination |
| types of elbow fx | Proximal radius fracture Medial epicondyle fracture |
| overuse injuries at the elbow | medial and lateral epicondylitis Osteochondritis Dissecans aka Medial Epicondylitis in children medial epicondylar apophysis/avulsion fx UCL sprain brachial plexus injury |
| what is posterior dislocation often caused by? | Usually caused by FOOSH |
| what is nursemaids elbow | radial head dislocation |
| treatment for nursemaids elbow | Putting the radius back where it belongs by a trained professional Will usually be followed by immobilization for 2 weeks, rest, ice, and NSAIDs PRN Surgery if the radius completely disrupts the capsule |
| are supracondylar fractures of the humerus easy to reduce? | no |
| what are supracondylar fractures of the humerus caused by? | childhood fall with elbow hyper extended – results in fracture/separation of humeral epiphysis |
| what causes proximal radius fracture | FOOSH forcing elbow into a valgus position |
| what causes olecranon fracture | Direct fall onto the olecranon Can be displaced, non-displaced and/or comminuted |
| when is an olecranon fracture impossible to reduce? | is if there is displacement |
| what causes medial epicondyle fx? | Result of a fall |
| what causes lateral epicondylitis | Repetitive wrist extension, extension with supination or gripping |
| symptoms of medial epicondylitis | Pain with wrist flexion and pronation |
| what is irritated in medial epicondylitis | Irritation of the flexor carpi ulnaris and radialis, pronator teres and flexor digitorum |
| medial epicondylitis in children is called | little leaguers elbow or Osteochondritis Dissecans |
| what is osteochondritis dissecans | Medial epicondylar apophysitis/avulsion fracture UCL sprain Repeated valgus stretch with tension on the flexor-pronator group |
| brachial plexus injury can occur with ___ | stretch |
| review brachial plexus | |
| tx for lateral epicondylitis acute phase | Rest and ice Oral anti-inflammatories Wrist split – especially at night phono |
| tx for lateral epicondylitis chronic phase | Taping Friction massage Activity/workstation adjustments Steroid injection Worse case scenario, surgery |
| medial epicondylitis tx acute phase | Same as lateral epicondylitis |
| medial epicondylitis tx chronic phase | Stretch IR, strengthen scapular stabilizers |
| osteochondritis dissecans tx | Rest – minimum of 8 weeks, decrease pitching Ice Stretch IR Worst case scenario? Surgery Tommy John surgery Medial collateral reconstruction Capsular Tightness Joint mobilizations Heat prior to treatment |
| closed pack position of the elbow | full humeral ulnar extension |
| open pack position of elbow | 70 degrees flexion, 10 degrees supination |
| normal carrying angle for women | 10-15 degrees |
| normal carrying angle for men | 5-10 degrees |
| review bones of wrist and hand | |
| intrinsic hand muscles | Opponens Pollicis Abd. Pollicus brevis Lumbricals Abd. Digiti minimi |
| extrinsic hand muscles | Flexor digitorum superficialis Flexor digitorum profundus Flexor pollicis longus Palmaris longus Extensor carpi radialis longus and brevis |
| ligaments of the wrist | Palmar radiocarpal Dorsal radiocarpal Ulnar collateral Radial collateral |
| ulnar nerve distribution | ½ of the ring finger and all of the 5th, palmar AND dorsal Radial Nerve |
| radial nerve distribution | All the dorsum of the hand EXCEPT ½ of the ring finger and all of the 5th |
| median nerve distribution | All of the palar EXCEPT ½ of the ring finger and all of the 5th Portion of dorsal 2nd, 3rd, and ½ of ring finger |
| normal wrist flexion ROM | 80 degrees |
| normal wrist extension ROM | 70 degrees |
| normal ulnar deviation ROM | 30 degrees |
| normal radial deviation ROM | 20 degrees |
| capsular pattern of wrist | Equal limitation of flexion and extension Slight limitation of radial and ulnar deviation |
| objective for wrist and hand eval | ROM MMT Palpation- crepitus, end feel, tightness, discomfort, pulse, swelling, temperature Sensation Abnormal alignments or deformities |
| subjective for wrist and hand eval | When does the pt have the most pain Do they notice a pattern on when pain arises What activities make it hurt How long have they been having pain/discomfort Imaging: MRI, X-ray |
| test for skiers thumb | Ulnar Collateral Ligament test Valgus force to MCP |
| Finkelstein's test | Tests for De Quervain’s Make a fist with thumb enclose, and move wrist into ulnar deviation |
| Phalen's test | Tests for Carpal Tunnel With dorsal aspect of the hands together, perform bilateral wrist flexion |
| Tinel's sign | at wrist for Carpal Tunnel Tapping at the carpal tunnel, attempts to recreate symptoms |
| carpal tunnel syndrome | Compression of the median nerve at the wrist caused by increased friction and pressure within the tunnel. Leads to pain and tingling, motor problems, and decreased sensation |
| PT management for carpal tunnel | Night Splint Find and alter the compressing force Splinting Strengthening Nerve glides |
| medical management for carpal tunnel | NSAID’s Corticosteroid injections If there is failure of non-operative treatments and atrophy of the intrinsic thenar muscles, then surgical intervention is indicated |
| colles fracture | Transverse fracture of radius FOOSH |
| smiths fracture | Radial and potential for metacarpal fracture Fall on back of hand with wrist in flexion |
| scaphoid fracture | FOOSH with wrist in extension and radial deviation |
| metacarpal fractures | boxers fracture and bennet fracture |
| boxers fracture | 4th or 5th MC |
| bennett fracture | Base of proximal 1st MC |
| colles fracture tx | Casted in flexion after non-invasive or surgical alignment AROM of fingers, elbow and shoulder |
| smiths fracture tx | cast |
| scaphoid fracture tx | Casted 6 weeks, longer if needed if non-union at 12 weeks bone grafting or compression screw operation Therapy: ROM |
| metacarpal fracture tx | Massage AROM Resisted exercises Grip |
| de quervain's syndrome | Inflammation of the abductor pollicis longus and brevis. |
| How does De Quervain’s manifest | Pain along the radial/ thumb side of the wrist Typically aggravated by the use of the thumb |
| de Quervain's tx | Activity modification Immobilization Ice Electrical Stimulation Iontophoresis? ROM Strengthening (when ROM is pain free) |
| tx for de Quervain's if conservative tx fails | Corticosteroid injection into first dorsal compartment Surgical release of of compartment for chronic cases |
| Dupuytren's contracture | a fibrotic hand condition characterized by the development of cords and nodules in the palm that causes one or more fingers to develop a flexion deformity. |
| conservative tx for Dupuytrens contracture | Steroid injection Splinting Serial casting Ultrasound |
| surgical intervention for Dupuytren's contracture | fasciotomy: limited fasciectomy: extensive fasciectomy, dermo fasciectomy |
| fasciotomy | divide the cords using a small needle or blade |
| limited fasciectomy | removal of the diseased tissues |
| extensive fasciectomy | removal of the diseased tissue, plus any surrounding tissue that has the potential of becoming diseased |
| dermofasciectomy | removal of the diseased tissue along with the skin overlying said tissues. The removed skin is them replaced with a skin graft. |
| trigger finger | Catching or sticking of finger or thumb due to thickening of the flexor tendon |
| PT tx for trigger finger | Prevent stress/ immobilize Stretch/ ROM US, Massage |
| other options for trigger finger tx | Corticosteroid injections Surgical release |
| skier's thumb | Acute sprain of the ulnar collateral ligament of the thumb typically caused by a quick and sudden hyperextension and valgus stress |
| grade 1 skiers thumb tx | Ice, NSAIDs, thumb spica tape, electrical stimulation |
| grade 2 skiers thumb tx | Thumb spica cast Theraputty exercises, ROM, paraffin, fluiodtherapy |
| grade 3 skiers thumb tx | Surgical repair Immobilize in a cast --> splint Theraputty exercise and ROM Avoid ABD and extension while encouraging opposition |
| stiff hand | capsular restriction Can be from CRPS, burns, Dupuytren’s or peripheral nerve injuries |
| treatment for stiff hand | Gentle ROM of elbow and shoulder Massage and ice Edema management Static and dynamic splints |
| what structures make up the anatomical snuff box | the abductor pollicis longus. extensor pollicis brevis. extensor pollicis longus |
Created by:
bdavis53102
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