Good luck
UCL Sprain/Tear
What is it? Cause? S/S? Treatment? Special Tests (PERFORM THEM)
What is it: strain or tear of the ulnar collateral ligament. It helps stabilize the elbow against valgus stress.
Causes: Repetitive overhead throwing, trauma, overuse
S/S: Medial elbow pain, Tenderness along the UCL, Pain with valgus stress, Swelling, Popping sensation or sound
Special tests: Valgus stress test
Treatment: Activity modification and temporary avoidance of throwing activities, strengthen wrist flexors, pronators, and dynamic medial elbow stabilizers. Wrist flexion curls, forearm pronation/supination, Shoulder ER
De Quervain's
What is it? Cause? S/S? Treatment? Special Tests (PERFORM THEM)
What is it: Tenosynovitis of the 1st dorsal compartment (APL and EPB)
Cause: Excessive radial and ulnar deviation common with picking up baby from crib, 30-50 → Females
Special test: Finkelstein
Treatment: Thumb spica splint → Bracing, Light stretching soft tissue, Into eccentrics
Bankart Tear
What is it? Cause? S/S? Treatment? Special Tests (PERFORM THEM)
What is it: a tear to the anterior inferior glenoid labrum. If the shoulder experiences a traumatic force, the humeral head will dislocate anteriorly by compressing or pulling the anterior inferior labrum, tearing it away from the glenoid.
Cause: FOOSH, Overhead trauma, recurrent shoulder dislocations
S/S: Anterior/deep shoulder pain, Feeling of instability, Clicking and catching, Weakness and decreased function
Special Tests: Sulcus Sign, Apprehension/Jobe Relocation, Load Shift, Crank Test
Treatment: Isometrics, rotator cuff strengthening, scapular stabilization, closed chain stability exercises
Biceps Tendinopathy
What is it? Cause? S/S? Treatment? Special Tests (PERFORM THEM)
What is it: Inflammatory or degenerative condition (fraying and tearing) of the biceps tendon due to overuse, instability, SAPS. If torn it can lead to instability because it is an anterior stabilizer
Cause: Overuse, instability, SAPS.
Special Tests: Palpation of long head of the biceps tendon, Speed’s, Yergason (transverse humeral ligament)
Treatment: Eccentrics
Thoracic Outlet Syndrome
What is it? Cause? S/S? Treatment? Special Tests (PERFORM THEM)
What is it: The brachial plexus becomes compressed along with the subclavian artery.
Cause: Hypertrophied/tight scalenes (anterior and middle), Upper cross (Tight pectoralis minor) leading to compression under the coracoid process, Elevated first rub due to tight scalenes
S/S: Numbness and tingling in
Treatment: First rib mobilization, Soft tissue of scalenes and pec minor– stretching
Special Tests: Roos, Adsons, Wrights, Edens
Lateral Epicondylitis
What is it? Cause? S/S? Treatment? Special Tests (PERFORM THEM)
What is it: Tendinopathy of the common wrist extensor tendon, most commonly involving the extensor carpi radialis brevis (ECRB)
Cause: Repetitive wrist extension, repetitive gripping, repetitive forearm rotation, poor load management, racquet sports/manual labor
S/S: Pain localized over the lateral epicondyle, Pain with resisted wrist extension, Pain with gripping, Reduced pain free grip strength, Tenderness over extension wad
Special tests: Cozens, Mills, Maudsleys
Treatment:
Acute - Isometrics, brace during activities, ice
Subacute on - Strengthening eccentrics, grip strengthening, mobilization with movement, scapular weakness (Up the chain)
Pronator Syndrome
What is it? Cause? S/S? Treatment? Special Tests (PERFORM THEM)
What is it: Median nerve gets stuck between pronator teres heads
Cause: Compression of the median nerve by the pronator teres muscle due to hypertrophy or inflammation of the muscle, repetitive pronation/supination, repetitive gripping activities
S/S: Sensory/pain syndrome, NO MOTOR LOSS, Median nerve symptoms
Treatment: Median nerve glides, Stretching, Reduce repetitive activity
Special tests: Provocative test for pronator syndrome
Scapholunate Disruption (SL Ligament tear)
What is it? Cause? S/S? Treatment? Special Tests (PERFORM THEM)
What is it: The scapholunate interosseous ligament connects two carpal bones scaphoid lunate) and works to stabilize these bones. When a tear occurs the scaphoid and lunate can move abnormally leading to SLAC wrist (scapholunate advanced collapse)
Cause: FOOSH, hyperextension with ulnar deviation, repetitive loading
S/S: Dorsal Wrist pain, Pain with wrist extension and weightbearing, Clicking clunking
Special tests: Watsons (scaphoid shift)
Treatment: Splints/immobilization, Gradual pain free ROM, Wrist stabilization and grip strengthening
AC Joint Pathology
What is it? Cause? S/S? Treatment? Special Tests (PERFORM THEM)
What is it: Tear or sprain of the AC and or CC ligaments leading to displacement of the acromion.
Cause: fall onto the tip of the shoulder, FOOOSH, repetitive overhead activity
Special tests: Crossed adduction, Resisted extension, O’briens
Would also look for step or piano key (>grade 3)
Treatment
Grade 3 or more → Surgery
Immobilize (1-4 weeks)
AROM below 90 degrees
Submax isometrics in neutral
Scapular stabilization (rows/scapular depression)
Medial Epicondylitis
What is it? Cause? S/S? Treatment? Special Tests (PERFORM THEM)
What is it: An overuse injury involving the common flexor tendons at the medial epicondyle causing pain and irritation where the wrist flexor and pronator muscles attach.
Cause: Thyroid and diabetes, Repetitive wrist flexion and forearm pronation, repetitive gripping activities
S/S: Pain and tenderness over medial epicondyle, Pain with resisted wrist flexion and forearm pronation, Decreased grip strength
Special tests: Valgus, Palpation
Treatment: Activity modification, stretching of the wrist flexors, soft tissue for pain, progressive strengthening including wrist flexion isometrics and eccentric loading
SLAP Tear
What is it? Cause? S/S? Treatment? Special Tests (PERFORM THEM)
What is it: Injury to the superior glenoid labrum where the long head of the biceps tendon attaches. Labrum helps depend the socket
Cause: Traction, FOOSH, peel-back mechanism of extreme abduction and ER, repetitive throwing
S/S: Deep shoulder pain, Pain with overhead activities and throwing, Clicking popping, Decreased throwing velocity, Pain during late cocking acceleration
Special tests: Biceps load 1, Biceps load 2, O’Briens, Crank
Treatment; Activity modification, Rotator cuff strengthening, Scapular stabilization
Adhesive Capsulitis
What is it? Cause? S/S? Treatment? Special Tests (PERFORM THEM)
What is it: The capsule around the GH becomes thick and fibrotic leading to pain and joint restriction.
Cuase: Diabetes, Hypothyroidism, Older age (post menopausal)
S/S: Diffuse pain at night, with rapid movement, and sleeping on the affected side, Global loss of PROM and AROM with pain at end range, Capsular pattern (ER>ABD>IR), Type 3 scapular dyskinesia
Stages
Freeing - 10-36 weeks, Pain is the primary limiter
Frozen - 4-12 weeks, Stiffness remains with almost a complete loss of ER
Thawed - 12-42, Gradual return of motion
Treatment
Early → Joint mobs grade 1 and 2 for pain relief
Exercise within pain limits to restore movement
Middle → Restore movement with low load prolonged stretching and RTC strengthening
Late → Return to prior level of function
Carpal Tunnel Syndrome
What is it? Cause? S/S? Clinical Prediction Rules? Treatment? Special Tests (PERFORM THEM)
What is it: A neuropraxia of the media nerve
Cause: Pregnancy, diabetes, hypothyroidism
S/S: Numbness and tingling in the thumb, index, middle, and radial half of the ring finger, Chronic → Thenar muscle atrophy
Clinical Prediction Rules:
Shaking hands for symptom relief
Wrist ratio index greater than 0.67
Symptom severity scale score greater than 1.9
Reduced median sensory field of digit 1
Age greater than 45
Special Tests: Phalens, Reverse phalens, Durkan's compression test, Tinel's sign
Treatment: Night splinting, Median nerve glides, Ergonomic education
Rotator Cuff Tear
What is it? Cause? S/S? Treatment? Special Tests (PERFORM THEM)
What is it:Tear of one of the rotator cuff muscles
Cause: FOOSH or traction injury. The most common tendon is the supraspinatus but can also be due to a subacromial impingement that frayed away at the tendons.
S/S: Weakness, Pain
Treatment: Surgery, Strengthen rotator cuff again and restore ROM, If impingement must fix mechanics
Cluster: Drop arm, Infraspinatus test, Painful arc - Pain 60-120
Can isolate muscle
Teres minor - hornblowers
Subscap- Lag sign, Belly press, Lift off
Subacromial Pain Syndrome
What is it? Cause? S/S? Treatment? Special Tests (PERFORM THEM)
What is it: Structures within the subacromial space become impinged (Supraspinatus, LHBT, Subacromial bursa, Coracohumeral ligament, articular capsule)
Cause: Primary - Result of soft tissue/boney changes, Typically >40, Secondary - Result of scapular dyskinesia and rotator cuff fatigue, Problem keeping the humeral head in the glenoid fossa, Typically 15-35
Special tests: Painful arc, Hawkins kennedy, Infraspinatus
Additional test: Neers, Yokums
Treatment- Restore force couples and scapular stabilizers
TFCC
What is it? Cause? S/S? Treatment? Special Tests (PERFORM THEM)
What is it: The TFCC stabilizes the distal radioulnar joint (FRUK) and distributes and absorbs forces through the ulnar side of the wrist
Cause: FOOSH with wrist extension and ulnar deviation, axial loading, chronic wear, aging, forceful twisting
S/S: Ulnar sided wrist pain, Clicking/popping, Pain with pronation and supination, Pain with gripping and weight bearing though the hand
Special Tests: TFCC Grind, Piano Key → Ulnar stability
Treatment: Immobilization, Activity limitation, Progressive forearm ROM (pain free), Grip strength