Conditions & Rehabilitation of the Elbow

Patient complains of right shoulder pain since falling on the right shoulder 3 weeks ago. There was no dislocation and x-rays were negative. AROM is 35° of flexion and abduction with scapular elevation noted. Passive ROM is nearly full, with mild pain and muscle guarding at the end of the range. Resisted abduction is weak with pain pointed out in the anterior and lateral deltoid region. There is no atrophy. Based on the above findings, the physical therapist should MOST LIKELY suspect:

• Adhesive capsulitis

• Axillary nerve palsy

• Supraspinatus tendinitis

• Rotator cuff tear

Answer explanation

1. Adhesive capsulitis 

• - Develops mostly with autoimmune disorders (e.g. diabetes, hyperthyroidism, trauma, or inflammation).  There is a symptom duration that does not usually only last for 3 weeks. It is within months. ER, AB, IR. This is IDIOPATHIC.

2. Axillary nerve palsy 

• - Numbness over part of the outer shoulder.

• - Pain in the Shoulder Region

• - Shoulder weakness, especially when lifting the arm and away from the body.

3. Supraspinatus tendinitis 

4. Rotator cuff tear 

• - Pain is usually felt over the anterolateral deltoid areas.

Patient presents to an outpatient clinic with an order to evaluate and treat the R forearm and wrist secondary to nerve compression. The patient has the following signs and symptoms: pain with manual muscle testing of pronation, decreased strength of the flexor pollicis longus and pronator quadratus, and pain with palpation of the pronator teres. What nerve is most likely compromised? What is most the likely area of compression?

• Ulnar nerve – Guyon’s canal

• Median nerve – carpal tunnel

• Ulnar nerve – pronator quadratus

• Median nerve – pronator teres

Which of the following muscle tendons most commonly ruptured in patients who suffer from RA?

• Flexor digitorum profundus

• Extensor carpi ulnaris

• Extensor carpi radialis longus

• Flexor pollicis longus

Answer explanation

Muscle of the thumb - usual site of RA

A patient complains of persistent wrist pain after painting a house 3 weeks ago. The patient demonstrates signs and symptoms consistent with de Quervain’s tenosynovitis. An appropriate special test to confirm the diagnosis is:

• A. Finkelstein’s test

• B. Phalen’s test

• C. Froment’s sign

• D. Craig’s test

In which of the following conditions is a nerve conduction velocity test MOST appropriate?

• A. CVA

• B. CTS (CARPAL TUNNEL SYNDROME)

• C. Myotonia

• D. DM

A patient presents with a hand deformity secondary to a peripheral nerve injury. Which of the following findings would MOST likely be noted on examination?

• A. Decreased strength with thumb opposition

• B. Fixed flexion of the metacarpophalangeal joints.

• C. Fixed hyperextension of the metacarpophalangeal joints.

• D. Wasting of the hypothenar eminence

A patient demonstrates a significant loss of strength when trying to grasp a cup. However, the patient has much less difficulty when holding onto a pencil. This type of clinical scenario is consistent with pathology affecting the:

• Median nerve

• Suprascapular nerve

• Musculocutaneousnerve

• Ulnar nerve

A 32-year-old tennis player is referred to PT/OT after being diagnosed with median nerve entrapment. The patient's chief complaints include paresthesias in the hand and progressive weakness. Which muscle would MOST likely contribute to the entrapment?

• Abductor pollicis longus

• Flexor digiti minimi

• Flexor digitorum profundus

• Pronator teres

A 66-year-old had a history of a fall on an outstretched arm and sustained fracture of the distal radius with dorsal angulation. This is called:

• Colles’ fracture

• Monteggia fracture

• Smith fracture

• Greenstick fracture

The 14-year-old male patient came into the clinic with a referral from the Orthopedic service. His diagnosis is a Monteggia fracture. What does this comprise?

• Fracture of the ulna with ulnar dislocation.

• Fracture of the ulna with radial head dislocation.

• Fracture of the radius with radial head dislocation.

• Fracture of the radius with dislocation of the ulna