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50 Cards in this Set
- Front
- Back
Radial Fractures:
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can cause loss in ability to pronate and supinate
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Biceps and Triceps tendinitis:
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usually at the point of insertion
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Olecranon Bursitis:
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often causes unexplained swelling, bewareof infectious causes.
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NerveEntrapments:
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· Ulnar nerve entrapments-posterior and medial dislocations, may cause atrophy and symptoms in the hand
· Radial nerve entrapments-radial tunnel, radial head, symptoms often appear lower in the nerves path · Medial nerve entrapments-pronation, pronator teres. Can mimic carpal tunnel type symptoms |
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Elbow and Forearm
CommonPresenting Complaints: |
· Epicondyle pain
· Pain at olecranon- avulsionfracture of the olecranon will occur before the triceps tendon will tear · Lack of full extension-compartment syndromes · Forearm pain and weakness- canoccur from holding a bag on your forearm for prolonged periods. |
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ElbowRed Flags and Cautions:
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FOOSH, dislocations, direct trauma,vascular change, child and traction force, unexplained locking (usually loosebodies within the joint), unexplained swelling (rheumatoid arthritis, goutetc.) and altered carrying angle.
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OsteocondrititsDessecans:
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Compression of the Lateral side- radialhead (can cause loose bodies) as well as having a distraction injury of themedial side (can stretch ligaments)
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Osteocondritits Dessecans:
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Loose bodies which are either cartilage or bone
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Osteocondritits Dessecans History :
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· Acute traumatic and overuse
· Swelling, heat, discoloration · Loss of function . Locking of elbow |
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Osteocondritits Dessecans Examination
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· Swelling, heat, discoloration-this flows into potential space in the arm · Functional ROM· Pain below medial epicondyle· Valgus stress increased- can dothis in neutral but often better to do with slight flexion and pronation.· Muscle weakness-extrinsic wristflexors· x-ray, MRI, ultrasounds
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Osteocondritits Dessecans Treatment
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· Adjust· STT to stabilizers- musclebalance, strengthen muscles inhibited by pain or trauma, muscle stripping forchronic conditions · Cross friction to ligament-chronic overuse situation · Ice· Strapping/bracing- tape in a Xshape, usually distal to proximal (in acute situation)· Ultrasound/laser· Exercise- acute/sub-acute phaseuse grip work/stress ball/rubber band wrapped around fingers. Flexion,extension, ulnar deviation, radial deviation- neutral, pronation. Activates ROMand strengthens muscles· Technique· Grade 3= referral- surgery toreattach the ligament· Be aware of the ulnar nerve
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MedialCollateral Ligament Sprain History:
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Acute or overuse injury resulting in swelling, heat, discoloration, lossof function and stability.
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Medial Collateral Ligament Sprain |
· Children can be prone toavulsion fractures· Anterior means there is stabilitythough flexion and extension· Posterior means there isstability at 60-135 degrees of flexion and extension· Be aware of instability
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Medial Collateral Ligament Sprain
Assessment |
· Pain below medial epicondyle· Function ROM changes· Increased valgus stress· Muscular weakness, diagnosticimaging
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Medial Collateral Ligament Sprain
Treatment |
· Elbow MAT· STT to stabilizing muscles· Ligament cross friction topromote healing· Ice· Strapping/bracing· Ultrasound/laser (physiologicaltherapies)· Exercise- generally andspecific/advice- technique, relative rest· Grade 3= referral
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ThrowersElbow:
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Flexor Tendinosis caused by medialcollateral ligament damage, muscle- acute or repetitive trauma.
Can lead to ostiocondritis desicans is a area of avascular necrosis thatdevelops, where the bone dies and that portion of bone will drop intojoint and cause locking of the elbow |
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Throwers Elbow History:
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can be acute or overuse.· Throwing sports· Vague medial elbow pain· Signs and symptoms of flexortendinosis/medial collateral ligament· Instability· Action reproduces pain
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Throwers Elbow Examination
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· Signs and symptoms of flexortendinosis/medial collateral ligament· Instability· Action reproduces pain- as wellas having arm in position and provide resistances· Valgus stress increased-dynamic valgus stress test· X-ray- calcification, loosebodies, spurs, US/MRI- particular if they complain of locking or lack of ROM
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Throwers Elbow Treatment
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· Adjust- cervical, thoracic,shoulder, wrist and hand/kinetic chain· Muscle imbalance/crossfriction- if there is instability you need to treat muscles so that the dynamicsupport is balanced.· Ice, support (bracing andstrapping)· Ultrasound andDifflam/anti-inflammatory · Advice· Strength exercise· Referral
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Osteoarthritis:
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Can occur at any ages, change in axis ofrotation or interference of motion, micro or macro trauma.
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Osteoarthritis Pathology
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· Lateral swelling· Medial osteophytes· Loose bodies in radialcapitular region and other regions can occur- can be cartilaginous or calcific(these can be relative contraindications)
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Osteoarthritis Hx
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· Progressive pain interfereswith motion, rest it feels better, after activity gets worse, often triggeredby change in activity· Examination:· Flexion· Swelling· Decreased joint play orhypermobility (medial collateral ligament sprain)
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Osteoarthritis Treatment
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· Adjustment the kinetic chain· Mobilisations- open up tissue,increase flexibility (also can include other forms of stretching- self managementetc.)· STT· Heat- heat before exercise · Diet, Supplements-anti-inflammatory e.g. omega 3, vit E, glucosamine · Advice on aggravating factors-can be something as simple as siting instead of standing, widening the grip onsomething to there is less stress on the elbow.
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LooseBodies:
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Radial head epiphysis, capitulumn is the second most common location, itis more common in males than females and is often age related.
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Loose Bodies:
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· Osteochondritits Dessecans-enlargement of the radial head, more common in males, often involved withsports such as baseball, gymnastics, martial arts etc. occurs mostly inteenagers. Can be associated with trauma but mostly is involved with overuse· Osteochondrosis- calcificationof the cartilage, changes in circulation, repetitive trauma, premature fusion· Other types of loose bodies areinvolved more with DJD· Think about the integrity ofthe joint?
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Loose Bodies History :
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Pain, locking, stiffness, swelling,difference in ROM (can’t extend –possible triceps tendonopathy, DJD withoutloose bodies or can’t flex- possible biceps injury), insidious, intermittentpain with certain activities
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Loose Bodies Examination:
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· Blocked extension-fullextension· Synovial swelling· Springy-block end feel· Diagnostic imaging (x-raydetermines type as well as presence)
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Loose Bodies Treatment
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· Adjustments and mobilizations· Ice- for swelling· Referral (as withosteochrondrosis)
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Dislocations:
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•Most common is posterior and lateral
• Often associated with fractures in the area •Be aware of possible damage to neurovascular component |
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Dislocations History :
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- Fall on outstretched hand with extension
- High levels of pain |
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Dislocations Treatment :
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- Refer in acute condition
- Post dislocation care |
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Fractures: Supracondylar fractures
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• Associated with posterior dislocation
• Can lead to acute compartment syndrome•Need to assess radial artery |
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Fractures:
Intercondylar/transcondylar/ comminuted condylar |
Occur with compression
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Fractures: Olecranon
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• Avulsion fracture with triceps
• Be aware of olecranon bursa |
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Fractures: Coronoid process
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• Associated with posterior dislocation
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Fractures: Radial head
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• Occur after foosh injury
• Commonly overlooked on the Xray |
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Fractures: Radial neck
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Lateral epicondylar fracture
• Occur in traction injuries• Can lead to complications with growth plates Medial epicondylar fracture • Avulsion and wrist flexor overuse• Need to be careful of ulnar nerve damage |
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Fractures: B-B fracture
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• Both bone fractures
• Occurs in the mid 1/3 of the bone •Causes displacement, angulation, rotation • Needs surgical stabilisation |
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Fractures: Distal Ulnar (Nightstick)
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• Trauma to the raised arm
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Fractures: Proximal ulnar fracture (Monteggia)
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• Associated with radial displacement
• Green stick fracture in children |
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Fractures: Distal Radial (Galeazzi)
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• Rare
• Is associated with dislocation of the distal radioulnar joint |
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Fractures: Treatment
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- Focus first on healing- Healing involves nutrition, spinal adjustments, relative rest- Focus then on rehabilitation- Adjust VSC and peripheral joint subluxation complex- STT to elbow stabilisers- ROM activities- Forearm strengthening and exercise as soon as arm is out of cast to try and restore function and flexibility before degeneration occurs- Advise on leisure/sport/work
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HumeralEpicondyle Fractures:
Lateral Epicondyle |
Lateral- traction injury, fall on hand withvarus stress. Can cause complication with the growth plate, non-union, valgusdeformity and ulnar nerve palsy. Elbow will appear swollen but not deformed andpassive flexion will decrease.
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Humeral Epicondyle Fractures:
Medial Epicondyle |
Medial- avulsion fracture due to wrist flexor overuse, dislocation. Ulnar nerve damage other contraindications are if there is deformation, loose bodies.
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Volkmann’sIschemic Compression:
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· Problems with finger flexion,pronation and supination · Decreased expansion
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Volkmann’s Ischemic Compression: Hx
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Cause of compression, pain swelling, discoloration,flexor compartment compromised, median nerve signs and symptoms
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Volkmann’s Ischemic Compression:
Assessment |
Pain, swelling, discoloration, flexorcompartment, ROM decreased neurological signs and symptoms
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CompartmentSyndrome of the Hand and Forearm:
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Often caused by supracondylar humeralfractures or radial/ulnar fractures.
Median nerve involvement, carpal tunnelrelease, exploration of entrapment (usually one of lacertus fibrosis, proximaledge of pronator teres) |
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Compartment Syndrome of the Hand and Forearm: Hx
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·Trauma or other cause ofcompression/overuse will result in pain, swelling and discoloration etc. · Flexor compartment issues· Decreased ROM· Neurological signs and symptoms
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Compartment Syndrome of the Hand and Forearm: Treatment
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· Prevention· Referral· Conservative treatment· Surgery
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