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hip and elbow
hip and elbow from jon's study guide
271
Anatomy
Graduate
11/06/2012

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Term
what potential systemic problems can masquerade as a hip dx
Definition
cancer (spinal metastasis, tumors), arterial insufficiency, urologic/renal, psoas abscess, appendicitis, diverticulitis, PID, ankylosing spondylitis, osteoporosis, TB, sickle cell, hemophilia
Term
Describe Gilmore's groin tear
Definition
adductor tear at their attachment to pubic ramus
Term
does overuse or overstress cause acute strain
Definition
overstress
Term
does overuse or overstress cause chronic strain
Definition
overuse
Term
describe grade 1 muscle strain
Definition
mild. Muscle has been stressed. Won't be painful/irritated until after the activity
Term
describe grade 2 muscle strain
Definition
moderate. The person usually feels the strain during the activity
Term
describe grade 3 muscle strain
Definition
severe. Muscle torn 75-100%
Term
where do most muscle strains/tears occur
Definition
musculotendinous junction
Term
does deleceration or acceleration cause more muscles strains?
Definition
deceleration
Term
what are causes of muscle strains
Definition
deceleration, acceleration, imbalance in strength, flexibility imbalance, weakness
Term
what are some commonly strained muscles
Definition
hamstrings, adductor longus, iliopsoas, rectus femoris
Term
what is the rehab time for mild muscle strains
Definition
2-3+ weeks
Term
what is the rehab time for severe muscle strains
Definition
up to 6 months
Term
what is the good thing about muscle injuries
Definition
there is a lot of blood to help heal.
Term
how to treat muscle strains
Definition
need to reduce swelling and get scar tissue down. As soon as pt can tolerate movement through the range, get them on a bike so they can elongate the muscle but control it. Rhythmic, repetitive motion to align scar tissue in the direction you want.
Term
what are signs/symptoms of muscle strains
Definition
ecchymosis, hemorrhage, pain with resistance, decreased PROM, TTP at lesion, swelling, defect
Term
when would the lesion not be TTP for muscle strain
Definition
if the muscle is not intact and there are no intact nerve endings
Term
Intervention for chronic muscle strain?
Definition
focus on prevention. Progress activities so muscle-tendon unit can with stand heavier workload. Maybe compression. Late stage rehab for active person: closed kinetic chain exercises, eccentrics
Term
Intervention for acute/subacute muscle strain?
Definition
RICE, deep friction massage to promote organized alignment of new fibers, myofasical release, gentle stretching, anti-inflammatory modalities, gradually resume activity, protect
Term
how long after acute muscle strain is there increased vulnerability for re-injury
Definition
5-7 days
Term
does iliopectineal bursitis or trochanteric bursitis occur less frequently?
Definition
iliopectineal bursitis
Term
where is pain with iliopectineal bursitis
Definition
groin
Term
when does someone with iliopectineal bursitis feel pain
Definition
resisted hip flexion, passive hip extension
Term
what causes a hip pointer
Definition
contusion to iliac crest
Term
when does someone with hip pointer feel pain
Definition
abdominal contraction, abduction
Term
interventions for hip pointer
Definition
rest, compression, ice, anti-inflammatory meds, anti-inflammatory modalities, refer for imaging, protect
Term
where do avulsions/apophyseal injuries occur
Definition
AIIS, ASIS, GT, LT, ischial tuberosity, iliac crest, symphysis pubis
Term
what causes extra-articularsnapping hip
Definition
ITB passes over GT OR iliopsoas snaps over front of hip
Term
what are the causes of intra-articular snapping hip
Definition
labrum: tear in labrum gets caught between acetabulum and femoral head. Loose body: loose body gets caught and makes a click.
Term
what is OA
Definition
loss of articular cartilage and reactive bone formation leading to pain, defromity, disability
Term
what is the most common hip problem
Definition
OA
Term
what is the path of locatino of hip OA pain
Definition
pain first felt in groin, then in anterior thigh and knee. Sometimes only complaint is knee pain
Term
what will you see in observation in patient with OA
Definition
difficulty rising from chair, antalgic gait, maybe assistive device, difficulty dressing (esp putting shoes and socks on)
Term
what will you see in inspection in patient with OA
Definition
atrophy of glutes and abductors, joint tightness, compensatory postural changes, asymmetry in bony landmarks
Term
what things to test for OA
Definition
PROM, capsular pattern, joint play, strength, functional activities, neuro screens, palpation, special tests
Term
how will PROM be in someone with OA
Definition
limited by pain/spasm if acute; limited by soft tissue restriction/discomfort if chronic
Term
what is the capsular pattern for the hip
Definition
flexion, abduction, IR but order can vary
Term
what to look for in joint play testing that indicates OA
Definition
restrictions in all ROM, hard end feel
Term
what determines strength in someone with OA
Definition
pain
Term
what are functional activities that cause pain in someone with OA
Definition
squatting, stair climbing, sitting, bending
Term
what are functional concerns for hip OA patients
Definition
balance, fall risk
Term
are neuro screens typically issues for OA patients
Definition
no
Term
how to palpate for hip OA
Definition
typically unable to locate one tender area with palpation
Term
what are special tests for hip OA
Definition
trendelenburg, scour, FABER
Term
describe trendelenburg test
Definition
in SLS, a drop of the iliac crest opposite stance leg = + indicating glute weakness of stance side
Term
describe scour test
Definition
flex knee, give axial pressure, run femur around superior rim of acetabulum from Add/IR to ABD/ER
Term
describe FABER
Definition
put leg in flexion, abduction, ER (figure 4)
Term
what is the onset of trochanteric bursitis
Definition
insidious or acute
Term
what sometimes goes along with trochanteric bursitis
Definition
ITB snapping
Term
what is the site of pain for trochanteric bursitis
Definition
lateral hip, radiates distally to lateral thigh and knee. Occasionally in lumbosacral region
Term
what is the nature of pain in trochanteric bursitis
Definition
deep, achy
Term
what functional activities cause pain with trochanteric bursitis
Definition
ascending stairs, rolling on involved side, other activities that press ITB into bursa
Term
will you see swellin, redness with trochanteric bursitis
Definition
no
Term
describe PROM with trochanteric bursitis
Definition
pain at very end range Abduction. Pain with flexion, adduction, IR
Term
what resisted motion causes pain with trochanteric bursitis
Definition
abduction
Term
what special test is positive with trochanteric bursitis
Definition
Ober's: Positive because they won't relax because relaxing hurts
Term
what is joint play like with trochanteric bursitis
Definition
normal mobility, painless
Term
will a neuromuscular exam show anything with trochanteric bursitis
Definition
no
Term
what will palpation show with trochanteric bursitis
Definition
tenderness over posterolateral GT. Occasional lateral thigh referred tenderness
Term
what determines gait change in someone with trochanteric bursitis
Definition
pain
Term
what causes acute labral tears
Definition
twisting with axial loading as in golf
Term
what causes chronic labral tears
Definition
low grade loading over time OR hip dysplasia
Term
what are the 2 types of femoral acetabular impingement?
Definition
CAM, Pincer
Term
what is the cam type femoral acetabular impingement
Definition
enlargement of femoral neck on anterior portion, causes pain with flexion and IR when the enlargement hits the acetabulum
Term
what is pincer femoral acetabular impingement
Definition
enlargement of acetabulum will put a pressure dent into the femoral neck when with IR and flexion. Gets irritated over time.
Term
in what population is femoral acetabular impingement most common?
Definition
young, active
Term
what is the onset of femoral acetabular impingement like?
Definition
slow onset of groin pain
Term
when does pain increase in someone who has femoral acetabular impingement
Definition
increases with high demand activities and sitting
Term
what are clinical indications of femoral acetabular impingement
Definition
ROM limitations of ADD and IR esp with hip flexed to 90; scour, labral tests
Term
what labral tests are positive with femoral acetabular impingement
Definition
F-AB-ER into E-AD-IR and F-AD-IR into E-AB-ER
Term
what does positive trendelenburg indicate
Definition
OA
Term
what does positive scour indicate
Definition
OA or FAI
Term
what does positive FABER indicate
Definition
OA, iliopsoas problem, SI problem
Term
what does positive OBER's indicate
Definition
tight IT band, trochanteric bursitis
Term
what does positive F-AB-ER into E-AD-IR indicate
Definition
femoral acetabular impingement, labral tear/impingement
Term
what does F-AD-IR into E-AB-ER indicate
Definition
femoral acetabular impingement, labral tear/impingement
Term
define greenstick fracture
Definition
one side of the bone is broken, the other is bent
Term
define torus fracture
Definition
cortical buckling
Term
define stress fracture
Definition
microscopic fractures
Term
define bowing fracture
Definition
bending of the bone
Term
define transverse fracture
Definition
fracture straight across the bone
Term
define oblique fracture
Definition
fracture occuring at angle across the bone
Term
define spiral fracture
Definition
fracture twisting around bone shaft
Term
define comminuted fracture
Definition
fracture in which bone splintered into fragments
Term
define depressed fracture
Definition
fracture in which fragments are driven
Term
define compressed fracture
Definition
bone compressed on one side (think vertebral)
Term
define pathologic fracture
Definition
occurs through area of diseased bone
Term
define avulsion fracture
Definition
pulling away a fragment of bone by ligament or tendon
Term
define epiphysis fracture
Definition
fracture through epiphysis
Term
what are the 4 possible fracture sites
Definition
diaphysis, metaphysis, epiphysis, intra-articular
Term
what is the metaphysis
Definition
the part of the long bone adjacent to epiphyseal plate that grows during childhood
Term
what is a complete fracture
Definition
bone fragments separate completely
Term
what is an incomplete fracture
Definition
bone fragments are still partially joined
Term
what are the 4 configurations of fractures
Definition
transverse, oblique, comminuted, spiral
Term
how do we describe the relationship of the fragments in a fracture
Definition
displaced, undisplaced
Term
how do we describe displacement of one fracture compared to another
Definition
describe it as the placement of the distal segment compared to the proximal segment
Term
what are the 2 relationships to the environment of a fracture
Definition
closed, open
Term
what is an open fracture
Definition
fracture or object penetrated the skin
Term
if a fracture has varus angulation, what does that mean
Definition
distal segment is angulated toward midline
Term
what do we call it when a fractured bone is now shorter than it should be
Definition
shortening
Term
are bones weaker in tension or in compression
Definition
weaker in tension
Term
describe a butterfly fracture
Definition
bone fails on tension side first, which puts even more force on the part of the bone that is still connected. However, the other part of the bone is still strong in compression, so the fracture goes above or below the compressed part of the bone
Term
what is the purpose of ottowa ankle rules
Definition
decision aid for excluding fractures of ankle and midfoot to help ppl avoid unnecessary xrays
Term
what are the Ottowa Ankle Rules
Definition
if you are between ages 2-55 and have any of the following, you need an xray: 1. tender over posterior 6cm or tip of med/lat malleoli; tender base of 5th metatarsal; tender navicular; inability to bear weight 4 steps BOTH immediately AND in ER (limping ok)
Term
what is the purpose of ottowa knee rules
Definition
decision aid for excluding fractures of the knee and help ppl avoid unnecessary xrays
Term
what are the Ottowa Knee Rules
Definition
Age 55 or older; Isolated tenderness over patella; Tender fibular head; Unable to flex knee past 90; Unable to bear weight immediately OR in ER for 4 steps
Term
what does Salter Harris classify
Definition
growth plate injuries
Term
what is a Salter Harris Type I
Definition
Separation of epiphysis from metaphysis. Rarely manipulated; requires immobilization
Term
what is a Salter Harris Type II
Definition
Epiphysis and growth plate partially separated from cracked metaphysis
Term
what is a Salter Harris Type III
Definition
fracture goes completely through epiphysis and separates part of the epiphysis and growth plate from the metaphysis
Term
what is the most common Salter Harris fracture
Definition
Type II: epiphysis and growth plate partially separated from cracked metaphysis
Term
how is a Type II salter harris treated
Definition
manipulated and immobilized
Term
is a type III salter harris fracture common
Definition
no
Term
how is a type III salter harris treated
Definition
may require surgery
Term
what is a type IV salter harris
Definition
fracture runs through epiphysis, across growth plate, into metaphysis
Term
how is type IV salter harris treated
Definition
requires surgery
Term
what is a type V salter harris
Definition
occurs when the end of the bone is crushed and the growth plate is compressed
Term
is a type V salter harris fracture common
Definition
no
Term
what is the prognosis for a type V salter harris fracture
Definition
poor: stunted growth
Term
what is the SALTR mnemonic
Definition
Straight across, Above (in metaphysis), Lower (in epiphysis), through (metatphysis, growth plate, epiphysis), Rammed
Term
what are the 3 types of acetabular fractures
Definition
posterior, anterior, central
Term
what is the most common type of acetabular fracture
Definition
posterior
Term
what is the MOI of a posterior acetabular fracture
Definition
forceful trauma
Term
what is a complication of posterior acetabular fracture
Definition
AVN
Term
what precautions must be used with posterior acetabular fracture
Definition
hip dislocation precautions
Term
is an anterior acetabular fracture rare
Definition
yes
Term
what is an MOI of central acetabular fracture
Definition
force of femoral head into acetabulum
Term
what are the 4 types of femoral neck fractures
Definition
subcapital, transcervical, basilar, intertrochanteric
Term
which femoral neck fracture types are intracapsular
Definition
subcapital, transcervical, basilar
Term
where is a subcapital fracture
Definition
just below the head
Term
where is a transcervical fracture
Definition
through the middle of the neck
Term
where is a basilar fracture
Definition
at the junction of the neck and shaft
Term
where is an intertrochanteric fracture
Definition
extracapsular: from GT to LT
Term
what is important in an intertrochanteric fracture
Definition
blood flow
Term
what must be avoided in an intertrochanteric fracture
Definition
active SLRs
Term
what are the 4 types of femur fractures
Definition
subtrochanteric, mid-shaft, supracondylar, condylar
Term
are subtrochanteric fractures complex?
Definition
yes
Term
what is the WB for subtrochanteric fractures
Definition
NWB-TDWB
Term
what must usually be done to fix a mid-shaft femur fracture
Definition
skeletal traction to align bone and reduce swelling before surgery
Term
what type of hardware is put into mid-shaft fracture
Definition
intermedullary nailing
Term
where is a supracondylar femur fracture
Definition
above the condyles
Term
how is a supracondylar femur fracture repaired
Definition
plates and screws
Term
what is an MOI for condylar fracture
Definition
fall on the knee
Term
what to do in healing condylar fracture
Definition
limint knee ROM
Term
what is a complication of condylar fracture
Definition
OA
Term
what are 4 types of tibial fractures
Definition
tibial plateau, midshaft, bimalleolar, trimalleolar
Term
what other bone is usualy involved in tibia mid-shaft fracture
Definition
fibula
Term
what is the main surgical management for tibial mid-shaft fracture
Definition
intermedullary nailing
Term
what is a distal trimalleolar tibial fracture
Definition
medial malleolus, lateral malleolus, part of the tibia
Term
what are the basic PT interventions for fractures
Definition
initial assessment, ambulation training, weightbearing precautions, AAROM, discharge planning
Term
what walking distance shows that a patient is safe to go home
Definition
50 feet
Term
what are the basics of fracture treatment per dr. dirschl
Definition
Managing trauma means more than making pretty x-rays; fracture reduction is not always required; closed reduction is preferred whenever possible
Term
what are the 2 main requirements for fracture healing
Definition
sufficient mechanical stability and healthy biology
Term
what are the 2 types of mechanical stability
Definition
primary bone healing, secondary bone healing
Term
what is primary bone healing
Definition
no motion whatsoever between fracture fragments. Osteoclasts go right across the segment and osteoblasts follow and heal.
Term
is primary bone healing fast or slow
Definition
slow
Term
what will hold to parts of bone together in primary bone healing
Definition
plates
Term
what are risks of primary bone healing
Definition
if there is too much stability, soft tissues/periosteum is stretched so tight that the cortex under the bone becomes necrotic.
Term
in what types of bones are we more likely to take the risk of necrosis with primary bone healing
Definition
in an area with good bloodflow where bone can heal
Term
what is secondary fracture healing
Definition
when there is a little bit of wiggle that turns the body on to heal faster than if there is no wiggle at all.
Term
why does secondary bone healing heal faster
Definition
periosteum that lines the bones gets involved. Hematoma in fracture site turns to clot, to callous, to cartilage, to bone
Term
what is another term for the healing that occurs in secondary bone healing
Definition
healing with callous = endochondral ossification
Term
what are the necessary parts of healthy biology for fracture healing
Definition
no infection, adequate nutrition, control diabetes if present
Term
what are the 2 goals of fracture care
Definition
relieve pain, restore function
Term
in what ways is pain relieved following fracture
Definition
reduction, stabilization, analgesia
Term
in what ways is function restored following fracture
Definition
reduction, stabilization, rehabilitation
Term
what are the 4 R's of fracture treatment
Definition
recognition of the fracture, reduction if needed, retention of reduction, rehabilitiation
Term
what are the 4 ways to retain fracture reduction
Definition
traction, casts/braces, external fixation, internal fixation
Term
what are the principles of fracture reduction
Definition
reduction is not always required. Closed reduction is preferred whenever possible
Term
what is the principle of closed reduction
Definition
3 point contact and stabilization is necessary to maintain most closed reductions
Term
when are open reductions indicated
Definition
when closed reduction cannot be obtained or maintained, when precise reduction is required
Term
when is precise reduction required necessitating open reduction
Definition
intraarticular fracture when open reduction is needed to restore articular congruity and stability; when surgery is required for function such as a femur fracture
Term
what are the advantages of internal fixation
Definition
rigid fixation, you may be able to visualize the reduction
Term
what are the advantages of external fixation
Definition
maintain biology, early patient mobilization, adjustable
Term
what is the rationale for doing a total joint replacement
Definition
correct alignment, release contractures: need to be sure that the benefits outweigh the risks
Term
what are potential TJR complications
Definition
infections, blood clots, heart attack, stroke
Term
are blood clots common after TJR
Definition
calf clots occur in 50% of knee replacements, but these are not as clinically significant as proximal clots, which are rare but more dangerous
Term
why are heart attacks and strokes potential TJR complications
Definition
because of hypotension of surgery and occasionally because of bone cement
Term
what are the general PT interventions/considerations of TJR
Definition
functional mobility, ADLs, therapeutic exercise, education about precautions, ROM
Term
what are the posterior approach THA precautions
Definition
no flexion > 90, no adduction past neutral, no IR past neutral
Term
should you transfer to injured or uninjured side following posterior approach THA
Definition
transfer to uninjured side
Term
what are the precautions for anterior approach THA
Definition
no flexion > 90, no extension past neutral, no adduction past neutral, no ER past neutral, no combined flexion/abduction/ER
Term
if glute med was incised or a trochanteric osteotomy was done in anterior THA, what are additional precautions
Definition
no active antigravity hip ABD for 6-8 weeks
Term
should you do step to or step through gait after anterior approach THA
Definition
step to the operated hip to avoid hyperextension
Term
what is the onset of developmental hip dysplasia
Definition
present at birth or early in life
Term
what are risk factors of developmental dysplasia
Definition
family history, breech position, female
Term
what are signs/symptoms of early diagnosis of DDH
Definition
asymmetric skin increases, Ortolani, Barlow
Term
what does ortolani test for
Definition
dislocation
Term
how to do ortolani
Definition
leg is adducted and flexed, then lifted into abducted frog legged position. Feel for click/clunk as femoral head pops back into place
Term
what does Barlow test for
Definition
instability
Term
describe the barlow test
Definition
leg is adducted and flexed. Push axially to try to dislocate the hip
Term
what are signs/symptoms of DDH with late diagnosis (1yr)
Definition
asymmetric skin creases, apparent shortening, limited abduction, limp, xrays
Term
what is early treatment of DDH
Definition
maintain reduction with harness that flexes, abducts the hip
Term
what are treatments for someone with DDH who is less than 2-3 years
Definition
obtain and maintain reduction, manipulation, traction, surgical reduction
Term
what are treatments for someone with DDH who is more than 2-3 years
Definition
reduction and reconstruction
Term
what is an acetabular osteotomy
Definition
need to open up acetabulum, put the head in it, but then we also need to reconstruct the acetabulum so that it will face the right direction. Have to put a piece of the ilium in it to keep it in place
Term
what are the reductions/reconstructions for DDH in someone >2-3 years
Definition
femoral osteotomy, acetabular osteotomy
Term
what is the age of onset of Legg-Calve-Perthes
Definition
4-8 years
Term
what is LCP
Definition
bone necrosis of femoral epiphysis
Term
what are the signs/symptoms of LCP
Definition
limp; loss of ABD; loss of IR; atrophy; mild activity-related pain (maybe in knee)
Term
what are prognostic factors for LCP
Definition
age of onset, extent of involvement, range of motion, sphericity
Term
what is the most important prognostic factor that we can do something about in LCP
Definition
sphericity of femoral head
Term
what is the best way to promote sphericity of femoral head
Definition
surgery
Term
what is the age of onset of slipped capital femoral epiphysis
Definition
boys 10-16 years; girls 9-14 years
Term
what are the characteristics of a kid who is most likley to have slipped capital femoral epiphysis
Definition
more common in boys and obese children
Term
what are the signs/symptoms of slipped capital femoral epiphysis
Definition
same as legg calve perthese disease but in an older child: limp, pain with activity (could be in knee), limited IR, limited ABD, atrophy
Term
what are the intervnetions of slipped capital femoral epiphysis
Definition
stop progression: put in a screw to keep epiphysis from slipping further; correct alignment if needed to prevent AVN
Term
what is the functional range of motion of elbow F/E
Definition
30-130
Term
what is the functional range of motion of elbow sup/pron
Definition
50-50
Term
what is the natural range of elbow motion sup/pron
Definition
85-75
Term
what type of person is most likely to get lateral epicondylitis
Definition
most commonly seen in males 35-50 yo in dominant arm
Term
what is the tendon that is injured in lateral epicondylitis
Definition
extensor carpi radialis brevis
Term
how is lateral epicondylitis diagnosed
Definition
pain/tenderness at lateral epicondyle, +Cozen's test, + Mill's test, + Chair lift test, normal x-rays
Term
what is the cozen's test
Definition
pain with resisted wrist extension and supination
Term
what is mill's test
Definition
pain with passive wrist flexion with elbow extended
Term
what is a positive chair lift test
Definition
pain with lifting back of chair with 3 finger pinch and extended elbow
Term
what are differential diagnoses of lateral epicondylitis
Definition
cervical pathology, shoulder, DJD of radial head/olecranon, fracture, radial nerve
Term
how to determine that cervical pathology C5 C6 is not causing lateral epicondylitis symptoms
Definition
if you put your hand on your head and that relieves pain, it is taking strain off the nerve implicating cervical tissues
Term
how to rule out shoulder problems that look like lateral epicondylitis
Definition
TOS testing
Term
what are potential mechanisms of lateral epicondylitis
Definition
trauma, repetitive use
Term
why is lateral epicondylitis such a bugger
Definition
poor blood supply to tendon, insufficient healing. Cyclical symptoms: sub-clinical and back
Term
what are non-operative interventions for lateral epicondylitis
Definition
rest, ice, NSAIDs, wrist brace, modalities, corticosteroid injections, PT
Term
do most patients do well with non-operative treatment of lateral epicondylitis
Definition
yes
Term
what are the 3 types of operative treatments of lateral epicondylitis
Definition
open, percutaneous, arthroscopic
Term
what is an open operation to repair lateral epicondylitis
Definition
excise ECRB, decorticate ECRB attachment area, pin it back down
Term
what is a percutaneous operation for lateral epicondylitis
Definition
release ECRB without pinning it back down
Term
what tendons are involved in medial epicondylitis
Definition
pronator teres, flexor carpi radialis
Term
how is medial epicondylitis diagnosed
Definition
Reverse Cozen's, Reverse Mill's
Term
what is reverse cozen's test
Definition
pain with resisted wrist flexion and pronation
Term
what is reverse mill's test
Definition
pain with passive wrist extension and elbow extended
Term
what are MOIs of medial epicondylitis
Definition
faulty mechanics, work station/athletic equpiment
Term
what are treatments for medial epicondylitis
Definition
cross friction massage, controlled exercise progressed based on pain, ice
Term
what types of exercises are good for medial epicondylitis
Definition
eccentric, controlled. Use theraba. 3 x 15 twice a day for 6-12 weeks. Gradually increase frequency, intensity, duration
Term
what nerve is impinged with cubital tunnel syndrome
Definition
ulnar
Term
how is cubital tunnel syndrome/ulnar nerve impingement diagnosed?
Definition
pain in ulnar nerve distribution, symptoms increase with activity, weakness and atrophy of hypothenar eminence and thumb adductor, + Tinel's sign, + Upper Limb Tension Test, pain with hyperflexion
Term
what are MOIs of ulnar nerve impingement
Definition
direct trauma, traction, compression, recurrent subluxation, degenerative changes of surrounding bone
Term
where would compression of ulnar nerve occur
Definition
in cubital tunnel, at arcade of struthers, at arcade of osborne
Term
what are interventions of ulnar nerve impingement
Definition
rest, NSAIDs, education and protection, strengthen surrounding muscles, maintain ROM and nerve mobility, surgery
Term
how long after ulnar nerve surgery can athletes return to play
Definition
3 months
Term
what usually impinges the median nerve with pronator teres syndrome
Definition
pronator teres, ligament of struthers, bicipital aponeurosis, flexor digitorum superficialis
Term
how is median nerve impingement with pronator teres syndrome diagnosed
Definition
pain along median nerve distribution, median nerve sensory disturbance, weakness to the motor distribution (pronator teres may be spared)
Term
what are MOIs for median nerve impingement with pronator teres syndrome
Definition
repeated forceful pronation and finger flexion, trauma, compression, hypertrophy from repetitive gripping
Term
interventions for median nerve ontator teres syndrome
Definition
protection, rest, decreased activity
Term
what is most likely entrapping the median nerve with anterior interosseous syndrome
Definition
pronator teres, FDS, FDP/FDL interface
Term
how is anterior interosseous syndrome diagnosed
Definition
deep forearm pain, no sensory disturbance (pure motor), weakness to FPL/lateral FDP/quadratus, + pinch grip test
Term
what is a positive pinch grip test
Definition
can't make ok signor can't keep fingertip to fingertip with resistance
Term
potential mechanisms for median nerve impingement anterior interosseous syndrome
Definition
repeated forceful finger flexion, trauma, compression, hypertrophy
Term
what are interventions for anterior interosseous syndrome
Definition
protection, rest, decreased activity
Term
what is another term for radial nerve impingement
Definition
posterior interosseous syndrome
Term
how is radial nerve impingement diagnosed
Definition
weakness, but pain is not at lateral epicondyle. Deep forearm pain. maudsley's test
Term
what is maudsley's test
Definition
resist 3rd finger extension. Pain at lateral epicondyle = lateral epicondylitis. Pain in forearm = posterior interosseous syndrome
Term
what is a differential diagnosis for radial nerve impingement
Definition
lateral epicondylitis
Term
what are mechanisms for radial nerve impingement
Definition
entrapment of supinators in Arcade of Froshe caused by grip with supination, wrist or finger extension, throwing
Term
if there is weakness with no pain, and there is no sensory loss, where is the radial nerve impingement
Definition
in or below the Arcade of Froshe
Term
if there is weakness with no pain, and there is sensory loss, where is the radial nerve impingement
Definition
proximal to Arcade of Froshe
Term
what are mechanisms for radial nerve impingement that has weakness and pain
Definition
trauma: radial fracture/dislocation or subluxation that puts pressure on radial nerve
Term
what type of injury is little league elbow
Definition
variation of UCL injury
Term
what else is going on with little league elbow
Definition
separation/stress of growth plate at medial epicondyle, may have associated radial shearing
Term
diagnosis of little league elbow
Definition
TTP, + Tinel's sign of ulnar nerve, 0 deg extension valgus stress test
Term
what are potential mechanisms of little league elbow
Definition
traumatic or repetitive valgus stress
Term
interventions for little league elbow
Definition
rest, NSAIDS, assess biomechanics that caused injury, strengthen flexor carpi ulnaris and FDS, surgery
Term
what type of surgery is done on little leaguer
Definition
Tommy John Procedure: use plamaris longus or extensor hallucis tendon to repair UCL.
Term
when can little leaguer play again after tommy john procedur
Definition
6 months
Term
how long must little leaguer be in splint without ROM after Tommy John procedur
Definition
1 week
Term
describe ligament injury trace
Definition
normal joint play. 1-2mm movement
Term
describe grade I ligament injury
Definition
integrity maintained, 0-25% injury, up to 5 mm movement, pain, solid end feel
Term
describe grade II ligament injury
Definition
partial integrity loss, moderate injury, 25-75% injury, 6-10mm movement, pain, solid-mushy end feel
Term
describe grade III ligament injury
Definition
75-100% injury, severe, >10mm movement, possibly no pain because of complete rupture
Term
what are some complications of post surgical elbow rehab
Definition
HO, capsular tightness
Term
when does capsular tightness occur following elbow surgery
Definition
after immobilization
Term
what is HO
Definition
heterotopic ossification: extra bone growth in an area where it shouldn't be
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