Elbow Evaluation
Physical Therapy Pt 5454 with Joseph at University of Connecticut
About this deck
By: Mike Rigdon
Created: 2011-02-22
Size: 72 flashcards
Views: 49
Created: 2011-02-22
Size: 72 flashcards
Views: 49
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What muscles would you expect to see motor loss in with damage to the Median Nerve?
1) Pronator Teres
2) Flexor Carpi Radialis
3) Palmaris Longus
4) Flexor Digitorum Superficialis
5) Flexor Pollicis Longus
6) Lateral 1/2 of Flexor Digitorum Profundus
7) Pronator Quadratus
8) Thenar Eminence
9) Lateral 2 lumbricals
2) Flexor Carpi Radialis
3) Palmaris Longus
4) Flexor Digitorum Superficialis
5) Flexor Pollicis Longus
6) Lateral 1/2 of Flexor Digitorum Profundus
7) Pronator Quadratus
8) Thenar Eminence
9) Lateral 2 lumbricals
Where would you expect to see sensory loss with damage to the Median Nerve?
1) Palmar aspect of the hand in the thumb, index, middle, and lateral half of the ring finger
2) Dorsal aspect of the hand in the distal 1/3 of the index and middle fingers and the lateral 1/2 of the distal 1/3 of the ring finger
2) Dorsal aspect of the hand in the distal 1/3 of the index and middle fingers and the lateral 1/2 of the distal 1/3 of the ring finger
What functional losses would you expect to see with damage to the Median Nerve
1) Pronation weak or lost
2) Weak wrist flexion and abduction
3) Radial deviation @ wrist is lost
4) Inability to oppose or flex thumb
5) Weak thumb abduction
6) Weak grip
7) Weak or no pinch (Ape hand deformity)
2) Weak wrist flexion and abduction
3) Radial deviation @ wrist is lost
4) Inability to oppose or flex thumb
5) Weak thumb abduction
6) Weak grip
7) Weak or no pinch (Ape hand deformity)
Median Nerve
What nerve roots does the median nerve originate from?
C6-8, T1
Where does the Anterior Interosseous Nerve originate from?
It is a branch of the median nerve
What motor loss would you expect to see with damage to the Anterior Interosseous Nerve?
1) Flexor Radialis Longus
2) Lateral 1/2 of the Flexor Digitorum Profundus
3) Pronator Quadratus
4) Thenar Eminence
5) Lateral 2 lumbricals
2) Lateral 1/2 of the Flexor Digitorum Profundus
3) Pronator Quadratus
4) Thenar Eminence
5) Lateral 2 lumbricals
What sensory loss would you expect to see with damage to the anterior interosseous nerve?
None
What functional losses would you expect to see with damage to the anterior interosseous nerve?
1) Weak pronation, especially @ 90 degrees elbow flexion
2) Weak opposition and flexion of the thumb
3) Weak finger flexion
4) Weak pinch (inability to to tip-to-tip) --> instead pulp-to-pulp
2) Weak opposition and flexion of the thumb
3) Weak finger flexion
4) Weak pinch (inability to to tip-to-tip) --> instead pulp-to-pulp
Where does the ulnar nerve originate from?
C7-8, T1
What motor loss would you expect to see with damage to the ulnar nerve?
1) Flexor Carpi Ulnaris
2) Medial 1/2 of Flexor Digitorum Profundus
3) Palmaris Brevis
4) Hypothenar eminence
5) Adductor Pollicis
6) Medial 2 lumbricals
7) All interossei (not all need to be weak, there may be a selective few that are weak)
2) Medial 1/2 of Flexor Digitorum Profundus
3) Palmaris Brevis
4) Hypothenar eminence
5) Adductor Pollicis
6) Medial 2 lumbricals
7) All interossei (not all need to be weak, there may be a selective few that are weak)
What sensory loss would you expect to see with damage to the ulnar nerve?
Dorsal and palmar aspect of the:
- Little finger
- Medial 1/2 of the ring finger
- Little finger
- Medial 1/2 of the ring finger
What functional losses are associated with damage to the ulnar nerve?
1) Weak wrist flexion
2) Loss of ulnar deviation @ the wrist
3) Loss of distal flexion of the little finger
4) Loss of abduction and adduction of fingers
5) Inability to extend 2nd and 3rd phalanges of little and ring fingers (benediction hand deformity)
6) Loss of thumb adduction
2) Loss of ulnar deviation @ the wrist
3) Loss of distal flexion of the little finger
4) Loss of abduction and adduction of fingers
5) Inability to extend 2nd and 3rd phalanges of little and ring fingers (benediction hand deformity)
6) Loss of thumb adduction
Where does the radial nerve originate from?
C5-8, T1
What motor loss would you expect to see with damage to the radial nerve?
1) Anconeus
2) Brachioradialis
3) Extensor carpi radialis longus and brevis
4) Extensor digitorum
5) Extensor pollicis longus and brevis
6) Abductor pollicis longus
7) Extensor carpi ulnaris
8) Extensor indices
9) Extensor digiti minimi
2) Brachioradialis
3) Extensor carpi radialis longus and brevis
4) Extensor digitorum
5) Extensor pollicis longus and brevis
6) Abductor pollicis longus
7) Extensor carpi ulnaris
8) Extensor indices
9) Extensor digiti minimi
What sensory loss would you expect to see with damage to the radial nerve
1) Dorsum of the hand (lateral 2/3)
2) Dorsum and lateral aspect of the thumb
3) Proximal 2/3 of the dorsum of index and middle finger
4) Medial 1/2 of the proximal 2/3 of the dorsum of the ring finger
2) Dorsum and lateral aspect of the thumb
3) Proximal 2/3 of the dorsum of index and middle finger
4) Medial 1/2 of the proximal 2/3 of the dorsum of the ring finger
What functional losses are associated with damage to the radial nerve?
1) Loss of supination
2) Loss of wrist extension (wrist drop)
3) Inability to grasp
4) Inability to stabilize the wrist
5) Loss of finger extension
6) Inability to abduct thumb
2) Loss of wrist extension (wrist drop)
3) Inability to grasp
4) Inability to stabilize the wrist
5) Loss of finger extension
6) Inability to abduct thumb
Where does the posterior interosseous nerve originate from?
It is a branch of the radial nerve
What motor loss would you expect to see with damage to the posterior interosseous nerve?
1) Extensor carpi radialis brevis
2) Extensor digitorum
3) Extensor pollicis longus and brevis
4) Abductor pollicis longus
5) Extensor carpi ulnaris
6) Extensor indices
7) Extensor digiti minimi
2) Extensor digitorum
3) Extensor pollicis longus and brevis
4) Abductor pollicis longus
5) Extensor carpi ulnaris
6) Extensor indices
7) Extensor digiti minimi
What sensory loss would you expect to see with damage to the posterior interosseous nerve?
None
What functional losses would you expect to see with damage to the posterior interosseous nerve?
1) Weak wrist extension
2) Weak finger extension
3) Difficulty stabilizing wrist
4) Difficulty with grasp
5) Inability to abduct thumb
2) Weak finger extension
3) Difficulty stabilizing wrist
4) Difficulty with grasp
5) Inability to abduct thumb
Name the 5 flexors of the elbow and their nerve supply
1) Brachialis- Musculocutaneous nerve
2) Biceps Brachii- Musculocutaneou
3) Brachioradialis- Radial nerve
4) Pronator teres- Median nerve
5) Flexor Carpi Ulnaris- Ulnar nerve
2) Biceps Brachii- Musculocutaneou
3) Brachioradialis- Radial nerve
4) Pronator teres- Median nerve
5) Flexor Carpi Ulnaris- Ulnar nerve
Name the 2 muscles that extend the elbow and their nerve supply
1) Triceps- Radial nerve
2) Anconeus- Radial nerve
2) Anconeus- Radial nerve
What 2 muscles supinate the forearm and what is their nerve supply?
1) Supinator- Posterior interosseous nerve (Radial)
2) Biceps Brachii- Musculocutaneous nerve
2) Biceps Brachii- Musculocutaneous nerve
What 3 muscles pronate the forearm and what is their nerve supply?
1) Pronator Quadratus- Anterios interosseous nerve (Median)
2) Pronator Teres- Median nerve
3) Flexor carpi radialis- Median nerve
2) Pronator Teres- Median nerve
3) Flexor carpi radialis- Median nerve
What 2 muscles flex the wrist and what is their nerve supply?
1) Flexor carpi radialis- Median nerve
2) Flexor carpi ulnaris- Ulnar nerve
2) Flexor carpi ulnaris- Ulnar nerve
What 3 muscles extend the wrist and what is their nerve supply?
1) Extensor carpi radialis longus- Radial nerve
2) Extensor carpi radialis brevis- Posterior interosseous nerve (Radial)
3) Extensor carpi ulnaris- Posterior interosseous nerve (Radial)
2) Extensor carpi radialis brevis- Posterior interosseous nerve (Radial)
3) Extensor carpi ulnaris- Posterior interosseous nerve (Radial)
Ulnohumeral (Trochlear) Joint:
1) Resting position
2) Close packed position
3) Capsular pattern
1) Resting position
2) Close packed position
3) Capsular pattern
1) 70 degrees elbow flexion, 10 degrees supination
2) Extension with supination
3) Flexion > Extension
2) Extension with supination
3) Flexion > Extension
Radiohumeral Joint:
1) Resting position
2) Close packed position
3) Capsular pattern
1) Resting position
2) Close packed position
3) Capsular pattern
1) Full extension and full supination
2) Elbow flexed to 90 degrees, forearm supinated to 5 degrees
3) Flexion > Extension > Supination > Pronation
2) Elbow flexed to 90 degrees, forearm supinated to 5 degrees
3) Flexion > Extension > Supination > Pronation
Superior Radioulnar Joint:
1) Resting position
2) Close packed position
3) Capsular pattern
1) Resting position
2) Close packed position
3) Capsular pattern
1) 35 degrees supination, 70 degrees elbow flexion
2) 5 degrees supination
3) Equal limitation of supination and pronation
2) 5 degrees supination
3) Equal limitation of supination and pronation
How is the median nerve most often injured?
1) Fracture/dislocation
2) Compression
3) Traction
4) Impingement under the Ligament of Struthers
5) Compression between the 2 heads of the pronator teres
2) Compression
3) Traction
4) Impingement under the Ligament of Struthers
5) Compression between the 2 heads of the pronator teres
Name 4 tests for detection of median neuropathy
1) Resisted pronation with elbow and wrist flexion for 30-60 seconds
2) Resisted elbow flexion and supination
3) Resisted middle finger flexion @ PIP
4) Manual pressure of pronator teres during pronation
2) Resisted elbow flexion and supination
3) Resisted middle finger flexion @ PIP
4) Manual pressure of pronator teres during pronation
If a patient is only able to perform a pulp to pulp finger pinch which nerve would you expect to be injured?
Anterior interosseous nerve
- Normally people would be able to a tip-to-tip pinch
- Normally people would be able to a tip-to-tip pinch
Where is the ulnar nerve typically compressed? What motion increases this compression?
It is often injured or compressed in the cubital tunnel. The compression increases with flexion
What muscles comprise the hypothenar eminence?
- Flexor digiti minimi
- Abductor digiti minimi
- Opponens digiti minimi
What makes up the Radial Tunnel?
1) Medial part of the brachialis
2) Anterior ECRL
3) Posterior capitellum
2) Anterior ECRL
3) Posterior capitellum
Which direction does the radial nerve wrap around the humerus?
From medial to lateral
How is the radial nerve typically injured?
Injured with a fracture where the nerve winds around the humerus
Posterior Interosseous Nerve:
1. Where is it typically compressed?
2. What is radial tunnel syndrome?
1. Where is it typically compressed?
2. What is radial tunnel syndrome?
1. In the Canal of Frohse
2. It is a condition in which the posterior interosseous nerve is compressed anterior to the radial head. It mimics lateral epicondylitis (lateral burning sensation)
2. It is a condition in which the posterior interosseous nerve is compressed anterior to the radial head. It mimics lateral epicondylitis (lateral burning sensation)
What forms the collateral ligament complexes in the elbow?
Specialized thickenings of the medial and lateral capsule
Ulnar Collateral Ligament:
1. Name the 3 bundles and what is their role in stabilization?
1. Name the 3 bundles and what is their role in stabilization?
1. Anterior Bundle
- Primary stabilizer in all degrees expect full extension (prevents valgus)
2. Posterior Bundle
- Especially taught in flexion beyond 60 degrees (prevents valgus)
3. Transverse Bundle
- Little contribution
- Primary stabilizer in all degrees expect full extension (prevents valgus)
2. Posterior Bundle
- Especially taught in flexion beyond 60 degrees (prevents valgus)
3. Transverse Bundle
- Little contribution
If you tear your UCL, how much joint play would you expect to feel?
2 mm (very little joint play)
Name the 4 divisions of the Lateral Collateral Ligament (LCL) in the elbow and what do they stabilize?
1. RCL
- Varus stability via approximation
2. Lateral UCL
- Primary varus stabilizer
3. Annular lig
- Stabilizes radius
- Anterior taut in supination
- Posterior taut in pronation
4. Accessory Collateral lig
- Stabilizes annular lig during varus
- Varus stability via approximation
2. Lateral UCL
- Primary varus stabilizer
3. Annular lig
- Stabilizes radius
- Anterior taut in supination
- Posterior taut in pronation
4. Accessory Collateral lig
- Stabilizes annular lig during varus
Ulnohumeral Joint:
1) What type of joint?
2) What is concave and convex?
3) Joint orientation
4) What motions occur at joint?
1) What type of joint?
2) What is concave and convex?
3) Joint orientation
4) What motions occur at joint?
1. Modified hinge joint
2/3. Concave- Ulnar trochlea
- Oriented up and anterior 45 degrees
Convex- Humeral trochlea
- Oriented anterior and downard 45 degrees
4. Flexion and Extension
2/3. Concave- Ulnar trochlea
- Oriented up and anterior 45 degrees
Convex- Humeral trochlea
- Oriented anterior and downard 45 degrees
4. Flexion and Extension
Ulnohumeral Joint:
What directions would you apply the glides to increase flexion and extension?
What directions would you apply the glides to increase flexion and extension?
Flexion- anterior glide (also superior)
Extension- posterior glide
Extension- posterior glide
Radiohumeral Joint:
1. What type of joint?
2. What is concave/convex?
3. What movements occur @ joint?
1. What type of joint?
2. What is concave/convex?
3. What movements occur @ joint?
1. Hinge/pivot joint
2. Convex- Humeral capitulum
Concave- Head of radius
3. Flexion, Extension, Pronation, Supination
2. Convex- Humeral capitulum
Concave- Head of radius
3. Flexion, Extension, Pronation, Supination
Distal Radioulnar Joint:
1. What surfaces are convex/concave?
1. What surfaces are convex/concave?
Concave- Radius
Convex- Ulna
Convex- Ulna
Proximal Radioulnar Joint:
1.. What surfaces are convex/concave?
2. What movements occur at the joint?
3. What ligament encircles the joint?
1.. What surfaces are convex/concave?
2. What movements occur at the joint?
3. What ligament encircles the joint?
1. Convex- Rim of the radial head
Concave- Radial notch on the ulna
2. Pronation/Supination
3. Annular ligament
Concave- Radial notch on the ulna
2. Pronation/Supination
3. Annular ligament
Proximal Radioulnar Joint:
1. What direction would you need to apply a glide to increase pronation? Supination?
1. What direction would you need to apply a glide to increase pronation? Supination?
Pronation- posterior glide
Supination- anterior glide
Supination- anterior glide
If a patient presents with a capsular pattern in the elbow, what pathologies would you be suspicious of?
1. Traumatic arthritis
2. Monoarticular steroid sensitive arthritis
3. RA
4. Septic arthritis
5. Arthrosis
6. Fracture of radial head (proximal fracture)
7. Crystal synovitis (gout)
2. Monoarticular steroid sensitive arthritis
3. RA
4. Septic arthritis
5. Arthrosis
6. Fracture of radial head (proximal fracture)
7. Crystal synovitis (gout)
If a patient presents with a non-capsular pattern in the elbow, what pathologies would you be suspicious of?
1. Proximal radioulnar sprain
2. Bicipital tendonitis (radial insertion)
- Passive pronation causes pain because the radial head comes down onto the bicep tendon
3. Ligamentous lesion
4. Bursitis (Olecranon)
5. Loose body
6. Tennis elbow
2. Bicipital tendonitis (radial insertion)
- Passive pronation causes pain because the radial head comes down onto the bicep tendon
3. Ligamentous lesion
4. Bursitis (Olecranon)
5. Loose body
6. Tennis elbow
Pain with resisted elbow flexion would cause you to be suspicious of:
Biceps @ 4 sites:
1. Long head
2. Belly
3. MTJ (musculotendonis junction)
4. TPJ (pain on passive pronation and resisted supination as well)
1. Long head
2. Belly
3. MTJ (musculotendonis junction)
4. TPJ (pain on passive pronation and resisted supination as well)
Pain with resisted elbow extension would cause you to be suspicious of:
Triceps MTJ
Pain with resisted forearm supination would cause you to be suspicious of:
1. Supinator brevis
2. Biceps
*If SPF- distal biceps lesion
2. Biceps
*If SPF- distal biceps lesion
Pain with resisted pronation would cause you to be suspicious of
1. Golfers elbow (medial epicondylitis)- most common
2. Pronator teres (rare)
2. Pronator teres (rare)
Pain with resisted wrist extension would cause you to be suspicious of
1. Tennis elbow (lateral epicondylitis)- lateral ECRB @ lateral insertion
- Supracondylar
- TPJ
- MTJ
- Muscle belly
- Supracondylar
- TPJ
- MTJ
- Muscle belly
Pain with resisted wrist flexion would cause you to be suspicious of
1. Golfers elbow (medial epicondylitis)
- TPJ
- MTJ
- TPJ
- MTJ
Bursitis of the elbow
1. Epicondylar (RA)
2. Radiohumeral
2. Radiohumeral
What manipulation technique would you use for a patient suffering from lateral epiconylitis?
Mills manipulation, only if elbow extension has full PROM and painless
What treatment would you use for lateral epicondylitis at the following sites:
1. ECRL (origin)- Supracondylar
2. Common extensor tendon- tenoperiosteal
3. Body of extensor tendon- tendinous
4. Belly of muscle- muscular
1. ECRL (origin)- Supracondylar
2. Common extensor tendon- tenoperiosteal
3. Body of extensor tendon- tendinous
4. Belly of muscle- muscular
1. DFM
2. DFM and Mills manipulation (only if passive extension is full and painless)
3. DFM
4. Injection of Procaine
2. DFM and Mills manipulation (only if passive extension is full and painless)
3. DFM
4. Injection of Procaine
What is the most common site for Lateral Epicondylitis
ECRB
UCL Repair:
1. What is the goal of the surgery?
2. What is the most common donor tissue?
1. What is the goal of the surgery?
2. What is the most common donor tissue?
1. Restore static stability of the anterior band
2. Palmaris longus
2. Palmaris longus
Describe the steps of an UCL repair
1. Dissection down to the flexor mass, retracted anteriorly
2. Visualization and inspect of the UCL
a. Complete rupture- joint will be visible
b. Potential undersurface tear examined through longitudinal incision in anterior band
3. Remnants of ligament augment repair
2. Visualization and inspect of the UCL
a. Complete rupture- joint will be visible
b. Potential undersurface tear examined through longitudinal incision in anterior band
3. Remnants of ligament augment repair
Describe the surgical steps of an UCL repair
1. 2 drill holes are made @ right angles just anterior and posterior to the sublime tubercle @ the level of insertion of the anterior band
2. Proximally, 2 convergent tunnels are drilled to meet @ the insertion of the ligament on the medial epicondyle
3. The graft if passes through the ulna and crossed in a figure 8 across the joint
4. Tensioned at 30 degrees and secured with non-absorbable sutures
2. Proximally, 2 convergent tunnels are drilled to meet @ the insertion of the ligament on the medial epicondyle
3. The graft if passes through the ulna and crossed in a figure 8 across the joint
4. Tensioned at 30 degrees and secured with non-absorbable sutures
What degree of ROM of safe immediately following an UCL repair? Why?
30 degrees of ROM is safe because during the surgery the ligament is tensioned at 30 degrees
What are the general ROM that are allowable following an UCL repair from weeks 1-6 post-surgery?
Week 1 - locked @ 90 degrees
Week 2- -30 to 100 degrees in hinge brace
- Progress in brace 10/10 degrees per week
Week 4 (0-135 degrees)
Week 5- D/C brace
Week 6- AROM
Week 2- -30 to 100 degrees in hinge brace
- Progress in brace 10/10 degrees per week
Week 4 (0-135 degrees)
Week 5- D/C brace
Week 6- AROM
What strengthening exercises can you perform after an UCL repair? When?
Week 2- submax isometrics (keep muscle pump going)
Week 5- light isotonics
Week 9- more agressive strengthening (may not be until week 12)
Week 5- light isotonics
Week 9- more agressive strengthening (may not be until week 12)
Throwers 10 protocol- Kevin Wilk
1. Diagonal pattern- D2 flexion/extension
2. ER and IR tubing
3. Shoulder abduction
4. Full can
5. Side lying ER
6. Prone- horizontal abduction, horizontal abduction @ 100 degrees, row, and row into ER
7. Press-ups
8. Push-ups starting from the wall in standing
9. Elbow flexion and extension
10. Wrist extension and flexion, pronation and supination
2. ER and IR tubing
3. Shoulder abduction
4. Full can
5. Side lying ER
6. Prone- horizontal abduction, horizontal abduction @ 100 degrees, row, and row into ER
7. Press-ups
8. Push-ups starting from the wall in standing
9. Elbow flexion and extension
10. Wrist extension and flexion, pronation and supination
Describe the steps of an ECRB release
1. Retract ECRL
2. Debride or release ECRB
3. Check for extensor digitorum involvement
4. Partial decortication of epicondyle
5. Scope Db same but from inside joint
2. Debride or release ECRB
3. Check for extensor digitorum involvement
4. Partial decortication of epicondyle
5. Scope Db same but from inside joint
Describe the ROM rehab following ECRB release
Week 1-2: at least 60% PROM (extension will be more limited b/c of increase tautness of tissue)
Week 3- Full PROM
Week 3- Full PROM
Describe the Strengthening rehab follow ECRB release
Start @ 2 weeks post-op
Progress as tolerated (maintain good skin closure)
Isometric --> Isotonic
No isotonics until full PROM
Progress as tolerated (maintain good skin closure)
Isometric --> Isotonic
No isotonics until full PROM
About this deck
By: Mike Rigdon
Created: 2011-02-22
Size: 72 flashcards
Views: 49
Created: 2011-02-22
Size: 72 flashcards
Views: 49
About StudyBlue
STUDYBLUE makes things that make you better at school.
Things like online flashcards with photos and audio.
Things like personalized quizzes and friendly reminders about when (and what) to study next.
Think of it as a digital backpack™: access to all of your study materials online and on your phone.
STUDYBLUE exists to make studying efficient and effective for every student, for free. Join us.
“Simply amazing. The flash cards are smooth, there are many different types of studying tools, and there is a great search engine. I praise you on the awesomeness.”
Dennis
Dennis