Therex test 3*

Elbow open-packed position

70° FLX and 10° supination

Elbow closed-packed position

Extension

Radiohumeral open packed-position

full extension and supination

Radiohumeral closed-packed position

elbow flexed to 90° and forearm supinated 5°

Proximal radioulnar open-packed

70° flexion and 35° supination

Proximal and distal radioulnar closed packed position

5 ° supination

Distal radioulnar open packed

10° supination

Lateral Epicondylitis

• overuse injury of the common wrist extensor origin

• the extensor carpi radialis most commonly affected

• inc pain with extension and radial deviation

What is the most important exercise for management of overuse injuries

eccentric contractions

Medial Epicondylitis

• An overuse injury that affects the wrist flexors’ origin

• mainly flexor carpi radialis

• inc pain with resisted wrist flexion and full passive wrist extension

Medial Valgus Stress Overload

• effects the MCL aka the UCL

• seen in throwing athletes

Cubital Tunnel Syndrome

• aka ulnar tunnel syndrome

• The ulnar nerve gets entrapped at the elbow

Acute rupture of the medial (ulnar) collateral ligament

• longer recovery period needed

• An internal brace of collagen tape is used to reinforce the ligament for athletes who don’t need full reconstruction

Lateral collateral ligament injury

• 2nd most commonly dislocated

• via hyperextension or posterior-lateral rotation

• can be treated conservatively or with a graft surgery

What type of fracture is this

Supracondylar

What type of fracture is this

Distal humeral fracture

What complications can occur with a distal humeral fracture

• nonunion, malunion, contractures

• VASCULAR COMPROMISE

What causes a Volkmann ischemic contracture

a distal humeral fracture that causes brachial artery obstruction due to displaced fragments

What are the 6 symptoms indicating Vascular Obstruction

1. severe pain in the forearm

2. limited/pain with finger movement

3. purple discoloration

4. paresthesia and loss of sensation

5. loss of radial pulse

6. pallor, anesthesia, paralysis

What type of fracture is this

Intercondylar fracture (T or Y)

What treatments for an intercondylar fracture are considered for young patients vs older patients

young= ORIF

old= bag of bones

What type of fracture is this

Radial head fracture

Myositis ossificans

abnormal bone formation in other tissues

Cozens test

• for lateral epicondylitis

• pronate forearm and extend and radial deviate the wrist

Tinel’s sign

• Ulnar nerve compression

• poke the medial side of the elbow

Radiocarpal (wrist) open-packed

neutral with slight ulnar deviation

Radiocarpal (wrist) losed-packed position

extension with radial deviation

Anatomical Snuffbox

The depression created by the abductor pollicis longus, extensor pollicis longus, and extensor pollicis brevis muscles

Colles fracture

• Most common distal radial fracture

• When the fragment is displaced in a dorsal direction (FOOSH)

• “dinner fork”

Smith Fracture

• fall of the dorsum of the hand

• fragment displaced in a palmar direction

• aka reverse Colles fracture

What is the point of the 6-pack exercises

to maintain MP and IP ligament length with wrist immobilization

Distal ulnar fractures

usually occur in combination with distal radius fractures

What is the most common carpal fracture

scaphoid fractures

Important scpahoid facts

• often dismissed as a sprain

• high incidence of nonunion

• take much longer to heal

Boxer’s fractures

• fractures of the neck of the fourth or fifth metacarpal

• occur when the patient strikes a hard object wuith a clenched fist

Bennett’s fracture

• palmar base of the proximal first metacarpal

How do most ligament sprains occur

with wrist hyperextension

Triangular Fibrocartilage Complex (TFCC)

• formed by ligaments and an articular disk

• Injury occurs via an axial force applied to the ulnar side of the wrist

• The healing is poor

Skier’s Thumb

An acute sprain of the ulnar collateral ligament of the thumb

Tendinitis

inflammation of the tendon

Tenosynovitis

inflammation of the synovial sheath of the tendon

Tendinosis

degeneration of the tendon

De Quervain’s Disease

• not a true clinical disease

• abductor pollicis longus and the extensor pollicis brevis tendon and sheaths

• radial-sided pain

Trigger Finger

• catching of the finger or thumb

• via swollen sunovium

Mallet finger

• interuption of the extensor tendon mechanism over the DIP joint

• flexor digitorium profundus

• DIP flexion

Boutonnière deformity

• central extensor tendon and triangular ligament interruption

• PIP FLX and DIP hyperextension

Swan-neck Deformity

• PIP hyperextension and DIP FLX

Dupuytren’s disease

• firm nodules under the palm

• via overactive fibroblasts/contractures

• full FLX

Fasciotomy

cutting the contracted fascia blindly by inserting a small blade

Dermofasciectomy

removal of the skin overlying the diseased tissue, as well as the diseased tissue

Carpal tunnel syndrome

• median nerve compression/entrapment

Ulnar tunnel syndrome

• compression in the Guyon canal/tunnel

• between pisiform and the hamate

Radial sensory nerve compression (wartenberg’s syndrome)

• sensation affected only

• back of the thumb, radial side of the hand, and radial PIP joint

• repetitive pronation

Complex Regional Pain syndrome (CRPS)

abnormall sever of prolonged pain response; can be type one or two

Ulnar collateral ligament instability test

tear of UCL

Allen test

occlusion of radial or ulnar artery

Froment’s sign

ulnar nerve compromise/paralysis

Phalen’s test

tests carpal tunnel syndrome

Tinel’s sign

tests for carpal tunnel syndrome

Finkelstein’s test

tests for tenosynovitis in the thumb (de Quervain’s disease)

What are the two arteries found around the hip joint?

• retinacular arteries

• femoral arteries

Hip open-packed position

30° FLX , 30° ABD, slight lateral rotation

Hip closed-packed position

full extension and medial rotation

LE D1 FLX PNF pattern

hip: FLX/Add/ER

knee: FLX

ankle: DF/inversion

LE D1 EXT PNF pattern

hip: EXT/ABD/IR

knee: EXT

ankle: PF/eversion

LE D2 FLX PNF pattern

hip: FLX/ABD/IR

knee: FLX

ankle: DF/eversion

LE D2 EXT PNF pattern

hip: EXT/ADD/ER

knee: EXT

ankle: PF/inversion

What is another name for the intertrochanteric fracture

extracapsular

What is another name for intracapsular fracture

femoral neck or subcapital

what is another name for the subtrochanteric fracture

proximal femoral shaft

What are some common clinical complications of hip fracture

malunion, delayed union, nonunion avascular necrosis

What is legg-calve-perthes disease

femoral head flattening that causes a disruption of the blood supply

What kind of orthosis is given to someone to keep the femoral head seated within the acetabulum when they have Legg-Calve-Perthes disease

abduction orthosis

Hemiarthroplasty is performed when a patient has

femoral head osteonecrosis

What is Osteoarthritis (OA)

focal loss of articular cartilage with variable subchondral bone reaction

What are some indications of a THA

RA, OA, fractures, WB pain, deterioration

Total hip replacement complicaations

• blood clots

• loosened components

• nerve injury

• dislocations

THA universal precautions

• avoid hip ADD

• avoid IR

• avoid FLX over 90

• avoid combining them

Pincer impingement

overhanging rim of the acetabulum; labrum and articular cartilage damage

Cam impingment

head of femur; damage to articular cartilage

Greater Trochanteric Pain Syndrome (GTPS)

• pain with abduction

• trochanteric bursitis

• tears of glute med or min

Thomas test

hip flexion contractures or tightness

90-90 SLR test

hamstring tightness

Trendelenburg test

testing for weak glute med

Knee open-packed position

25° FLX

Knee closed-packed position

full EXT and lateral tibial rotation

what are the rules of rehabilitation according to Gray

1. Create a safe environment

2. Do not hurt the patient

3. Be agressiove w/o breaking first 2 rules

What are the progression steps post knee injury

1. progress ROM/quad control

2. establish normal gait

3. demonstrate ascending normal steps

4. demonstrate decending normal steps

5. running

6. plyometrics

Sould the time frame of a assessment-based guidline incorportate fixed or flexible time

flexible time frame

Anterior Cruciate Ligament (ACL)

• resists anterior translation of the tibia on the femur

• controls hyperextension of the knee

• females tear more than men

What test is used to assess the integrity of the ACL

• Lachmans test

• Anterior Drawer test

• Pivot shift

What is the most specific ACL test

Lachman

How is the Lachman performed?

knee in 25-30° FLX, the clinician attempts to displace the tibia anteriorly

How is the anterior drawer test performed?

The knee is flexed to 90°, and the clinician attempts to provide an anteriorly directed force onto the tibia

Posterior Cruciate Ligament Injuries

• The primary restraint to the posterior displacement of the tibia

• strongest ligament in the knee, injury occurs less often

What tests can be done to test the PCL

• posterior drawer test

• Godfrey posterior sag test

• active quad drawer test

What is the most common and accurate PCL test

Posterior drawer test

How is the posterior drawer test performed

The knee is flexed to 70° and the clinician stabilises the ankle on the table as the patient attemps to straighten the knee using the quad

Which ligament has a longer rehab/WB percaution time ACL or PCL

PCL

Medial collateral ligament injuries

• The most common ligament injury in the knee

• via valgus forced applied to the knee while the foot is fixed