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MSK Final - ELBOW/ WRIST & HAND/ TMD > Elbow and FA- Abd Elb thru Med Apophysitis > Flashcards

Elbow and FA- Abd Elb thru Med Apophysitis Flashcards

1
Q

What causes an abducted elbow?

A

Trauma with FOOSH

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2
Q

What are the pathomechanics of an abducted elbow?

A

Leads to medially fixated olecranon

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3
Q

What will we find in our scan with an abducted elbow?

A
  • increased carrying angle
  • ROM limitations with pain
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4
Q

What ROM limitations will we find with an abducted elbow?

A
  • Elbow flexion and forearm supination due to lack of lateral ulnar glide
  • Wrist flexion and radial deviation due to radius shifting distally from contact with capitulum
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5
Q

What will we find with resisted testing/MMT for an abducted elbow?

A

Wrist extension and radial deviation painful

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6
Q

What would be our findings with the biomechanical exam of an abducted elbow?

A

Accessory motion - limited lateral glide
Palpation - CET TTP

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7
Q

What is the rx for an abducted elbow?

A
  • POLICED
  • Correct lateral glide, possibly with manipulation
  • Stabilization with MET
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8
Q

Will there be a protective/inflammatory stage with an abducted elbow?

A

YES - bc trauma

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9
Q

What is the cause of a radial nerve entrapment?

A

Overuse/repetitive stress/trauma

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10
Q

What is the prevalence of radial nerve entrapment?

A

Rare

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11
Q

What are the 3 names of where a radial nerve entrapment can happen?

A
  • Radial tunnel syndrome
  • Posterior Interosseous Nerve Compession Syndorme
  • Wartenberg Syndrome
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12
Q

What is radial nerve entrapment often confused with?

A

Lateral elbow tendinopathy - BUT presentation is different

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13
Q

What is the course of the radial nerve?

A
  • Off posterior cord from brachial plexus
  • passes inferior to teres major
  • posterior to brachial artery in posterior arm
  • travels just anterior to lateral epicondyle before entering posterior forearm
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14
Q

Radial nerve syndrome only has ______ no _________.

A

Symptoms, NO signs

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15
Q

What is radial tunnel syndrome at the PIN?

A

Neuropathy involving posterior interosseous nerve (PIN) branch

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16
Q

What is the site and TTP with radial tunnel syndrome?

A
  • TTP 2-5 cm distal to lateral epicondyle
  • Between distal edge of supinator and around radial neck posteriorly
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17
Q

What are symptoms with radial tunnel syndrome?

A
  • Dorsoradial proximal forearm pain and possibly paresthesias into dorsal thumb and web space
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18
Q

What are symptoms of radial tunnel syndrome provoked by?

A

Supination/pronation and elbow flexion

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19
Q

What is NOT present with radial tunnel syndrome?

A

Motor or sensory deficit

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20
Q

What are the symptoms of posterior interosseous nerve compression syndrome?

A

More severe radial tunnel syndrome with same symptoms plus…
- sensory and motor dysfunction
- positive dural mobility and special tests

21
Q

What can the sensory and motor dysfunction with posterior interosseous nerve compression include?

A
  • SENSORY: Decreased sensation over dorsoradial forearm and dorsal thumb and web space
  • MOTOR: wrist and finger extension weak and painful
22
Q

What will be positive in the biomechanical exam with posterior interosseous nerve compression?

A

Radial nerve dural mobility
special test: (+) resisted supination test

23
Q

What is the difference between a a spinal nerve and C6? How can we tell?

A

Elbow flexion wont be limited because it is cutaneous, we won’t get confirmation of the spinal nerve which will tell it is the radial nerve

24
Q

What is wartenberg syndrome?

A

Neuropathy; compression of superficial sensory radial nerve between brachioradialis and ECRL

25
Q

What can we expect with Wartenberg syndrome?

A
  • No motor innervation so no weakness
  • only sensory symptoms or paresthesias and pain over dorsoradial forearm and dorsal aspect of 1st 3 and a half digits
26
Q

What is the rx for terminal nerve branch injuries?

A
  • POLI (NO C) ED- when compression is the cause we don’t use
  • Bracing/Splinting
  • Neural mobilizations if an adhesion
  • MET with optimal stresses to create neural motion and the above elimination of compression
27
Q

When is it okay to reproduce symptoms?

A

Tension restriction - NOT ok to reproduce
Adhesion restriction - OK to reproduce

28
Q

What is the prevalence of medial tendinitis/ tendinosis

A

.4%

29
Q

What is medial tendinitis/tendinosis also known as?

A

Thrower’s, little league, or golfer’s elbow

30
Q

What structures are involved with medial tendinosis/tendinitis?

A

Pronator teres
flexor carpi radialis
flexor carpi ulnaris
flexor digitorum superficialis
flexor digitorum profundus

31
Q

What are some hallmark S&S of tendinitis specific to the medial elbow?

A
  • Pain with lengthening flexors/pronators
  • TTP over medial epicondyle and common flexor tendon
  • S&S more recent, overuse history, something changed

** tendinosis is over or equal to 6 months

32
Q

What are complications with medial tendinosis/tendinitis?

A
  • medial epicondyle apophysitis in adolescent overhead throwers
  • Ulnar collateral ligament involvement
33
Q

What is medial epicondyle apophysitis due to?

A

Growth with high activity

34
Q

What population is medial epicondyle apophysitis most common in?

A
  • adolescents, males more than females
  • Mostly overhead throwers but also with racquet sports
35
Q

What is medial epicondyle apophysitis also known as?

A

Little league elbow

36
Q

What are the pathomechanics of medial epicondyle apophysitis?

A
  • bone growth exceeds wrist flexor and pronator lengthening
  • increased tendon tension
  • Growth plate is the weak spot in adolescents
  • Inflammation
37
Q

What is the “weak spot” in adults? Children?

A

Tendons in adults, growth plate in children

38
Q

What are complications with medial epicondyle apophysitis?

A
  • avulsion and/or premature closure
  • Ulnar collateral ligament involvement
39
Q

What are symptoms of medial epicondyle apophysitis?

A
  • Gradual onset with overuse
  • A “pop” may indicate trauma or an avulsion
  • Above etiology with possible loss of velocity
40
Q

What are signs of medial epicondyle apophysitis?

A
  • ROM - loss of extension with pain
  • Resisted /MMT: possibly weak and/or painful muscles that attach to common flexor tendon
  • Palpation: TTP over medial epicondyle
41
Q

What is our rx for medial epicondyle apophysitis?

A

Pt education on:
- soreness rule
- load management (i.e. pitch count, active rest with alternate positions, rest days)
- movement cues (i.e. pitching mechanics)
POLICED

42
Q

What rx do we have to be careful with concerning medial epicondyle apophysitis?

A

Prolonged stretching due to vulnerability of growth plate

43
Q

What should our MET include for medial epicondyle apophysitis?

A
  • for trunk, cuff, scapular, and LE impairements
44
Q

What should we have caution with MET for medial epicondyle apophysitis?

A

Muscles and tendons attached to growth plate

45
Q

Why would we want to exercise non-involved structures with medial epicondyle apophysitis?

A

They are already being overused, need to take stress off of involved structures

46
Q

What is RTP?

A

A throwing progression program for those with medial epicondyle apophysitis

47
Q

What is the prognosis for medial epicondyle apophysitis?

A
  • can become recurrent/persistent problem
48
Q

When does the growth plate typically fuse with medial epicondyle apophysitis?

A

Around 15 years of age

MSK Final - ELBOW/ WRIST & HAND/ TMD (6 decks)

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