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Supination and pronation occur at what joints of the distal UE
proximal and distal radioulnar joint
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Movement of 0-150° motion occurs at what joint and what is the movement
humeroulnar joint & Flex/Ext
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Movement of 0-90° motion occurs at what joint and what is the movement
Humeroradial joint & Supination/Pronation
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This ligament of the elbow resists valgus forces
medial (ulnar) colateral ligament
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this ligament resists varus forces and prevents posterior translation of the radial head
lateral (radial)collateral ligament
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This ligament holds the radius in proper relation to the ulna and humerus
annular ligament
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Brachialis, Biceps Brachii and brachioradialis are responsible for what motion of the UE
Flexion
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Triceps brachii and anconeus do what motion of the UE
Extension
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What muscles supinate the forearm
- Biceps brachii
- Brachioradialis
- Supinator
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What muscles pronate the forearm
- Pronator teres
- Pronator quadratus
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Name the Wrist flexors
- flexor carpi radialis
- flexor carpi ulnaris
- palmaris longus
- flexor digitorum superficialis
- profundus
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Name the wrist extensors
- extensor carpi radialis longus/brevis
- extensor carpi ulnaris
- extensor digitorum
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which nerve is responsible for cutaneous sensation of 5th digit and part of the 4th digit
Ulnar nerve
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This nerve disorder appears long after the initial injury, is more observable in adults and is unique to this nerve
Tardy ulnar palsy
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Cubital tunnel entrapment is caused by
compression caused by edema(trauma, pregnancy) osteophytes, arthritis, repeated microtrauma
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This deep branch of this nerve may get trapped with a radial head fracture and cause motor deficits or changes
Radial nerve
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Direct trauma to the superficial branch of this nerve will cause sensory changes to the snuff box, radial dorsum and the digits
Radial nerve
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Muscular innervation of triceps, anconeus, wrist extensors, extensor pollicus longus/brevis, abductor pollicus longus, supinator and brachioradialis is accomplished by what nerve
Radial nerve
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Which nerve controls cutaneous sensation of the dorsum of the hand and digits 1-3
Radial Nerve
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This disease is indicative of compression of the superficial branch of the radial nerve causes nocturnal pain along radial dorsum, ofetn caused by compression of a tigjht cast or edema
Wartenberg's Disease
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Cutaneous ditribution of palmar surface of digits
1-3 and medial half of 4th digit is what nerve
Median nerve
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Muscular innervation of pronator teres, pronator quadratus, wrist flexors (except FCU), radial half of flexor digitorum profundus, abductor pollicus brevis are controlled by what nerev
Median nerve
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This is a cardinal sigh of diabetic peripheral neuropathy
Stocking/glove parasthesia
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Hypomobility of the the joint may be caused by
- RA, DJD, JRA
- fractures, dislocations
- adhesions & contractures after acute trauma
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What are some cause of limitation for supination and pronation
- fractures
- subluxation/dislocation
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Patient Ed., modifying ADL's, reduction of inflammation, PROM-AAROM with in pain limits,
isometrics at multiple angles, proximal and distal joint exercises, distal to proximal massage is accomplished during what stage of treatment
Protection phase
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Grade III-IV mobs, manual self stretching of periarticular tissue, joint tracking and resistive exercises in open/close chainnincluding dital and proximal joints is accomplished in what stage
controlled motion phase
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Severe comminuted fractures of distal humerus, fracture/dislocation of radial head, chronic synovitis with deterioration in joint spaces are all indications for what kind of surgery
Excision of radial head
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What are some Max protection treatments s/p radial head excision
- Mobility of unoperated joints
- PROM-AAROM within pain free ranges
- continuos passive machine (CPM)
- sub-maximal pain-free multiple angle exercises
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What are some contraindications after radial head excision
- Varus and valgus stress in terminal flex/ext
- no handling of heavy objects
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After TEA with a reflected tricep what exercises would be contraindicated
isometric contractions of triceps for several weeks
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What are some precautions after TEA
- no resisted elbow ext. 6-12 weeks if tricep reflected
- apply resistance above elbow with strengthening exercises to avoid elbow stress
- avoid pushing up from chair, using crutches,
- cane or carrying objects for 6 weeks
- no high load PRE
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Myositis ossification occurs most often where in the elbow
- in muscle-tendon unit of brachialis
- capsule or ligamentous structures
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Myositis ossificans (heterotopic or ectopic bone formation) in the elbow occurs most often in what type of patients and as a result of what actions
- TBI, SCI, burn patients
- as a result of aggressive stretching of elbow flexors post injury/immobilization
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What tretaments can be used to manage elbow ectopic bone formation
- PROM in pain free range
- rest to alllow bone reabsorbtion
- surgery may be necessary
- NO massage, passive stretching, resistive exercises after traume to brachialis
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Inflammation at the origin of the musculotendinous junction of extensor carpi radialis brevis, caused by repetitive overuse of wrist extensors with forearm pronated is a sign of what diagnosis
Lateral epicondylitis (tennis elbow)
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What are the two types of supracondylar fractures
Type I humeral fragment lies posterior secondary to strong pull of tricep
Type II humeral fragment lies anterior, flexion injury result of trauma
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How is a supracondylar fracture (transverse fracture of distal humerus) treated
closed reduction and immobilization for 4-6 weeks in flexed position
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Severe forearm muscle pain, purple discoloration of hand, loss of radial pulse parasthesia leading to paralysis are symptoms of what diagnosis
Volkmann ischemic contractures
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No active elbow extension >90° for 2 months, limited active resistive tricep extension once bony union has occured are all precautions for what type of fracture
Olecranon fracture
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What procedure is used in elderly patients with a intercondylar Y or T fracture
a collar and cuff sleeve with elbow maximally flexed to allow gravity to reduce fracture fragments "bag of bones"
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Isometric exercises starting with elbow flexed, pronated and wrist extended progressing to wrist flexion then elbow extension is used in maintenance of
lateral epicondylitis
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Isometric exercises starting with elbow and wrist flexed progressing to wrist extension, supination and elbow extension is used in maintenance for
medial epicondylitis
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Immobilization, activity modification cryotherapy, joint functions
mobility maintenance (low intensity isometrics, cross fiction massage) are used in max protection phase for
Lateral and medial epicondylitis
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