Musculoskeletal system disorders

What motions does the median nerve support?

• palmar abduction

• opposition

• thumb MCP flexion

• digits 2-3 IP flexion/extension

• PIP flexion

• digits 2-3 DIP flexion

What motions does the ulnar nerve support?

• 5th digit abduction

• 5th digit opposition

• 5th digit MCP flexion and opposition

• thumb CMC adduction

• digits 4-5 MCP flexion and extension

• digits 2-5 adduction and abduction

• digits 4-5 DIP flexion

What motions does the radial nerve support?

• MCP extension

• 5th digit MCP extension

• 2nd digit extension

• thumb IP extension

• thumb MCP and CMC extension

• Thumb CMC abduction and extension

What are the wrist flexors innervated by?

median and ulnar nerve

What are the wrist extensors innervated by?

radial nerve

What are the pronators innervated by?

median nerve

What are the supinators innervated by?

radial nerve

What are the elbow flexors innervated by?

musculocutaneous and radial nerve

What are the elbow extensors innervated by?

radial nerve

What is the rotator cuff innervated by?

subscapular, superscapular, axillary nerve

What is shoulder flexion innervated by?

axillary and musculocutaneous nerve

What is shoulder abduction innervated by?

suprascapular and axillary nerve

What is shoulder horizontal abduction innervated by?

axillary nerve

What is shoulder horizontal adduction innervated by?

lateral pectoral nerve

What is shoulder extension innervated by?

thoracodorsal, subscapular, axillary nerve

What is scapular upward rotation innervated by?

spinal accessory, long thoracic nerve

What is scapular downward rotation innervated by?

C3-4, dorsal scapular, toracodorsal, long thoracic nerve

What is scapular adduction innervated by?

spinal accessory, dorsal scapular nerve

What is scapular abduction innervated by?

long thoracic nerve

What is scapular elevation innervated by?

C3-4, spinal accessory nerve

What is scapular depression innervated by?

spinal accessory nerve

What is dupuytrens disease?

• fascia of palm and digit become thick and contracted

• orthotics unsuccessful

• injections or incision

• first 3 digits extension, 4-5 flexion

• post surgical = full extension orthosis

What is skiers thumb?

• rupture of ulnar collateral ligament (thumb)

• thumb spica

• caution with palmar abduction

What is complex regional pain syndrome?

• severe pain, edema, discoloration, osteoporosis, sweating, blotchy, temp changes

• modality (desensitization, fluido, hot pack)

• orthotic for contractures

What is a colles fracture?

distal radius, dorsal displacement

What is a smiths fracture?

distal radius, volar displacement

What should be done in the immobilization phase for a fracture?

• AROM above or below stabilized part

• edema control

• no resistance

What should be done in the mobilization phase for a fracture?

• edema control

• may need orthosis

• AROM

• strenghten when approved

What is dequervains?

• tenosynovitis of APL and EPB

• thumb spica

• ice massage

What is lateral epicondylitis?

• degenerative tendon origin

• overuse of wrist extensors

• elbow strap/wrist orthosis

What is trigger finger?

• tenosynovitis of finger flexors

• finger orthosis

What is the duran protocol for tendon repair?

• 0-4 weeks = dorsal blocking orthosis (wrist 10 flexion, MCP 40 flexion, IP extension)

  • passive flexion of PIP and DIP

• 2.5 weeks = passive place, active hold

• 4-6 weeks = wrist AROM

• 6-8 weeks = gentle stretch

• 12 weeks = regular activity

What is the early active mobilization protocol for flexor tendon repair?

• dorsal blocking orthosis

• place and active hold in extension

• tenodesis place and hold flexion

• partial finger flexion

• tendon glides

• 6 weeks = ADL

• 8 weeks = gentle strength

What is the early active mobilization protocol for mallet finger (extensor tendon repairs)?

0-8 weeks = DIP extension orthosis

6-8 weeks = gentle AROM

What is the early active mobilization protocol for boutinnieres (extensor tendon repairs)?

• 0-6 weeks = PIP extension orthosis

• AROM DIP in orthosis

What is carpal tunnel syndrome?

• narrowing due to swelling

• numbness of digits 1- half of 4

• tinels and phalens sign

• wrist orthosis in neutral

• median nerve glides

What is cubital tunnel syndrome?

• ulnar nerve compression at elbow

• numbness ulnar forearm and hand

• power grip weakness

• froments and tinels sign

• elbow orthosis 30 degrees

• ulnar nerve glides

What is radial nerve palsy?

• radial nerve copression

• weakness of extensors

• wrist and MCP extension orthosis

What is a median nerve lasceration?

• sensory loss = palm, palmar surface digits 1-half of 4, dorsal digits half of 2-4

• motor loss

  • low leision = MCP flexion 2-3, opposition, abduction, thumb MCP flexion

  • high leision = MCP flexion 2-3, opposition, abduction, thumb MCP flexion, flexion DIP 1-3, radial wrist flexion

• wrist flexion orthosis

• web space orthosis

What is an ulnar nerve lasceration?

• sensory loss = ulnar palmar and dorsal, half of 4-5 palamr and dorsal

• motor loss

  • low leision = adduction and abduction MCP, MCP flexion 4-5, thumb flexion and adduction, abduction opposition and flexion 5

  • high leision = adduction and abduction MCP, MCP flexion 4-5, thumb flexion and adduction, abduction opposition and flexion 5, ulnar deviation, 4-5 DIP flexion

• claw hand

• froments sign

What is a radial nerve injury?

• sensory loss

  • high leision = medial dorsal forearm, radial dorsal palm, 1- half of 4

• motor loss

  • low leision = wrist extension, MCP extension, thumb extension

  • high leision = wrist extension, MCP extension, thumb extension, elbow extension

• wrist drop

• dynamic extension orthosis

What is rotator cuff tendonitis?

• activity modification = reduce over shoulder level

• modalities

• strengthen below shoulder

• PROM 0-6 weeks post op

What is adhesive capuslitis?

• freezing = becomes painful at end range

  • ice, estim, A/PROM

• frozen = less painful but loss of ROM

  • heat before exercise, ice after, A/PROM

• thawing = pain subsides and ROM returns

  • stretching

• Loss of ROM ER → abduction → IR → flexion

• inflammation

What is shoulder dislocation?

• strenghten rotator cuff

• avoid abduction with ER