Common Presentations (elbow, wrist, hand)

Question 1

what are the non-diagnosis specific outcome measures we discussed in class?

Answer 1

numerical pain rating scale, patient specific functional scale, global rating of change

Question 2

what are some general UE outcome measures? Hand-specific?

Answer 2

DASH, Quick DASH; Michigan hand outcomes Questionnaire

Question 3

Unless there is a clear MOI that rules out___, you MUST include ___screening during any UE eval

Answer 3

cervical spine

Question 4

what components are you looking for in an UQS?

Answer 4

symmetry, quality of movement, willingness to move, pain. end feel, neurological exam

resisted isometrics in neutral anatomical position

Question 5

what are some posture observations you need to keep in mind re:UE pathologies?

Answer 5

head on neck, neck on trunk, arm and scapula position, carrying angle of elbow

Question 6

How are elbow dislocations defined? Most common type/ MOI?

Answer 6

position of olecranon on humerus-posterior/posterolateral ; traumatic/FOOSH

Question 7

What other pathologies are likely to occur in a posterolateral elbow dislocation

Answer 7

tear of LCL,UCL and possible joint capsule, brachialis and wrist flex/ext muscles

Question 8

what muscles are innervated by the median nerve (but not AIN)?

Answer 8

pronator teres
FCR
palmaris longus
flexor dig superficialis
L.O.A.F.

Question 9

What median nerve-innervated muscles are represented by “L.O.A.F”

Answer 9

1/2 lumbricals, opp policis, abd poll brevis, flex poll brevis (superficial head)

Question 10

which muscles are innervated by the AIN branch of the median nerve?

Answer 10

1/2 flex digit profundus
flex pollicis longus
pronator quadratus

Question 11

what muscles are innervated by the ulnar nerve?

Answer 11

FCU, 1/2 flex digiti prof, opp digiti minimi, abd digiti minimi, flexor digiti minimi

1/2 lumbricals, interossei, add poll, flex poll brevis (deep portion)

Question 12

what muscles are innervated by the radial nerve (but not PIN)?

Answer 12

triceps
anconeus
brachioradialis
ECRL
ECRB
supinator

Question 13

what are 5 common observations you might see in an elbow/wrist/hand pt?

Answer 13

prominent distal ulna, ulnar drift, common finger deformities, myelopathy of the hand, postural changes

Question 14

what 3 characteristics describe myelopathy of the hand.

Answer 14

muscle wasting, loss of power in the fingers, pre-existing cervical spinal cord compression/pathology

Question 15

what s/s might you expect after an elbow dislocation? interventions?

Answer 15

rapid swelling and deformity, severe pain and positive x-ray
PROM, proprio??

Question 16

what components contribute to elbow instability? WHat might we find in the pt Hx?

Answer 16

humeroulnar and humeroradial articulation=~50% and the ligaments ad muscle of the area make up to other 50%; MOIs of FOOSH and repetitive use

Question 17

what special tests do we have for elbow instability?

Answer 17

valgus stress
moving valgus stress
varus stress

Question 18

what are the ROM and MMT expectations you would have for a pt with ligamentous instability?

Answer 18

MMT- strong but potentially limited by guarding
RMO- pain @ end range due to stress

Question 19

what are the goals for the acute phase (first 2 weeks) for ligament sprains?

Answer 19

rest and activity mod for 2-4 weeks; ROM, promoting healing/limit atrophy, decreasing pain and inflammation

Question 20

what are the goals for the subacute phase for ligament sprains?

Answer 20

increasing motion @ 10*/week to 135, strengthening of flexors and extensors in full range starting with isometrics++

Question 21

what are the criteria for the chronic phase for ligament sprains?

Answer 21

full ROM, pain-free, no increased laxity, >4/5 MMT in flexors and extensors

Question 22

what are the goals for the chronic phase for ligament sprains?

Answer 22

continue strengthening elbow flex/ext muscles, ,forearm sup/pro, wrist flex/ext

Question 23

what are the intervention focuses of epicondylitis?

Answer 23

pain management, strength/flexibility/endurance, kinetic chain impairments, cross friction, eccentrics, bracing

Question 24

what are the special tests for lateral epicondylitis?

Answer 24

Cozen’s, Mill’s ,(passive tennis elbow test) resisted tennis elbow test