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MSK Final - ELBOW/ WRIST & HAND/ TMD > Elbow and FA- Sprains thru Ulnar n. Entrapment > Flashcards

Elbow and FA- Sprains thru Ulnar n. Entrapment Flashcards

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1
Q

How does valgus stress overload happen?

A
  • Trauma (FOOSH)
  • Overuse/repetitive stress with overhead sports
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2
Q

What structures are involved with valgus stress overload?

A

3 portions of UCL

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3
Q

What does the Anterior portion of the UCL do? Where is it?

A
  • primary stabilizer
  • medial epicondyle to coronoid, anterior to ulnar nerve
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4
Q

Where is the posterior portion of the UCL?

A

Medial epicondyle to olecranon

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5
Q

Where is the transverse portion of the UCL?

A

Olecranon to coronoid

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6
Q

What does the transverse portion of the UCL do?

A

Provides varus stability and prevents valgus stress

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7
Q

What would be signs of UCL sprains?

A

limited and painful ROM in extension, creates more valgus position

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8
Q

What are some signs of valgus stress overload?

A
  • ROM painful and limited with extension
  • Stress tests positive with distraction and relief with compression
  • Positive stability tests
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9
Q

What stability tests are positive with a valgus stress overload?

A
  • Valgus stress test at 0 and 90 degrees
  • UCL instability
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10
Q

What other conditions must we differentiate valgus stress overload from?

A

Medial epicondyle apophysitis and tendiopathy

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11
Q

What is the mechanism of Varus stress overload?

A

Same as UCL but with Varus stress

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12
Q

What structure is involved with varus stress overload?

A

RCL

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13
Q

What shape is the RCL?

A

Triangular

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14
Q

What does the RCL do?

A

Provides lateral stability and prevents varus stress

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15
Q

Where does the RCL run?

A

Lateral epicondyle to annular ligament to lateral radius

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16
Q

What are some specific S&S for varus stress overload?

A

ROM more pain and limitation with flexion
Positive stability tests (varus stress test at 0 and 90 degrees)

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17
Q

What is the general Rx for Sprains?

A

POLICED
-possible brief period of immobilization
- bracing and taping PRN
-MET

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18
Q

What is MET for sprains ultimately for?

A

Tissue integrity and stabilization

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19
Q

What is the MD rx for UCL?

A
  • Direct repair vs. reconstruction with palmaris longus graft
  • Reconstructive surgery known as Tommy John sx
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20
Q

How long is the ideal recovery from UCL surgeries?

A

12-18 months

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21
Q

Why is a palmaris longs graft repair of the UCL successful?

A

Both are made of the same collagen type so that they both resist tension

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22
Q

What is a pushed dislocation?

A

When the radial head goes proximal or is pushed into a subluxation/dislocation

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23
Q

What is the mechanism of a pushed dislocation?

A

Falling on an outstretched hand (FOOSH), usually on thenar eminence which shoves radial head proximally

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24
Q

What are some complications of a pushed dislocation?

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A

may also cause a fx of distal radius and ulna aka Colle’s fx

25
What is a pulled dislocation?
Radial head distal or pulled subluxation/dislocation - forceful traction through lateral forearm
26
What structures are involved with a pulled subluxation?
Radioulnar articulations held together by: - annular ligament - interosseous membrane
27
Where does the annular ligament run?
Attaches anteriorly and posteriorly on radial notch, encompasses radial head and holds It against ulna
28
What does the Interosseous membrane do?
Keeps radius and ulna together, serves as a muscle attachment for forearm and wrist muscles
29
What are some complications of a humeroulnar dislocation?
- the three nerves around elbow: radial, ulnar, median - Brachial artery emergency referral - fractures of radial head - frequent loss of terminal extension
30
Why can humeroulnar dislocations result in a loss of terminal extension?
Due to intimate bony congruency of deep joint, immobilization makes it hard to get the extension back
31
What is the Rx for subluxations/dislocations?
Like ligamentous sprains for worse case hyper mobility/instability
32
How many sets and reps for acute dislocations?
1-2 sets of 10-15 with light resistance
33
What is a supracondylar fracture?
Distal humeral segment is fractured and displaced
34
What is an intercondylar fracture?
Fracture within the humeral condyles
35
What are some complications with the brachial artery along with condylar fractures?
- Volkmann's ischemic flexion contracture ** EMERGENCY REFERRAL
36
What are the 3 types of radial head fractures?
- Nondisplaced - Displaced - Comminuted
37
What can be difficult after an olecranon fracture?
Regaining full extension
38
What are typical S&S of fractures?
Multiple planes of limitation and weakness, won't like distraction or vibration
39
What are special tests after trauma / fracture?
- lack of pronation (highest LR) - lack of supination - lack of extension ROM - high sens - Other motions restricted - high spec
40
When does PT begin after a fracture?
When clinical union occurs - between 4-8 weeks
41
What is pain from fracture typically NOT from?
Bone
42
What is PT for fractures focused on?
Consequences of prolonged immobilization where every tissue is negatively influenced
43
Why is elbow extension difficult after fractures/surgery?
Elbow is immobilized in flexion after all fractures / surgeries making the regaining of full extension difficult
44
What is the 2nd most common compression neuropathy seen by hand surgeons?
ulnar nerve entrapment
45
Where can ulnar nerve entrapment happen?
- cubital tunnel at elbow - FCU heads in proximal forearm - Guyon's canal in hand
46
What is the etiology of ulnar nerve entrapment?
- Trauma (FOOSH) - Overuse/repetitive stress with elbow/hand - Age related joint changes/ RA at elbow/wrist
47
What two nerve roots make up the ulnar nerve in the cubital tunnel?
C8 and T1
48
What are some symptoms of cubital tunnel syndrome?
- Medial hand/finger paresthesias - Weak grip
49
What are signs of cubital tunnel syndrome with ROM?
- possible limitation with elbow flexion and paresthesias and radial deviation - Possible limited ext at end range
50
What are some signs of cubital tunnel syndrome found in resisted testing?
Possible weak wrist and 4th and 5th digit flexion, thumb abduction, and grip
51
What are some neurological signs of cubital tunnel syndrome?
- possible diminished sensation over ulnar nerve distribution - positive ulnar nerve dural mobility test
52
What are some special tests for cubital tunnel syndrome?
- elbow flexion test - Tinel's ( Tap test) - Wartenberg's sign
53
Where can we palpate for cubital tunnel syndrome? Why?
Over ulnar nerve - Provocation with ulnar nerve pressure up to 60 seconds - May be able to sublux ulnar nerve
54
What are some specific S&S for flexor carpi ulnaris ulnar nerve subluxation?
- ROM - elbow WNL - ONLY Wartenberg special test positive - NO provocation or ulnar nerve subluxation in cubital tunnel with palpation - Provoked at FCU heads
55
What are some specific S&S for Guyon's canal ulnar nerve subluxation?
- ROM: elbow WNL - Resisted testing - hand but NO wrist weakness - ONLY Wartenberg special test positive - Palpation: No paresthesias or ulnar nerve subluxation in cubital tunnel; Provocation at guyon's canal
56
Where is Guyon's Canal?
Hook of hamate at wrist
57
What is the Terminal nerve branch injury Rx?
- POLI (NO C) ED - when compression is the cause - Bracing/splinting to assist with eliminating compression - MET with optimal stresses
58
What is the MET prescription for terminal nerve branch injury?
MET with optimal stresses to create neural motion/flossing and elimination of compression ** want movement without undesirable symptoms

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

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