Lecture Exam 2 Flashcards by Alyicia Ewing

ROM norm for flexion of shoulder

0-180

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ROM norm for extension of shoulder

180-0

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ROM norm for hyperextension of shoulder

0-60

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ROM norm for abduction of shoulder

0-180

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ROM norm for adduction of shoulder

180-0

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ROM norm for MR of shoulder

0-70

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ROM norm for LR of shoulder

0-90

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the goniometer placement for which shoulder movement is being described?

axis: over the LATERAL aspect of the greater tubercle

stationary arm: parallel to midaxillary line of the thorax

moving arm: aligned with LATERAL midline of the humerus

shoulder flexion

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the goniometer placement for which shoulder movement is being described?

axis: over the LATERAL aspect of the greater tubercle

proximal arm: parallel to midaxillary line of the thorax

distal arm: aligned with the LATERAL midline of the humerus

shoulder extension

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the goniometer placement for which shoulder movement is being described?

axis: close to the ANTERIOR aspect of the acromial process

stationary arm: aligned so that it’s parallel to the midline of the ANTERIOR aspect of the sternum

moving arm: aligned with the ANTERIOR midline of the humerus

shoulder abduction

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the goniometer placement for which shoulder movement is being described?

not usually measured or recorded because its the return to 0 from its opposing action

shoulder adduction

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the goniometer placement for which shoulder movement is being described?

axis: over the olecranon process

stationary arm: perpendicular to or parallel with the floor

moving arm: aligned with the ulna

shoulder MR

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the goniometer placement for which shoulder movement is being described?

axis: over the olecranon process

proximal arm: perpendicular to or parallel with the floor

distal arm: aligned with the ulna

shoulder LR

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name the 3 synovial joints of the shoulder

glenohumeral joint (GH)
acromioclavicular (AC)
sternoclavicular (SC)

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which synovial joint of the shoulder is being described?

made up of the humeral head & glenoid fossa

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which synovial joint of the shoulder is being described?

triaxial plane joint
weak capsule supported by superior & inferior AC ligaments

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which synovial joint of the shoulder is being described?

triaxial with disk
supported by anterior/posterior ligaments AND interclavicular/costoclavicular ligaments

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what is the capsular pattern of the shoulder?

ER&raquo_space;> abduction&raquo_space;> IR

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which peripheral joint’s open pack position is being described?

55-70 degrees of abduction with 30 degrees of horizontal adduction

shoulder joint

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which peripheral joint’s closed pack position is being described?

mac abduction & ER

shoulder joint

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what’s the end feel of the shoulder joint?

firm (joint capsule)

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which special test of the shoulder is being described?

PURPOSE: tests for bicep tondenitis & assesses the integrity of the bicep tendon

HAND PLACEMENT: stabilize same side shoulder

FORCE: resisted shoulder extension

+ SIGN: pain in bicipital groove is reproduced

speeds test

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which special test of the shoulder is being described?

PURPOSE: tests for full thickness RC tear

HAND PLACEMENT: passively raise arm to 90 degrees of abduction

FORCE: slowly lower arm

+ SIGN: can’t slowly control downward descent

drop arm test

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which special test of the shoulder is being described?

PURPOSE: tests for supraspinatus weakness

HAND PLACEMENT: patient is in caption (thumbs down/IR)

FORCE: downward pressure

+ SIGN: pain is reproduced

empty can test

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which special test of the shoulder is being described? PURPOSE: general shoulder impingement test HAND PLACEMENT: (patient is standing or sitting) depress or stabilize scapula FORCE: passive IR of shoulder & then passively range into *maximal* flexion + SIGN: pain is reproduced

neer's test

which special test of the shoulder is being described? PURPOSE: subacromial impingement test HAND PLACEMENT: shoulder & elbows are flexed 90 degrees FORCE: passively MR shoulder + SIGN: pain is reproduced

kennedy hawkins test

which special test of the shoulder is being described? PURPOSE: tests for subscapularis tear HAND PLACEMENT: arm is behind the back with the dorsal surface of hand against the back FORCE: ask patient to lift hand from back + SIGN: unable to lift hand off of back/away from body

lift off sign

which special test of the shoulder is being described? PURPOSE: tests for anterior instability of GH joint HAND PLACEMENT: (patient is in supine) shoulder in 90 degrees of abduction & elbow in 90 degrees of flexion FORCE: slowly ER patient's shoulder + SIGN: patient is apprehensive & feels like their is instability

anterior apprehension test

which muscle does this action & nerve innervation belong to? action: scapular elevation & UR nerve: spinal accessory cranial nerve XI/C3 & C4 sensory component

upper trap

which muscle does this action & nerve innervation belong to? action: scapular retraction nerve: spinal accessory cranial nerve Xl/C3 & C4 sensory component

middle trap

which muscle does this action & nerve innervation belong to? action: scapular depression & UR nerve: spinal accessory cranial nerve Xl/C3 & C4 sensory component

lower trap

which muscle does this action & nerve innervation belong to? action: scapular elevation & DR nerve: C3, C4, & dorsal scapular C5

levator scapula

which muscle does this action & nerve innervation belong to? action: scapular retraction, elevation, & DR nerve: dorsal scapular C5

rhomboids

which muscle does this action & nerve innervation belong to? action: scapular protraction & UR nerve: long thoracic C5, C6, C7

serratus anterior

which muscle does this action & nerve innervation belong to? action: scapular protraction, depression, DR, & tilt nerve: medial pectoral nerve C8-T1

pectoralis minor

which muscle does this action & nerve innervation belong to? action: shoulder flexion, MR, abduction, & horizontal adduction nerve: axillary C5 & C6

anterior deltoid

which muscle does this action & nerve innervation belong to? action: shoulder abduction nerve: axillary C5 & C6

middle deltoid

which muscle does this action & nerve innervation belong to? action: shoulder extension, hyperextension, LR, & horizontal abduction nerve: axillary C5 & C6

posterior deltoid

which muscle does this action & nerve innervation belong to? action: shoulder abduction nerve: suprascapular C5 & C6

supraspinatus

which muscle does this action & nerve innervation belong to? action: shoulder LR & horizontal abduction nerve: suprascapular C5 & C6

infraspinatus

which muscle does this action & nerve innervation belong to? action: shoulder LR & horizontal abduction nerve: axillary C5 & C6

teres minor

which muscle does this action & nerve innervation belong to? action: shoulder MR nerve: subscapular C5 & C6

subscapularis

which muscle does this action & nerve innervation belong to? action: first 60 degrees of flexion nerve: lateral & medial pectoral C5 -T1

pec major (clavicular portion)

which muscle does this action & nerve innervation belong to? action: first 60 degrees of extension (180-120) nerve: lateral & medial pectoral C5-T1

pec major (sternal portion)

which muscle does this action & nerve innervation belong to? action: shoulder MR, adduction, & horizontal adduction nerve: lateral & medial pectoral C5-T1

pec major (both portions)

which muscle does this action & nerve innervation belong to? action: shoulder extension, hyperextension, MR, & adduction nerve: thoracodorsal C6, C7, C8

latissimus dorsi

which muscle does this action & nerve innervation belong to? action: shoulder extension, MR, & adduction nerve: lower sub scapular C5, C6, C7

teres major

which muscle does this action & nerve innervation belong to? action: stabilizes shoulder joint nerve: musculocutaneous C5, C6, C7

coracobrachialis

which pathology is being described? - tendons of the RC (usually supraspinatus) are compressed/crowded under the coracoacromial arch - over time repetitive movements, pain, stress, & friction can cause the tendons to wear & tear - poor limited blood supply

impingement syndromes

what are the 3 types of acromion processes?

type 1: flat type 2: curved type 3: crooked

when treating an impingement syndrome with conservative treatment, which phase is being described? - Decrease/modify pain - Meds for pain/inflammation - Rest - Stretching/strengthening - Scapular strengthening & stabilization exercises - Pendulum exercises - Isometrics - Patient education - Modalities

protection phase

when treating an impingement syndrome with conservative treatment, which phase is being described? - Increased use of injured area - Increased intensity of isometrics - Stretch & strengthen RC muscles - Scapular stabilization - Open & closed chain endurance exercises

controlled motion phase

when treating an impingement syndrome with conservative treatment, which phase is being described? - Functional training - Increased duration & intensity of exercises - plyometrics

return to function phase

when treating an impingement syndrome with non-conservative treatment, which phase is being described? - Lasts 3-4 weeks - Control pain & inflammation - Almost ALWAYS address mobility - Pendulum - Posture - About 1-week post-op: pain-free, low intensity isometrics - Submax isometrics - AAROM of shoulder & AROM of wrist, hand & elbow

maximum protection phase

when treating an impingement syndrome with non-conservative treatment, which phase is being described? - restore & maintain full/pain-free ROM - self-stretching - postural exercise - develop dynamic stability, strength (low-load with a slow increase in reps), endurance, & control of GH joint & scapulothoracic joint - stabilization exercises - functional activities

moderate protection phase

when treating an impingement syndrome with non-conservative treatment, which phase is being described? - Begins ~8 weeks post-op & lasts 12-16 weeks - Strength - Endurance - Functional activities

minimum protection phase

what does SAD stand for & what is it a treatment option for?

Subacromial Decompression - used to eliminate/decrease the abnormality causing an impingement - allows increased movement of tendons with pain/compression

describe these components of SAD: release acromioplasty distal clavicle excision removal of osteophytes removal of subacromial bursa

release: of coracoacromial ligament acromioplasty: shaving the end of the acromion to create more room in the shoulder joint distal clavicle excision: removal of distal end of the clavicle to increase joint space removal of osteophytes: at AC joint removal of subacromial bursa

name the 4 types of tendonitis of the shoulder

supraspinatus tendonitis infraspinatus tendonitis bicipital tendonitis bursitis

are the following treatments of tendonitis conservative or non-conservative? - NSAIDS (anti-inflammatory meds) - Avoid activities that place a load on the tendon - Isometric exercise - Once pain decreases, work on building strength

conservative

what are the size classifications of the following RC tears? 1cm or less 1-3cm or less 3-5cm or less 5cm+

1cm or less: *small* 1-3cm or less: *medium* 3-5cm or less: *large* 5cm+: *massive*

what are the 2 classifications of thickness for an RC tear?

partial thickness tear full thickness tear

when treating an RC tear with non-conservative treatment, which phase is being described? - Prevent loss of ROM of peripheral joints - Prevent shoulder stiffness - PROM (as allowed) - Self-assisted/wand exercise - Postural training - Scapular stabilization

maximum protection phase

when treating an RC tear with non-conservative treatment, which phase is being described? - Self or AAROM with end range hold - Pain-free AROM - Look for substitution motions - Isometric & dynamic scapulothoracic stabilizers - Gradually increase resistance with submax isometrics - Scar mobilization - Use of UE for light, functional activities

moderate protection phase

when treating an RC tear with non-conservative treatment, which phase is being described? - Full ROM of shoulder - Strengthening continues - Return to functional activities - Task specific training - No high demand activities for 6 months – 1 year - Endurance training - Phase may begin 12-16 weeks post op

minimum protection phase

which pathology are these signs & symptoms for? chronic intermittent activity dependent

glenohumeral joint instability & dislocation

loss of articulation between humeral head & glenoid fossa

dislocation

partial disloaction

subluxation

which type of dislocation is being described? - common - posteriorly directed force while humerus is in elevation, ER & horizontal abduction

anterior dislocation

which type of dislocation is being described? - less common - force applied while humerus is in flexion, adduction & IR

posterior dislocation

which type of hypermobility is being described? - when shoulder starts to slip from the joint with no significant injury - can be unidirectional or multidirectional

atraumatic hypermobility

which type of hypermobility is being described? occurs with anterior dislocation of the shoulder

traumatic hypermobility

when treating GH joint instability/dislocation with conservative treatment, which phase is being described? - Compression fracture of the posterolateral aspect of the humeral head because of anterior shoulder instability - Pain control - Avoid any position that reproduces the mechanism of dislocation of the arm - Maintain range/strength in joints below that are non-compromising to shoulder - Once immobilization is over, gradually return to ROM (still protecting shoulder from abduction/ER)

protection phase

when treating GH joint instability/dislocation with conservative treatment, which phase is being described? Submax isometrics * Pain free * Neutral position: add,abd/ IR, ER/ elevation, extension * Partial WB & stabilization exercises * Limited ER from neutral to 50 degrees * Avoid dislocation positions * Work up to full IR & 90-degree flexion * DO NOT PUT IN 90 DEGREES ABDUCTION * AVOID COMBINATION OF ABDUCTION & ER

controlled motion phase

when treating GH joint instability/dislocation with conservative treatment, which phase is being described? - Scapular & RC strengthening - Anterior shoulder strengthening - Look at scapulohumeral rhythm: focus on normal scapular motion & stabilization - Avoid prohibited motions for up to 3 months after original injury - Full, pain free ROM - No palpable tenderness - Machine, CKC, OKC, cable systems - Progress from easy to hard - Discuss with PT when progression is appropriate - Endurance activities - May take up to 4 months for patient to be able to return to full activity

return to function phase

which injury associated with GH instability/dislocation is being described? may be associated with bicep long head tear & *anterior instability*

SLAP lesion

which injury associated with GH instability/dislocation is being described? avulsion (separation) of the capsule & glenoid off of the anterior rim of the glenoid labrum due to *traumatic anterior dislocation*

Bankhart lesion

which injury associated with GH instability/dislocation is being described? compression fracture of the *posterolateral* aspect of the humeral head because of *anterior shoulder instability*

Hill-Sach's lesion

name and describe the 2 types of adhesive capsulitis

primary: spontaneous/more common secondary: occurs after immobilization/trauma

which of the 4 stages of adhesive capsulitis is being described? - Gradual onset of pain that increases with movement - Night pain - Loss of ER ROM - BL RC strength - Lasts less than 3 months

stage 1

which of the 4 stages of adhesive capsulitis is being described? - Continual pain & intense pain at rest - Motion is limited in all directions - Lasts 3-9 months

stage 2 (freezing)

which of the 4 stages of adhesive capsulitis is being described? - Pain only with movement - Limited GH joint motions - Scapular substitutions patterns - Weakness - Lasts 9-15 months

stage 3 (frozen)

which of the 4 stages of adhesive capsulitis is being described? - Minimal pain - Significant capsular restrictions due to adhesions - Gradual improvement of ROM - Lasts 15-24 months - May never get ROM back

stage 4 (thawing)

when treating adhesive capsulitis with conservative treatment, which phase is being described? - Educate pt - Activity modification - Passive or assisted ROM in pain free range available - Joint mobs - Isometrics - Grip ball squeezes

protection phase

when treating adhesive capsulitis with conservative treatment, which phase is being described? - Progress ROM to point of pain for shoulder & scapula - Wand exercise, table stretches, pulleys - Self-mobs - Stretching (manual & self) - Postural changes - Modalities as needed

controlled motion phase

when treating adhesive capsulitis with conservative treatment, which phase is being described? - Stretching - Strengthening - Posture - Prepare for real life

return to function phase

what are the degrees of the sprains?

1st degree 2nd degree 3rd degree

what is the goal of ORIF (Open Reduction Internal Fixation) when treating AC joint sprains/dislocations

immobilization with the goal of regaining functional strength & ROM of the joint

what procedure is being described? - Incisions is 17cm long >> deltoid is retracted - Surgery takes 1 ½ - 2 ½ hours - Post op ROM for abduction: 143 degrees

TSA (Total Shoulder Arthroplasty)

when treating an AC joint sprain/dislocation with non-conservative treatment (after a TSA), which phase is being described? - Control pain - PROM: surgical guidelines - AROM: scapula - Supine self-assisted ROM - Codman’s (NO CIRCLES) - Functional activity with elbow at waist level - Maintain above/below joint integrity

maximum protection phase

when treating an AC joint sprain/dislocation with non-conservative treatment (after a TSA), which phase is being described? - Avoid aggressive stretching or resistance exercises or overuse of involved shoulder with ADLs - AAROM - Transition gradually to AROM - Wand exercises behind back - Low intensity, pain-free stretching - Pain-free submax isometrics - Dynamic scapular strengthening

moderate protection phase

when treating an AC joint sprain/dislocation with non-conservative treatment (after a TSA), which phase is being described? - End range of self-stretching - Strengthening: pain-free, low load, high rep - Functional activity training

minimum protection phase

after an rTSA, which post op date(s) do the following rules apply to? (day 1, days 2-21, weeks 3-8, weeks 4-5, or weeks 9-12)? * No passive ER until week 2 * No circular pendulums

day 1

after an rTSA, which post op date(s) do the following rules apply to? (day 1, days 2-21, weeks 3-8, weeks 4-5, or weeks 9-12)? * Do not exceed PROM 120 degrees of flexion, 30 degrees of ER, & 45 degrees of scaption * Avoid pulleys unless it’s pure flexion

days 2-21

after an rTSA, which post op date(s) do the following rules apply to? (day 1, days 2-21, weeks 3-8, weeks 4-5, or weeks 9-12)? * No passive adduction or horizontal adduction beyond neutral * No combined ER & abduction * No passive flexion over 140 degrees

weeks 3-8

after an rTSA, which post op date(s) do the following rules apply to? (day 1, days 2-21, weeks 3-8, weeks 4-5, or weeks 9-12)? * NO active ER more than 45 degrees * NO IR behind back

weeks 4-5

after an rTSA, which post op date(s) do the following rules apply to? (day 1, days 2-21, weeks 3-8, weeks 4-5, or weeks 9-12)? * No lifting more than 5lbs if painful * Should have 90 degrees of active abduction * Should have 45 degrees of active ER * Should have 70 degrees of active IR

weeks 9-12

normal ROM for elbow flexion

0-150 degrees

normal ROM for elbow extension

0 degrees

normal ROM for elbow pronation

0-80 degrees

normal ROM for elbow supination

0-80 degrees

the goniometer placement for which elbow motion is being described? o *Axis:* over the lateral epicondyle of the humerus o *Stationary arm:* aligned with the LATERAL midline of the humerus (using acromion process for reference) o *Moving arm:* aligned with the LATERAL midline of the radius (using the radial head & radial styloid process for reference)

elbow flexion

the goniometer placement for which elbow motion is being described? o *Axis:* center it LATERALLY & PROXIMALLY to the ulnar styloid process o *Stationary arm:* align parallel to the ANTERIOR midline of the humerus o *Moving arm:* place across the DORSAL surface of the forearm, just PROXIMAL to the radius & ulna

elbow pronation

the goniometer placement for which elbow motion is being described? o *Axis:* place it MEDIALLY & just PROXIMALLY to the ulnar styloid process o *Stationary arm:* align parallel to the ANTERIOR midline of the humerus o *Moving arm:* place across the VENTRAL surface of the forearm, just PROXIMAL to the styloid process

elbow supination

what is the capsular pattern of the humeroulnar joint?

flexion loss > extension loss

what is the capsular pattern of the humeroradialis joint?

flexion loss > extension loss

what is the capsular pattern of the proximal & distal radioulnar joint?

pronation loss = supination loss

what is the open pack position of the humeroulnar joint?

70 degrees flexion & 10 degrees of supination

what is the open pack position of the radiohumeral joint?

full extension & supination

what is the closed pack position of the humeroulnar joint?

full extension & supination

what is the closed pack position of the radiohumeral joint?

90 degrees of flexion & 5 degrees of supination

which special test of the elbow is being described? o PURPOSE: looks at integrity of MCL of the elbow (is it intact?) o POSITION: supine with elbow flexed at 20 degrees (clinician stands towards feet) o HAND PLACEMENT: stabilize above joint line o FORCE: abduction of the FA o + SIGN: pain or excessive movement

valgus stress test

which special test of the elbow is being described? o PURPOSE: looks at integrity of LCL at the elbow o POSITION: supine with elbow flexed at 20 degrees (clinician stands towards head) o HAND PLACEMENT: stabilize above joint line o FORCE: adduction of the FA o + SIGN: pain or excessive movement

varus stress test

which special test of the elbow is being described? o PURPOSE: Tests for ulnar entrapment (provocation/tapping nerve test) o POSITION: o HAND PLACEMENT: support FA o FORCE: Tapping the groove between the olecranon process & medial epicondyle o + SIGN: pain, numbness, tingling

tinel's sign

which special test of the elbow is being described? o PURPOSE: tests for medial epicondylitis o POSITION: elbow fully extended & supinated; then passively extend wrist o HAND PLACEMENT: stabilize UE o FORCE: push hand back into further extension o + SIGN: reproduce pain/symptoms

golfer's elbow test

which special test of the elbow is being described? o PURPOSE: tests for lateral epicondylitis o POSITION: extend elbow & pronate FA o HAND PLACEMENT: on dorsum of wrist o FORCE: resist further extension against clinician’s hand o + SIGN: reproduces pain/symptoms

tennis elbow test

which special test of the elbow is being described? o PURPOSE: tests for lateral epicondylitis o POSITION: o HAND PLACEMENT: o FORCE: resists middle finger extension o + SIGN: reproduces pain/symptoms

lateral epicondylitis test

which muscle does this action & nerve innervation belong to? action: elbow flexion nerve: musculocutaneous C5, C6

brachialis

which muscle does this action & nerve innervation belong to? action: elbow flexion & forearm supination nerve: musculocutaneous C5, C6

biceps brachii

which muscle does this action & nerve innervation belong to? action: elbow flexion nerve: radial C5, C6

brachioradialis

which muscle does this action & nerve innervation belong to? action: elbow extension nerve: radial C6, C7, C8

triceps

which muscle does this action & nerve innervation belong to? action: assistes in elbow extension (not a prime mover) nerve: radial C6, C7, C8

aconeus

which muscle does this action & nerve innervation belong to? action: forearm pronation nerve: median C6, C7

pronator teres

which muscle does this action & nerve innervation belong to? action: forearm pronation nerve: median C8, T1

pronator quadratus

which muscle does this action & nerve innervation belong to? action: forearm supination nerve: radial C6

supinator muscle

which pathology is being described? - associated with repetitive (overusing) wrist extension - commonly involved ECRB - pain/weakness in common wrist extensor tendon & humeroradial joint with gripping activities or activities that require firm wrist stability - also known as "tennis elbow"

lateral epicondylitis

which pathology is being described? - associated with repetitive (overusing) wrist flexion - commonly involves common flexor tendon - pain in common flexor/pronator tendon at the medial epicondyle - also know as "golfer's elbow"

medial epicondylitis

what are some functional limitations of medial & lateral epicondylitis?

keyboarding throwing sports (golf & tennis) hammering using hand tools

when treating lateral/medial epicondylitis with conservative treatment, which phase is being described? o Decrease pain - Immobilization - Avoid aggravating activities - Ice o Develop soft tissue & joint mobility - Cross friction massage - If nn symptoms are present: implement nn gliding/mobilizations - Soft tissue mobilization: decrease tightness - Isometrics in pain-free ranges - Gentle passive stretching o Maintain UE function - Active ROM: to all joints to maintain integrity of the UE - Resistive exercises: to shoulder & scapular stabilization exercises

protection phase

when treating lateral/medial epicondylitis with conservative treatment, which phase is being described? o Manual stretching o Continue with cross friction massage o Joint mobs by PT o Force dispersing strap/brace o Increased strengthening o Initiate concentric & eccentric exercise with caution o Make sure they are appropriate & don’t “flare up” the pt o Activity modification o Promote gradual return to all functional activities o Plyometric if appropriate

controlled motion/return to function phase

which pathology is being described? - onset: transverse fx of distal 1/3 of the humerus - 2 types

supracondylar fracture

is the following a type l or type ll supracondylar fx? fall onto an outstretched, extended arm >> fragment is displaced posteriorly

type l

is the following a type l or type ll supracondylar fx? flexion injury with direct trauma to the posterior elbow >> fragment lies anterior to humerus

type ll

the following treatment parameters are for what pathology? - focus on gentle active motion that doesn’t stress the fracture site - Typically immobilized 4-6 weeks - Gentle AROM after cast is removed - no resistance exercise or progressive ROM allowed until x-ray shows healing - above/below joints are maintained - passive stretching is contraindicated during early healing phase o DO NOT PUT STRESS OVER HEALING FX SITE

supracondylar fracture

the following are potential complications what kind of surgery? - Intraoperative fracture o Component malpositioning o Ulnar damage - Postoperative o Deep infection o Joint instability o Wound healing insufficiency o Triceps insufficiency - Months/years later o Loosening of components o Periprosthetic fracture o Mechanical failure o Premature wear if components

TEA (Total Elbow Arthroplasty)

when recovering from a TEA, which phase is being described? - Control pain, inflammation, & edema - Maintain careful inspection of wound - Protect soft tissue as it begins to heal - Maintain mobility of shoulder, wrist & hand - Regain motion of FA & elbow (if permitted by procedure used) - Goals can include maintaining mobility of shoulder, wrist & hand (if allowed ROM to elbow & FA) - Minimize atrophy of UE musculature o Isometrics may be used to achieve this - first 4 weeks

maximum protection phase

when recovering from a TEA, which phase is being described? *4-6 weeks postoperatively* - Soft tissue has healed sufficiently to increase stress *12 weeks* - (Barring complications) only minimum protection is needed - Increase ROM - Regain functional strength & muscular endurance

moderate/minimum protection phase

ulnar entrapment (ulnar nerve C8, T1) at the medial aspect of the elbow is the cause of

CTS (Cubital Tunnel Syndrome)

the following directions are for which test? - Sequentially add o Wrist extension & forearm supination o Full elbow flexion o Shoulder girdle depression o Hold this position, then add shoulder LR & abduction o Hands end near ear with fingers posteriorly - SB (side bend) neck to opposite side

ulnar nerve tension test

normal ROM for wrist flexion

0-80 degrees

normal ROM for wrist extension

0-70 degrees

normal ROM for radial deviation

0-20 degrees

normal ROM for ulnar deviation

0-30 degrees

the goniometer placement of which wrist motion is being described?

wrist flexion/extension

the goniometer placement of which wrist motion is being described?

radial/ulnar deviation

what is the capsular pattern of the wrist?

- equal flexion & extension slight loss of UD & RD

what is the open pack position of the wrist?

10 degrees of flexion & slight UD

what is the closed pack position of the wrist?

full extension

which special test of the wrist is being described? o PURPOSE: tests for inflammation of APL & EPB o POSITION: pronation; make a fist with the thumb tucked o HAND PLACEMENT: o FORCE: passively ulnar deviate o + SIGN: reproduce symptoms

finkelstein's test

which special test of the wrist is being described? o PURPOSE: puts pressure on median nerve o POSITION: fully flex both wrists o HAND PLACEMENT: o FORCE: press opposite dorsums of hands together & hold for 1 minute o + SIGN: reproduce symptoms

phalen's

which special test of the wrist is being described? o PURPOSE: tests for CTS o POSITION: wrists are fully extended with both palms together (prayer) o HAND PLACEMENT: o FORCE: lower hands & throw elbows out o + SIGN: reproduce symptoms

reverse phalen's

which special test of the wrist is being described? o PURPOSE: tests for CTS o POSITION: sitting with FA fully supinated o HAND PLACEMENT: hand & wrist are held in neutral position o FORCE: tap at midpoint of carpal tunnel o + SIGN: pain, numbness, or tingling

tinel's sign

which special test of the wrist is being described? - squeeze a dynamometer

grip strength

which muscle does this action & nerve innervation belong to? action: wrist flexion & UD nerve: ulnar C8, T1

FCU (Flexor Carpi Ulnaris)

which muscle does this action & nerve innervation belong to? action: wrist flexion & RD nerve: median C6, C7

FCR (Flexor Carpi Radialis)

which muscle does this action & nerve innervation belong to? action: wrist extension & RD nerve: radial C6, C7

ECRL (Extensor Carpi Radialis Longus)

which muscle does this action & nerve innervation belong to? action: wrist extension nerve: radial C6, C7

ECRB (Extensor Carpi Radialis Brevis)

which muscle does this action & nerve innervation belong to? action: wrist extension & UD nerve: radial nerve C6, C7, C8

ECU (Extensor Carpi Ulnaris)

what pathology is being described? - Entrapment/compression of median nerve is caused by: - Repetitive motions - Genetic link - Race - Canal size - Occupation

carpal tunnel syndrome

the following are associated conditions of which pathology? o DM o Obesity o Hypothyroidism o Inflammatory arthritis o Pregnancy o Alcohol abuse (& may also see) o Thenar mm atrophy o + Phalen’s test o Loss of 2-point discrimination o + Tinel’s at the wrist o Sensory changes over median nerve distribution

carpal tunnel syndrome

the following is non-operative management of what pathology? o Modify activity: home & work o Educate patient & HEP o MD prescribe medication: o Possibly injections o Splint wrist in neutral o Allow inflammation to subside before starting resistance training o Gentle ROM/gripping exercise that do not flare symptoms o Postural exercises needed o Joint mobs by PT if needed o Tendon gliding exercises for extrinsic tendons o Median nerve glides/mobilization o EMG ordered for cases where compression may be coming from cervical root/BP issue

carpal tunnel syndrome

the following is operative management of what pathology? o Surgical release of transverse carpal ligaments/removal of scar tissue - Can be open or endoscopic - Open is a safer alternative - Decreases risk that median nn or ulnar area will be damaged - 80-90% of board-certified hand surgeons use open technique - Surgery has a 90-93% success rate & is cost-effective to manage CTS - Usually performed as an outpatient procedure with local sedation

carpal tunnel syndrome

when treating carpal tunnel syndrome with non-conservative treatment, which phase is being described? o Immobilization for 7-10 days o Patient education o Avoid active wrist flexion & extension past neutral o Avoid active finger flexion with wrist flexion o Pain/edema/wound management o Active tendon gliding o Maintain integrity of FA, elbow, & shoulder

maximum protection phase

when treating carpal tunnel syndrome with non-conservative treatment, which phase is being described? o AROM initiated as tissue heals & sutures are removed ( ~ day 10-12) o Scar mobilization: to prevent scar tissue from forming o Nerve glides o Isometrics being around 4 weeks o Grip/pinch around week 6 o Dexterity exercises & sensory stimulation o Overall, CTS can return o May see an increase in incidence of this 10-15 years after CT release

moderate protection phase

which pathology is being described? - involvement of the ulnar nerve in the tunnel between the hook of hamate & the pisiform - sensory symptoms in: - little finger - ulnar side of hand - fatigue & weakness in the hand with repetitive motions - provoking activities - knitting - biking - tying knots - falling onto ulnar side of hand - prolonged handwriting

compression in tunnel of guyon

the following is non-operative management of what pathology? o Similar to that of CTS o Avoid pressure to the base of the hand o Possible use of hand-based ulnar orthosis to provide rest o Ulnar nerve mobilization

compression in tunnel of guyon

the follow is operative management of what pathology? o Release of ulnar tunnel o Immobilization of wrist for 3-5 days o Gentle ROM o Guidelines similar to CTS surgery (except use ulnar nn mob techniques)

compression in tunnel of guyon

what pathology is being described? o caused by repetitive tension or a sudden increase of repetitive activities o thickening/swelling of sheath & tunnel of the tendons of the  abductor pollicis longus  extensor pollicis brevis o 3-5x greater in women during pregnancy or menopause o signs & symptoms o repetitive ulnar deviation  increased pain o pain & swelling at radial styloid process o pain & decreased ROM at the thumb o pain when making a fist o + Finkelstein’s test

De Quervain's Tenosynovitis

the following is conservative management of what pathology? o NSAIDS o Wrist/thumb immobilization o Eliminate any activity that causes pain o Ice o Ionto/phono o PROM progressing to AROM when pain free  Emphasize concentric & eccentric o PT for joint mobs if indicated o Surgical decompression for chronic cases o Post-op mobilization for 1 week o If conservative tx fails  Injection of the 1st dorsal compartment

De Quervain's Tenosynovitis

which pathology is being described? o Most common fx at the wrist (FOOSH fall) o Fall on the palmar side of hand & bone gets pushed to dorsal side of wrist o Rehab - Gentle, active PAIN-FREE ROM after immobilization with x-ray confirmation of secure bone healing - Control edema - Encourage soft tissue extensibility - No resistive exercise until secure bone union (may be up to 8 weeks) - Rehab may last up to 1 year

colles fracture

which pathology is being described? o Reverse colles fracture o Fall on the dorsal side of hand & bone gets pushed to palmar side of wrist o Rehab is similar to colles fx

smith's fracture

- most common fracture in carpal bones - injury due to wrist extension - Rehab o Displaced: ORIF with rigid immobilization o Length of time to heal is LONG (be cautious with rehab) o Gliding of the wrist & finer muscle o DO NOT STRESS motions that cause pain o Light strengthening o Gradual return to closed chain exercise o May have patient in Spica splint between exercise session o Return to activities 12 weeks after cast is removed

scaphoid fractures

is the following a stable/non-displaced or proximal pole scaphoid fracture? closed reduction with cast for 6 weeks

stable/non-displaced fracture

is the following a stable/non-displaced or proximal pole scaphoid fracture? closed reduction with cast for 12-24 weeks

proximal pole fracture

what pathology is being described? o Affects the palmar fascia o Affect is bilateral (45% involve the ulnar digits) o Not usually painful o 20–30-degree contracture at MCP joint (indication for surgical intervention) o Unable to flatten hand onto table o Surgical approaches o Fasciotomy o Regional fasciectomy o Extensive fasciectomy o Dermofasciectomy o Patient treatments o Wound care o Splinting to allow flexion (limits full extension at the MP) o CHT designs/makes splints during rehab process o Watch for signs of CRPS

Dupuytren's Contractures

what pathology is being described? o Gradual onset usually after some type of injury/painful lesion o Most often seen in women 30-55 o Higher incidence in smokers o Most commonly occurs after fx of distal radius & ulna - 2 types - 3 stages - Signs & symptoms o Pain: out of proportion to injury o Trophic skin changes o Autonomic disturbances o Loss of mobility & function o Edema

CRPS (Complex Regional Pain Syndrome)

is the following type l or type ll CRPS? o Develops after an initiating noxious event o Spontaneous pain or allodynia/hyperalgesia o Edema/vascular changes o Non-nerve origin o Abnormal sudomotor activity

type l

is the following type l or type ll CRPS? o Develops after nerve injury o Not limited to territory of nerve injury o Edema/skin blood flow abnormality o Abnormal sudomotor activity

type ll

which stage of CRPS is being described? o Acute/reversible o Lasting 3 weeks- 6 months o Pain o Edema o Excessive sweating o Discoloration (red) o Temperature changes o Rapid nail growth

stage l

which stage of CRPS is being described? o Dystrophic/vasoconstriction o Lasts 3-6 months o Pain/edema increase o Burning pain o Skin dries o Atrophy o Sympathetic hyperactivity o OP may develop o Skin mottling & coldness

stage ll

which stage of CRPS is being described? o Begins 6months – 1 year post injury o Atrophic stage o Severe atrophy o Inelastic fibrous tissue o Pain can decrease or become worse o Overall condition can last for months or years o Spontaneous recovery can occur between 18-24 months

stage lll

the following treatment parameters are for what pathology? o Initiate Rx as soon as Dx is made o Reduce pain/swelling o Eliminate pain-producing things o TENS, massage, heat o Protection of area o Patient education o Compression wraps (if tolerable) o Active exercised as long as it doesn’t increase pain o Desensitization (brief periods 5x a day) o Address psychological component

CRPS (Complex Regional Pain Syndrome)

Lecture Exam 2 Flashcards

(182 cards)