elbow, wrist and hand rehab 1
Terms
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- an injury to the UCL of the thumb MCP jont with the mechanism of injury is a torsional force applied to an ABD thumb is also called.
- Gamekeeepers/skiers and goalkeepers thumb
- space with in the carpal tunnel is reduced even more in postions of _____________and ________________.
- wrist flexion, and extension
- If conservative treatment fails a surgical release of the ________________ may be performed
- flexor retinaculum
- __median nerve dysfunction causes atrophy of the thenar eminence of the palm flattens
- ape hand deformity
- surgical repair/reconstruction using an autograph may occur with complete ruptures is known as____________
- Tommy Johns surgery
- Rehab treatment is similar in distal radius fx's regardless of fixation (cast, ORIF, external) only the timetable is different ROM is important to __________________________.
- decrease edema, maintain ROM, prevent atrophy
- Pt. complains of pain on the medial side of the elbow and tenderness to palpation of the ligament
- UCL
- Intial injury presents with rapid swelling, severe elbow pain and a shortened forearm with the olecranon being pushed posterioly
- elbow dislocation
- what dind of rupture is belived to occur from rubbing of the tendon around the fx sit. Pt. is unable to extend the thumb IP jont and surgical repair is indicatied
- (EPL) extensor pollicis longus
- Medial epicondylitis is also known as what?
- golfers elbow/ little league elbow
- compression in (CTS) may be associated with?
- tenosynovitis, pregnancy, arthritis, or trauma
- trauma to the lateral extensor tendons or a progression of RA causes flexion of the DIP and MCP joints and hyperextension
- Swan neck deformity
- burning pain that radiaties up the forearm or distally into the hand over the radial aspects of the wrist
- sign of DeQuervians tenosynovitis
- treatment includes pain and edema control and maintaining ROM, taping or splinting may be used for pain control, exercise in pain free range.
- wrist sprain
- constist of entrapment of the ulnar nerve as it runs between the olecranon and medial epicondyle
- cubital tunnel syndrome
- The ulnar collateral ligament is most often injured from repetitive____________ forces, dudring overhead throwing
- Valgus
- inflammation of the tendon sheaths of the ABD pollics longus, and extensor brevis, this is usually and overuse injury
- DeQuervains tenosynovitis
- In lateral epicondylitis pain increases with passive stretch of wrist extensors(full wrist _________ with elbow___________ and forearm_____________
- flexion, extended, pronated
- Mechanism of injury is forceful hyperextension or compression. If no fx are involved, coban wrap can be used to control edema, buddy taping is used for protection and to encourge ROM
- finger joint dislocation
- Pt. c/o pain along lateral aspect of the forearm, tenderness to palpate____________, pain radiaties down forearm or up to the shoulder.
- lateral epicondylitis
- splinting to rest the tendons and avoidance of aggravation factors, anti-inflammatory medications modalites for pain and edema control, exercises to maintain/regain mobility and strengrth
- treatments for DeQuervians tnosynovitis
- In lateral epicondylitis pain increases with resisted ____________or __________________
- wrist extension, forearm supination
- teatment includes pt. ed on keeping wrist in neutral, work related erogonomics, splint ot wear at night/day, cortisone shot and median glide exercises
- CTS
- In DeQuervains tensynovitis decreased _________________and ____________ strenght , pain increases with resisted thumb_______and _______________.
- pnch and grip, ABD and extension
- usually due to a FOOSH or hyperextension of an elbow may rupture UCL, brachioradialis, wrist flexors or extensor tendons
- elbow dislocation
- a weak spot in the synovial lining of tendon sheaths or joints lumps seen on the dorsl aspect of the wrist or hand, usually treated with aspirtaion
- ganglion cysts
- tightening of the palmar fascia causes a flexed contracture of the 4th and 5th digits cause is unknown but may have a genetic componet may be surgically released if function is affected
- Dupuytrens contracture
- Pt. c/o pain with repetive or substaind use of the hand, mumbness and tingling in the thumb, and first 2-3 fingers. pain at night and clumsiness or weakness of the hand
- CTS
- associated with baseball pitching, golfing, swimming and occupations that require strong grips or pronation. ykbar berve nat be involved
- medial epicondylitis
- in a Smith's fx the distal radius displaces______________, less common
- ventrally
- structures that pass through the tunnel include in carpal tunnel
- median nerve(1), flexor digitorum superficialis/tendon(4) flexor digitorum profundus/tendon(4), flexor pllicis longus tendon(1)
- what muscles are innervated by the median nerve?
- flexor digitorum supwrficialis, 1/2 profundus, pronator quadratus, pronator teres (wrist flexors), 1/2 lumbricals and thenar eminence
- Complications of distal radius fx's inculde,_________________ and ____________________________
- (RSD)= reflex sympathetic dystrophy, extensor pollicis longus, (EPL) and carpal tunnel syndrome
- In medial epicondylitis repetiive trauma to the _____________or ________________ causes chronic inflammation at their proximal attachment on the humerus
- flexor carpi radialis , pronatior teres
- repetive micro trauma to wrist extensors, and supinators, most common is extensor carpi radialis brevis which causes chronc inflammation at its proximal attachment
- Pathology of lateral epicondylitis
- Fx of the neck of the 5th metacarpal, this is the most commonly fractured metacarpal, caused by a impacted with a closed fist as with punching someone
- boxers fx
- once immobilization has ended ______ROM is started immediatley, ___ROM is started soon after the pt. is then progressed ino strengthening exercises
- Active, passive
- what muscles are innervated by the ulnar nerve?
- Hypothenar eminence, flexor digitorum profundus, 1/2 lumbricals, palmar and dorsal interossei, ADD pollicis
- in a colles fx the distal radius displaces_______________ results in "dinner fork" deformity
- dorsally
- carpal tunnel syndrome (CTS) compresses what nerve?
- median
- In treatment of elbow dislocation if the brachialis in involved massage, passive stretching and resistive exercise are contraindicated due to the risk of what?
- myositis ossification
- Pt. c/o medial elbow pain and parethesia in the ulnar merve distribution
- cubital tunnel syndrome
- __________stress causes pain and reveals joint laxity in UCL
- Valgus
- most common carpal injury caused by a FOOSH, pt. has pain in the anatomical snuffbox. this fx is often missed in x-ray, mistaken as wrist sprain
- scaphoid fx.
- young pt.s may experince an avulsion fx of the __________in UCL
- medial epicondyle
- atheletes with Tommy Johns can return to throwing ____________ after surgery
- 22-26 weeks or 6 months
- What muscles are innervated by the radial nerve?
- triceps, anconeus, brachioradialis, wrist and digit extensors, supinator, ABD pollicis longus
- Whats another name for Lateral epicondylitis?
- tennis elbow
- Post-op rehab for CTS includes _____________, nerve gliding and tendon gliding exercises and ____________
- desensilization training, and scar tissue mobilization
- Rupture of the central slip of the extensors, mechanism causes hyper extenion of the DIP jont flexion of PIP joint. Injury is caused by forced flexion of a finger , a progresion of RA treatment is with immobilization followed by exercises to regain mobility and strenght
- Boutonniere deformity
- common problematic activites or occupations of lateral epicondylitis
- computer work, construciton or janitorial work, assembley line, or gardening
- an avulsion of the DIP extensor tendon. Mechanism of injury is forced flexion of the PIP joint. treatment is with immobilization followed by blocked AROM exercise to regain DIP flexion
- Mallet finger
- In elbow dislocation 25-50% fx's occur to what bone?
- head of radius
- repetitive or prolonged pressue on the ulnar nerce as it passes between the ____________ and the ______________ causes paresthesia in the ulnar nerve distribution of the hand and weakness in intrinsic muscles of the hand also known as?
- hook of hammate, pisiform, ulnar nerve compressiona t guyons canal
- what are the intrinsic muscles involved in Gunyons canal
- 1/2 lumbricals, thenar eminence, palmar/dorsal interossei, ADD pollicis
- treament for gamekeepers injury for incomplete terars is immobilization, followee by___________and _________________ARIM. __________stresses are avoided initially
- flexion and extenson, ABD
- rest, avoidance of aggravation activites and protective padding, followed by ROM, surgical decompression is considered if conservative treatment fails
- cubital tunnel syndrome
- ulnar nerve dysfunction causes muscle atrohy of intrinsic hand muscles. Contractures leave the finger in flexion at the PIP and DIP joint and hyperextension at the MCP joints
- claw hand deformity
- treatment of lateral epicondylitis would include
- rest, modalities to reduce inflammation, a tennis elbow strap to reduce tension at the site, cross friction massage to break adhesions and increase circulation
- after CTS surgery, pt needs to avoid _________ wrist flexion past neutral and finger flexion with wrist flexed to prevent ____________ of the flexor tendons
- active, bowstringing
- this usually a dx of exclusion, if the pt. experienced minor trauma , and fx's and ligament ruptures are ruled out, the pt. is given this dx,
- wrist sprain