2.4.2. Physical Exam

Question 1

Where does most pain come from on the elbow?

Answer 1

The lateral epicondyle being hit

Question 2

Where do our wrist extensors begin?

Answer 2

Lateral epicondyle

Question 3

Describe what is considered the “elbow joint space” and where we might get some pain

Answer 3

bound triangularly by the olecranon, lateral epicondyle, and the radial head. Nerve entrapments can occur in the wrist extensor region.

Question 4

Where do the flexor tendons originate in the elbow?

Answer 4

Medial epicondyle

Question 5

What is the first thing we should rule out with snuffbox tenderness?

Answer 5

Scaphoid fracture

Question 6

How many bones are in the wrist and what do we call this category of bones?

Answer 6

8, we call them carpals

Question 7

Penumonic for the wrist bones:

Answer 7

Starting from the thumb: “Scarred Lovers Tried Positions That They Couldn’t Handle” Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, Hamate

Question 8

8 bones of the wrist?

Answer 8

Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, Hamate

Question 9

What is the most easily fractured wrist bone?

Answer 9

Scaphoid

Question 10

What is FOOSH?

Answer 10

Fall on outstretched hand

Question 11

What is DeQuervain’s tenosynovitis?

Answer 11

painful condition affecting the tendons on the thumb side of your wrist. If you have de Quervain’s tenosynovitis, it will probably hurt every time you turn your wrist, grasp anything or make a fist.

Question 12

What causes DeQuervain’s tenosynovitis

Answer 12

Although the exact cause of de Quervain’s tenosynovitis isn’t known, any activity that relies on repetitive hand or wrist movement — such as working in the garden, playing golf or racket sports or lifting your baby — can make it worse

Question 13

Describe Carpel Tunnel Syndrome

Answer 13

You have 9 flexor tendons jammed in the tunnel (see below) rubbing on the median nerve, which in time, cuases pain, hence “Carpal Tunnel Syndrome”

Question 14

Label the bones of the wrist

Question 15

Label the parts of the elbow

Question 16

What nerves cover sensation in these areas?

Question 17

What are we looking for on inspection of the elbow?

Answer 17

Swelling

Erythema

Bruising

Deformity

Question 18

If we see this bruise and bulge in the arm, what is the injury?

Question 19

What do we palpate on our elbow exam?

Answer 19

Lateral epicondyle

Radial Head

Olecranon

Medial Epicondyle

Biceps Tendon

Question 20

What does the U, the blue circle, and the green triangle represent in this diagram?

What part of the elbow is the examiner pointing to?

Answer 20

U = lateral epicondyle

Blue circle is radial head

Green triangle is joint triangle

Finger of examiner is the olecranon

Question 21

What range of motion tests for the elbow?

Answer 21

Flexion

Extension

Pronation

Supination

Question 22

What are our vascular tests of the elbow?

Answer 22

Radial and ulnar pulses

Question 23

What movements are we testing for elbow strength?

Answer 23

Flexion

Extension

Pronation

Supination

Question 24

What special test do we do for the elbow?

Answer 24

Resisted Long Finger Extension - Position with elbow near full extension and wrist in neutral position with fingers extended. Press on dorsal 3rd finger to force into flexion while patient actively extends to resist you. If resistance causes pain at lateral epicondyle of the elbow, the test is positive and suggests lateral epicondylitis.

Question 25

What are we inspecting for on the hand/wrist?

Answer 25

Swelling/Erythema/Bruising

Heberdon’s Nodes

Bouchard’s Nodes

Thenar Atrophy

Deformity

Question 26

What are Heberdon’s Nodes? Compare them to Bouchard’s Nodes?

Answer 26

These are hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints for Bouchard’s and the DIPs for Hberdon’s. They are a sign of either osteoarthritis or Rheumatoid arthritis.

Heberdon’s

Bouchard’s

Question 27

What do we palpate for the hand/wrist exam?

Answer 27

Distal radius (styloid)

Distal Ulna (styloid and head)

Anatomic Snuffbox

Scaphoid Tubercle (volar)

Question 28

What ROM tests do we do for the wrist?

Answer 28

Flexion

Extension

Ulnar/Radial Deviation

Question 29

What finger ROM tests do we perform?

Answer 29

MCP/DIP/PIP Flexion

MCP/DIP/PIP Extension

Rotational abnormality of fingers (flex all finger joints together and they should point towards the scaphoid)

Question 30

What neurovascular tests do we do for the fingers?

Answer 30

1. 2 point discrimination (<10mm) at radial, ulnar, and medial distributions

2. Radial/Ulnar Pulses

Allen Test - hand is elevated and the patient/person is asked to make a fist for about 30 seconds. Pressure is applied over the ulnar and the radial arteries so as to occlude both of them

Question 31

What special tests do we perform for the wrist/fingers?

Answer 31

1. Carpal Tunnel Testing - Phalen Maneuver
2. Median Nerve Testing - Tinel’s Test
3. DeQuervain’s Tenosynovitis Testing - Finkelstein’s Test

Question 32

Describe the Phalen Maneuver

Answer 32

Dorsum of hands are placed together in maximum wrist flexion for 30 seconds. If there is numbness or tingling in the distribution of the median nerve, you have a positive test for Carpel Tunnel Syndrome

Question 33

Describe the Tinel’s Test

Answer 33

Using index finger or reflex hammer, lightly tap the median nerve at the distal palmar crease. Parasthesis (tingling, prickling, or slight burning sensation) in the median nerve region is a positive Tinnel’s sign. You can also do this test on any superficial nerve including the ulnar nerve at the elbow or wrist

Question 34

Describe the Finkelstein’s Test

Answer 34

Patient makes a fist with the thumb inside the fingers. Push the fist into ulnar deviation. Pain at the dorsoradial aspect of the wrist indicates DeQuervain’s.