musc > week 8 > Flashcards

week 8 Flashcards

(52 cards)

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1
Q

Four requirements to maximise healing:

A
  1. minimise pain, swelling, inflammation, to offer the best possible conditions for healing
  2. protection of DAMAGED tissue
  3. controlled mobilisation during the collagen
    maturation and remodelling initiation phase.
  4. progressive loading of the tissue
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2
Q

Dislocations Complications

A
  • Long-term loss of extension
  • Heterotopic ossification
  • Chronic posterolateral instability
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3
Q

Associated injuries to dislocations

A
  • avulsion of either medial or lateral epicondyle
  • coronoid and radial head fractures
  • osteochondral lesions
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4
Q

Dislocation management – simple
dislocation

A

Early active Mx group: started active/active assisted ROM
after 2 days (within pain) but no passive ROM for first 3
weeks (sling for first 2-3 days as needed).

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5
Q

simple dislocation is

A

Elbow dislocation without associated fractures is considered a simple dislocation

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6
Q

Complex dislocation is

A
  • Dislocation plus fractures = unstable
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7
Q

Complex dislocation management –

A
  • Immobilization: typically involves the use of a posterior splint at 80-90o of elbow flexion to maximise stability and capsular volume for up to three weeks.
  • Commence hand and wrist ROM immediately
  • Splint kept on for 24/24 except during ROM exercises
  • Gentle elbow AROM can be done with lying supine with shoulder supported at 90 degrees flexion -active assist flexion and extension to -30 degrees
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8
Q

Radial head subluxation
(Nursemaid’s Elbow) is

A
  • Dislocation of the radio-ulnar joint from being pulled by the hand or wrist in a pronated position
    Usually in children
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9
Q

Radial head subluxation
(Nursemaid’s Elbow) Mx

A
  • Minimal rehab as younger age group
  • Brace may be used for first 3 weeks – healing of passive structures
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10
Q

Radial head fracture type 1

A

(non-displaced or minimally displaced <2mm #

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11
Q

Radial head fracture management type 1

A

– typically conservative management.
* Short-term immobilisation (sling/brace) for 2-7 days then early ROM (especially
extension)

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12
Q

Radial head fracture management type 2-4

A

Type III might need an arthroplasty (ie. partial elbow replacement  specifically a radial head replacement) if >3 fragments

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13
Q

Medial Epicondyle avulsion fractures S+S

A
  • Sudden “pop” during a throw followed by pain.
  • Point tenderness over the medial epicondyle.
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14
Q

MCL elbow MOI

A

usually a fall-, valgus force- or throwing related- injury
Valgus stress test to assess for MCL injury

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15
Q

elbow MCL physiotherapy management
1. Acute phase (0-72 hrs):

A
  • Minimise tissue damage
  • Reduce pain
  • Promote healing
  • Maintain ROM, strength, proprioception in unaffected areas
  • POLICE
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16
Q

elbow MCL physiotherapy management
Sub-acute (2-6 weeks)

A
  • Maintain and restore ROM, strength, proprioception
  • Functional rehabilitation
  • Assess & correct and predisposing factors
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17
Q

Physiotherapy management - LCL

A

likely to be part of a post-op management associated with a complex dislocation

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18
Q

Medial Instability

A
  • micro trauma to ligament leads to
    inflammation and damage
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19
Q

Medial Instability Presentation

A
  • Laxity on valgus stress tests
  • Pain over medial elbow during elbow flexion and throwing
  • Unable to throw at full speed
  • Possible swelling * Loss of ROM – especially extension
  • Ulnar nerve sensitivity
  • Positive radiographic examination
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20
Q

Long-term problems of acute traumatic
elbow injuries

A
  • Loss of ROM (especially extn) – linked to duration of immobilisation
  • Loss of strength (elbow/wrist/shoulder)
  • Recurrent instability
  • Heterotopic ossification
  • Neurovascular compromise
  • Chronic pain syndromes
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21
Q

chronic Lateral Elbow pain conditions

Study These Flashcards
A

Lateral elbow tendinopathy/Tennis elbow
Radial Tunnel Syndrome
Osteochondritis dissecans

22
Q

chronic Medial elbow pain conditions

Study These Flashcards
A

Medial epicondylalgia/flexor tendinopathy (golfer’s elbow)
* Little leaguers elbow (medial epicondylar apophysitis)
* Posterior impingement
* Neural entrapments
* Median nerve
* Ulnar nerve

23
Q

Lateral elbow tendinopathy - what is it?

Study These Flashcards
A

Lateral elbow tendinopathy (LET) is the most
common musculoskeletal disorder of the elbow

24
Q

diagnosis of LET

Study These Flashcards
A

based on the presence of pain over the lateral humeral epicondyle that may radiate distally into the forearm

25
Risk Factors to LET
handling tools heavier than 1 kg, handling loads heavier than 20 kg at least 10 times per day, and repetitive movements for more than 2 hours per day
26
Lateral elbow tendinopathy – integrative model
tendon pathology motor control impairments sensory system impairments
27
what is the most effected tendon pathology
extensor carpi radialis brevis
28
Lateral elbow tendinopathy – integrative model Motor system impairments
* Changes to grip, wrist and finger strength * Impaired reaction time with wrist and finger movements * Impaired joint position sense for wrist extension * Gripping occurs in greater level of wrist flexion (inefficient)
29
Clinical Presentation of Lateral elbow tendinopathy history
may be associated with repetitive use (occupational/ recreational)
30
Clinical Presentation of Lateral elbow tendinopathy area of pain
* lateral epicondyle +/- into forearm
31
Clinical Presentation of Lateral elbow tendinopathy assessment cluster
 Pain with palpation over lateral epicondyle  Pain on isometric resisted wrist extension or 2nd/3rd finger extension  Pain on gripping
32
Management of LE
* Conservative management is recommended first * Need to address the three components of the integrated model of multifactorial pathology involved: Tendon pathology Motor control impairments Sensory system impairments
33
Current EBP and best practice for LET
Wrist extensor exercise (+/- MWM) - graded and progressive for 8 weeks Manual Therapy at elbow
34
Exercise – isometrics
* Likely a good introduction if too painful to do isotonic exercise * Aim is for pain relief
35
Radial Tunnel Syndrome (RTS) MOI
* Repeated use of extensor / supinator muscle mass * Compression of deep branch of radial nerve = posterior interosseous nerve (PIN) as it passes through the supinator
36
RTS – signs & symptoms
* Pain tends to be the dominate feature * Pain is relatively deep in upper forearm (distal to elbow) * The pain is aggravated by gripping and twisting tasks * The radial nerve is often tender on palpation
37
RTS: Treatment
* Proposed Physiotherapy management includes: * Early management is crucial to try and prevent damage to the nerve through either ongoing trauma or secondary inflammation and swelling. * Flexibility and postural exercises - trunk, cervical and thoracic spine to reduce any role posture may have on the nerve tissue. * Cervical/ thoracic mobilisations and NDT techniques (radial nerve ULNT2B) sliders to assist with the mobility of the nerve
38
Osteochondritis Dissecans
* Poorly localised lateral elbow pain, with crepitus, catching and locking * Swelling and flexion contractures may be present * Complication from laxity/instability of MCL * Tenderness on palpation of capitellum through elbow flex/ext * Radiographs required
39
Treatment Osteochondritis Dissecans Non-displaced lesion:
* Sports physician/Orthopaedic RV required * Rest, gentle ROM ex initially (prevent loss of extension ROM) * Gradual strengthening around shoulder, elbow, wrist and kinetic chain to prepare for loads associated with throwing * No throwing until symptoms gone and full ROM restored
40
Treatment Osteochondritis Dissecans displaced lesion:
* Sports physician/Orthopaedic RV required * Rest * Arthroscopic debridement, removal of loose bodies may be needed * Post-op physiotherapy Mx will focus on restoring ROM then strength * Poor prognosis – older patient, larger lesion, lesion on a weight-bearing area
41
Medial Epicondylalgia (Golfers elbow) = Flexor Tendinopathy Aggravating factors
* Resisted wrist flexion and ulnar deviation * Resisted pronation * Passive elbow and wrist extension in supination * History of increased load or change of technique/ equipment
42
Medial Epicondylalgia (Golfers elbow) = Flexor Tendinopathy treatment
* Isometrics - to target pain if necessary (30-45 second holds x 5) * Isotonics- long slow load/ concentric/ eccentric strengthening and progressive load * Eccentric programs (3 sets 15 reps twice daily) * Counterforce brace
43
Medial elbow pain: Little Leaguer’s Elbow
* Age <15yo most likely Little League Elbow Syndrome (LLES) * Can lead to medial epicondyle avulsion fracture which requires surgery, if continued throwing despite pain
44
Medial elbow pain: Little Leaguer’s Elbow Rehab
* Load management - stop throwing * Restore motion and when appropriate, begin strengthening dynamic stabilizers of medial elbow * Consider shoulder, trunk and lower limb kinetic chain to improve throwing mechanics
45
Posterior Impingement Caused by 3 situations
 Repetitive hyperextension/ valgus stress overload syndrome- adolescent throwers  Valgus instability  OA in the older patient of the radiocapitellar (RH) joint
46
Posterior Impingement of the Elbow Treatment
 Rest from aggravating factors- may use ROM limiting brace if compliance poor  Restriction of extension movements and throwing  Return of pain free ROM  Increase strength and stability at joint- supinators/ pronators, flexor/ extensor strength  Correction of throwing technique
47
Nerve entrapment Median Nerve
* Can get entrapped above elbow at ligament of Struthers or below elbow between pronator teres and at carpal tunnel
48
Nerve entrapment Median Nerve symptoms
sensation changes and/or pain at palmar aspect of hand and fingers +/- weakness in wrist flexors
49
radial nerve entrapment
* Divides at elbow into superficial sensory and deep motor branches * Entrapment of superficial branch causes pain/sensation over radial aspect of wrist or thumb
50
radial nerve entrapment can impact
wrist extension
51
Nerve Entrapment Ulna Nerve
* Can be entrapped at Arcade of Struthers (above elbow), at medial epicondyle and cubital tunnel * Sometimes between two heads of flexor carpi ulnaris
52
Nerve Entrapment Ulna Nerve S+S
* Pain or paraesthesia in sensory distribution (i.e. 4th & 5th fingers, medial forearm) * +ve Tinel’s sign
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