8) Elbow & Hands

Question 1

What is critical to healing & what is not?

Answer 1

Inflammation is critical; Edema is not

Question 2

Inflammation causes the release of what, and what does this cause?

Answer 2

Chemotactic factors (histamine, prostoglandins, bradykinin, substance P, complements, etc)

*Causes vasodilation

Question 3

Vasodilation does what?

Answer 3

*Incr interstitial fluid & macrophages & activates fibroblasts–> blocks venous & lymphatic drainage

Question 4

What is chronic inflammation characterized by?

Answer 4

Exuberant fibrous tissue, loss of tissue elasticity, & scaring

Question 5

What are the physical therapy gremlins?

Answer 5

Edema & pain

Question 6

Why does edema cause pain?

Answer 6

It compresses nerves

Question 7

Does pain always occur at the location the pt feels it?

Answer 7

No, it occurs in the cortex

Question 8

What is common for a pt to have after surgery?

Answer 8

Adhesions

Question 9

How many days post-op does scar tissue start to form?

Answer 9

11 days

Question 10

What is good about a splint?

Answer 10

It allows for PROM, but no AROM, so pt can move w/out putting stress on their tendons

Question 11

Does a pt need to be in a splint during the fibroplastic stage?

Answer 11

No

Question 12

What should be avoided in the fibroplastic stage?

Answer 12

Forceful grip

Question 13

Why does the Tinel’s sign work?

Answer 13

*

Question 14

Tinel’s Sign

Answer 14

Test for carpal tunnel syndrome where percussion over the irritated area of a damaged peripheral nerve elicits distal electrical sensation to tell you the location of nerve damage

Question 15

Phalen’s Test

Answer 15

Tests for median nerve compression by reproducing tingling at fingers

Question 16

Tx for carpal tunnel syndrome

Answer 16

• Modify activities & the workplace
• Avoid wrist flexion
• Brace/splint for protection
• Rest from repetitive activity
• Pt ed
• US
• Tendon gliding exercises
• Steroid injections

Question 17

What are the indications for surgical management of carpal tunnel syndrome?

Answer 17

• Sensory/motor deficits
• Persistant pain
• Sx’s despite supportive care

Question 18

What are the post-op complications of carpal tunnel surgery?

Answer 18

Hypersensitivity/Hypertrophy

Question 19

DeQuervain’s Tenosynovitis

Answer 19

Entrapped & inflamed tenosynovium of the thumb’s extensor tendons at the wrist

Question 20

Sx’s of DeQuervain’s tenosynovitis

Answer 20

• Tenderness at the 1st dorsal compartment of the wrist

* (+) Finkelstein’s Test

Question 21

What is a requirement for a pt to have DeQuervain’s tenosynovitis?

Answer 21

Pt should not have jt pathology or nerve dysfxn

Question 22

Fx for DeQuervain’s tenosynovitis

Answer 22

• Rest w/temporary exercise modification
• Heat & anti-inflammatory modalities
• Protective splint to relax tendons
• Steroid iontophoresis or injection
• Surgical release of extensor compartment for chronic/unresponsive cases

Question 23

What PA is great for DeQuervain’s tenosynovitis?

Answer 23

Phonophoresis

Question 24

How many days does Ca2+ deposition begin post-fx?

Answer 24

21

Question 25

What is the surgical tx for wrist & hand fx's?

Answer 25

Pinning & InFix

Question 26

What is the benefit to pinning & InFix of of hand & wrist fx's?

Answer 26

* Allows for early, controlled mobilization of uninvolved jt's * Maintains fx position

Question 27

Does pinning & fixation of wrist & hand fx always completely stabilize the bone fragments?

Answer 27

No

Question 28

What does ExFix of wrist & hand fx allow for?

Answer 28

Immediate skin care, edema care, & jt mobilization bc the pt won't need a cast

Question 29

What does InFix of the distal radius allow for?

Answer 29

Early jt motion

Question 30

Will a pt need a cast w/an InFix?

Answer 30

No, but they should still have a splint for protection

Question 31

When can you start AROM after an InFix?

Answer 31

Immediately

Question 32

What structure actually causes the pain of a fx?

Answer 32

Periosteum

Question 33

What carpal bone is the most commonly fx'ed?

Answer 33

Scaphoid

Question 34

Why do pt's w/pain for >2yrs have a very hard time getting rid of their pain?

Answer 34

Bc the brain has gotten used to the pain stimulus

Question 35

Colle's Fx

Answer 35

Fx of the distal radius, usually dorsally displaced

Question 36

What is the most common fx in adults?

Answer 36

Colle's Fx

Question 37

What does a colle's fx require PT for?

Answer 37

* Wrist stiffness * pain * persistent swelling * weakness * post-traumatic OA

Question 38

Do most wrist ligament tears respond well to rest & rehab?

Answer 38

Yes

Question 39

Where do 90% of wrist sprains occur & why is this so bad?

Answer 39

*Occur at the scaphoid-lunate ligament-->Bade bc it doesn't heal which causes instability & makes pt prone to subluxation

Question 40

Sx's of wrist sprain

Answer 40

* Persistant pain * clicking * shifting sensation * tenderness w/palpation

Question 41

What is basilar jt OA?

Answer 41

OA of the CMC jt of the thumb

Question 42

What pt pop is basilar jt OA most common in?

Answer 42

Middle-aged women

Question 43

Describe the surgery done for basilar jt OA

Answer 43

Trapezium is removed, clean out osteophytes, & then sometimes a piece of tendon is coiled up to use as a spacer & shock absorber

Question 44

What is the fxnl purpose of the elbow?

Answer 44

To position & propel the hand in space

Question 45

Full ROM of elbow

Answer 45

0-145

Question 46

Fxnl ROM of elbow

Answer 46

30-130

Question 47

Where does 50% of hand strength come from?

Answer 47

Forearm muscles

Question 48

Forearm muscles provide what percent of hand strength?

Answer 48

50%

Question 49

What do forearm fx's in adults require & why?

Answer 49

Surgical fixation & early controlled mobilization bc they won't regain their ROM like kids do

Question 50

What is the most common injury as the result of falling on an outstretched hand?

Answer 50

Radial head fx

Question 51

What will be limited if an articular jt fx heals displaced?

Answer 51

Elbow flexion, extension, pronation, & supination *Can also cause OA

Question 52

When can you allow controlled AROM in GA after radial head fx?

Answer 52

As soon as pain & fx stability allow

Question 53

What does controlled motion after radial head fx help to prevent?

Answer 53

Capsular adhesions & contractures

Question 54

Sx's of lateral epicondylitis

Answer 54

Pain & tenderness at lateral epicondyle & elbow ache w/activity

Question 55

In a pt w/lateral epicondylitis, what reproduces pain?

Answer 55

Resisted elbow & wrist extension

Question 56

Will a pt w/lateral epicondylitis have normal ROM?

Answer 56

Yes

Question 57

Tx for lateral epicondylitis

Answer 57

* Modify/stop aggravating activity * No splint for elbow, although can splint wrist * Modalities for pain & inflammation

Question 58

What is RA?

Answer 58

Autoimmune disease that causes jt ankylosis, which affects ADL's

Question 59

What is key for RA tx?

Answer 59

Early recognition of jt swelling & decr ROM

Question 60

What can prevent further destruction w/RA?

Answer 60

Aggressive care of jt inflammation flare-ups

Question 61

What is the first stage of tissue response to injury & how long does this last?

Answer 61

Inflammation & edema; Lasts 3 wks

Question 62

True or False: When scar tissue starts to form, its very thin & has little tensile strength.

Answer 62

True

Question 63

Why do you need to be careful w/muscle contractions after surgery?

Answer 63

It can rip the stitches.

Question 64

Can PRE's be done during the fibroplastic stage?

Answer 64

Yes but w/caution

Question 65

What does Tinel's sign tell you?

Answer 65

Where the nerve has been damaged