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PT10113 MSK > S2L2: Elbow and Forearm > Flashcards

S2L2: Elbow and Forearm Flashcards

(69 cards)

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1
Q

What part of the humerus articulates to the ulna?

A

Trochlea

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2
Q

What is the type of joint of the humero-ulnar articulation?

A

Modified Hinge Joint

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3
Q

What ligament provides stabilizing action against varus forces at the elbow?

A

Radial Collateral Ligament

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4
Q

Among the elbow flexors, which one contracts actively always regardless of the position of the forearm?

A

Brachialis

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5
Q

Among the elbow flexors, which one is most effective between 80-100° of flexion?

A

biceps brachii

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6
Q

Where is the common origin of wrist flexor muscles?

A

Medial epicondyle

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7
Q

What nerve provides sensory supply on the lateral side of the dorsum of the wrist and hand and lateral 3 1⁄2 digits?

A

Radial nerve

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8
Q

What nerve may be entrapped between the two heads of the flexor carpi ulnaris?

A

Ulnar nerve

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9
Q

What is the end feel for elbow flexion?

A

Soft

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10
Q

What is the dermatome assigned at the level of the lateral epicondyle?

A

C5

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11
Q

Characteristics of overuse syndromes

A

Cumulative trauma disorders
Repetitive strain injury
Repeated submaximal overload and/or frictional
wear to a muscle or tendon resulting in inflammation and

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12
Q

Tennis Elbow

Pain in the common origin of wrist
extensors aggravated by gripping

Activities that irritate the tendoperiosteal junction & elicit
symptoms:

Backhand stroke in tennis
requiring wrist stability

Repetitive work tasks: computer
keyboarding

Repetitive wrist extension: pulling
weeds

A

Lateral elbow tendinopathy

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13
Q

Golfer’s Elbow

Pain in the common origin of wrist flexors

Little Leaguer’s Elbow

Baseball pitchers

Activities that irritate the tendoperiosteal junction & elicit symptoms:

Repetitive movements towards flexion: swinging a golf club, pitching a ball

Work-related grasping

Shuffling papers

Lifting heavy objects

A

Medial elbow tendinopathy

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14
Q

Intervention Scenario: restore the state of muscles & tendons by doing the following goals

A

Protection Phase

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15
Q

Intervention to control pain, edema, or spasm (R, U, A, A)

A

Rest in a splint, counterforce brace
(To spread the impact towards the muscle belly, not to the origin)

Use cryotherapy and other modalities such as TENS

Avoid provocative activities

Activity modification (lift with forearm supinated)

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16
Q

Intervention to develop soft tissue and joint mobility (3)

A

Technique for wrist extensor muscle
[Flexed elbow, pronated, wrist extended & provide isometric resistance (6SH x 10 reps)]

Technique for wrist flexor muscles
[Flexed elbow, supinated, wrist flexed & provide isometric resistance (6SH x 10 reps)]

Cross fiber massage
(Massage can be applied because tendinopathy does not have swelling)

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17
Q

Intervention to maintain UE function (2)

A

AROM exercises for elbow, forearm, and wrist

PRE’s for shoulder and scapular muscles with resistance applied above the elbow

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18
Q

Documentation for pain (STG)

A

STG> Pt will report ↓ in pain from 6/10 to 3/10 p 6 PT sessions in order to light activities at home

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19
Q

Documentation for cryotherapy

A

P>Ice massage X 5 mins/until analgesia on (R) lateral epicondyle/common origin of wrist extensors to ↓ pain

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20
Q

Rehabilitation goals for controlled motion and return to function phase (I, R, S, P)

A

Increase muscle flexibility and scar mobility
Restore joint tracking of the radio-humeral joint
Strengthen the muscle & improve endurance
Progress to functional training & conditioning

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21
Q

Intervention to increase muscle flexibility and scar mobility (S, S, C)

A

Inhibition and passive stretching (GPS, HR, CR)
Self stretching
Cross fiber or friction massage

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22
Q

Intervention to restore joint tracking of the radio-humeral joint (M, S)

A

MWM
Self-mobilization

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23
Q

Intervention to strengthen the muscle & improve endurance (I, I, E)

A

Isometric to isotonic to eccentric resistive exercises
Include shoulder and scapular muscles particularly ER, extension, & horizontal abduction

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24
Q

Intervention to progress to functional training & conditioning

A

Improve endurance, power, and flexibility (include trunk)

May use plyometrics (faster eccentric components)

Patient education on prevention, proper technique (warm up, biomechanics)

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25
Etiology of joint hypomobility (F, D, A, B, M)
Fracture Dislocation Other causes: - Arthritic conditions - Burns - Myositis ossificans
26
Non-operative management phases: Protection phase rehabilitation goals (E, C, M, M)
Educate the patient Control inflammation Maintain soft tissue and joint mobility Maintain integrity and function of related areas
27
Intervention to educate the patient
Anticipated length of acute symptoms Joint protection, activity modification: no lifting, pushing, fatigue Residual stiffness are common, loss terminal extension (10-15°)
28
Intervention to control inflammation
Reduction of the dislocation splinted for 5-7 days; then hinged elbow brace in full pronation for 4-6 weeks in a sling; 20-30° elbow flexion to prevent ulnar neuropathy Arthritic pts: Gr 1 and 2 joint mob for pain (oscillations) Avoid: valgus force esp for ulnar dislocation
29
Intervention to maintain soft tissue and joint mobility
Controlled ROM ex Gentle isometrics or multiple angle muscle sets within pain-free ranges
30
Intervention to maintain integrity and function of related areas
Shoulder, wrist, finger ROM Elevation, superficial massage if (+) distal swelling
31
Non-operative management phases: Controlled motion phases (O, I, I, I)
Observe precautions after trauma Increase soft tissue and joint mobility Improve joint tracking at the elbow Improve muscle performance and functional abilities
32
Intervention to observe precautions after trauma
Heterotopic Ossification (redness, painful to touch, tenderness, ectopic bone formation) Bony end feel, malunion (end feel felt is different from normal) Diminished brachial pulse Forced terminal extension should be avoided
33
Intervention to increase soft tissue and joint mobility
Passive joint mobility Reduction of a pulled elbow Reduction of a pushed elbow Manual & self-stretching, HEP
34
Intervention to improve joint tracking at the elbow
MWM (if accessory glide is not present)
35
Intervention to improve muscle performance and functional abilities
Active light resistance exercises Open to closed-chain Return to play for athletes if 90% of the strength of the other UE (unaffected) is reached
36
Non-operative management phases: Return to function phase rehabilitation goals
Further improve muscle performance Restore functional mobility
37
Intervention to further improve muscle performance
Use exercises that replicate the repetitions and demands of daily activities, such as pushing, pulling, lifting, carrying, and gripping to prepare the joints & muscles for specific tasks
38
Intervention to restore functional ability
If restrictions remain, use vigorous manual or mechanical stretching and joint mobilization techniques (Gr 3 & 4 joint mob)
39
Documentation (LTG)
LTG> Pt will be able to lift a sack of rice X 5-10 times c proper lifting techniques & biomechanics p 3 mo. of PT sessions
40
Plan/Interventions
P> Functional Training> lifting of a half sack of rice X 10 reps X 1 set to simulate work on rice field
41
Post-op management
Excision of the radial head (Comminuted fracture pts) Total elbow arthroplasty (Both radioulnar & humeral components)
42
Days of immobilization following excision of radial head
1-3 days
43
Guidelines for immobilization following excision of radial head (4)
90° flexion with forearm in neutral using a well-padded posterior splint Ulnar nerve is not compressed Elevate arm for comfort and to minimize edema If joint is tenuous, delay ROM exercise for 1 week, afterwards it is done with a hinge splint in place Communicate with the MD first prior to doing ROM exercises
44
Days of immobilization for total elbow arthroplasty
8-12
45
Guidelines for total elbow arthroplasty (3)
Use of compression dressing and posterior/anterior splint Full extension to 70°-80° flexion and a neutral position of forearm Wear splint at night for 6 weeks Waiting to stabilize the new components placed
46
Precautions of total elbow arthroplasty
Postpone resisted elbow extension for 6-12 weeks if triceps-reflecting approach was done Apply resistance proximal to the elbow joint (above) Avoid push up activities and carrying objects for 6 weeks Some recreational activities should not be done (e.g. bowling, tennis, badminton)
47
Lifting limits of total elbow arthroplasty for 3 months
1 lb
48
Lifting limits of total elbow arthroplasty for 6 months
2 lbs
49
Lifting limits of total elbow arthroplasty for more than 6 months
No more than 5 lbs
50
Intervention scenario for total elbow arthroplasty (primary and secondary)
Compensate - healthy UE can help lift or do functional activities Prevent - prevent the loosening or dislocation of arthroplasty
51
Impingement in hypertrophied heads of pronator teres
Median nerve
52
Nerve injured in the: Musculospiral groove Radial neck
Radial nerve
53
Nerve injured in the: Cubital tunnel Impingement between heads of flexor carpi ulnaris
Ulnar nerve
54
Non-operative management for peripheral nerve injury (4)
Patient education Rest and protection Focus on decompression Maintain musculoskeletal integrity
55
Cubital tunnel protection phase: patient education
About symptoms and diagnosis Encourage compliance to PT
56
Cubital tunnel protection phase: Rest and protection
Night splints or rolled up towels to prevent elbow flexion during sleep >90°=ulnar nerve compression Modalities to decrease pain and swelling TENS, pulsed ultrasound, cryotherapy (very acute)
57
Cubital tunnel protection phase: Focus on decompression
Discontinue sleeping with elbows flexed Avoid leaning onto elbows while studying or working on a computer
58
Cubital tunnel protection phase: maintain msk integrity
PROM -> AAROM -> AROM
59
Cubital tunnel moderate and minimum protection phases goals (2)
Improve functional strength and muscular endurance Return to function phase
60
Cubital tunnel moderate and minimum protection phases: Improve functional strength and muscular endurance
Strengthening is commenced when symptoms subside Especially to ring & little finger Discontinue PREs immediately if symptoms are aggravated
61
Cubital tunnel moderate and minimum protection phases: Return to function
For throwing athletes, complete cessation of symptoms before initiating a throwing program Optimal function is prevented by symptoms
62
ULTT for median nerve (5)
ULTT1 (CDAESE) Cervical spine: contralateral side flexion Shoulder: depression and 110º abduction Elbow: extension Forearm: supination Wrist: extension
63
ULTT for ulnar nerve (6)
ULTT 4 (CDAEFSERE) Cervical spine: contralateral side flexion Shoulder: depression, 10º-90º abduction, ER Elbow: flexion Forearm: supination Wrist: extension and radial deviation Fingers: extension
64
ULTT for radial nerve (6)
ULTT3 (CDAIEPFUF) Cervical spine: contralateral side flexion Shoulder: depression, 10º abduction, IR Elbow: extension Forearm: pronation Wrist: flexion and ulnar deviation Fingers: flexion
65
T/F: Mobilizations start from proximal to distal
False: distal to proximal
66
Management for PNI phases (3)
Acute, recovery, chronic
67
Management for PNI: Acute (6)
Immediately after injury or surgery Immobilization Regeneration Rate: 1mm per day (range 0.5-9.0mm) Movement is controlled/maintained No tightness or contracture p healing Splinting Provide protection to prevent reinjury Patient education Prevent touching cold/hot surface & sharp objects d/t loss of sensations Check skin for dryness & irritation Intervention Scenario: Restore (primary) Goal is to regenerate nerve by protecting & ensure it heals and grow Compensate (secondary) bc pt should still move and function by using healthy UE
68
Management for PNI: Recovery (5)
Signs of re-innervation: (+) muscle contraction & increased sensitivity Motor retraining -NMES & FES -Active ROM Desensitization -Reintroduce textures (soft, rough etc. for 5-10 mins) Discriminative sensory re-education -Teach pt to isolate and locate stimulus; sensory testing Intervention Scenario: Restore (primary) -To improve sensation (correct hypersensitivity) & reeducate of proper sensations
69
Management for PNI: Chronic (4)
Re-innervation potential peaked with minimal or no signs of neurological recovery Compensatory function -Use unaffected side or adaptive equipments Preventive care -Prevent atrophy (use ES) -Check for integumentary problems such as dryness, wounds etc. -Educate pt to avoid touching extremes sensation objects Intervention Scenario: Compensate & prevent

PT10113 MSK (5 decks)

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