elbow chapter 22
Elbow mobilizations:
-varus -valgus -distraction -Mill's manipulation
The normal elbow ROM is _______________ degrees to approximately _______________ degrees of flexion.
0; 145
What percentage of elbow dislocations are anterior?
1-2%
Fractures occur what percent of the time with elbow dislocation?
10%
What is the average normal carrying angle for men?
10°
What is the normal carrying angle for women?
13°
What position do you place the arm in to perform a valgus stress test?
20-30 deg. of flexion with full humeral external rotation
When performing a ligament stability test for UCL laxity, the elbowshould be in how many degrees of flexion before applying valgus stress?
20°-30°
How long is the return to throwing following an UCL spain/tommy john?
3-4 months
Most daily activities can be carried out within a functional ROM of:
30-130 degrees
How should you brace/rest someone's arm with cubital tunnel syndrome?
45 deg. of elbow flexion
Lateral epicondylitis occurs at what ratio to medial epicondylitis?
7:1
For secure bone healing to occur, active elbow flexion past 90 and resistance exercises for elbow extension after olecranon fractures must be deferred for how many weeks after injury?
8 weeks
It is clinically important that flexion of the elbow after nondisplaced olecranon fractures not exceed __________ for the first 6-8 weeks after injury.
90°
Radial head fractures are generally classified into four types. Type I is defined as which of the following?
A nondisplaced fracture
The three stages of ulnar neuropathy consists of:
Acute onset of radicular symptoms, Recurrence of symptoms as the athlete attempts to return to sport, Persistent motor weakness and sensory changes
Which of the following describes the types of supracondylar fractures?
All of the above Type II Extension type Type I Flexion type
what are structures that can be injured as a result of elbow dislocation?
All of the above Ulnar nerve, Radial nerve, Brachial artery, Median nerve
Supracondylar fractures occur most often to which group?
Children
What is the most common treatment for supracondylar fractures?
Closed reduction and immobilization for 4-6 weeks
Which of the following is not a symptom of vascular obstruction after supracondylar fracture?
Crepitus at fracture site
Ulnar neuropathy is also known as:
Cubital tunnel syndrome
any inflammatory condition of either the lateral or medial epicondyle of the distal humerus is known as
Epicondylitis
Which of the following describe(s) the muscles of the common wrist extensor origin?
Extensor carpi radialis longus, Extensor carpi radialis brevis, Extensor digitorum,
Which motion is most commonly affected (restricted) after radial head fractures?
Flexion of the elbow, Extension of the elbow, Supination, Pronation
Which of the following is not advocated during the early recovery phase of rehabilitation for lateral epicondylitis?
Functional activities
Increased valgus deformity and the varus elbow malalignment is called?
Gunstock deformity
A type I nondisplaced intercondylar fracture is treated with which of the following?
Immobilization for approximately 3 weeks
Treatment of type 1 radial head fractures involves which of the following?
Immobilization for up to 4 weeks
Treatment of type I radial head fractures involves which of the following?
Immobilization for up to 4 weeks
Nondisplaced olecranon fractures generally are treated with which of the following?
Immobilization for up to 8 weeks
Isolated posterior elbow dislocations are managed how?
Immobilization in flexion
which soft tissue injury affects the common wrist extensor orgion of the extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, and extensor digiti minimi
Lateral epicondylitis
What is the most common complication after elbow dislocation?
Loss of elbow extension
The most complication after elbow dislocation is:
Loss of extension
Which soft tissue injury is known as "golfer's elbow"?
Medial epicondylitis
Which soft tissue injury affects the common wrist flexor origon of the pronator teres, flexor carpi radialis, flexor digitorum sublimis, and flexor carpi ulnaris
Medial epiconylitis
Which injury to the elbow occurs commonly among patients who participate in repetitive throwing activities
Medial valgus stress overload
How can the PTA enhance the effectiveness of low-load, long duration static stretching (once the inflammatory process has ended) in order to relax the soft tissues?
Moist hot packs, Ultrasound
Early active motion usually can begin after the first week after immobilization for a dislocated elbow; however, passive stretching is related to the development of what?
Myositis ossificans
Type II radial head fractures always are treated with which of the following?
ORIF, Excision
Lateral epicondylitis is caused by which of the following
OVeruse, repetive motion disorder, cumaltive trauma
Lateral epicondylitis is caused by which of the following?
Overuse, repetitive motion disorder, cumulative trauma
Generally, a patient w/ lateral epicondylitis has pain w/ palpatation around location of the elbow w/ AROM of the wrist
Palpating the lateral epicondyle
Which muscles make up the common flexor tendon of the medial epicondyle?
Pronator teres, Flexor carpi radialis, Flexor carpi ulnaris
What type of fracture represent one third of all elbow fractures and nearly 20% of all elbow trauma?
Radial head fracture
Which of the following is the most common fracture that occurs with elbow dislocation?
Radial head fractures
What are the symptoms of Volkman's Ischemic Contracture?
Severe pain in the forearm muscles Limited and extremely painful finger movement Purple discoloration of the hand with prominent veins Initial parathesia followed by loss of sensation Loss of radial pulse Loss of capillary return Pallor, anesthesia, paralysis
An important component for all resistance exercises used with lateral epicondylitis is the performance of:
Slow, controlled eccentric contractions
T/F Eccentric muscle contractions produce greater tension than either concentric or isometric exercise.
TRUE
T/F Exercising the muscle eccentrically allows it to withstand greater resistance and prevent injury which occurs by eccentrically loading an inflexible muscle.
TRUE
T/F Long term, rigid immobilization is not indicated during lateral epicondylitis treatment.
TRUE
T/F When using a hammer for the first time during supination/pronation exercises for a patient with lateral epicondylitis, the PTA should instruct the patient to grab the hammer closer to the head, and the progress away from the head as the patient gets stronger.
TRUE
What mechanisms may be responsible for ulnar nerve symptoms?
Tensile forces Compressive forces Nerve instability
What type of surgery is performed on someone that has experienced a UCL sprain?
Tommy John Surgery
T/F A leading mechanism for tensile force on the ulnar nerve is valgus stress.
True
T/F Individuals who use hand tools such as hammers, screwdrivers, or pliers can easily be affected by lateral epicondylitis
True
T/F Lateral Epicondylitis is commonly referred to as "tennis eldbow"
True
T/F Posterior elbow dislocations are the most common, whereas anterior anterior dislocations represent 1-2% of all elbow dislocations.
True
T/F Ulnar neuropathy is often a secondary pathology to UCL insufficiency.
True
This type of supracondylar fracture happens when an individual falls on extended, outstretched arm as if they're trying to catch themselves; displaced fracture posteriorly due to the pull on the triceps:
Type I
Which of the following is a type of supracondylar fracture?
Type I- Extension type Type ll- Flexion type
This type of supracondylar fracture occurs after direct trauma to the posterior elbow and displaced fracture anteriorly:
Type II
Which type of supracondylar fracture is the most common?
Type l
A type _______________fracture is defined as a comminuted fracture of the entire radial head.
Type three
Due to repetitive throwing and increased valgus force at the elbow which ligament has stress overload?
Ulnar ligament
Which of the following is considered the most significant complication after supracondylar fracture?
Vascular compromise
Medial epicondylitis is chronic overuse of the _____, whereas medial valgus stress overload is the overload to the ______.
Wrist flexors, ulnar collateral ligament
The PTA can enhance the affectiveness of LLLD stretching by:
applying moist heat, performing ultrasound
The term golfers elbow is typically associated with what sport?
baseball
The most common treatment of supracondylar fractures is by _______________and _______________for 4 to 6 weeks.
closed reduction; imoblization
Ulnar Neuropathy is also called:
cubital tunnel syndrome
T/F A type IV intercondylar fracture, which is severely comminuted with significant separation, always is treated with an ORIF procedure.
false
T/F During the subacute recovery phase of rehabilitation for lateral epicondylitis, initial instruction for patients to perform forearm pronation and supination must include the use of a hammer while holding the end of the shaft away from the head of the hammer.
false
T/F Medial valgus stress overload is synonymous with medial epicondylitis.
false
T/F Passive stretching is advocated during the early recovery phase of healing after supracondylar fractures.
false
T/F The signs and symptoms of ischemic obstruction are always immediately evident after injury.
false
A tommy john surgery uses what type of technique?
figure of eight
Type 2 distal humerus fracture:
flexion injury that occurs after direct trauma to posterior elbow & displaced fracture anterior
Which muscle is usually affected by golfer's elbow?
flexor carpi radialis, flexor carpi ulnaris, palmaris longus
Management of valgus stress injuries must take into account the _______________of ligaments.
healing constraints
when treating a person w/ lateral epicondylitis what are some modalities that could be used to help w/ pain management
ice massage on affected area phono/ionto prescribed analgesics/ NSAIDS rest and protection of the affected area
During treatment of a person w/ lateral epicondylitis, during which phase of treatment would the PTA want to focus on resolving pain and swelling
initial acute management
Lateral Varus tests what ligament:
lateral collateral ligament
Tennis elbow is also known as ______________ affecting extensor carpi radialis longus, brevis, extensor digitorum, and extensor digiti minimi.
lateral epicondylitis
Type 1 distal humerus fracture:
most common, fall on outstretched extended arm; displaced fracture posterior due to pull on the triceps
A PTA reads a recent entry in a patients medical record that indicates aspiration was performed in the elbow region. This scenario is MOST commonly associated with:
olecranon bursitis
A tommy john is common in?
overhead and throwing athletes
What is the most common elbow dislocation?
posterior
What type of fracture represent approximately one third of all elbow fractures and nearly 20% of all elbow trauma?
radial head fracture
Ulnar collateral ligament sprain is also called?
tommy john
T/F After excision of the radial head in type IV comminuted fractures, the radial shaft may migrate and cause pain at the distal radioulnar joint.
true
T/F Displaced or comminuted fractures of the olecranon can be treated with an ORIF procedure or, in cases of severely comminuted fractures, excision of up to 80% of the olecranon.
true
T/F Full recovery from an olecranon fracture may take 6 months to 1 year.
true
T/F In severe cases of tennis elbow, the use of a wrist cock-up splint is advocated for the management of inflamed wrist extensor tendons.
true
T/F It is not uncommon for some patients to be left with some residual loss of range of motion after intercondylar fractures
true
T/F The elbow is the 2nd most dislocated joint in the body.
true
T/F When considering the "carrying angle" on a patient women usually have greater carrying angles then men.
true
T/F With the exception of the shoulder, the elbow is the most frequently dislocated joint in the body.
true
Medial Valgus tests what ligament:
ulnar collateral ligament
What stresses should you avoid if you have an UCL sprain/tommy john?
valgus and external rotation at the elbow
A PTA treats a patient with suspected ulnar nerve palsy. Which finding is MOST consistent with the diagnosis?
wasting of the hypothenar eminence
Lateral epicondylitis is caused by repetitive overuse of:
wrist extensors
Because of general bone quality (osteoporosis), which of the following can be used for treatment in an elderly patient with a type IV intercondylar fracture?
"Bag of bones" procedure