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PCMI > 1.6. Elbow, Wrist, and Hand Complaint > Flashcards

1.6. Elbow, Wrist, and Hand Complaint Flashcards

1
Q

What reflexes would you test for the elbow joint exam? What scale do you use?

A
  1. Biceps
  2. Triceps
  3. Brachioradialis
    0-4 scale, 2 is normal
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2
Q

What is the vascular exam for the elbow?

A

Checking brachial pulse

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3
Q

What are the 5 specialty exams for the elbow?

A
  1. Valgus stress test: sprained medial collateral l.
  2. Varus stresst test: sprained LCL
  3. Tinel test: ulnar nerve entrapment (cubital tunnel)
  4. Medial (golfer) epicondylitis test
  5. Lateral (tennis) epicondylitis test
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4
Q

What are the most common issues with anterior elbow pain?

A
  1. gout

2. osteoarthristis

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5
Q

What is the most common causes of lateral elbow pain?

A

lateral epicondylitis

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6
Q

What are the most common causes of medial elbow pain?

A
  1. Cubital tunnel syndrome (ulnar n.)

2. Medial epicondylitis

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7
Q

What is the most common cause of posterior elbow pain?

A

olecranon bursitis

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8
Q

What is the classic presentation of Tennis Elbow (lateral epicondylitis)?

A
  • Gradual onset of pain at lateral elbow

- Pain is aggregated by resisted wrist extension (lateral epicondylitis test)

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9
Q

What is the etiology of Tennis Elbow (lateral epicondylitis)?

A

Caused by repeated motion like playing tennis or activities which result in micro tears or micro avulsions of common extensor tendons

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10
Q

What are common treatments for Tennis Elbow (lateral epicondylitis)?

A
  • Rest, ice, bracing, short course NSAIDs
  • Steroid injection
  • PT
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11
Q

What is the classic presentation of Medial Epicondylitis (Golfer’s Elbow)?

A
  • gradual onset of pain at medial elbow with or without grip weakness
  • pain localized over medial epicondyle and aggravated by resistent wrist flexion (medial epicondylitis test)
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12
Q

What is the etiology of Medial Epicondylitis (Golfer’s Elbow)?

A

repetitive motions from playing golf or other activities which result in micro tears or microavulsions of common flexor tendons

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13
Q

What is the common treatment of Medial Epicondylitis (Golfer’s Elbow)?

A
  • Rest, ice, bracing, short course NSAIDs
  • Steroid injection
  • PT
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14
Q

What is the most common bursitis seen?

A

Olecranon bursitis

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15
Q

What are the 2 types of olecranon bursitis?

A

Septic and aseptic

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16
Q

What is the typical etiology of olecranon bursitis?

A

Common after trauma from leaning on elbow, however can have inflammatory or infectious etiologies (inflammatory arthritis, gout, trauma, hemorrhage, infection)

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17
Q

Why do you have to be careful about aspirating fluid from a joint? When would you do this?

A
  • Concern that you might introduce bacteria to aseptic joint

- concern about infection or crystal disease

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18
Q

What is the treatment for olecranon bursitis?

A
  • ice, compression, dressing, avoiding aggravating factors
  • antibiotic if septic
  • therapeutic aspiration
  • bursectomy
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19
Q

What is the epidemiology of ulnar nerve entrapment (cubital tunnel syndrome)?

A
  • 2nd most common compressive neuropathy in UE, 2nd to carpal tunnel
  • 60% of pt’s with medial epicondylitis have ulnar n. entrapment as well
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20
Q

What is the etiology of ulnar nerve entrapment (cubital tunnel syndrome)?

A

Compression of ulnar n. anywhere allow course, but most common at cubital tunnel of medial elbow

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21
Q

What is the clinical presentation of ulnar nerve entrapment (cubital tunnel syndrome)?

A
  • medial elbow pain with repetitive activity, associated with paresthesia in ulnar border of forearm, hand, and 4th/5th digits
  • Can have atrophy of intrinsic hand muscles if prolonged
  • pain at night when elbow is fully flexed
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22
Q

How would you diagnose ulnar nerve entrapment (cubital tunnel syndrome)?

A
  • Tinel sign
  • Nerve conduction/EMG testing
  • MRI
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23
Q

What is the Tinel sign?

A

Tapping in ulnar groove between medial epicondyle and olecranon
-positive if elicits tingling in arm/hand

24
Q

What is the treatment for ulnar nerve entrapment (cubital tunnel syndrome)?

A
  • night splinting, elbow pads, avoiding leaning on elbows and prolonged flexed arm
  • PT
  • Surgical decompression or translocation
25
Q

What are 4 common specialty exams for the wrist and hand joint exam?

A
  1. Phalen’s sign: testing for carpal tunnel
  2. Tinel’s sign: testing for cubital tunnel
  3. Finkelstein test: testing for de Quervain’s tenosynovitis
  4. Assess for trigger finger
26
Q

What is a Mallet finger?

A

loss of terminal extension of the DIP joint

27
Q

What are 3 common infections of the hand?

A
  1. Paronychia
  2. Cellulitis or abscess
  3. Herpetic whitlow (HSV of finger)
28
Q

Would osteoarthritis present as symmetric or asymmetric?

A

asymmetric

29
Q

Would rheumatoid arthritis present as symmetric or asymmetric?

A

symmetric

30
Q

What are 5 common risk factors for carpal tunnel syndrome?

A
  1. Female, especially during pregnancy
  2. Obesity
  3. Autoimmune diseases: dm, RA, hypothyroidism
  4. Osteoarthritis
  5. Repetitive movement/workplace factors
31
Q

What is the clinical presentation for carpal tunnel syndrome?

A
  • wirst pain with paresthesia along 1st 3 digits and half of 4th
  • Symptoms often worse at night
  • Patient shakes hand to relieve pain (flick sign test)
32
Q

How do you perform Phalen’s sign?

A

Flex wrists against one another

-positive if numbness/tingling in median n. distribution within first 60 secs

33
Q

What is the etiology of de Quervain’s Tenosynovitis?

A

inflammation of tendon and synovial sheath covering ext policies braves and abductor pollicis longus (snuff box)

34
Q

What are the risk factors for de Quervain’s Tenosynovitis?

A
  • female
  • 30-50 years of age
  • repetitive activities
  • new mother (picking up children)
35
Q

What is the classic presentation of de Quervain’s Tenosynovitis?

A
  • subacute radial wrist pain at base of thumb and distal radius with thumb movement
  • pain worsens with gripping or holding objects
36
Q

How would you clinically diagnose de Quervain’s Tenosynovitis?

A
  • Finkelstein test: flexion of thumb elicits pain

- Imaging not typically performed, but could consider US

37
Q

What is the treatment for de Quervain’s Tenosynovitis?

A
  • thumb spika splint
  • NSAIDs or steroid injection
  • surgery
38
Q

What is the etiology of Rheumatoid Arthritis?

A
  • autoimmune

- inflammatory arthritis

39
Q

What are the risk factors for Rheumatoid Arthritis?

A
  • female
  • smoking
  • obese
  • family historyu
  • HLA-DRB1 genotype
40
Q

What is the classic presentation of Rheumatoid Arthritis?

A
  • SYMMETRIC joint pain, swelling, stiffness lasting LONGER THAN 1 HOUR
  • common wrist, MCP and PIP joint
41
Q

What exam findings would be present in RA?

A
  • Edema, synovitis
  • Ulnar deviation
  • swan neck deformities
  • Boutonniere deformities (PIP hyperextension and DIP flexion)
    • MCP squeeze test
  • Rheumatoid nodules
42
Q

What would you use to diagnose RA?

A
  • Labs: ESR, CRP, RF, anti cyclic citrullinated peptide (Anti-CCP)
  • X-ray findings: marginal bone erosion, ulnar deviation at MCP, joint space narrowing, periarticular osteopenia
43
Q

What 3 medication categories would you use to treat/manage RA?

A
  1. NSAIDs
  2. Glucocorticoids
  3. Disease modifying anti rheumatic drugs (DMARDS) (ex: methotrexate, leflunomide)
44
Q

What are the risk factors for osteoarthritis?

A
  • age >50
  • obesity
  • female
  • joint trauma
  • genetics
45
Q

What are the clinical pearls for OA?

A
  • Asymmetric joint pain lasting <1 hour after waking up and improves with activity
  • Herberden’s nodes: @ DIP joint
  • Bouchard’s nodes: @ PIP joint
46
Q

What is the etiology of ganglion cysts?

A

thought to arise from herniation of CT from tendon sheaths, ligaments, joint capsule, bursa

47
Q

What age group does ganglion cysts typically first present in?

A

20’s-40’s

48
Q

What is the classic presentation of ganglion cysts?

A
  • painful, smooth, firm to rubbery cyc=stic lesion in wrist, hand, feet, etc
  • typically on dorsal wrist or palmar wrist over fingers
49
Q

How would one clinical diagnose a ganglion cyst?

A
  • transulluminate cyst to differentiate from solid tumor

- ultrasound or MRI

50
Q

What is the classic presentation of a scaphoid fracture?

A
  • wrist pain on radial aspect in anatomical snuff box

- decreased grip strength

51
Q

When would a scaphoid fracture be an emergency?

A

open fractures, displaced fractures, neurovascularly compromised fractures

52
Q

what is the classic presentation of a distal radial fracture (Colle’s fracture)?

A

distal wrist pain and swelling with possible deformity (dinner fork appearance), although some have no deformities

53
Q

What type of splint would you use for a Colle’s fracture?

A

volar or sugar tong

54
Q

What is the etiology of trigger finger “stenosing flexor tenosynovitis”?

A

disparity in size of flexor tendon to surrounding reticular pulley system/sheath, impairing gliding of flexor tendon

55
Q

What is the cause of Dupuytren’s contracture?

A
  • progressive fibrosis of palmar fascia which results in gradual joint stiffness and inability to fully extend finger
  • Pope’s sign

PCMI (15 decks)

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