MSK UE D/D and Interventions FF

what part of the neurovascular bundle is entrapped w/ TOS

brachial plexus, subclavian artery/vein and phrenic nerve

types of TOS

1. neurological - C8-T1 sx

2. arterial - pulselessness, poor endurance, cold extremities

3. venous - warm, edema

interscalene triangle TOS site special test and intervention

Adson test; stretch anterior scalene (same way to stretch SCM)

costoclavicular space TOS site special test and intervention

Military Brace Test; 1st rib mob

Axillary Interval (pec minor space) TOS site special test and interventin

Wright, Roos and Allen test; stretch pec minor

subacromial impingement presentation

- anterior/lateral shoulder pain; could be at night

- painful arc 60-120 deg

- (+) neer, hawkin's kennedy, yocum, empty can

rotator cuff tear presentation

- 40+ y/o (acute or overuse)

- loss of strength w/ shoulder pain

- wakes at night w/ pain

- (+) ER lag sign, Hornblower's, drop arm, belly press/lift off

SLAP tear presentation

- usually due to dislocation but could be overhead overuse

- deep anterior shoulder pain

- clunking/clicking w/ biceps loading

- (+) O'brien, Biceps load, Clunk

AC Joint presentation

- from landing on shoulder, displacing girdle inferiorly

- pain at top of shoulder

- painful arc 170-180 deg

- (+) AC sheer test, step deformity

bicipital tendinopathy presentation

- 20-45 y/o

- pain w/ overhead movements

- pain w/ stretching biceps

(+) Yergason's, Speed

SLAP Repair key points for rehab

avoid tension at biceps for 6 weeks

if biceps detached:

- limit elevation over 90

- PROM in scapular plane 1st 2 weeks

RC rehab (for a tear?)

- resistance shouldn't cause pain

- address RC muscle strength before large primary movers

- no CKC for 6 weeks

- dynamic strengthening ~ 8 weeks for small tear, ~ 12 weeks for large tear

adhesive capsulitis stages

1. inflammation 0-3 months (mild sx but loss of ER/abduction)

2. freezing 3-9 mo - restriction all directions and persistent pain

3. frozen 9-15 mo - pain only w/ movements, atrophy, horrible ROM

4. thawing 15-25 mo - slow recovery (use corticosteroid to help w/ posterior inferior glides)

lateral elbow tendinopathy presentation

- pain at lateral epicondyle

- ECRB involvement

(+) cozen, Mill's, maudsley

medial elbow tendinopathy presentation

- pain at medial elbow

- pronator teres and FCR involvement

Nursemaid's elbow

from pulling into traction causing annular ligament slippage

De Quervain's presentaiton

abductor pollicis longus and extensor pollicis brevis involvement

- (+) finklestein

carpal tunnel syndrome presentation

median nerve impacted past wrist

- thenar atrophy

- night pain

(+) phalen's and tinel

colles fracture

dorsal displacement of radius due to FOOSH

- dinner fork deformity

smith fracture

volar displacement of radius due to landing on flexed wrist

- garden spade deformity

boutonniere deformity

extension of MCP and DIP, flexion of PIP

- due to central tendon slip of extensor hood

swan neck deformity

flexion of MCP and DIP, extension of PIP

- due to volar plate tear or contracture of intrinsic muscles

mallet finger

rupture or avulsion of extensor tendon at distal phalanx

ulnar nerve motor innervation MAFIA

Medial 2 lumbricals

Adductor pollicis

Flexors on ulnar side (FCU, FDP)

Interossei

Abductor digiti minimi

cubital tunnel syndrome

entrapment of ulnar nerve between FCU heads

- weakness in FDP (and muscles below)

Guyon's canal syndrome

entrapment of ulnar nerve between hook of hamate and transverse carpal ligament

- only hand muscle/sensory involvement (FDP spared)

what muscle opens the mouth

lateral pterygoid

- 35-55 mm

what muscle closes mouth

medial pterygoid, masseter and temporalis

disc displacement w/ reduction presentation

popping/clicking w/ opening and closing

- confirmed w/ palpation to lateral poles

- no deviation or difficulty opening mouth

hypomobility of TMJ presentation

decreased mouth opening and deviates to ipsilateral side

hypermobility of TMJ presentation

increased mouth opening and deviates to contralateral side

capsulitis of TMJ

pain, limited mouth opening and deviation to same side