Lecture 7 Flashcards by Charlene Enriquez

What is lateral epicondylitis

Tennis elbow
Tendonitis/tendinosis of the ECRB

Common in tennis players or players who engage in heavy lifting

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What is the mechanism of injury of lateral epicondylitis

Repetitive overuse

Common on the common extensor tendon attachment

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What are the physical examinations of lateral epicondylitis

“Push on it, stretch, contract it”

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When you palpate the lateral epicondylitis what does it feel like

Focal tenderness at ECRB attachment

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What are the special tests for lateral epicondylitis

Cozen’s test
Mill’s test
Maudsley test

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What is the cozen’s test

Resisted wrist extension w/ elbow fully extended and forearm pronated

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What is the mill’s test

Passive wrist flexion in pronation

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What is the maudsley’s test

Resisted extension of 3rd digit

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What is the PT management for lateral epicondylitis

Protect/ rest
Counter-force strap (“tennis elbow strap”)

Ionotophoresis/phonopheries

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What is the medical management for lateral epicondylitis

Steroid injections
PRP (platelet rich plasma)

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Why would someone with lateral epicondylitis get surgery

Fail to respond after 6-12 months of compliant non surgical treatment

Extensor carpi radialis brevis - release and debridement

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What is medial epicondylitis

“Golfer’s elbow”

Tendonitis/tendinosis of the pronator, teres , FCR and FDS tendons

Common in golfers

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What is the mechanism of injury for medial epicondylitis

Repetitive eccentric forces on the common flexor tendon attachment (medial epicondyle)

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What are the physical examinations for medial epicondylitis

“Push on it, stretch, contract it”

Limited wrist extension with end range pain

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What is the palpation for medial epicondylitis

Focal tenderness at FCR/PT attachment on medial epicondyle

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What are the special tests for medial epicondylitis

Golfer’s elbow test (active)
Golfer’s elbow test (passive)

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What is Golfer’s elbow test (active)

Resist wrist flexion with the arm in extension and supination

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What is Golfer’s elbow test (passive)

Passive wrist extension in supination

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What is the PT management for medial epicondylitis

Rest/protect
Counter force strap
Iontophoresis/phonophoresis
Ther-ex

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What is the medical treatment for medial epicondylitis

Steroid injections
PRP (platelet rich plasma)

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Why would someone with medial epicondylitis get surgery

Fail to respond after 6-12 months of compliant non-surgical treatment

PT/FCR - release and debridement

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What is the motor branch of the radial nerve

Posterior interosseous nerve (PIN)

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The posterior interosseous nerve (PIN) can get entrapped within the radial tunnel and cause “ two separate conditions” known as

Radial tunnel syndrome
PIN compression syndrome

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What is radial tunnel syndrome

Compression of PIN in the radial tunnel that causes forearm pain but does not cause strength loss

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What is PIN compression syndrome

Compression of PIN in the radial tunnel that causes forearm pain and strength loss

What is the mechanism of injury for radial nerve entrapments

Repetitive pronation/supination activities

Pt presents w/ insidious onset of deep aching pain in the proximal dorsoradial forearm. What is this

Radial nerve entrapment

What is the palpation findings for radial nerve entrapment

Tenderness 3-5cm DISTAL TO LATERAL EPICONDYLE

What are the special tests for radial nerve entrapments

Maudsley’s test Wrist flexion w/ passive pronation test Resisted supination test

What is the PT management for radial nerve entrapment

DONT USE COUNTERFORCE STRAP Rest/protect Ionto/phono Ther-ex

Why would you get surgery for radial nerve entrapment

Fail to respond to PT PIN release

What is ulnar collateral ligament sprain/rupture

Sprain or rupture of the ulnar collateral ligament of the elbow Causes VALGUS INSTABILITY of elbow

What is the mechanism of injury of ulnar collateral ligament sprain/rupture

Repetitive overuse - high force throwing athletes (pitchers) Acute trauma - occurs in pitchers

What would a patient present with for ulnar collateral ligament sprain/injury

Medial elbow pain Functional loss of throwing

What are the physical examinations for ulnar collateral ligament sprain

Tenderness on UCL Usually normal but may see loss of extension Strength is strong

What is the special tests for ulnar collateral ligament sprain/injury

Positive elbow valgus test Flex elbow 20 degree ER humerus and apply valgus force

What diagnostic imaging tool would you use to see ulnar collateral ligament sprain

MRI

Why is Tommy John’s surgery

UCL anterior band ligament reconstruction Grafts Surgery reconstruct the ligament

What is carpal tunnel syndrome

Compression of medial nerve in carpal tunnel Common in people who engage in repetitive vibratory activity

What is the mechanism of injury of carpal tunnel syndrome

Repetitive overuse Inflammation of flexor tenons within carpal tunnel which compress the medial nerve

What are the patient presentations for carpal tunnel syndrome

Patient complains of pain/numbness on palm side of the hand along the thenar eminence and 1st 3 digits Pain/numbness worse at night

What are the physical examinations for carpal tunnel syndrome

Strength: weak Neuro screen: negative Thenar atrophy !!

What are the special tests for carpal tunnel syndrome

Carpal tunnel compression test Phalen’s test Tinels test Semme-Weinstein testing

What is the carpal tunnel test

Press thumbs over carpal tunnel for 30 secs to provoke symptoms

What is the phalen’s test

Passive wrist flexion for 60 secs

What are the PT managements for carpal tunnel syndrome

Protect/rest Night splint Ther-ex

What are the medical treatments for carpal tunnel syndrome

Steroid injection PRP (platelet rich plasma)

Why would a pt would need surgery for carpal tunnel syndrome

Fail to respond to non-surgical treatment Carpal tunnel release = cut of flexor retinaculum

What is cubital tunnel syndrome

Compression of ulnar nerve in cubital tunnel Common in people who engage in repetitive elbow flexion activity

What is the mechanism of injury for cubital tunnel syndrome

Repetitive elbow flexion or direct compression

Patient presents with pain/numbness on the ulnar side, ring finger and pinky. They also say that it’s worse at night

Cubital tunnel syndrome

What are the physical examinations for cubital tunnel syndrome

Claw hands Palpation: cubital tunnel may be tender

What is the strength for cubital tunnel syndrome

No strength loss Severe = weak ADD/ABD of digits Weak grip

What are the Neuro findings for cubital tunnel syndrome

Sensory loss along ulnar distribution

What are the special tests for cubital tunnel syndrome

Elbow flexion test Forment’s sign Tinel’s test Stemmes- Weinstein testing

What is the PT management for cubital tunnel syndrome

Protect/rest/ activity Splint/brace Ther-ex

What is the medical treatment for cubital tunnel syndrome

Steroid injection PRP (platelet rich plasma)

Why would a pt get surgery for cubital tunnel syndrome

Decompression of ulnar nerve in cubital tunnel Decompression surgery may or may not include transposition of ulnar nerve

What is guyons canal syndrome

Aka ulnar tunnel syndrome Compression of ulnar nerve in Guyon’s canal Causes pain/numbness

What is the mechanisms of guyon’s canal syndrome

Ganglion cyst - most common cause Compression activities

What are the patient presentation for Guyon’s canal syndrome

Pt complain of hand weakness and pain/numbness on ulnar side of the hand Worse at night

What are the physical examinations for guyons canal syndrome

Claw hand

What are the Neuro findings for guyon’s canal syndrome

Sensory loss along ulnar distribution on palmer surface of the hand

What are the special tests for guyon’s canal syndrome

Elbow flexion test Forments signs Tinel’s test Semmes-Weinstein testing

What are the PT managements for guyon’s canal syndrome

Protect/rest/activity Night splint Ther-ex

What are the medical treatments for guyon’s canal syndrome

Steroid injections PRP

Why would a patient get surgery for guyon’s canal syndrome

Decompression of ulnar nerve in Guyon’s canal Causes pain

What is dequervain tenosynovitis

Thickening and swelling of extensor retinaculum causes increased tendon friction in 1st dorsal compartment

What are “trigger finger”

Finger get “stuck” in flexion and unable to extend due to impingement of flexors tendons in the A1

What are the physical examinations of trigger fingers

Flexion/extension of motion of involved digit causes pain, clicking, snapping or gets “stuck” in flexion

What are the most common digits affected by trigger fingers

Ring finger and thumb

What is dupuytren’s contracture

Benign thickening of the digital and palmer fascia that lays btw the skin and flexor tendons of the hand Worse The fibrosis forms painful nodules that creates FLEXION CONTRACTURES of the digits

What are the most common digits involved in dupuytrens contractures

Ring and small finger Can also occur in the PLANTAR FASCIA of feet

What are the treatments for dupuytrens contracture

Collagenase injections Surgery

What is the olecranon bursitis

Chronic pressure on elbow creates inflammation/swelling of olecranon bursa

Lecture 7 Flashcards

(75 cards)