msk final Flashcards
(336 cards)
1
Q
what movements does the humeroulnar joint help guide?
A
flexion and extension
2
Q
what are the articulations of the HUJ?
A
trochlea and trochlear notch
3
Q
what movement does valgus help with at the HUJ
A
extension
helps clear hips
4
Q
what movement does varus help with at the HUJ?
A
flexion
helps with eating
5
Q
does the HUJ follow cave on vex rules?
A
no
6
Q
what does the deep concavity of the HUJ resrict?
A
traditional distraction - 45 deg
traditional cave on vex glide - posterior medial/lateral at 60 deg
7
Q
what motion does posterior glide help at HRJ?
A
extension
8
Q
what motion does anterior glide help at HRJ?
A
flexion
9
Q
what are the articulations of HRJ?
A
capitulum and radial head
10
Q
what movements does the humeroradial joint help guide?
A
flexion and extension
pronation and supination
11
Q
what is the concavity of the HRJ?
A
cave on vex
12
Q
what influence on the length of radius does the HRJ have?
A
posterior-medial radial head is thicker
in pronation, pushes radial distally
13
Q
synkinetic with PRUJ
A
ext and pro go together
flex and sup go together
14
Q
what are the articulations of PRUJ?
A
radial head and radial notch
15
Q
what motions does the PRUJ help guide?
A
pro and sup
16
Q
what is the concavity of PRUJ?
A
vex on cave
17
Q
what motions does the DRUJ help guide?
A
pro and sup
18
Q
how much force does TFCC absorb?
A
20%
19
Q
what is the concavity of DRUJ?
A
cave on vex
least congruent in pronation
most congruent in supination
20
Q
what are common disruptions of DRUJ?
A
colles fracture:
malalignment and RU lig dysfunction
ulnar styloid fracture:
RU lig dysfunction
21
Q
what are the carpals intrinsically stabilized by?
A
form closure
force closure
22
Q
what is the arthrokinematics of carpals?
A
radiocarpal - vex on cave
mid-carpal - non traditional
23
Q
what is the scapholunate angle?
A
30-60 deg in the palmar direction
at risk during FOOSH
24
Q
tapeziometacarpal joint (CMC 1)
A
saddle joint
cave on vex in flex/ext
vex on cave in abd/add
25
CMC 2&3
very rigid
26
CMC 4&5
complex planar joint
allows flexion and extension of MC 4 & 5
27
MCP joint
condyloid
allow abd and add
cave on vex
28
IP joints
hinge joints
only flex/ext
cave on vex
29
what side of arm are the flexors on?
anterior
30
what flexors can jeopardize the median nerve?
FDS
FDP
31
what flexor can crush the ulnar nerve in the cubital tunnel?
FCU
32
what extensor muscle connects the ulna to the hand?
ECU
33
what extensors are prone to lateral epicondlyopathy?
ECRB
ECRL
34
what extensors make up part of the snuff box?
AbdPL
EPB
35
what extensors form the extensor hood?
ED
EI
EDM
36
clinical pearl of the lumbricals
on thumb side and come off of profundus
mechanical advantage of flexion
contribute to median nerve entrapment
37
clinical pearl of interossei
attach on the side needed to perform their function
ulnar nerve
38
overview of median nerve
sensation: palmar and dorsal distal 1-3
proximally compressed at pronator teres
distally compressed at carpal tunnel
39
overview of radial nerve
sensation: dorsal 1-3
prox compressed at radial tunnel between two heads of supinator
40
overview of ulnar nerve
sensation: dorsal and palmar 4-5
prox compressed at cubital tunnel
dis compressed at guyon's canal
41
what nerve is entrapped by anterior interosseous syndrome?
median
42
what muscles are affected by AIS?
FPL
FDP (2,3)
PQ
43
what is the presentation of AIS?
no snesory loss
weakness of tip pinch grasp
-unable to make ok sign
-unable to button shirts
possible pain at prox, medial forearm
44
what nerve is entrapped in posterior interosseous syndrome?
radial nerve
45
what muscles are impacted in PIS?
Supinator
ECRB
ED
EDM
ECU
AbdP
EPL
EPB
EI
46
what is the presentation of PIS?
no sensory loss
weakness in MCP ext, some wrist ext
possible pain at radial tunnel
inability to create full open hand motion
47
quickDASH
11 of 30 questions
higher scores indicate increased severity
48
amount of activity - kennedy stages
pain after - reduce by 0-25%
pain before and after - reduce by 25-50%
pain before during and after, perf unaffected - 50-75%
pain before during and after, perf affected - 75-100%
49
where are pain patterns most accurate?
more distal
50
frontal view observation
guarding of arm
carrying angles - should be valgus
skin appearance
swelling
hand atrophy
51
side view observation
attitude of hand
wrist deformities
swelling
hand deformities
nail bed changed
52
what is the radial nerve neural hand deformity?
wrist drop
53
what is the ulnar nerve neural hand deformities?
wartenburg - DM pull pinky into abd
froment - add poll impacted
claw hand
54
what is the median nerve neural hand deformities?
ape hand
okay sign
55
moberg pick up test
12 items
once with eyes open
once with eyes closed
56
prox radial MMT
ECRL/B
pt in wrist extension, resistance on thumb side
57
dis radial MMT
ED
pt 2nd digit in ext, resistance on pip
58
prox med MMT
FCR
pt in wrist flexion, resis on thumb side
59
dis med MMT
FPB
pt tumb in flexion, resistance pulls thumb up
60
prox ulnar MMT
FCU
pt in wrist flexion, resis on pinky side
61
dis ulnar MMT
Pl
pt in finger add, resistance pushed finger into abd
62
humeroulnar joint medial glide
for extension!
supine
arm partially supinated
push distally and medial
63
humeroulnar joint lateral glide
for flexion!
supine
push prox and lateral
64
humeroradial joint distracton
client supine
only grasp radius and distract
65
humeroradial joint posterior glide
client supine
drive the radius post/lateral at 60 deg
66
humeroradial joint anterior glide
client supine
use heel of hand to deliver force
anterior is subject to client position
67
distal RU dorsal glide of the radius
sitting, in 10 deg supination
push radial head posteriorly
68
DRUJ volar glide of the radius
sitting, in 10 deg supination
push radial head anteriorly
69
wrist dorsal glide
used for flexion
sitting, neutral wrist
glide prox row of carpals posterior
70
wrist palmar glide
used for extension
sitting, neutral wrist
glide prox row of carpals anterior
71
specific carpal bone posterior glide
basically palpation with overpressure
72
trapeziometacarpal joint dorsal glide
sitting, wrist neutral
push towards ulna for flexion
to radius for extension
dorsally for abduction
palmarly for adduction
73
CMC 2-5 dorsal glide
4&5 should move, 2&3 should not
posterior force goes to ceiling
74
MCP 1-5 glides
just grab and go for it
direction of movement is movement is helps
75
IP 1-5 glides
glide in respective direction
76
biceps squeeze test
distal biceps tear
squeeze biceps firmly with both hands
+ lack of forearm supination as biceps is squeezed
77
cozen's test
lateral epicondylopathy
palpate lat epi
client extends wrist against resistance
+ reproduction of pain in lat epi
78
Maudsley's lateral epicondylitis test
lateral epicondylopathy - ECRB specifically
palpate lat epi
client extends 3rd against resistance
+ reproduction of pain in lat epi
79
medial epicondylitis test
client sitting
palpate med epi
supinate pts forearm, extend wrist and elbow
+ pain at med epi
80
varus stress test
for lateral instability
palpate RCL
apply adduction force to distal forearm
+ distraction pain laterally and compression pain medially at joint line, laxity
81
valgus stress test
for medial instability
palpate UCL
apply abduction force to distal forearm
+ distraction pain medially and compression pain laterally at joint line, laxity
82
moving valgus stress test
for dynamic medial instability due to bands of UCL
valgus stress at elbow through ROM
+ pain reproduction when elbow is extended. highest level of pain should be between 70-120 deg
83
chair push up test
for posterior-lateral radial instability, TFCC instability
client's fingers face out, push up from chair using arms
+ reluctance to extend elbow fully, radius pushing out laterally
84
elbow flexion test for cubital tunnel
client fully flexes elbow and extends wrist
hold for 3 min
adding wrist flexion for FCU tendon
+ reproduction of symptoms along ulnar nerve distribution
85
wrist flexion and median nerve compression
for carpal tunnel syndrom
even and constant pressure over median nerve with wrist flexed to 60 deg
+ repro of symptoms along median nerve distribution within 20-30 seconds
86
phalen's test
for carpal tunnel syndrome
press dorsal surfaces of hands together for 60 seconds
+ paresthesia in cutaneous distribution of median nerve
87
reverse phalen's test
for carpal tunnel syndrome
press palmar surfaces of hands together for 60 seconds
+ paresthesia in cutaneous distribution of median nerve
88
finkelstein's test
for stenosing tendovaginitis (swelling of sheath)
client makes a fist and clinician ulnarly deviates fully
both sides must be done to be correct, can do one side at a time
+ pain over APL and EPB
89
watson scaphoid test
for scapholunate instability
thumb over scaphoid tubercle
move from ulnar dev to radial dev
release thumb
+ sublux or clunk at thumb and reproduction of pain
90
ulnomeniscotriquetral dorsal glide or piano key test
for UMT instability or TFCC tear
thumb on dorsal ulna, index finger on pisiform
push together to perform dorsal glide of pisiform
+ repro pain or laxity
91
ulnar collateral ligament test
for thumb instability
thumb into extension, apply valgus stress to MCP joint
+ valgus movement great than 30 deg
92
grind test
for 1st CMC arthritis
compress 1st MC into trapezium
+ pain at 1st CMC
93
bunnell-littler test
for hand intrinsic tightness
trial 1) MCP in extension
trial 2) MCP in flexion
flex IP
+ less PIP motion with MCP extension = tightness, need stretching
if no change, capsular problem, need mobs
94
bend and stretch
perpendicular load and stretch tissue
95
ischemic compression
press into trigger point until tissue release
96
myofascial release holds
picking up skin
this is done to someone with stuck skin
97
scar massage
wait until its healed enough that you are comfortable pulling on it
ok to be underagressive
thumbs uniform for fresher scar
once fully healed - can break adhesions
98
cross friction massage
for tendinopathy
finger over finger
1 direction for opathy
2 for tenovaginitis
2 min at light intensity and 2 more min more forceful
99
humeroulnar joint distraction in extension
for extension restriction
supine
arm in pronation
pre-positioned to full ex
distraction force in posterior-distal direction at 45 deg
30-45 sec 4x or until capsular change
100
humeroulnar joint mobilization in extension
sidelying with involved side down
arm in pronation
full extension
mob force post-med at 60 deg
30-45 sec 4x or until cap change
101
humeroulnar joint distraction in flexion
sidelying
supination
flexion limit
distraction force in post-distal direction at 45 deg
30-45 sec 4x or until cap change
102
humeroulnar joint mobilization in flexion
sidelying, involved side down
supination with med epi up
flexion limit
mob force in post-lat direction at 60 deg
30-45 sec 4x or until cap change
103
humeroradial joint and PRUJ distraction and mobilization in extension
sitting with arm on table
in supination with cubital fossa up
extension
mob force in post-lat at 60 deg
distraction force along radius as arm brought into pronation
30-45 sec 4x or until cap change
104
humeroradial joint and PRUJ mobilization in flexion
sitting with arm on table
in pronation with cubital fossa up
flexion
mob force in post-lat at 60 deg
distraction force along radius as arm brought into supination
30-45 sec 4x or until cap change
105
distal radioulnar joint mobilization in supination or pronation
sitting with arm on table
sup or pro (whichever is restricted)
SUP: mob force along volar surface of radius in posterior direction along joint line
PRO: mob force along dorsal surface of radius in anterior direction along joint line
30-45 sec 4x or until cap change
106
radiocarpal joint volar mobilization in extension
sitting with arm on table
in wrist extension
stabilizing force applied to distal radius and ulna
mob force applied to dorsal surface of proximal carpal row in volar direction
30-45 sec 4x or until cap change
107
radiocarpal joint dorsal mobilization in flexion
sitting with arm on table
in wrist flexion
stabilizing force applied to distal radius and ulna
mob force applied to volar surface of proximal carpal row in dorsal direction
30-45 sec 4x or until cap change
108
radiocarpal joint medial mobilization in radial deviation
sitting with arm on table and wrist off table
wrist in rad dev and slight flexion
stab force applied to distal radius and ulna
mob force applied to lateral surface of proximal carpal row in medial direction
30-45 sec 4x or until cap change
109
radiocarpal joint lateral mobilization in ulnar deviation
sitting with arm on table and wrist off table
wrist in ulnar dev and slight extension
stab force applied to distal radius and ulna
mob force applied to medial surface of proximal carpal row in lateral direction
30-45 sec 4x or until cap change
110
intercarpal joint volar/dorsal mobilization or manipulation
sitting with pt hand in yours
from neutral into flex or ex
EX: force applied to dorsal surface of hypomobile carpal with overlapping thumbs
FLEX: force applied to volar surface of hypomobile carpal with overlapping index fingers
mob: 30-45 sec 4x or until cap change
manip: 1-2 times
111
1st carpometacarpal distraction
pt sitting with arm on the table
stabilize distal carpal row
distraction force applied along axis of 1st MC
30-45 sec 4x or until cap change
112
1st carpometacarpal mobilization
sitting with arm on table
stabilization force applied to distal carpal row
mob force to base of 1st MC
- flexion: medial force to lateral surface
- extension: lateral force to medial surface
- abduction: dorsal force
- adduction: palmar force
30-45 sec 4x or until cap change
113
metacarpalphalangeal joint distraction or mobilization
sitting with arm on table
stabilizing force to distal MC
mob force to base of 1st phalanx
- flexion: volar force
- extension: dorsal force
- abduction: force away from 3rd finger
- adduction: force toward third finger
30-45 sec 4x or until cap change
114
interphalangeal joint distraction or mobilization
sitting with arm on table
stab force applied to distal portion of proximal phalanx
- flexion: volar force
- extension: dorsal force
30-45 sec 4x or until cap change
115
what are the three phases of epicondylopathy?
reactive - 20's, inflam, heal on its own
disrepair - 30's heal poorly
degenerative - 40's, breakdown, cell death, need PT
116
which set of muscles are more commonly affected by epicondylopathy?
extensors - tennis elbow
esp extensor carpi radialis brevis
117
what is the pain pattern for epicondylopathy?
localized to distal epicondyle
118
what are the risk factors for epicondylopathy?
35-50 yo
repetitive movements
women>men
119
what will you observe with epicondylopathy?
avoidance of grasping or active wrist flexion/extension
120
what will an examination find with epicondylopathy?
pain with palpation/contraction
+ cozen, maudsley's, mills or medial epicondylitis test
- c spine, nerve entrapment, and chair push up test
decreased grip strength
patient rated tennis elbow evaluation
121
patient education for epicondylopathy
activity reduction
ice
orthotics - wrist extension, counterforce
122
manual therapy for epicondylopathy
mobs: HR, PRUJ, DRUJ
STM/MFR: cross friction in 1 direction
instrument assisted for extensor muscles
123
ther ex for epicondylopathy
scapular strengthening
hand intrinsic strengthening
isometrics - if pain reducing
eccentric training - 2 sets of 15 with 2 RIR, 48 hr rest
rapid eccentrics
rapid concentrics
radial nerve glides
124
MOI for distal biceps tear
rapid high force
eccentric loading
flexed and supinated arm
125
what often happens before a distal biceps tear?
prior degeneration
repetitive pronation
126
pain pattern for distal biceps tear
localized, non-radicular pain over biceps
127
risk factors for distal biceps tear
> 45 yo
repetitive pronation
smoking
heavy eccentric loading
128
what will you observe with a distal biceps tear?
displaced biceps muscle belly
swelling
ecchymosis
129
what will an examination find with a distal biceps tear?
pain with resisted elbow flexion
decreased flexion/supination strength
+ biceps squeeze test
130
pt ed for distal biceps tear
adherence to protocol
importance of protected phase
131
manual therapy for distal biceps tear
mobs: HU, HR, PRUJ
132
ther ex for distal biceps tear
protected phase
- orthotic bracing
- spot-treat movement system
progressive phase
- ROM exercise
-stretching
strengthening phase
- isometric
isotonic
sport/work-specific
133
MOI of UCL injury of elbow
repetitive trauma
overhead athletes
134
which bundle of the UCL is most vulnerable?
anterior bundle
135
what two muscles keep the UCL stabilized?
flexor carpi ulnaris
flexor digitorum superficialis
136
what is the pain pattern for UCL injury of the elbow?
localized to the distal epicondyle
137
what are the risk factors for UCL injury of the elbow?
repetitive movements
138
what would you observe with UCL injury of the elbow?
decreased throwing velocity
139
what would an examination of UCL injury of the elbow reveal?
pain with palpation
+ moving valgus test
- medial epicondyle testing
140
pt ed for UCL injury of the elbow
activity reduction
141
manual therapy for UCL injury of the elbow
mobs: HU, HR, PRUJ, DRUJ, shoulder ER, scapula, thoracic spine
STM/MFR: cross friction in 1 direction
142
ther ex for UCL injury of the elbow
anterior core, subscap and grip strength
flexor/pronator strength
SURGICAL PROTOCOL
immediate motion:
- pain control
- PROM, AAROM, AROM
intermediate
- resistance training - strength/control
- mobilization
advanced strengthening
- progress resistance
- power/endurance
- plyometrics
progressive return to activity
ulnar nerve glides
143
MOI for LCL
hyperextension force in olecranon fossa
levers trochlea past coronoid process
144
frequency of LCL injury
most common dislocation <10 yo
2nd most common >10
145
pain pattern for LCL injury
localized to the distal epicondyle
reports of elbow giving way
146
risk factors for LCL injury
history of radial dislocation
history of lateral epicondylitis
147
what would an observation of LCL injury reveal?
apprehension of supination and loading
148
examination of LCL injury
pain with palpation
decreased extension ROM
+ chair push up test
- lateral epicondylitis testing
149
pt ed for LCL injury
activity avoidance
bracing
150
manual therapy for LCL injury
mobs: HR, PRUJ, DRUJ, shoulder IR
151
ther ex LCL injury
grip and extensor strength
SURGICAL PROTOCOL
immediate motion:
- pain control
- PROM, AAROM, AROM
intermediate:
- resistance training - strength and control
- mobilization
advanced strengthening
- progress resistance
- power/endurance
- plyometrics
progressive return to activity
radial nerve glides
152
MOI of annular ligament injury
longitudinal pull on the radius
full extension and supination
153
most common annular ligament injury in children
nursemaid's elbow
154
pain pattern of annular ligament injury
localized to distal epicondyle
155
risk factors annular ligament injury
age 2-4
156
examination of annular ligament injury
pain with. palpation
decreased ROM
+ chair push up test
- lateral epicondylitis testing
157
pt ed for annular ligament injury
referral for imaging and potential relocation
158
ther ex for annular ligament injury
grip strength
wrist extension strength
159
osteoarthritis
secondary to prior trauma
chondral degenerative process
160
panner's disease
disruption of blood supply to capitulum
repetitive valgus stress or trauma (6-11)
161
osteochondritis dissecans
genetic predisposition to poor sunchondral health/blood supply
repetitive valgus stress or trauma (10-20+)
162
pain pattern for elbow arthropathy
deep in elbow joint
163
risk factors for elbow arthropathy
OA: age >55
panner's: 6-11
panner's/OCD: boysboys
history of joint trauma
history of heavy joint loading
164
observation in elbow arthropathy
swelling
nodules
165
examination of elbow arthropathy
pain in ROM
decreased ROM
OA: crepitus
ODC: loose bodies - sharp pain and dead arm feeling
166
what are loose bodies?
things floating in joint
167
what nerve does cubital tunnel syndrome involve?
ulnar
168
what is the pain pattern for cubital tunnel syndrome?
radicular pain and paresthesia form medial elbow to medial hand
169
risk factors for cubital tunnel syndrome
prolonged elbow flexion
UCL inflam
170
examination of cubital tunnel syndrome
+ tinel's, elbow flexion test
- c spine, medial epi testing
decreased grip strength
wartenburg sign
froment sign
claw
171
what is wartenburg sign?
abd of pinky
172
what is froment sing?
thumb cannot adduct so has to flex for pinching
173
pt ed for cubital tunnel syndrome
activity reduction
heat for sym reduction
night orthotics
174
manual therapy for cubital tunnel syndrome
STM/MFR
FCU
cubital tunnel retinacuclum
175
ther ex for cubital tunnel syndrome
stretch FCU
ulnar nerve glides
176
MOI for elbow fracture
high force impact
177
most common treatment for elbow fracture
ORIF
varus deformity expected
178
pain pattern for elbow fracture
diffuse pain
179
risk factors for elbow fracture
men aged 12-19 doing sketchy shit
women >80 due to osteoporosis
fall hx
180
observation of elbow fracture
swelling
obvios deformity
181
examination for elbow fracture
decres ROM - stiffness
decres grip strength
+ elbow extension test
182
pt ed for elbow fracture
ice
orthotics - static progressive or JAS
183
manual therapy for elbow fracture
mobs: HU, HR, PRUJ, DRUJ
STM/MFR: biceps, triceps, forearm musculature
184
ther ex for elbow fracture
PROTOCOL
inflam phase:
0-2 weeks
manage pain/inflam
light ROM
fibroplastic phase:
3-8 weeks
increase ROM
begin light strengthening
remodeling phase:
2-6 months
progress strength
mobilizations
static-progressive orthotics
all nerve glides
185
what nerve is involved with carpal tunnel syndrome?
median
186
pain pattern for carpal tunnel syndrome
pain/paresthesia in lateral hand
worse at night
187
risk factors for carpal tunnel syndrome
age > 45
women>men
diabetes
188
observation for carpal tunnel syndrome
flick sign - shaking decres sym
wrist ratio > 0.7
thenar atrophy
189
examination of carpal tunnel syndrome
+ phalen's, tinel's, wainer CPR, Durkan's
- scaphoid fx, finklestein, TOS, c spine
decres grip strength/sensation
decres coordination with moberg
190
what is wanier CPR
age > 45
flick sign - shaking decres sym
wrist ratio > 0.7
decres grip strength
decres sensation
191
pt ed for carpal tunnel syndrome
possible injection or surgery consult
heat
activity mod
- decres full MCP flex/udev
- work in 0-45 deg pro
- work in slight ext/udev
orthotics
- 2 deg ext/udev
-night, during heavy work or pregnant
192
manual therapy for carpal tunnel syndrome
STM/MFR:
flexor retinaculum
medial arm
instrument assisted
193
ther ex for carpal tunnel syndrome
distal median nerve glides
flexor ret stretch
hand intrinsic stretch
finger flexor stretch
POST-SURGICAL
activity avoidance
light paper taping over incision
light isometrics progressing to tendon glides
distal median nerve glides
194
MOI for distal radius fracture
FOOSH
contact sports
195
colles fracture
dorsal displacement
196
smith's fracture
volar displacement
197
pain pattern for distal radius fracture
diffuse wrist pain
198
risk factors for distal radius fracture
> 50 yo
fall risk
women > men
199
observation for distal radius fracture
avoidance of grasping or active wrist flexion/ext
200
examination of distal radius fracture
decres ROM
decres grip/pinch strength
decres push off strength test
201
pt ed for distal radius fracture
ice/heat
orthotics
202
manual therapy for distal radius fracture
mobs: HR, PRUJ, DRUJ, radiocarpal, MCP, IP
STM/MFR: forearm musculature
203
Ther ex for distal radius fracture
PROTOCOL
protective:
- 1-6 weeks
- wrist immob
- monitor pain/CRPS
- finger/elbow/shoulder ROM
motion:
- after immob
- wirst AROM - ext, sup, pro, finger flex
- tendon gliding
function:
- bone healing
- strength - isometric to isotonic
- mobilization
all nerve glides
204
MOI of triangular fibrocartilage complex injury
FOOSH
forced rotation while gripping
205
what is triangular fibrocartilage complex injury treated with?
active stabilization
bracing
injection
206
pain pattern for triangular fibrocartilage complex injury
localized to distal ulna
207
risk factors for triangular fibrocartilage complex injury
hx: distal forearm injury
ulanr variance
advancing age
rep mvmts
208
observation of triangular fibrocartilage complex injury
localized swelling
crepitus
209
examination for triangular fibrocartilage complex injury
pain with palpation and ROM
+ ulnomeniscotriquetral sweep
decres grip strength
210
pt ed for triangular fibrocartilage complex injury
ice
orthotics
possible referral if bracing not working
211
manual therapy for triangular fibrocartilage complex injury
mobs: HR, PRUJ, DRUJ
STM/MFR: cross fric in one direction on ECU and FCU
212
MOI of stenosing tenovaginitis
trauma and repetitive stress
213
pain pattern for stenosing tenovaginitis
localized pain
DeQ: radial styloid
trigger finger: A1 pulley
214
risk factors stenosing tenovaginitis
repetitive/forceful jobs
wom>men
215
observation of stenosing tenovaginitis
local nodule
AROM: catching/crepitus
216
examination of stenosing tenovaginitis
pain with palpation/AROM
+ finkelstein's
decres strength
- scaphiod fracture
217
pt ed for stenosing tenovaginitis
activity avoidance
ergonomic mods
ice
US
orthotics - rigid
refer for injection
218
manual therapy stenosing tenovaginitis
STM/MFR
- cross fric in 2 directions
219
ther ex for stenosing tenovaginitis
grip strength
gentle tendon glides
stretching
strengthening kinematic chain
220
MOI of scaphoid fracture
most common carpal fracture
vulnerable due to 45 deg angulation
compression and extension and radial deviation
221
pain pattern of scaphoid fracture
localized distal radius
222
risk factors for scaphoid fracture
15-30 yo
men > women
223
observation for scaphoid fracture
swelling
224
examination for scaphoid fracture
pain with palpation
+ scaphoid compression, snuffbox tenderness
- finkelstein's
decreased grip strength
225
pt ed for scaphoid fracture
screening and referral
ice
orthotics
- thumb spica
- progressive orthotics
226
manual therapy for scaphoid fracture
mobs: radiocarpal, DRUJ, light carpal, MCP, IP
227
ther ex for scaphoid fracture
PROTOCOL
protective:
- 2-4 weeks
- wrist immob
- monitor pain/CRPS
- finger/elbow/shoulder ROM
motion:
- after immob
- finger/wrist AROM
- stretching/tendon gliding
function:
- starts at bone healing
- strength: isometric to isotonic
- mobilization
median nerve glides
228
what is the pain pattern for ulnar collateral ligament tear of the 1st?
localized to the medial 1st MCP
229
risk factors for ulnar collateral ligament tear of the 1st
fall risk
230
observation for ulnar collateral ligament tear of the 1st
focal swelling
231
examination of ulnar collateral ligament tear of the 1st
pain with palpation
+ ulnar collateral ligament test
232
pt ed for ulnar collateral ligament tear of the 1st
screening and referral
ice orthotics - thumb spica
233
manual therapy for ulnar collateral ligament tear of the 1st
mobs: DRUJ, carpal mobilization, CMC, IP
234
ther ex for ulnar collateral ligament tear of the 1st
2-8 weeks after immob
pinch and grip strength
wrist strength
stretching
median nerve glides
235
pain pattern for metacarpal fracture
localized to MC
236
risk factors for metacarpal fracture
age 22-34
high force loading
men > woman
237
observation for metacarpal fracture
focal swelling
ecchymosis
guarded mvmt
238
examination for metacarpal fracture
pain with palpation
decres strength
239
pt ed for metacarpal fracture
referral
ice
orthotics - rehab ready splinting
240
manual therapy for metacarpal fracture
mobs: carpal, MCP, IP
STM/MFR: hand intrinsics
241
ther ex for metacarpal fracture
PROTOCOL
protective
- 3-7 days
- hand immob
monitor pain/CRPS
finger/elbow/shoulder ROM
motion
- 7-21 days
- tendon gliding
- finger/wrist ROM
function
- 4-8 weeks
- wean from orthotic
- strength - metric to tonic
- aggressive stretching and mobilization
242
pain pattern for dupuytren's contracture
localized to the palm and 4/5 digits
catching/locking
243
risk factors for dupuytren's contracture
alcoholism
diabetes
smoking
men > women
north european ancestry
244
observation for dupuytren's contracture
dupuytren's nodule
obvious deformity
245
examination for dupuytren's contracture
ROM decres at 4/5 MCP and IP
+ table top test
246
pt ed for dupuytren's contracture
wound management
orthotics
247
manual therapy for dupuytren's contracture
mobs: carpal, MCP, IP
STM/MFR: forearm, hand intrinsics
248
ther ex for dupuytren's contracture
PROTOCOL
wound management
- weeks 1-2
- orthotics
- wound cleaning
- mid-range ROM
motion
- weeks 2-3
- progressive ROM
- light mobs
- tendon gliding
discharge
- 4-6
- achieve end range ROM
- isometric strength
- wean from therapy
249
what is mallet finger?
extensor tendon laceration
250
pain pattern of mallet finger
localized to DIP
251
risk factors for mallet finger
impact sports or professions
252
observations for mallet finger
DIP flexion
PIP extension
focal swelling
253
examination for mallet finger
pain on palpation
decres grip strength
254
complex considerations for wist and hand tendon pathology
dependent on PROTOCOL
protocol types
- immob
- early passive motion
- early active motion
protocol dependent on
- flexor vs extensor side
- zone of injury
- severity of injury
- surgical intervention type
- strength of suture used
- patient: age/health, motivation, socioeconomic
255
mallet finger considerations
PROTOCOL
- 6 weeks mallet splint
- light ROM exercise
GOAL
- strong tendon
- glides freely
256
two types of CRPS
type I: reflex sympathetic dystrophy
type II: causalgia
257
pain pattern for CRPS
unilateral
non-dermatomal
hyperalgesia & allodynia
258
risk factors for CRPS
advancing age
women > men
fracture or crush injury
259
observation for CRPS
warm/red to cold/blue
edema/sweating
trophic change
260
examination for CRPS
decres ROM
weakness/dystonia
anxiety/depression
budapest criteria
261
what is the budapest criteria?
hyperalgesia & allodynia
warm/red to cold/blue
edema/sweating
trophic change
need 3 of 4, 1 at eval
262
pt ed for CRPS
PNE
relaxation exercises
cardio program
ice or heat
263
manual therapy for CRPS
desensitization
retrograde therapy
264
ther ex for CRPS
guided motor imagery
mirror box therapy
pain free AROM
graded exposure
isometric strengthening
push/pull stress loading
return to work
265
what joint do bouchard's nodules occur at?
PIP
266
what joint do heberden's nodules occur at?
DIP
267
pain pattern for wrist and hand OA
localized to DIPs and 1st CMC
268
risk factors for wrist and hand OA
age > 50
women > men
269
observation for wrist and hand OA
crepitus
swelling
270
examination for wrist and hand OA
pain in ROM
decres grip strength
decres ROM
271
pt ed for wrist and hand OA
joint protection
anti inflam diet
ice for acute and heat for recurrent
orthotics
272
manual therapy for wrist and hand OA
mobs: carpal, CMC, MCP, IP
273
ther ex for wrist and hand OA
daily AROM
hand intrinsic strengthening
isometric grip strength
forearm strength
274
what are the inflammatory responses of RA
destroys cartilage
destroys bone
distends capsular associated ligaments
destroys tendons
275
4 classes of RA
I inflammatory
II proliferative
III destructive
IV collapse and deformity
276
what does a swan neck deformity look like?
PIP joint goes down
277
what does boutonniere deformity look like?
PIP goes up
278
pain pattern for RA
diffuse
in fingers and hands
279
risk factors of RA
family hx
smoking/periodontitis
women > men
280
observation of RA
I focal swelling
III/IV obvious deformity
281
examination of RA
I pain in palpation and ROM
decres grip strength secondary to
- I/II pain
- III/IV deformity
III/IV tendon rupture
282
pt ed for RA
joint protection
I/II ice or III/IV heat
orthotics
- I/II compression gloves
- III/IV night orthoses and specific to deformity
283
manual therapy for RA
STM/MFR: spot treat contractures and tightness
284
ther ex for RA
pain free AROM
isometric strengthening
general conditioning
285
prolonged stretching (elbow)
supine, weight on wrist
for extension, extend to end ROM
for flexion flex to end ROM
286
elbow AROM
from neutral into supination and pronation
flexion and extension
287
biceps strengthening
using dumbell
palm up
concentric flexion and controlled down
can do eccentrics if needed
288
triceps strengthening
using dumbell
supine, arm straight up
concentrically extend
289
counterforce bracing
place it distal to point of pain
adds to the insertion of muscle
not going to be a solution - bandaid
does not help nerve
290
prolonged stretching (wrist)
wrist and finer flexors- pull all into extension
wrist flexors- make fist and pull into extension
wrist extensors- with straight fingers, pull wrist into flexion
wrist and finger extensors- pull all into flexion
291
wrist AAROM
flex/ex: roll hand over the ball
pro/sup: tilt ball like steering wheel
292
wrist AROM
ex/flex
pro/sup
rdev/udev
293
jux a cisor
get the washer from start to finish only using wrist movements.
external cuing makes motor learning skyrocket
294
wrist flexor strengthening
for med epi - 2 sets of 15
palm up
use dumbell
use theraband
twist a therabar - not as good
295
wrist extensor strengthening
for lateral epi
palm down - far enough off table - want full ROM
use dumbell
use theraband
twist a therabar - not as good
296
radial/ulnar deviation strengthening
using hammer/bat
- radial - in front of body
- ulnar - elbow at 90 flex
using band
- rad - band under foot
- ul - wrap band around both hands
297
pronation/supination strengthening
using hammer/bat for eccentric - help back to neutral
- supination - start at neutral and sup
- pro - start and neutral and pro
using band for concentric
- sup - start pro and sup all the way over, controlled back
- pro - start sup and pro all the way over, controlled back
298
OtC orthoses
wrist brace- good to take pressure off joint
anti vibration gloves - for nerves or RA
299
overview of protection principles
respect pain
balance rest and activity
exercise in pain free range
reduce effort
avoid positions of deformity
use larger joints
use adaptive equipment as needed
300
hand intrinsic stretching
press claw hand into table
can use other hand to add pressure on top
for stiffness post surgical
301
flexor retinaculum stretching
for carpal tunnel syndrome
press hand into wall
pull back on thenar emeinence
302
tenodesis movement "dart throwing"
active wrist motion causes passive finger motion
wrist extension and flexion
can hold something but dont have to
passive insuff
considered tendon gliding
if for mvmt control: do for 2 min
303
joint blocking
block just proximal to joint
MCP flexion - not much to block
PIP flexion
DIP flexion
DIP extension
for strength: 3x8 3x/week
for mvmt control: long duration
304
tendon glides
for mobility and ROM
motor reprogramming: 2-5 min
everything straight
intrinsic plus: lumbrical position
straight fist, max FDS: fist, but straight DIPs
full fist, max FDP: complete fist
hook fist, FDS vs FDP: only IPs flexed
305
finger extension
extend against resistance
hand master
rubberbands
theraputty
power web
306
finger flexion exercises
flex against resistance
isolated flexion in putty
power grip (fist) in putty
intrinsic flexion (MCP flexion) in putty
extrinsic flexion (IP flexion) in putty
power web
flexors are more efficient with putty
307
putty thumb exercises
pinch the long
pinch a ball
opposition
thumb punches (flexion)
abduction with rubber band
308
functional reach and grasp practice
for power:
- cylindrical - holding glass of water
- spherical - opening door know
- hook - holding bag, strongest grip
precision:
- pincer - fingers to thumb tip
- 3-jaw chunk
- lateral - key
309
in hand manipulation and translation
manip
- squirt bottle
- carabiner open/close
translation
- pen/key pickup
- single-coin placement
310
manual dexterity
beads in theraputty
bolt in washer or nut
311
distal upper extremity nerve glides
start with 1 x 10
fully passive
median: pull fingers 2-3 and wrist into extension
median thumb bias: roll thumb into supination
radial: pull fingers 2-3 and wrist in to flexion
ulnar: pull fingers 4-5 and wrist into extension
312
graded motor imagery
card
imagine
mirror therapy
313
phases of throwing
wind-up
stride
arm cocking
arm acceleration
arm deceleration
follow through
314
what muscles need to be strengthened in throwing
subscap for cocking and accel
t minor for decel
SA and lower trap
315
aspects of good form
synchronous trunk and hip translation
hand on top
max abd
closed front shoulder
foot leads to target
shoulder square to target
316
what are muscle relaxant medications?
neuromuscular blockers
- for PNS
- used in surgery
spasmolytics
- CNS
- ex. flexeril, baclofen
317
who benefits from muscle relaxant medications?
pts with muscle spasm due to overexertion
pts with spasticity
318
what are anti-inflammatory medications?
opioids
- highly controlled
- oxycodone, hydrocodone
NSAIDs
- Cox-1 / Cox-2 inhibitors
- aspirin, ibuprofen, aleve (1&2)
- celebrex, meloxicam (2)
-- more effective on joint pain, less digestive issues
319
who benefits from anti-inflammatory medications?
pts experiencing pain or inflam
320
what are neuropathic medications?
antidepressants
- SSRI, SNRI for chronic pain
- cymbalta for neuropathic pain
anticonvulsants
- neurontin or lyrica for neuropathic pain
321
who benefits from neuropathic medications?
pts with neuropathic conditions
nerve based pain, hyperalgesia, allodynia
322
what is a corticosteroid injection?
injection of anesthetic and anti-inflam medication into inflamed tissue
323
who benefits from corticosteroid injection?
arthropathy - OA
tendinopathy - biceps/tricpes, lateral epi
tenovaginitis - DeQ, Trigger finger
324
what is platelet rich plasma?
injection of high concentration autologous platelets into injured tendons, ligs, or arthritic joints.
solution can be in/activated and/or be either leukocyte rich or poor.
325
who benefits from platelet rich plasma?
with mild to moderate CT injury
most lit support for lateral epicondyle
326
what does PRP do?
its used for tissue growth
327
what is the surgical intervention for dupytren's contracture?
fascial contracture is managed by either surgical fasciectomy or enzymatic fasciotomy and manipulation
328
what is the carpal tunnel surgical intervention?
surgical sectioning of the flexor retinaculum by way of open release, mini-open release, or endoscopic release.
329
which CTS intervention is the most predictable but had the hardest recovery?
open release
330
who benefits from carpal tunnel surgical intervention?
pts with acute nerve compromise at the CT or recurrent issues with signs of median neuropathy
331
what is the surgical intervention for distal radius fracture?
anatomic reduction of fracture using casting, closed treatment, or ORIF
332
who benefits from surgical intervention for distal radius fracture?
pt with colles fx and other distal radius fx
333
how does surgical intervention for distal radius fracture work?
pull bones back together so they can heal
334
what is the surgical intervention for trigger finger?
dissection of the A1 pulley under local anesthetic
335
who benefits from surgical intervention for trigger finger?
pts with severe or recurrent trigger finger
336
what is the only pathology that involves ulnar drift?
RA
