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Flashcards in Musculoskeletal injuries 1 practcial Deck (77):
1

Signs and Symptoms
• Pain localized over the tibial tubercle
• Swelling over the patellar tendon
• Pain increases with activity and decreases with rest
• Usually present bilaterally
• More common in males between the ages of 11-15
• x-rays show regularity of the tibial tuberosity

Osgood schlatter's disease

2

treatment for Osgood schlatter's

Treatment
• Rest from painful activities
• Restore strength and flexibility to lower extremity muscles

3

igns and Symptoms • Localized pain on the calcaneal apophysis
• Pain increases on palpation and with activity and decreased with rest
• More common in males
• Most common between the ages of 11-15 years
• x-rays reveal sclerosis and irregularity of the apophysis

calcaneal apophysitis / sever's disease

4

what is the treatment for calcaneal apophysitis

Treatment
• Heel lifts
• Ice and rest
• Casting (only way to make the child rest)
• Orthotics
• Proper athletic shoes
• Stretching of gastrocnemius and soleus muscles
• Strengthening of lower extremity muscles

5

Signs and Symptoms
• Pain over the distal pole of the patella
• Palpable prominence evident
• Pain increases with activity and decreases with rest
• Higher location than Osgood Schlatter's disease
• Common in females between the ages of 8-13
• Common in males between the ages of 10-15
• Bilateral involvement usually
• x-rays reveal irregularity or fragmentation of the inferior pole of the patella

sinding Larsen Johansson Disease

6

what is the treatment for sinding Larsen Johansson disease

Treatment
• Same as for
○ Strengthening and stretching lower extremity

7

Signs and Symptoms
• Pain in the groin, anterior thigh and knee
• Antalgic gait pattern
• Decreased hip abduction, extension and external rotation
• More common in males between the ages of 3-8 years

Legg Calve Perthes Disease

8

what is the treatment for legg calve perthes disease

Treatment
• Immobilization in an abducted position in non weight bearing. Immobilization may last 1-2 years.
• Surgery to prevent further deformity of the femoral head

9

Signs and symptoms
Grade 1
• Normal gait pattern and posture
• Slight pain on palpation
• Little or no swelling
• Full ROM of the lumbar spine and hip

Grade 2
• Antalgic gait pattern with shorten swing phase
• Patient stands in flexed and side flexed position towards the side of the injury
• Pain on palpation
• Visible swelling and bruising
• Active lumbar spine and hip flexion ROM decreased and painful
• Pain and weakness with resistance testing
• Positive Thomas test

Grade 3
• Pain with coughing sneezing or laughing
• Severe pain, swelling and bruising (must rule out a fracture or a eruption of muscle or ligament)
• All other findings as per grade 2

hip pointer

10

what is the treatment for hip pointer

Treatment
• Rest, ice, compress and elevate the area (RICE) PRICE p=protect
• Crutches for walking
• Non steroidal anti-inflammatory medications (NSAIDS)
• Electrical modalities such as TENS, interferential current and ultrasound
• Protective pad over the area
• Stretch and strengthen the appropriate muscles

11

Signs and Symptoms
• Burning or arching pain over or posterior to the greater trochanter
• May report a snapping sensation in the hip region with movement
• Pain on palpation of the greater trochanter of the hip
• Pain with active flexion, abduction and internal rotation of the hip (tensor fascia latae muscles) and extension and external rotation of the hip (involved)
• Pain with resistance testing of the hip for the associated muscle involved

trochanteric bursitis

12

what is the treatment for trochanteric bursitis

Treatment
• Ice
• Protected rest
• NSAIDS
• Electrical modalities such as ultrasound and interferential current
• No compression because that is the whole cause of the bursitis
• Stretching of the tight muscle
• Determine the potential cause of this problem an modify
• Aspiration of the bursa
• Surgical removal of bursa

13

Signs and symptoms
• Snapping of the hip with certain active and passive movement
• May also have associated pain with these movements
• Positive Ober's test -ITB when it gets tight can cause the noise

snapping hip syndrome

14

what are the treatments for snapping hip syndrome

Treatment
• NSAIDS
• Stretching of the tight structures and strengthening of the weak muscles involved
• Alter the biomechanics and technique of the activity

15

Signs and symptoms
• history of poor posture, inflexibility and muscle imbalance
• Antalgic gait pattern with the inability to fully extend the knee at heel strike
• Sharp pain in the posterior thigh and buttocks. May also have bruising and palpate a defect within the muscle.
• Increased pain with active hip extension and knee flexion
• Increased pain with passive hip flexion and knee extension
• Pain and weakness with resisted hip extension and knee flexion (with the knee internally and externally rotated)

hamstring muscle strain

16

what is the treatment for hamstring muscle strain

Treatment
Phase 1:
• Protected rest, ice, compression and elevation
• NSAIDS
• Use of crutches if an antalgic gait pattern is evident

Phase 2:
• Electrical modalities such as ultrasound and EMS
• Introduce slow, pain free and gradual stretching program
• Begin gentle isometric strengthening exercises

Phase 3:
• Progressive stretching and strengthening exercises
• Sport specific exercises that involve rapid stops, starts and directional changes
• Focus on the prevention of future injuries

17

Signs and symptoms
• Bruising and swelling over the anterior thigh
• Antalgic gait pattern
• Pain with active hip flexion and knee extension
• Pain with passive hip extension and knee flexion
• Weakness with resisted knee extension and hip flexion
• Palpable tenderness in anterior thigh region

quadriceps muscle contusion

18

what is the treatment for quadriceps muscle contusion

Treatment
• Rest, ice, compress and elevate the area with the knee in maximal flexion
• Crutches may be used initially for the first few days keeps the extremity in a non weight bearing position
• NSAIDS
• Gentle stretching and strengthening program initially
• Electrical modalities such as ultrasound and EMS
• Progress exercises to include sport specific exercises, jumping, stopping and starting, changing directions and changing speed
• May also want the athlete to wear a protective pad upon returning to their sport

19

Signs and Symptoms
• Develops as a complication of a muscle contusion
• Warm, firm and swollen on palpation
• Have longer pain and dysfunction and does not respond to initial treatments
• Self limiting progression with maturation at 6-12 months
• x-rays are required for diagnosis of this injury. Bone mass in muscle evident on radiograph 3-4 weeks after injury

myositis ossificans

20

what is the treatment for myositis ossificans

Treatment
• Protected rest, ice, compression and elevation is required
• NSAIDS
• May take 6-12 months to resolve and if conservation treatment is not effective then surgical excision may be required

21

Signs and Symptoms
• Tightness and pain reported in the anterior thigh region
• Antalgic gait pattern
• Pain with active knee extension and hip flexion
• Pain with passive knee flexion and hip extension
• Pain and weakness with resisted knee extension and hip flexion
• Palpable pain and defect in the quadriceps muscle

quadriceps muscle strain

22

what is the treatment for quad muscle strain

Treatment
• Rest, ice, compress and elevate the area with the knee in maximal flexion
• Crutches may be used initially for the first few days keeps the extremity in a non weight bearing position
• NSAIDS
• Gentle stretching and strengthening program initially
• Electrical modalities such as ultrasound and EMS
• Progress exercises to include sport specific exercises, jumping, stopping and starting, changing directions and changing speed
• May also want the athlete to wear a protective pad upon returning to their sport

23

adductor muscle strain

Signs and Symptoms
• Antalgic gait pattern
• No pain with running straight ahead of backwards but pain with side to side movements
• Palpable tenderness over pubis ramus or lesser trochanter
• Palpable defect in muscle belly
• pain with active hip adduction
• Pain with passive hip extension, abduction and external rotation
• pain with resisted hip adduction

24

what is the treatment for adductor muscle strain

Treatment
• Rest, ice, compress and elevate the area with the knee in maximal flexion
• Crutches may be used initially for the first few days keeps the extremity in a non weight bearing position
• NSAIDS
• Gentle stretching and strengthening program initially
• Electrical modalities such as ultrasound and EMS
• Progress exercises to include sport specific exercises, jumping, stopping and starting, changing directions and changing speed
• May also want the athlete to wear a protective pad upon returning to their sport

25

Signs and Symptoms
• Minimal swelling is evident
• Antalgic gait pattern in which the individual may be unable to fully extend his knee on heel strike
• Decreased extension at the end of active and passive ROM
• Pain on the medial joint line of the knee on palpation
• Pain and possibly gapping with the valgus stress test

medial collateral ligament sprain

26

what is the treatment for medial collateral ligament sprain

Treatment
• Protection rest, ice, compression and elevation
• May use crutches for ambulating in the early stages
• Modalities such as ultrasound and interferential current
• Gentle active ROM exercises as soon as the acute symptoms subside
• Gentle strengthening exercise progression from isometric to concentric to eccentric and to close kinetic chain exercise
• No surgery is required in the case of a grade 1 injury but it may take 4-6 weeks to heal
• In the case of a grade 2 and 3 non operative treatment is usually the treatment of choice
• Complete tears of the ligament may require a cast brace to immobilize the knee joint or a surgical repair
• Figure-8 test to see if the patient can return to play, running cutting and planting on the affected leg is stressed with this test
• May require a MCL stabilizing brace upon return

27

Signs and Symptoms
• Minimal swelling is evident
• Antalgic gait pattern in which the individual may be unable to fully extend his knee on heel strike
• Decreased extension at the end of active and passive ROM
• Pain on the medial joint line of the knee on palpation
• Pain and possibly gapping with the varus stress test

lateral collateral lig sprain

28

what is the treatment for LCL

Treatment
• Protection rest, ice, compression and elevation
• May use crutches for ambulating in the early stages
• Modalities such as ultrasound and interferential current
• Gentle active ROM exercises as soon as the acute symptoms subside
• Gentle strengthening exercise progression from isometric to concentric to eccentric and to close kinetic chain exercise
• No surgery is required in the case of a grade 1 injury but it may take 4-6 weeks to heal
• In the case of a grade 2 and 3 non operative treatment is usually the treatment of choice
• Complete tears of the ligament may require a cast brace to immobilize the knee joint or a surgical repair
• Figure-8 test to see if the patient can return to play, running cutting and planting on the affected leg is stressed with this test
• May require a MCL stabilizing brace upon return

29

Signs and symptoms
• Patient usually hears a pop with injury
• Patient describes a rapid onset of swelling, nausea and pain deep inside the knee joint (disrupt artery)
○ Hemarthrosis -need to drain blood, because the blood will destroy the bone.
• The knee feels like it gives way and feel unstable
• Antalgic gait pattern evident with the knee bent at heel strike
• Decreased active and passive ROM of the nee for all movements
• Decreased strength will resistance testing for all movements
• +ve anterior drawer and lachman test

Anterior cruciate lig sprain

30

what is the treatment for ACL sprain

Treatment
• Similar to the treatment protocol for a MCL sprain in the acute stages
• Surgery is often indicated in the case f a grade 3 ACL sprain
• Refer to the protocol that the orthopaedic surgeon uses for the treatment of these injuries post operatively

31

Signs and Symptoms
• Patient usually hears a pop with the injury
• Patient describes a rapid onset of swelling nausea and pain deep inside the knee joint
• The knee feels like it gives way and feels unstable
• Decreased active and passive ROM of the knee for all movements
• Decreased strength with resistance testing for all movements
• +ve posterior drawer and posterior sag test

posterior cruciate lig sprain

32

what is the treatment for PCL

Treatment
• Similar to the treatment protocol for a MCL sprain in the acute stages
• Surgery is often indicated in the case f a grade 3 ACL sprain
• Refer to the protocol that the orthopaedic surgeon uses for the treatment of these injuries post operatively

33

Signs and Symptoms
• Patient may have heard a pop with the injury
• Experience locking of the knee with the inability to bend or straighten the knee
• Patient may describe a clicking grinding or popping sensation in the knee
• Pain localized over the medial or lateral joint lines
• Decreased and painful ROM at the extremes of rotation and flexion
• Slight swelling around the nee. Delayed swelling
• +ve McMurray's and Apley's compression tests

meniscal injuries

34

what is the treatment for meniscal injuries

Treatment
• Similar to the treatment protocol for a MCL sprain in the acute stages
• Surgery is often indicated in the case f a grade 3 ACL sprain
• Refer to the protocol that the orthopaedic surgeon uses for the treatment of these injuries post operatively

35

Signs and Symptoms
• Initially pain is present only after running or late in a run. Later this becomes sore earlier in the run and may progress to where it is sore all of the time
• Pain with climbing stairs and running up or down hills
• Pain and crepitus may be evident with active flexion and extension of the knee
• Palpable tenderness on the lateral aspect of the knee that may progress to soreness throughout the ITB
• +ve Obers test
○ Used for the hip as well, executed the same way but whether is it positive on the knee or hip is determined by the location of pain

iliotibial band friction syndrome

36

what is the treatment for iliotibial band friction syndrome

Treatment
• Rest, ice, compression and elevation
• NSAIDS
• Massage
• Bracing
• Treat the mechanical cause of the problem
• May have to examine footwear and require orthotics
• May have to alter the training schedule regime and training surface
• Stretch the ITB and associated muscle such as the hip abductor flexor and lateral thigh muscle

37

Signs and Symptoms
• Pain with squatting, jumping and stair climbing
• Initially have pain after the activity progresses to where pain is present at the start of the activity but subsides after the warm up and reappears after the activity; later stages complain of constant pain including night pain
○ Think fracture with night pain
• Pain with passive knee flexion at the end of range (beyond 120 degrees)
• Pain with resisted knee extension
• Pain on palpation of the patellar tendon
• Enthesitis

patella tendonitis

38

what is the treatment for patellar tendonitis

Treatment
• Rest
• Modalities such as ice, heat, ultrasound and neuromuscular electrical stimulation may be used
• Bracing
• Deep transverse friction or massage
• Modify the cause of the problem and training regime
• Stretching and strengthening of associated lower extremity muscle

39

Signs and symptoms
• Deep dull and achy pain over the anterior aspect of the knee
• Pain with descending stairs, prolonged sitting and squatted
• Crepitus, clunking and pain reported with squatting kneeling and bending and straightening knee
• Palpable tenderness over the lateral facet of the patella
• Pain on compression of the patellafemoral joint

patellafemoral pain syndrome (movie going)

40

what is the treatment for patellafemoral pain syndrome

Treatment
• Modalities such as ice, ultrasound and neuromuscular stimulation
• Stretching and strengthening program for the associated lower extremity structures
• Surgical release of the tight lateral structures
• Taping or bracing to correct misaligned patella and tracking

41

Signs and Symptoms
• Audible pop followed by collapse of knee
• Sudden onset of swelling
• Tenderness along the medial and lateral border of the patella
• Positive patellar apprehension test

patellar dislocation

42

what is the treatment for patellar dislocation

Treatment
• Reduction of the dislocation and aspiration of the hemarthrosis if necessary
• Immobilization in a split
• Isometric contractions of the quadriceps and straight leg raising while in the splint
• Stretch the Iliotibial band and hamstrings
• Strengthening the vastus medialis muscle
• Bracing of the patellafemoral joint
• Surgery

43

Signs and Symptoms
• Table of degrees in textbook (grade 1, 2 and 3)
• Grade 3: Blood pooling; swelling, limp, blood pooling/ bruising
• Grade 1: nothing just tender
• Peroneals muscle strain

lateral ankle sprain

44

what is the treatment for lateral ankle sprain

Treatment
Phase 1:
• rest, ice, compression and elevation
• Put a horse shoe around the malleolus for compression and wrap a tensor bandage around the ankle
• Preventative taping
• Use crutches for walking
Phase 2:
• Modalities (ultrasound, IFC- increase blood flow, TENS -painful)
• Deep friction massage over the ligaments
• Stretching and strengthening exercises
• Proprioception exercise using wobbles board and balance exercises
• May require taping or bracing
Phase 3:
• Progression of stretching strengthening and sport specific exercises
• Remodeling phase can last up to one year

45

Signs and symptoms
• Pain and swelling on the medial aspect of the ankle not as much swelling as lateral
• Point tenderness over the DL
• Pain with passive dorsiflexion of the ankle

Pain and laxity with talar tilt (this is a test) positive if gapping and or pain

medial ankle sprain

46

medial ankle sprain treatment

Treatment
• Same as for lateral ankle sprain:
Phase 1:
• rest, ice, compression and elevation
• Put a horse shoe around the malleolus for compression and wrap a tensor bandage around the ankle
• Preventative taping
• Use crutches for walking
Phase 2:
• Modalities (ultrasound, IFC- increase blood flow, TENS -painful)
• Deep friction massage over the ligaments
• Stretching and strengthening exercises
• Proprioception exercise using wobbles board and balance exercises
• May require taping or bracing
Phase 3:
• Progression of stretching strengthening and sport specific exercises
• Remodeling phase can last up to one year

47

Signs and Symptoms
• Pain with activity in the early stages and progresses to the point of pain with activity and at rest in the later stages
• Palpable tenderness on the posteromedial side of the tibia
• Percussion is negative (to rule out, tapping on the area and if it hurts it is a stress fracture if it does not it’s a medial tibial stress syndrome)
• Pain with active and passive of motion and with resistance testing depending upon the muscle involved
• Soleus- plantar flexion
• Tibialis posterior - plantar flexion and inversion
• Tibialis anterior dorsiflexion and inversion

medial tibial stress syndrome (shin splints)

48

what is the treatment for medial tibial stress syndrome

Treatment
• Rest, ice, compression and elevation
• NSAIDS
• Non weight bearing activities
• Strengthening exercises using theraband or rubber tubing (only strengthen weakened muscles)
• Stretching excises for the soleus, tibialis posterior and tibialis anterior muscles
• Reassess the equipment used training technique, surface, shoes and schedule and any other anatomical factors that may be the cause of the problem

49

Signs and Symptoms
• History of trauma to the anterior aspect of the lower leg, excessive exercise, vascular injury or prolonged externally applied pressure
• Dull ache and sense of fullness is compartment; often bilateral
• As the person continues to use the foot the pain may become more severe and disabling; pain is predictable
• Weakness with resisted testing of dorsiflexion and eversion of the ankle and extension of the first tow
• The patient may walk with a drop foot
• Numbness between the 1st and 2nd web space of the toes or over the entire dorsum of the foot
• What every compartment is affected will be apparent in the lower extremities
• Palpable tenderness and mass over the area the skin in the region feels very tight and increased skin temperature
• Decreased dorsalis pedis pulse (should be strong on both sides)

compartment syndrome

50

what is the treatment for compartment syndrome

Treatment
How would you treat a compartment syndrome?
• Rest, ice, crutches,
• Total rest and ice
• Do not apply compression (already under too much pressure) and elevation ( it is hard enough for the heart t supply the distal components and elevation will increase the demands on the heart)
• Referral to a physical for consultation and monitoring is absolutely necessary
• Fasciotomy (open wound can be in the hospital for 1 or 2 months)

51

Signs and symptoms
• Initially presents with a pin during activity in the early stages and the with pain both during activity and at rest in the later stages
• Pain with active (using the muscle) plantar flexion and passive (stretching the muscle) dorsiflexion of ankle
• Pain and weakness with resisted plantar flexion
• Palpable tenderness or nodule over the achilles tendon

Pain during the push off phase of walking and running

Achilles tendonitis or tendinosis

52

what is the treatment for tendonitis or tendinosis


Treatment
• Rest, ice, compression and elevate
• NSAIDS
• Heel lift
• alter the training regime and the potential biomechanical causes of the problem
• Stretching exercises
• Introduce non weight bearing exercises

Eccentric heel drop strengthening (180 reps per day)

53

Signs and Symptoms
• Feels like they were kicked in the heel
• Hears and feel a characteristic "pop"
• Visible swelling, bruising or a defect in the tendon
• Excessive passive dorsiflexion
• Weakness with resisted plantar flexion and inability to stand on toes
• May have palpable gap and tenderness in the region
• May be painless if completely ruptured
• +ve Thompson Test (not Thomas ) this is basically squeezing the calf normally functioning achilles will plantar flex )

Achilles tendon rupture

54

what is the treatment for Achilles tendon rupture

Treatment
• Surgical repair
• Immobilization in a cast
• The course of action is dependent on the supervising physician

55

Signs and Symptoms
• Pain first thing in the morning with the first few steps and after resting for a while. This pain diminishes after a few minutes of walking
• Tightness in the achilles tendon is evident with passive dorsiflexion
• Palpable tenderness over the anteromedial calcaneal tubercle of the heel
• Pain with passive extension of the toes and dorsiflexion of the ankle
• Normal resistant test and other tests all come out as normal

plantar fasciitis

56

what is the treatment for plantar fasciitis

Treatment
• Rest, ice, compression and elevation
• Modalities
• Stretching of the achilles tendon
• Low dye taping
• Extracorporeal shockwave therapy (cant use it in children, diabetes, people who use aspirin)
• Heel pad or corrective orthotics
• Strengthening of the intrinsic foot muscles
• Address the biomechanical cause of the problem
• Cortisone injection into region
• Surgery

57

Grade 1
• No visible deformity
• Slight swelling evident
• Minimal palpable pain
• No restriction in movement but may report pain
Grade 2
• Visible prominence on the medial end of the clavicle
• Moderate swelling evident
• Moderate palpable tenderness
• Restriction in abduction and horizontal adduction and pain reported with all movements
• Pain and weakness with all movements
Grade 3
• Gross prominence of the medial end of the clavicle
• Severe swelling evident
• Severe palpable tenderness
• As per grade 2 for mobility and strength testing but the pain may be more severe

sternoclavicular (SC) joint sprain

58

what is the treatment for sternoclavicular joint sprain?

Treatment
• Rest and ice to the region
• NSAIDS
• Immobilization of the shoulder in a sling, figure 8 strap or a clavicular strap. For grade 3 injuries, reduction mat be required and the immobilization is maintained for 3-5 weeks
• Stretching and strengthening program. This is not initiated for 3-4 weeks in grade 2 or 3 injuries
• Surgical excision of the medial part of the clavicle

59

Grade 1
• No visible deformity
• Slight swelling evident
• Palpable pain over the joint line
• No restriction on movement but may report pain with abduction greater than 90 degrees
Grade 2
• Visible elevation of the lateral end of the clavicle
• Moderate swelling evident
• Moderate palpable tenderness
• Restriction and pain with abduction and horizontal adduction
• Pain and weakness with all movements
Grade 3
• Gross prominence of the lateral end of the clavicle
• Severe swelling evident
• Severe palpable tenderness, depression and step down deformity
• As per grade 2 for mobility and strength testing but the pain may be more severe

acromioclavicular joint sprain

60

what is the treatment for acromioclavicular joint sprain

Treatment
• Rest and ice the region
• NSAIDS
• Immobilization of the shoulder in grade 1 injuries is only used when pain is present. For grade 2 and 3 injuries immobilization is maintained for 2-4 weeks (ex. Sling)
• Modalities (common ultrasound and IFC)
• Stretching and strengthening program
• Surgical management for grade 2 and 3 injuries is sometimes considered

61

Signs and Symptoms
• The client may report intense shoulder pan initially and then less painful
• Tingling and numbness in the arm and shoulder
• +ve x-ray findings
• The patient holds the arm in a slightly abducted and externally rotated position when anteriorly dislocated
• The patient may hold the arm adducted and internally rotated across the chest when posteriorly dislocated
• Marked pain and restriction in the active shoulder ROM
• Marked pain and weakness in the shoulder
• Palpation of the axilla reveals the presence of the humeral head with an anterior dislocation
○ When everything hurts it is something serious like a fracture or dislocation
• Palpable bulge in the posterior aspect of the shoulder with a posterior dislocation
• Marked pain and restriction in the active shoulder ROM
• +ve apprehension and Sulcus test

shoulder dislocation

62

what is the shoulder dislocation treatment

Treatment
• Treat as a fracture, immobilize the arm in the position it is found in and seek medical attention as a physician to reduce the dislocation
• Apply ice to the region to control pain, muscle spasm and hemorrhage
• After the shoulder is reduced, the shoulder is immobilized in a sling for 3-6 weeks
• Gentle stretching and strengthening exercises may begin after the period of immobilization

63

Signs and Symptoms
• Deep anterior shoulder pain reported
• Unable to sleep on the affected side
• Painful arc with abduction or downward flexion between 70-90 degrees
○ Elbow flexion weakness biceps
• Pain and muscle weakness may be evident with the associated muscle
• +ve impingemnet test
• The patient may present with a +ve empty can test or speed's test depending upon which muscle in the shoulder

rotator cuff impingement syndrome

64

what is the treatment for rotator cuff impingement syndrome

Treatment
• Restriction movements below shoulder height
• Rest and ice
• NSAIDS
• Modalities (TENS-pain, ice- 15 minutes, ultrasound- increase blood flow)
• Modifications of the aggravating activity or technique
• Stretching and strengthening exercises

Surgical repair of the rotator cuff and labrum

65

Sings and Symptoms
• Snapping or cracking sensation
• Severe pain and rapid swelling
• Total loss of function
• Arm held in flexion , with forearm appearing shortened
• Obvious deformity with the olecranon and redial head visible and palpable posteriorly
• Slight indentation in triceps visible just proximal to olecranon
• Nerve palsy (cant move hands or wrist, nerve may be damaged, in tension or torn)

elbow dislocation

66

what is the treatment for an elbow dislocation

Treatment
• Apply ice and immobilize the elbow and seek medial attention to have the elbow reduced
• The immobilization period is 3-6 weeks
○ More time than fracture because you have damage to all the soft tissue in the area, and it is required
• Stretching and strengthening exercises

67

Signs and Symptoms
• Palpable tenderness is evident over the MCL of the elbow
• +ve valgus stress test
• Diagnosis is based upon the clinical presentation, subjective and objective assessment findings

medial collateral ligament sprain

68

what is the treatment for MCL of the elbow

Treatment
• Rest, ice and compress the area
• NSAIDS
• May require immobilization n a sling for approx.. 10 days
• Protected ROM exercises
○ Not to the end of range, or within pain free limits

Strengthening exercises

69

Signs and Symptoms
• Pain over the lateral epicondyle of the elbow and the extensor muscle belly
• Pain and muscle weakness may be evident with activities requiring gripping and wrist extension
• Pain with active wrist extension and passive wrist flexion
• Pain with weakness with resisted wrist extension with the elbow in full extension (ECRL) and flexed to 90 degrees (ECRB)
• Pain with resisted extension of D3 of the hand (EDC)
• +ve Tennis elbow test

Lateral epicondylitis (tennis elbow) or medial epicondylitis (golfers elbow)

70

what is the treatment for lateral epicondylitis and medical epicondylitis

Treatment
• Rest, ice and compress the area
• NSAIDS
• Night splint
• Tennis elbow strap
• Modalities
• Stretching and strengthening program
• Modify the cause of the problem examining the activity, technique, equipment used or the training regime
• Cortisone injection

71

Signs and Symptoms
• Visible swelling in the posterior aspect of the elbow
• If ruptures, goose egg visible
• Tenderness on palpation of the posterior aspect of the elbow
• Motion limited at extreme of flexion- tension increases over bursa

olecranon bursitis

72

what is the treatment for olecranon bursitis

Treatment
• Rest, ice and compression
• NSAIDS
• Modalities
• Protective padding over the area
• Aspiration of the area

73

Signs and Symptoms
• The patient complains of numbness or shocking pain in the posterior and medial aspect of the elbow or in D4 and D5 of the hand
• +ve tinel test of the elbow

ulnar nerve entrapment

74

what is the treatment for ulnar nerve entrapment

Treatment
• Rest
• NSAIDS
• Surgical release

75

Signs and Symptoms
• Sudden snap in the elbow region during an eccentric and sudden loading of the elbow
• Swelling, bruising and visible indentation on inspection
• Pain on palpation over the radial tuberosity and anterior aspect of the elbow
• Pain and weakness with resisted elbow flexion and forearm supination

biceps muscle strain

76

what is the treatment for biceps muscle strain

Treatment
• Modalities
• Stretching and strengthening exercises
• Surgical repair on young active person

77

signs and symptoms:
the lunate may also sublux or dislocate in a dorsal direction

dorsal dislocation