Exam 2

Question 1

what nerves are most at risk for entrapment?

Answer 1

long thoracic

axillary

spinal accessory

suprascapular

Question 2

what muscle does the long thoracic nerve innervate?

Answer 2

serratus anterior

Question 3

what muscles do the axillary nerve innervate?

Answer 3

deltoid

teres minor

Question 4

what muscles do the spinal accessory nerve innervate?

Answer 4

trapezius

infraspinatus

Question 5

what would you see with long thoracic nerve palsy?

Answer 5

scapular winging

Question 6

does scapular winging occur more in the frontal plane with abduction or with flexion?

Answer 6

with flexion

Question 7

what weakness is indicated by the flip sign?

Answer 7

serratus anterior

scapular weakness

Question 8

what would you see with axillary nerve palsy?

Answer 8

deltoid atrophy

weak abduction and flexion

may see compensatory motions

Question 9

what would you see in spinal accessory nerve palsy?

Answer 9

trapezius atrophy and weakness

may have a flip sign

Question 10

what is scapular dumping?

Answer 10

scap doesn’t come down from abduction smooth and slow, but rather quickly releases at the end of the motion

form of scapular dyskinesia

Question 11

which capsule of the elbow is more loose, posterior or anterior?

Answer 11

posterior capsule

Question 12

does the lateral collateral lig resist valgus or varus forces?

Answer 12

varus forces

Question 13

are varus or valgus forces more common

Answer 13

valgus forces

Question 14

do the posterior or anterior fibers of the lateral collateral lig resist varus forces more in extension?

Answer 14

the anterior fibers

Question 15

do the posterior or anterior fibers of the lateral collateral lig resist varus forces more in flexion?

Answer 15

the posterior fibers

Question 16

does the medial collateral lig resist varus or valgus forces?

Answer 16

valgus forces

Question 17

do the posterior or anterior fibers of the medial collateral lig resist valgus forces more in extension?

Answer 17

the anterior fibers

Question 18

do the posterior or anterior fibers of the medial collateral lig resist valgus forces more in flexion?

Answer 18

the posterior fibers

Question 19

what is the carrying angle of the elbow?

Answer 19

allows elbows to be at the side without hitting the pelvis

normal is about 15 deg

Question 20

what is epicondylalgia?

Answer 20

pain of the epicondyles

Question 21

what is alteral epicondylalgia?

Answer 21

tennis elbow

tendinopathy of the extensors and radial deviators

primarily involves ECRB, 1/3 ext dig communis

usually from overuse but cna be traumatic

overhand lifting (pronated)

Question 22

what is stage 1 of lateral epicondylalgia?

Answer 22

inflammatory

often resolves

epicondylitis

Question 23

what is stage 2 of epicondylalgia?

Answer 23

fibroblastic and vascular response w/in tendon

Question 24

what is stage 3 lateral epicondylalgia?

Answer 24

pathologic changes (tendinosis) or rupture

more chronic

Question 25

what is stage 4 lateral epicondylalgia?

Answer 25

fibrosis calcification

Question 26

what is the primary management of lateral epicondylalgia in stages 1 and 2?

Answer 26

ice US compression e-stim ionophoresis (drives meds into the area)

Question 27

what is the primary management of lateral epicondylalgia in stages 3 and 4?

Answer 27

friction massage to break up adhesions and reorganize collagen fibers eccentrics!!!

Question 28

t/f: chronic conditions can have an acute overlay

Answer 28

true

Question 29

when are symptoms of lateral epicondylalgia elicited?

Answer 29

with active wrist extension or grasping

Question 30

t/f: pts with lateral epicondylalgia may frequently drop items

Answer 30

true

Question 31

what tests would indicate lateral epicondylalgia?

Answer 31

(+) Cozens (+) Mills

Question 32

what is a counterforce brace?

Answer 32

pad puts pressure on the affected muscle and provides some relief bc the muscle thinks it's pulling more distally spreads the area of forces to decrease pain

Question 33

what is a (+) Cozens sign?

Answer 33

resist wrist extension in sitting or standing (+)=painful at the lateral epicondyle

Question 34

what is a (+) Mills test?

Answer 34

put pt in full pronation, elbow extension, and wrist flexion (+)=painful at the lateral epicondyle

Question 35

what is the 1st sign of improvement of lateral epicondylalgia?

Answer 35

pt can hold elbow at their side without pain

Question 36

what is the 2nd sign of improvement of lateral epicondylalgia?

Answer 36

decreased pain with the Mills test (elbow flexion will feel better first)

Question 37

what is medial epicondylalgia?

Answer 37

golfer's elbow tendinopathy of the common flexor tendons, primarily FCR, and pronator teres overuse due to: repeated stress to flexor-pronator tendons, increased valgus stress, failure of the ulnar collateral ligament

Question 38

which is more painful with resisting wrist flexion: MCL injury or med epicondylalgia?

Answer 38

medial epicondylalgia

Question 39

which becomes chronic more: lateral or medial epicondylalgia?

Answer 39

lateral epicondylalgia

Question 40

t/f: pain with med epicondylalgia increases with resisted wrist flexion, pronation and passive wrist extension, supination

Answer 40

true

Question 41

what is the intervention for medial epicondylalgia?

Answer 41

RICE, modalities, avoid immobilization, stretching, PRE’s (conc and ecc), bracing (counterforce bracing on medial side)

Question 42

what is little league elbow?

Answer 42

ulnar collateral sprain chronic valgus and external rotation forces (ie. tennis serve, throwing) may occur from FOOSH, chronic med epicondylalgia +valgus stress testing

Question 43

what is the intervention for medial collateral sprains?

Answer 43

RICE 2-4 wks, modalities, PRE’s for FCU, pronator teres, FDS, and shoulder surgical repair in athletes only involving palmaris longus graft w/wo ulnar n transposition

Question 44

what are the common surgical procedures for medial collateral sprains?

Answer 44

Tommy John and docking to reduce valgus stress

Question 45

what is the docking technique?

Answer 45

cinch up MCL preserves the ulnar nerve nerve transpostion-take ulnar nerve and move it in front of medial epicondyle to reduce friction insutu ulnar nerve transposition-free up the nerve so it slides better due to possible scarring around it

Question 46

what is the valgus stress test?

Answer 46

move elbow into flexion and extension with valgus stress applied

Question 47

what is a radial collateral sprain?

Answer 47

posterolateral rotary instability combination of compression, external rotation and varus forces or secondary to chronic lateral epicondylalgia

Question 48

is UCL or RCL more common?

Answer 48

UCL