Exercise Interventions for the Elbow, Wrist, and Hand Flashcards
1
Q
What muscles flex the elbow
A
- brachialis
- biceps brachii
- brachioradialis
2
Q
What muscles extend the elbow
A
- triceps brachii
- anconeus
3
Q
What muscles supinate the elbow
A
- supinator
4
Q
What muscles flex the wrist
A
- medial epicondyle
- flexor carpi radialis
- flexor carpi ulnaris
- palmaris longus
- flexor digitorum superficialis
- flexor digitorum profundus
5
Q
What muscles extend the wrist
A
- lateral epicondyle
- extensor carpi radialis longus
- extensor carpi radialis brevis
- extensor carpi ulnaris
- extensor digitorum
6
Q
Therapeutic approaches for trauma injuries
A
- education
- immobilization
- protected weight bearing
- progress ROM, gliding, stretching, & strengthening as tolerated
- special attention to structures involved
7
Q
Therapeutic approaches for neurological injuries
A
- education
- bracing (rest)
- activity modification
- neural glides
- mobilization
- stretching & strengthening exercises
8
Q
Therapeutic approaches for overuse injuries
A
-education
- bracing (counter force)
- mobilization
- stretching
- strengthening
- eccentrics
- modalities
- activity modification
- global conditioning
9
Q
Define epicondylitis
A
- acute injury
- inflammation is present
10
Q
Define epicondylosis/epicondylopathy
A
- chronic injury
- microtrauma accuring over extended time resulting in structural variations in the tendon
11
Q
Define epicondylgia
A
- pain at epicondyle due to tendinopathy of the attachment site of the forearm muscles
12
Q
Define tendinopathy
A
- clinical syndrome describing overuse tendon injury characterized by pain, swelling, and/or functional limition
13
Q
Epicondylagia treatment for pain
A
- immobilization
- counterforce brace
- relative rest
- ice for pain management
- modalities: ultrasound or iontophoresis
14
Q
Epicondylalgia treatment for soft tissue & joint mobility
A
- cross friction/deep transverse friction massage
- neural mobilization
- soft tissue mobilization
- muscle mobility techniques
- passive stretching
15
Q
Describe deep transverse friction massage (DTFM)
A
- technique often used to reduce damage & scarring caused by inflammation
- it increases blood flow to the joint, which facilitates healing of the tendon by increasing the supply of oxygen transported to the injury
16
Q
Lateral epicondylalgia treatment for soft tissue mobilization
A
- effleurage
- petrissage
- trigger point deactivation
17
Q
Lateral epicondylalgia treatment for muscle mobility
A
- hold-relax techniques focusing on wrist extensor or flexor muscle groups
- start with elbow flexed & muscle in shortened position, progress to lengthening positions over several reps
- don’t go into the painful range
18
Q
Epicondylalgia treatment for resistance exercise
A
- start with endurance level reps & progress to strength based reps to match patient’s functional demands
- eccentric training: adds increased stress to the muscultendious unit, slow speed, comfortable, try to extend elbow, when returning to the starting position use the intact extremity to lift the heavy weight, full pain free ROM is critical
19
Q
Eccentrics for tendinopathy
A
- promotes tendon healing
- lengthens the muscle-tendon unit under tension
- stimulates collagen formation/protein synthesis
- increased blood flow = healing support
- stimulate growth factors = healing support/tissue repair
- improve/stimulate proper alignment = enhanced mechanical properties
- slow, controlled lowering
- more weight than can lift with concentric contractions
- common application is 3-5 sets of 10-15 reps
20
Q
Activity modifications for prevention
A
- regular activity, warm up/cool down prior to sport
- well fitting equipment
- modification or eliminating activities causing exacerbation
- pitch count for children, limit/avoid curve ball for medial epicondyle
- strengthen lower extremities & core to improve kinetic chain & decrease stress of the shoulder & elbow
21
Q
What ROM is considered “stiff” for the elbow
A
- <120 degrees elbow flexion and lacking 30 degrees from full extension
22
Q
What to do for elbow hypomobility
A
- use stretches to increase ROM (healing phase must be completed)
- biceps & triceps muscle length
- can use LLLD (low load long duration) stretch with weight
- use a table to extend elbow/shoulder
- stretch flexion/extension & also pronation & supination
- use mobilizations to increase elbow flexion/extension
23
Q
Define myositis ossificans/heterotopic ossification
A
- formation of bone in atypical locations
24
Q
Describe myositis ossificans/heterotopic ossification and how to manage it
A
- 40% incidence after elbow fracture
- locking sensation/hard end feel, warm to touch, erythema, swelling, history of trauma, begins about 2 weeks after trauma
- NSAIDs to prevent
- symptom based approach focused on ROM exercises, gentle stretching, muscle setting, & endurance based AROM exercises
- make sure to not “overdo it”
25
Describe self stretching of the muscles of the lateral epicondyle
- passive stretching
- 20-30 sec holds, pain free stretch with emphasis on avoiding "quick" stretch
- extend arm, pronate forearm, flex/ulnar deviate wrist, flex fingers, press on back of hand
26
Describe self stretch of the muscles of the medial epicondyle
- passive stretching
- extend elbow, supinate forearm, extend/radially deviate wrist
- mobilization of the elbow joint
- strengthening of the flexor-pronator mass
27
Exercises for Performance Initiation, Stability, & Motor Control
- alternating isometrics
- rhythmic stabilization
- can be performed in open or closed chain
28
Exercises for muscle performance of elbow flexion
- supination = good all around
- neutral = brachioradialis and brachialis
- pronated = increased grip challenge, brachioradialis
- close together = increase stress to long head biceps
- far apart = increase stress to short head biceps
29
Exercises for muscle performance of elbow extension
- overhead position
- "skull crushers"
- seatbelt extension
- bent over position
- standing position using a cable column
30
Exercises for performance improvement/advanced skill of upper extremity
- lawnmowers
- bench press
- upper body ergometer (UBE)
- diagonal patterns
- pull/lift/carry
- simulated functional tasks
- plyometric training
31
Describe power grip
- partially flexed fingers against the palm
- full hand with use of isometric contractions
- thumb reinforces fingers
- max force with slight extension & ulnar deviation
- flexor digitorum profundus of the 4th and 5th finger provide major grip force
- extensor digitorum provides compressive force for stability and balance
32
Describe precision grip
- manipulate object not in contact with palm
- dynamic contractions
- thumb and index finger
- example: holding a pencil
33
Describe combined grip
- combine digits 1, 2, and sometimes 3
- example: pinching
34
Common interventions for the wrist and hand
- educate regarding mechanism of injury, modify the activity to allow for healing, components of the rehab process
- rest and use orthosis is indicated
- tendon mobility & gliding exercises
- cross friction massage
- gentle stretching exercises including dural glides
- initiate strengthening program
- modalities: ultrasound
35
Mobilization of the wrist
- anterioposterior and posterioanterior glides of the wrist
- radial and ulnar glides of the wrist
- wrist distraction with mobilization
- door sill hang (traction technique
- soft tissue massage
36
Describe place and hold exercises
- a form of gentle muscle setting (static/isometric) used during the early post-op period following tendon repair before AROM is initiated but when minimal level of stress on the repaired tendon & passive joint movement are beneficial for maintaining joint mobility & tendon excursion
- usually a blocking orthosis is worn and the joint is placed in partial ROM positions & held for 5-10 seconds
- appropriate for tissue healing phase of rehab
37
Median nerve focus dural glide in the hand
- start in a full fist, straight hand, wrist extension, supination, thumb extension/abduction, overpressure of thumb
- progress until symptoms are provoked (max position)
- alternate between the preceding position & the max position
- progress to the next position if tolerated
- 3-4 times per day as tolerated
38
Contraindications for dural glides
- acute/unstable neurological signs
- cauda equine symptoms (LE) with bowel/bladder changes
- spinal cord injury (SCI) or symptoms of SCI
- neoplasm & infection
39
Precautions for dural glides
- aggravation of symptoms
- rapidly worsening condition
- active disease
- vascular compromise
40
Exercise techniques to increase wrist flexibility/ROM
- Wrist extension: palm on table and move forearm up over the stabilized hand or prayer position
- Wrist flexion: dorsal surface of hand on table and move forearm up over the stabilized hand, sit on pronated hand, or dorm of hands together and flex wrists to 90 degrees and hands should point down
- Individual joints for flexion or extension: stabilize forearm on table, have fingers over the edge, stabilize proximal and stretch distal
41
How to stretch your lumbricals and interossei
- flex your DIP and PIP joints while extending the MCP joints and apply overpressure (similar to cracking knuckles)
42
How to stretch adductor pollicis
- extend and abduct your thumb and massage the webbing between your thumb and index finger near your CMC joint
