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MSK 1 > 10/7 - Elbow Complex Part 2 > Flashcards

10/7 - Elbow Complex Part 2 Flashcards

(57 cards)

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1
Q

what attachment is likely implicated in lateral tendinosis

A

origin of extensor carpi radialis brevis

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2
Q

what is tendinopathy in general terms

A

degenerative condition, NOT INFLAMMATORY

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3
Q

what are the 3 possible etiologies of tendinopathies

A
  1. vascular
    - degeneration d/t vascular compromise
    - ability to absorb and generate force declines
  2. mechanical loading
    - microscopic degeneration leading to scar tissue
  3. neural modulation
    - neurally mediated mast cell degranulation and release of substance P
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4
Q

what is a way that we might be able to detect a mechanical loading etiology to a tendinopathy

A

might be able to palpate changes
could have some tenderness

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5
Q

what are 4 risk factors for a tendinopathy

A

inc age
tendons crossing 2 joints
excessive loading (volume, magnitude, speed)
altered biomechanics

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6
Q

how do altered biomechanics contribute to a risk factor for tendinopathies

A

weakness
limited flexibility
poor form w movement

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7
Q

how is inc age a risk factor for tendinopathy

A

age has a cumulative effect of load over time

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8
Q

what impact does prox weakness have on distal mobility

A

inc demand on distal mobility
- will rely on distal ms to work harder to create stability

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9
Q

what is the most typical MOI behind a tendinopathy

A

overuse

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10
Q

what is the main way to rehab a tendinopathy

A

loading the tissue
- inc collagen formation in the area

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11
Q

why are isometrics chosen initially for management of a tendinopathy

A

d/t high reactivity

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12
Q

what type of resistance do we want to be adding when rehab-ing a tendinopathy

A

heavy and slow
- for concentric exercise

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13
Q

what are other names for tendinosis

A

epicondylitis
epiconylalgia

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14
Q

what does lateral tendinosis lack

A

an inflammatory response

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15
Q

what is the best way to try to recreate sx at any ms

A

ask ms or work or put ms on stretch

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16
Q

what actions do pts w lateral tendinosis have difficulty with

A

gripping
passive wrist flex
active wrist/finger ext

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17
Q

what is the demographics for lateral tendinosis

A

females 35-50
physical/office work (ie typing)

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18
Q

what are tests to r/i lateral tendinosis

A

cozen test - resist wrist ext in pronation and RD (getting ECRB to work)

maudsley - 3rd finger resistance (EDC)

mill - elbow flex to 90, pronation
- support elbow & flex wrist and extend elbow

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19
Q

what modification can be added to the mill test to further provoke sx if mill test not sufficient

A

add ulnar deviation

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20
Q

what are differential dx for lateral tendinosis (6)

A
  1. tendinitis vs tendinosis
  2. C6-7 nerve root
  3. radial tunnel syndrome
  4. posterolateral rotary insufficiency
  5. posterior interosseous n. compression
  6. intra-articular pathology
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21
Q

what is a main way that can tease out lateral tendinosis from other differential dx

A

assessing the end feel
- degenerative n. vs muscular restriction
- capsular or bony?

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22
Q

what intervention was helpful in lateral tendinosis? what wasn’t?

A

MWM - improved pain and grip

Mill’s manip - improve pain but not grip

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23
Q

what is another term for lateral tendinosis

24
Q

is a tendinosis acute or chronic? what are the implications of this?

Study These Flashcards
A

chronic
lacks inflammatory response

25
what is one reason other than chronicity that you don't see inflammatory process in individuals w tendon irritation
taking anti-inflammatory meds
26
what are the main structures implicated w a medial tendinosis
FCR pronator teres
27
what is another term for medial tendinosis
golfer's elbow
28
what are MOI for medial tendinosis (3)
flexor-pronator fatigue UCL fails to stabilize valgus forces rapid change in level of stress
29
what are components to a physical exam to r/i medial tendinosis (4)
1. palpation of medial epicondyle - pain w/i 5 cm 2. grip strength - (+) pain, deficit 3. strength - wrist flex, pron 4. stretch - wrist ext, sup
30
what is a precaution when utilizing a HHD to assess grip strength in someone you suspect medial tendinosis in
caution in the presence of ulnar neuritis
31
what are 4 differential dx for medial tendinosis
C7, C8, T1 n. compression thoracic outlet syndrome ulnar n. injury medial elbow instability (UCL)
32
C7,8/T1 and thoracic outlet vs medial tendinosis
thoracic outlet and cervical pain are more diffuse and broader area - not pinpoint area like MT
33
sx of ulnar n. damage/irritation
weakness w opposition weakness, paresthesias, numbness
34
what intervention will benefit majority of people with tendinosis
conservative management or PT
35
what is the criteria to require surgical intervention for tendinosis (3)
failure of conservative management >1yr constant pain intra-articular pathology
36
which tendinosis is more commonly requiring an intervention
lateral tendinosis
37
what are 3 typical surgical procedures for lateral tendinosis
1. release of common extensor origin 2. debridement &/or repair of extensors 3. decortication or drilling of lateral epicondyle
38
what is the typical post-op rehab after a surgical intervention for tendinosis
gradual restore of motion once mobility is back, then restoring strength
39
location of sx and c/o in bicipital tendinopathy
c/o pain at radial tuberosity sx w resisted elbow flex and supination
40
rehab program for bicipital tendinopathy (4)
relative rest restore ms length & GHJ capsular mobility eccentric loading of elbow flexors & supinators progressive return to throw program
41
MOI for distal biceps tendon rupture
rapid eccentric contraction while in supination
42
what motions will cause pain and weakness in a distal biceps tendon rupture
elbow flex and supination
43
what are visible signs of a distal biceps tenodn rupture
popeye deformity (+) ecchymosis in antecubital fossa
44
what is super important in the management of a distal biceps tendon rupture and why
TIMELINE - direct referral to surgeon - if surgical, needs to be as soon as possible, the longer it takes to get to a surgeon - the less option surgery is as biceps retracts up, harder to restore anatomic footprint - quality of tissue deteriorates and length of tissue dec
45
general progression of post op management of distal biceps tendon rupture repair
focus on restoring full ROM by 6 weeks - gradual ext triceps strengthening first then biceps isometrics - do co-contraction exercises first to avoid isolated biceps contractions unrestricted activity by 16 weeks
46
what are risk factors for a nerve injury (3)
superficial location of nerve pathway thru narrow bony canal or in b/w ms nerve location high risk area for trauma
47
what are typical nerve injury mechanisms
direct or indirect trauma traction friction compression
48
what is the most common MOI for ulnar nerve (2)
traction valgus force at elbow
49
what are the components of the pathway that the ulnar n. passes through
walls - medial epicondyle and olecranon roof - aponeurosis floor - UCL, joint capsule, olecranon
50
what is the MOI for cubital tunnel syndrome (2)
traction (valgus force in throwers) postures of valgus
51
what are differential dx for cubital tunnel syndrome
cervical radiculopathy thoracic outlet syndrome
52
what is a consideration w the common c/o with cubital tunnel syndrome
c/o painless "snapping" or "popping" during A/P flex/ext - if accompanies by numbness and tingling that is the rubbing the nerve which will cause irritation
53
what are 4 tests to r/i cubital tunnel syndrome
tinel @ ulnar n. froment sign elbow flex test pressure provocation test
54
what are the keys to success in non-operative management of cubital tunnel syndrome (2)
prevent excessive flex postures prevent ext pressure on nerve
55
what are patient education points for cubital tunnel syndrome
avoid elbow flex >90 avoid valgus stress avoid excessive wrist/finger flex
56
what are indications for surgical intervention for cubital tunnel syndrome (3)
failure of conservative management evidence of ms atrophy (+) nerve conduction findings
57
what type of outcome measures are often used and what are 2 examples
patient reported outcome measures - DASH and qDASH

MSK 1 (31 decks)

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