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92 Cards in this Set
- Front
- Back
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What are the nerve roots of the musculocutaneous nerve?
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C5 - C7
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What are the nerve roots of the radial nerve?
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C5 - T1
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What are the nerve roots of the medial nerve?
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C6 - T1
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What are the nerve roots of the ulnar nerve?
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C8 - T1
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What is the typical ROM in the elbow (from flexion to extention)?
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5 of hyperextention - 145 degress of flexion
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How much flexion/extention ROM is necessary at the elbow for ADLs?
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30 - 130 degrees
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TRUE or FALSE
We can lose 30 degrees of elbow extension and still be okay. |
TRUE
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What is the typical ROM for pronation and supination?
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85 degree of pronation -- 75 degrees of supination
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What is the function arc for elbow flexion?
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30 - 130 degrees (100 degree arc)
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What is the functional arc necessary for ADLs in pronation/supination?
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50 degrees in either direction (pronation/supination)
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What two muscles are primarily used for supination of the forearm?
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biceps brachii and supinator
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1) Which muscle is used for heavy tasks of supination?
2) Lighter tasks? |
1) heavier tasks uses biceps brachii
2) lighter tasks uses supinator (biceps doesn't fire) |
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What are 4 potential reasons for a lack of active supination in a patient?
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1) cervical impingement (C5 - C7)
2) tight pronators 3) weak supinators 4) interosseous membrane |
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What can happen as a result of a tight supinator muscle?
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Inability to pronate
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Posterior Interosseous Nerve is a branch of which nerve?
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radial nerve
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Anterior interosseous nerve is a branch of which nerve?
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median nerve
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Which muscle attaches near where the radial nerve comes around the lateral humerus?
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ECRL
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Which muscle does posterior interosseus nerve come through that could cause impingement if tight?
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supinator
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What muscle group would be affected by posterior interosseous nerve syndrome (radial nerve entrapment)?
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wrist extensors
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What is a cause of pronator syndrome?
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compression of the median nerve as it comes through the PT muscle
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What is a result of a tight pronator teres muscle?
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limited supination
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What is pronator syndrome?
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median nerve entrapment/compression as it comes through PT muscle
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What is anterior interosseus nerve syndrome?
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more distal, motor only, and presenting similar Sxs as pronator teres syndrome
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What is radial head resection?
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removal of the radial head after an injury
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Are muscles disrupted during radial head resection?
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No. All muscles attach below the radial head on the shaft of the radius.
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1) What part of the elbow breaks in adults during a dislocation?
2) In kids? |
1) radial head
2) supracondylar ridge |
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What is the MOI for a radial head fx or dislocation?
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Fall on an outstretched hand
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What position is the arm in for a posterior dislocation of the ulna/fx of the radial head?
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supinated and then the elbow goes valgus and causes compression of the lateral side where the radius is
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What muscle is affected by the ulna dislocating posteriorly (humeral head comes anterior)?
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brachialis
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What ligament resists posterior translation of the ulna?
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lateral collateral ligament, medial collateral, not radial portion of lateral collateral
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What is the main problem after immobilization due to a fracture?
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fractures result in post-immobilization capsular tightness
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What is a capsular pattern for tightness after immobilization?
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FLEX > EXT (flexion is more limited than extension)
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What is a muscular pattern for tightness after immobilization?
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EXT > FLEX (extenision more limited than flexion)
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What direction must a person apply a mobiliation force to distract the ulna from the humerus?
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proximally against the elbow at 45 degree angle, pushing posterior/distally
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What is an another problem besides a radial head fx during an ulnar posterior dislocation?
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capitulum gets broken off
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TRUE or FALSE
PTs can distract the ulna from the humerus by applying an inferior force? |
FALSE -- the olecranon process inhibits this (must push posterior/inferior at a 45 degree angle)
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What direction is the roll/glide of the ulna at the elbow joint during open chain elbow flexion?
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ANTERIOR -- NOT superior as it might seem
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What direction is the roll/glide of the radius at the elbow joint during open chain elbow flexion?
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anterior
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How might a nondisplaced radial head fracture be treated?
(A Crack) |
2-3 wks of immobilization (no surgery)
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How might a displaced radial head fx be treated?
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If it's displaced more than 2-3 mm, then it requires surgery
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What are the options for treating a displaced radial head fracture?
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1) radial head resection
2) prosthetic implant |
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How might a comminuted radial head fx be treated?
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Surgery will be required -- either radial head resection or prosthetic implantation
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Which set of ligaments protect from a valgus force at the elbow?
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Medial collateral ligament
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Which set of ligaments protect from a varus force at the elbow?
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Lateral collateral ligaments
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What part of the capsular ligaments are injured in a dislocation of the ulna from the humerus?
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anterior portion of capsular ligaments
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What are the arthrokinematics at the proximal radioulnar joint during pronation (radius on ulna)?
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(Convex radial head on concave ulna) SO roll anterior and glide posterior
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What are the arthrokinematics at the proximal radioulnar joint during supination (radius on ulna)?
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(Convex radial head on concave ulna) SO roll posterior and glide anterior
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What are 4 nerves associated with the elbow?
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Musculocutaneous, radial, medial, ulnar
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Which nerve has innervation from C5 - C7 nerve roots?
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musculocutaneous nerve
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Which muscle has innervation from C5 - T1 nerve roots?
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radial nerve
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Which nerve has innervation from C6 - T1 nerve roots?
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median nerve
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Which muscle has innervation from C8 - T1 nerve roots?
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ulnar nerve
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What type of muscles attach to the medial epicondyle?
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pronators, flexors
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What type of muscles attach to the lateral epicondyle?
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supinators, extensors
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Which nerve passes laterally around the lateral epicondyle (and therefore innervates most extensors and supinators)?
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radial nerve
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Which nerve passes anterior to the medial epicondyle?
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Median nerve
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Which nerve passes posterior to the medial epicondyle?
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ulnar nerve
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Anterior interosseous nerve is a branch of what nerve?
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median nerve
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Posterior interosseous nerve is a branch of what nerve?
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radial nerve
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What are the 2 main elbow extensors and their innervation?
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1) triceps brachii
2) anconeus Both are innervated by radial nerve |
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What are the 4 main elbow flexors and their innervations?
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1) biceps brachii -- MCN
2) brachioradialis -- RN 3) pronator teres -- MN 4) brachialis -- lat 1/2 RN, MCN |
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What are the 2 main pronators of the forearm and their innervation?
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1) pronator teres
2) pronator quadratus both are innervated by median nerve |
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What are the 2 main supinators of the forearm and their innervation?
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1) biceps brachii -- MCN
2) supinator -- RN |
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What are two nerves that innervate supinator muscles?
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MCN and RN
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What are 3 nerves that innervator elbow flexors?
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MCN, RN, MN
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1) What is a nerve that innervates extensor muscles?
2) What happens if this nerve gets damaged? |
1) RN
2) paralysis of the extensor muscles |
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What is a nerve that innervates pronator muscles?
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MN
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Where is the sensory innervation of the musculocutaneous nerve?
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lateral forearm, and lateral/proximal humerus
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Where is the sensory innervation of the radial nerve?
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posterior/lateral distal forearm and hand, webbed space of thumb
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Where is the sensory innervation of the median nerve?
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lateral palm, palmar surface of the thumb, lateral 2 1/2 fingers (in addition to the thumb), specifically the distal ends of digits 2, 3
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Where is the sensory innervation of the ulnar nerve?
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ulnar side of the hand, medial ring finger and little finger, but primarily the little finger and the ulnar border of the hand
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How is myositis ossificans caused?
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it's caused by a bleeding into the muscle, this trauma leads to activation of osteoprogenitor cell that form bone in a muscle
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What precautions should a PT take when treating a pt with myositis ossificans?
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passive stretching can be a continuous stimulus to bone formation in the muscle
**stretching tears fibers around the bony area and causes bleeding into muscle starting the process again |
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What activities cause lateral epicondylitis?
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*tennis
*playing a stringed instrument *piano *screwing *hammering *typing *carrying heavy objects *a pitcher *frisbee *painting (basically a motion that causes repetition or strain to the extensor/supinators) |
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What is another name for lateral epicondylitis?
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tennis elbow
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What is another name for myositis ossificans?
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heterotropic ossification
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How is the tendon and muscle related in the MTJ?
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the tendon grows around pieces of muscle, increases surface area for the myotendinal junction
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Which muscle is more susceptible to injury or lateral epicondylitis ECRB or ECRL? WHY?
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ECRB -- the length is much smaller and yet it has a larger moment arm
**shorter fiber and larger moment arm sets it up for injury during wrist flexion |
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What is a differential diagnosis for lateral epicondylitis?
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-cervical involvement (C6-7) referred pain or myotomes
-radial tunnel syndrome |
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What are some ways to treat lateral epicondylitis?
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*wrist spint to support wrist in extension
*tennis elbow band -rest for 4-8 weeks -stretches -- light and low duration -isolate muscles doing eccentric motions and overload...causes intense pain but usually ROM increases and pain decreases |
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How does a PT know when they may begin a strengthening program based on lateral epicondylitis signs/sxs
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1) consistant lowered pain
2) painfree AROM 3) pain with daily activity 4) MMT (decreased pain with resistance) |
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Briefly describe a surgery for lateral epicondylitis. How common is it?
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Fairly rare, detatch ECRB from lateral epicondyle, roughen the lateral epicondyle and reattach
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During the first 2 weeks of rehab from lateral epicondylitis surgery what motions should a PT avoid?
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1) passive flexion of the wrist
2) active flexion of the wrist 3) active extension of the wrist |
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During the first 2 weeks of rehab from lateral epicondylitis surgery what motions should a PT use?
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passive extension
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When a PT begins to flex the wrist after lateral epicondylitis surgery, what position should the elbow be in and why?
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flexion because the muscle is slack at the elbow in this position
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Should supination or pronation be used first after lateral epicondylitis surgery?
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supination first because there is less tension to the lateral epicondyle, then pronation later
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What is medial epicondylitis similar to in it's presentation?
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lateral epicondylitis
**extend flexors to see if there is pain, extend wrist or fingers to see what type of flexor it is |
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After a traumatic dislocation of the elbow, is the joint unstable?
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No, it's not like the shoulder. The elbow is relatively stable.
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What must a PT be when dealing with post-immobilization tightness in flexion/extension?
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aggressive early on so that the changes aren't permenant
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Is it harder to gain back flexion or extension after immobilization?
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extension, people like to eat and use flexion more
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After a long-term immobilization what interventions can a PT use?
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1) AROM -- see what pt can do
2) PROM 3) capsular tightness is addressed after mm are stretched with PROM |
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How can a PT determine between cervical/lateral epicondylitis/radial tunnel?
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CERVICAL: spurlings, PROM that closes down foramen
LATERAL EP: contract muscles, stretch muscles, be specific (for each muscle) and stabilize well RADIAL TUNNEL: radial nerve tension tests, similar to stretch of mm |
