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39 Cards in this Set
- Front
- Back
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Osteochondritis Dissecans Age group? MOI? Is it common? results in? |
>10 yo -compression lesion of radiocapitellar joint, bony articular injury to anterolateral capitellum -leading cause of permanent elbow disability in young pitching athletes -repetitive chronic impact of radial head against capitellum during cocking and acceleration phase -results in: loose bodies, overgrowth of radial head, early arthritic changes
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Osteochondritis Dissecans
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-crepitus with sup/pron, TTP over joint, insidious onset
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Osteochondritis Dissecans
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Tx: dependent on cartilage -intact and stable can be tx conservatively -activity mod 3-6 weeks -when motion is full, begin isometrics -exercise to lateral compartment limited -gradual return to activity 3-6 months -Surgical: only if failed non-operative tx, presence of loose bodies and unstable lesions
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Olecranon Bursitis
bursa location? Causes? tx?
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-aka Miner’s elbow, student’s elbow -bursa between superior olecranon and skin -Causes: trauma, inflammatory disease (gout), infection, prolonged pressure -Tx: medication, relative rest, padding -may need to be drained or else it can lead to cellulitis, may require resection if a thick scar
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Tendon Ruptures -Brachialis:
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-dislocation commonly associated -myositis ossificans or delayed instability if unrecognized dislocation -most tears are partial
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-Triceps Avulsion or Rupture |
-deceleration stress superimposed on contracting triceps
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Distal Humerus Fx:
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-extension fx caused by FOOSH -flexion fx occur more in elderly bc not quick enough to protect themselves -aa and nn at risk
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Supracondylar Fx:
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-transverse fx of the distal 1/3 of humerus PT: held in flexion to allow triceps to help maintain fx in stable position -AROM of shoulder and wrist while immobilized -PROM may stress healing site |
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Type 1 Supracondylar Fx: |
FOOSH, distal fragment posterior (majority of humerus posterior), pull of triceps →
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Type 2 Supracondylar Fx: |
flexion injury, direct trauma to posterior elbow, distal fragment anterior → |
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Olecranon Fx:
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-direct fall on point of elbow, hyperextension force that also dislocates joint, forceful contraction of triceps, triceps tendon rupture
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Displayed Olecranon Fx: |
ORIF -AROM flexion past 90 not allowed until 8 weeks -fully recovery 6 months to 1 year! |
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Non-Displayed Olecranon Fx: |
-immobilization 6-8 weeks -gentle AROM 3 weeks -flexion no more than 90 for 6 weeks
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Posterior Dislocation
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-closed reduction and immobilization in 90 flexion for 3-6 weeks -hand and shoulder motion allowed -no passive stretching bc of risk of myositis ossificans -other structures usually injured bc of serverity (may take up to 12 weeks to heal) -most common complication is loss of extension -after 10 weeks, 30 degree loss of extension common; 10 deg loss after 2 years |
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Elbow Fracture-Dislocation |
-passive stretching strictly avoided -loss of pronation/supin if immob > 4 weeks -loss of extension
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-child presents with what? for radial head dislocation |
elbow pronated, partially flexed, and held by side
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tx of radial head dislocation |
-immobilization not necessary for first episode -tx of subluxation delayed > 12 hrs following reduction -UE immobilized 10 days in long arm posterior splint elbow in 90 flexion and forearm full supination -if 3x, cast for 3 weeks -closed chain exercises if no fx
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Distal Radioulnar Joint arthrok |
(Concave on Convex) 1. Dorsal Glide -open pack -increases supination 2. Ventral Glide -loose pack -increases pronation
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Proximal Radioulnar Joint arthrok |
1. Dorsal Glide -loose pack -increases pronation 2. Ventral Glide -loose pack -increases supination
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Humeroradial Joint arthro Distraction technique |
(Concave on Conex) 1. Distraction -loose pack -good for general motion, and for reducing a proximal positional fault -may increase distraction by ulnarly deviating wrist
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Humeroradial Joint Compression technique |
2. Compression -elbow 90 flex, neutral rotation, wrist extension -PT’s hand under pt’s elbow, other hand grasps pt’s hand on the volar surface -compress through the radius -good for distal positional faults -may increase the effect by radially deviating the wrist
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Humeroradial Joint Dorsal/ventral glide |
3. Dorsal Glide -loose pack -glide proximal radius dorsally through thenar eminence of PTs hand -increases elbow extension 4. Ventral Glide -loose pack -pt can be sidelying -incrases elbow flexion |
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Humeroulnar Joint arthro Distraction mob |
(Concave on Convex) 1. Distraction, Loose-Pack -pt’s forearm and hand rests on PTs shoulder -good for general joint mobility
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Humeroulnar Joint Lateral/medial glide |
2. Medial Glide -loose pack -pt’s forearm bw PT’s upper arm and trunk to stabilize -good for elbow flexion, extension, abduction 3. Lateral Glide -loose pack -good for flexion, extension, and adduction
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Humeroulnar Joint Lateral/medial gap |
4. Medial Gap -loose pack 5. Lateral Gap -loose pack -be careful not to allow pronation during mob |
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Ulnar Neuritis |
aka Cubital tunnel syndrome
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-Differential Diagnosis for ulnar neuritis |
-Guyon’s Canal -Spinal Cord (ALS, Synringomyelia, C8-T1 nerve roots) -Medial epicondylitis -Thoracic outlet
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Pronator Teres Syndrome test
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-pt seated with elbow flexed to 90 -PT strongly resists pronation and elbow extension simultaneously + test = tingling/paresthesia in the median nerve distribution |
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Tinel Sign test
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-elbow in slight flexion -tap the area of the ulnar groove + test = tingling sensation in the ulnar N distribution
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Elbow Flexion Test
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-pt seated with elbows flexed, wrist extended, and shoulder girdle adducted and depressed -pt holds this position for up to 5 minutes -this position compresses the ulnar N in the cubital groove d/t constriction of the cubital tunnel retinaculum and relaxation of the UCL + test = tingling/paresthesia in the ulnar N distribution
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Radiocapitellar Compression Test
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pt seated with elbow on table in midrange flexion -PT’s hand cups under the elbow on the table with thumb or finger on radial head -PT’s other hands pushes with an axial load to the radiocapitellar joint through the radius via the wrist -PT holds the pt’s wrist in extension and radial deviation -active or passive supination/pronation performed with pt’s arm in midrange flexion + test = pain and crepitus in the radiocapitellar joint is indicative of degenerative changes
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Valgus Extension Overpressure
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-for osteophytes in trochlea and olecranon fossa -pt seated with elbow moved from slight flexion to full extension -pt’s elbow is extended while maintaining a valgus stress + test = pain in the elbow caused by a posteromedial osteophyte abutting the medial margin of the trochlea and olecranon fossa
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1. Tennis Elbow/Cozen’s/Method 1
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-elbow flexed 60-80 deg -pt makes a fist with arm pronated, radially deviates and extends the wrist against resistance + test = pain in lateral epicondyle
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2. Tennis Elbow/Mills/Method 2
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-elbow pronated, wrist flexed -PT palpates the lateral epicondyle, overpressure at the wrist into more flexion and extends elbow + test = pain in lateral epicondyle
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3. Tennis Elbow/Method 3
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-resist extension of 3rd digit distal to the PIP joint + test = pain while contracting the ED mm 4 |
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4. Medial Epicondyle
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-forearm supinated, elbow and wrist extended -palpate the medial epicondyle + test = pain in medial epicondyle
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Ulnar/Medial Collateral Lig (Valgus Stress Test)
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-pt seated in 25 deg elbow flexion -ER shoulder + test = excessive gapping
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2. Good Hands
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-elbow 30 deg flexion and supinated + test = pain in lateral elbow -also perform #1 with this test
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3. Radial/lateral Collateral Ligament (Varus Stress Test)
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-elbow 25 flexion -ensure limited arm IR and pronation + test = excessive gapping
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