Elbow, Wrist, Hand Flashcards
(130 cards)
1
Q
Treatment for a proximal vs. a distal biceps rupture
A
proximal may be therapeutic but distal is an orthopedic urgency
2
Q
what is the role of long head of the biceps in the shoulder
A
it may contribute to anterior stability but it is also a common source of anterior shoulder pain
3
Q
tenodesis
A
release the tendon and reattach
4
Q
tenotomy
A
release the tendon and let it fall
5
Q
in what cases would you want to do a tenodesis of the long head of the biceps over a tenotomy
A
manual labor and those in overhead athletics may want a tenodesis for improved supination strength and less cramping
otherwise best to do a tenotomy
6
Q
T or F: a proximal biceps rupture may be therapeutic
A
T: sometimes it feels better after
7
Q
SLAP lesion
A
superior labrum anterior to posterior
8
Q
4 types of slap lesion procedures
A
repair, debridement, tenodesis, tenotomy
9
Q
T or F: many slap tears are no longer repaired because they end up having pain after
A
T
10
Q
T or F: recent evidence shows that their is no benefit to repair a SLAP lesion vs. doing a biceps tenodesis
A
T: much easier rehab with biceps tenodesis!
11
Q
what is used to classify slap lesions? How many types of lesions are there?
A
snyder classification, 4 different types
12
Q
special tests for slap lesions
A
active compression, speeds
13
Q
T or F: slap lesions are usually an isolated injury
A
F: they are rarely seen in isolation
14
Q
A trial of ______ can be helpful with SLAP to identify the source of symptoms
A
injection
*diagnosis is difficult
15
Q
SLAP lesion postoperative management
A
period of immobilization, prevent stiff shoulder, progress based on impairments and healing
16
Q
For both SLAP repair and biceps tenodesis you are typically in a sling for how long
A
2-4 weeks
17
Q
which one can you start immediate passive motion with… biceps tenodesis or SLAP repair?
A
- biceps tenodesis
- SLAP repair has motion restriction for 4-6 weeks
18
Q
people with biceps tenodesis can return to sport in about ____ months while those with SLAP repair take _____ months
A
3
6
19
Q
what often causes a distal biceps rupture
A
unexpected eccentric load (tailgate drops and you catch with one hand)
20
Q
what age are distal biceps ruptures most typical in?
A
40-60 year olds
21
Q
special tests for distal biceps rupture
A
hook test
22
Q
why is early surgical repair advocated for distal biceps rupture
A
because the tendon will retract
*inferior outcomes if delayed by >4 weeks
23
Q
what pt population may not have surgery for distal biceps rupture?
A
older pt with co-morbidities
24
Q
what movements do you want to avoid for 2-3 weeks after distal biceps repair?
A
full extension and hard supination
- starts with a period of immobilization and then several weeks of controlled motion in a brace
25
typically, pts with distal biceps repair have full motion by _____ to ____ weeks and can return to work fully in _____ to ______ months
6-8 weeks
2-4 months
26
what is the second most common dislocated joint? what way is it usually dislocated?
elbow, posterior lateral (named for position of ulna)
27
what is the most common MOI for an elbow dislocation?
hyperextension of elbow
28
simple elbow dislocation
- no fracture
- dislocation, brace, immediate rehab
- can return to sport in weeks
29
complex elbow dislocation
- often unstable, may involve a fracture
- controlled motion when cleared by ortho
- surgical fixation allows for early motion
30
terrible triad of the elbow
elbow dislocation, radial head fx, coronoid fx
** requires surgery
31
why is the elbow so susceptible to stiffness?
- congruity of humeroulnar articulation
- three joints in one capsule
- blending of ligaments with the capsule
32
capsular pattern of the elbow - what motion do you lose more of?
flexion > extension
33
how much elbow motion do you need for ADLs?
- 100 degree arc - extension/flexion 30-130
- 50 degree rotation - 50 pronation, 50 supination
34
the ulnar collateral ligament gives you ______ stability
valgus
35
two bands of the UCL
anterior - tight in extension, lax in flexion
posterior - tight in flexion, lax in extension
36
which band of the UCL gives you the most valgus resistance
anterior
37
what populations are UCL injuries common in
overhead throwers and athletes, gymnastics, wrestling
38
2 types of UCL injury
attenuation or acute traumatic
39
T or F: an attenuation UCL injury will not tighten or heal w/o surgery
T: but an acute could!
40
Is rehab appropriate for UCL injuries
a non-operative trial is appropriate for most
41
what was the first surgery for a UCL injury
Tommy John Surgery
42
T or F: all risk factors for UCL injuries are modifiable
T: decrease pitch counts/pitching time!
*this is usually a parent/player issue
43
Hip_____ rotation deficits and decreased rotator cuff and core strength are risk factors for UCL injury
internal
44
What is a major issue sometimes seen in Tommy John surgeries?
mistaking the median nerve for the palmaris longus and using it for the graft
45
are most athletes able to return to sport after a UCL injury
yes, but this does not always mean a return to prior level of function
46
how long should players wait after a UCL repair to return to full throwing
10-18 months
47
lateral epicondylitis causes pain with what motions? what about medial epicondylitis?
lateral = pain with extension and supination
medial = pain with flexion and pronation
48
epicondylitis is common in what decades
4th and 5th
49
what muscle is affected in lateral epicondylitis
extensor carpi radialis brevis
50
what kind of exercise is good for chronic (tendinosis) epicondylitis
eccentric
51
T or F: there is good evidence for forearm support band for epicondylitis
F: limited evidence
52
special tests for lateral epicondylitis
cozens
mills
maudsley
53
where does the ulnar nerve often become entrapped? (2) where does it cause pain?
cubital tunnel, guyon's canal
medial elbow pain
54
where does the median nerve often become entrapped? (3)
where does it cause pain
pronator teres, FDS, carpal tunnel
aching pain and weakness in forearm
55
where does the radial nerve often become entrapped? where does it cause pain?
posterior interosseous nerve within radial tunnel
lateral elbow and supinator pain
56
special test for nerve entrapment
tinel's
57
whis is the 2nd most common compressive US neuropathy
cubital tunnel syndrome
58
why is night splinting often important for cubital tunnel syndrome?
the cubital tunnel narrows during elbow flexion so keeping the arm straight at night can help decrease the pressure
59
non-operative treatment for cubital tunnel
ergonomic changes, compliance with night splinting, activity mods
60
what can cubital tunnel turn into chronically?
claw deformity
*continue monitoring for neuro worsening/motor involvement
61
T or F: cubital tunnel is highly associated with throwing and UCL injury
T
62
Gunyon's canal
hook of hamate and pisiform
63
Compression of the ulnar nerve at Gunyon's canal is common in
cyclists (handlebar palsy)
64
how to distinguish between compression in the cubital tunnel and compression in the gunyon's canal
test the flexor capri ulnaris (most proximal innervation of ulnar nerve)
65
special tests for ulnar neuropathy
froment's sign (loss of adductor pollicis)
wartenberg's sign (unapposed 5th digit)
tinnels sign
pressure provocation test
elbow flexion test
66
what nerve is froment's sign testing?
ulnar nerve - tests adductor pollicis (flexor pollicis longus innervated by AIN compensates on positive test)
67
median nerve roots
C5-T1
68
what often causes median nerve compression
repetitive forearm movements (carpenter, mechanic, tennis, baseball)
69
What is the most common entrapment site for the median nerve
carpal tunnel
70
where does pronator syndrome cause numbness
first 3 digits
71
how to differentiate between pronator syndrome and carpal tunnel syndrome
with carpal tunnel, the palmar cutaneous branch is spared and you have forearm pain
72
T or F: anterior interosseous nerve compression is a motor only palsy
T
73
Two signs/symptoms of anterior interosseous nerve compression
1) pronator quadratus weakness
2) inability to flex thumb IP joint (OK sign)
74
radial nerve roots
C5-C8, T1
75
what fracture may sacrifice the radial nerve?
humeral shaft
76
is there motor or sensory loss with radial tunnel syndrome
no -- it is a painful condition but no motor or sensory losses
77
is there motor or sensory loss with PIN compression
yes, significant motor loss
78
provocation ttests for radial runnel
1 - resisted supination
2 - resisted wrist ext
3 - middle finger extension
4 - elbow extension, pronation, wrist flexion (stretching it)
79
what is the common site of compression for the PIN
arcade of frohse
80
what movement is weak with PIN entrapment
- weakness of thumb and finger extension
- radial deviation during extension
81
what is the only wrist extensor innervated by pure radial nerve (not PIN)
extensor carpi radialis longus (this is why you radially deviate during extension if you have PIN entrapment)
82
what surgical procedure can lead to PIN syndrome
distal biceps repain
83
do you know you extensor compartments?
YES
84
ulnar nerve proximal and distal innervation
proximal = FCU
distal = intrinsic hand
85
median nerve proximal and distal innervation
proximal = pronator teres
distal = lumbricals 1st and 2nd
86
radial nerve proximal and distal innervations
proximal = triceps
distal = extensor indicis
87
functionally, impairment of the ulnar nerve will lead to difficulties with what tasks? what about median nerve?
ulnar = fine motor
median = pronation
88
what is the most common compressive neuropathy
carpal tunnel syndrome
89
what can cause carpal tunnel syndrome
repetitive wrist motions, pregnancy, DM, RA
90
symptoms of carpal tunnel
- intermittent noctural parestheis
- progression to thenar weakness and atrophy
91
special tests for carpal tunnel
tinel and phalen
92
carpal tunnel treatment
activity modification, education, splinting, impairment based rehab
93
what are 3 things that can cause radial sided wrist pain
scaphoid fracture
scapholunate dissociation
radial sided tendinopathies
94
what are three things that could cause ulnar sided wrist pain
ECU injury/tendinopathy
TFCC injury
ulnar abutment
95
claw hand deformity
- ulnar nerve
- hyperextension at MCP and hyperflexion at IP
96
ape hand
- median nerve injury
- thenar muscles atrophy so you have unopposed adductor pollicis
97
sign of benefiction
- only appears actively
- when trying to make a fist digits 4 and 5 can close (ulnar innervated) but not the first three digits
98
most commonly injured carpal bone
scaphoid
99
where do you have tenderness with a scaphoid fracture
anatomical snuff box
100
what is a major concern with a scaphoid fracture
risk of avascular necrosis due to retrograde blood supply
101
due to retrograde blood supply, do to proximal or distal pole scaphoid fractures heal better
distal
102
what kind of splint for radial sided wrist pain
thumb spica
103
why should you always treat scaphoid pain as a fracture
because the fracture is not always visible on plain films
*CT or MRI may be needed if films are normal
104
with a scapholunate injury, if the films are normal treat it as a
sprain
105
triangular fibrocartilage complex (TFCC)
supports distal radioulnar joint with gripping and rotating
106
special test for scapholunate
watson
s
107
kienbock's disease
- avascular necrosis of the lunate
- unknown cause
- pain, swelling, stiffness
108
special test for sequervain's
finkelstein's test
109
dequervain's tenosynovitis involves what muscles
1st extensor compartment
- abductor pollicis longus and extensor pollicis brevis
110
intersection syndrome is a repetitive use injury involving what muscles
1st and 2nd extensor compartments
- abductor pollicis longus, extensor pollicis brevis, extensor carpi radialis longus and brevis
111
management of TFCC
- period of immobilization
- NSAIDs
- cortisone injections
- surgical options
112
ulnar abutment syndrome
- puts more force on the ulnocarpal and increases incidence of ulnar sided wrist pain
- could be related TFCC injury
- manage same as TFCC
113
boutonniere deformity
- central slip injury
- flexion of PIP and hyperextension of DIP joint
114
what are the four forearm fractures
1 - colles - distal radius - FOOSH
2 - smith - distal radius (fall on flexed wrist)
3 - barton - intra-articular distal radius (MVA, sports, falls, osteoporosis)
4 - monteggia fracture - proximal 1/3 of ulnar, radial head dislocation (FOOSH with pronation)
115
what is the most common forearm fracture
distal radius
116
gamekeeper's thumb
UCL injury of thumb
pain and swelling along 1st MCP
117
how is a boutonniere deformity (central slip) splinted
PIP in full extension, DIP free to move
118
jersey finger
forceful hyperextension of the DIP joint
119
do jersey fingers need surgery
yes
120
how to eval a jersey finger
hold PIP and ask for DIP flexion
121
mallet finger
forceful flexion of the extended DIP joint
- extensor hood rupture
122
how is the finger splinted in mallet finger
DIP in full extension
123
swan neck deformity
hyperextension of PIP
124
what kind of splint for swan neck deformity
double ring
125
what hand deformities do you see with RA? OA?
RA = ulnar deviation and swan neck
OA = herberden's nodes
126
what is dupuytren's contracture
palmar fascia contracture
- not really a role for PT
127
T or F: if someone had a flexor tendon repair, immediate passive ROM is important to encourage lack of adhesions
T: you need early protected motion within 3-5 days
*passive flexion is important
128
how many annular flexor tendon pulleys? how many cruciate?
5 annular
3 cruciate
129
tendons have poor _______ healing capacity
intrinsic
130
what can you wear to help with trigger finger
night splint
