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msk 2nd shift > ana of elbow, forearm, wrist and hand > Flashcards

ana of elbow, forearm, wrist and hand Flashcards

1
Q

primary role of the elbow

A

position hand in appropriate location to perform fine motor abilities, gripping, grasping

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2
Q

what are the 3 joints of the elbow complex

A

ulnohumeral
radiohumeral
superior radioulnar

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3
Q

what motions are present in the elbow complex

A

1 deg of freedom - flex-ext

but some rotation in sup RU joint

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4
Q

discuss the stability of the elbow

A

1° stabilized by ligaments hence it does respond well to trauma

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5
Q

most common type of dislocation in the elbow

A

posterolateral dislocation d/t empty back part in RH joint

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6
Q

discuss the congruency of joints in the elbow

A

mostly superficial yung sa trochlea, olecranon and cornoid of UH lng yung deep

and sa RH meron empty back part

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7
Q

what inert structures can be found on the medial elbow

A

MUCL or UCL - on medial side; restricts valgus motion and fan shaped

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8
Q

what ligament is most commonly injured in the elbow

A

MUCL

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9
Q

what can be found in the posterior portion of UCL

A

houses ulnar nerve as it passes by cubital fossa

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10
Q

what inert structures can be found on the lateral elbow

A

radial collateral lig and lateral ulnar collateral lig

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11
Q

what does the LUCL do

A

has to restrict more - d/t to empty space in lateral elbow

stronger than medial ligaments

fan shaped

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12
Q

second most commonly injured ligament in the elbow

A

LUCL

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13
Q

proximal row of carpals

A

scaphoid
lunate
triquetrum
pisiform

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14
Q

distal row of carpals

A

trapezium
trapezoids
capitate
hamate

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15
Q

movements in the DRUJ

A

uniaxial pivot - pronation and supination

and some radial/ulnar dev

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16
Q

rc joint movements

A

biaxial ellipsoid - flex/ext and radial/ulnar deviation

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17
Q

keeps the stability of proximal carpals to radiocarpal bones

A

radioscapholunate ligament

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18
Q

most common injured lig of the wrist

A

radioscapholunate ligament

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19
Q

how is radioscapholunate ligament usually injured

A

pronated FOOSH per pwede din FOOSH tas either ext, ulnar dev and intercarpal supination

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20
Q

second most common injured lig of the wrist

A

Lunotriquetral Ligament

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21
Q

MOI for Lunotriquetral Ligament

A

wrist ext, radial dev and intercarpal sup

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22
Q

what is the TFCC

A

cushion for the triquetrum as it articulates with the ulna

bears the weight of the triquetrum at the proximal carpal bones

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23
Q

weight distrib on wrist

A

60% borne on the radius and 40% on the ulna but mostly on the TFCC

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24
Q

relate tendons to resting pos of hand

A

tendons are in the most ready or most efficient position to contract and to perform its action

no active or passive insufficiencies present in the tendon

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25
Q

relate resting pos of hand and immob

A

immobilize using cast or orthosis, this is our preferred position to avoid contractures and tightening of the muscular tissue of the hand

26
Q

which is mobile and stable betw proximal and distal transverse arch

A

proximal arch has to be more stable than your distal transverse arch

27
Q

components of proximal transverse arch

A

carpal tunnel
distal row of carpals
CMC of thumb

28
Q

Keystone of the proximal transverse arch

A

Capitate

29
Q

Keystone of the distal transverse arch and longitudinal arch

A

2nd and 3rd MCP

30
Q

compare stab and mob of proximal and distal carpal bones

A

Wrist and proximal carpal bones (RC joint) is geared towards mobility (2o of freedom), whereas the distal carpal bones requires stability

31
Q

compare stab and mob of 2nd and 3rd MTC and distal carpal bones

A

2nd and 3rd metacarpals as well as distal carpal bones are geared towards stability

hypermobility in 2nd or 3rd metacarpal, there is compromise in the hand present

hamate/trapezium (basta distal row) is unstable there will be instability in the hand

32
Q

MOI for posterior elbow disloc

A

FOOSH c extended shoulder, elbow, and wrist + ulnar dev

33
Q

usual presentation of lateral epicondylitis

A

35 yo or older

inflammation of tendons at common extensor origin at elbow d/t overuse or repetitive stress/strain in wrist flexion and extension

pain present in motion or even at rest

34
Q

usual presentation of nursemaid’s elbow

A

young children

elbow lacks supination and head of radius is dislocated d/t tug on arm the radial head is distracted from anullar ligament

35
Q

discuss effect of repetitive throwing in sports

A

throwing can create severe valgus force

medial side traction = sprain of MCU
lateral side compression

36
Q

usual presentation of little leaguer’s elnow

A

concomitant valgus sprain on the medial side of elbow

excessive concomitant compression on the lateral side

Younger population is more predisposed due to the not fully developed inert stabilizers

37
Q

usual effect if MOI is FOOSH

A

elbow disloc or wrist fractures

consider also clavicle, AC and labrum

38
Q

usual effect if MOI is fall on tip of elbow

A

Contusions or Displacemens of the Radius
and Ulna on the olecranon or on to the humerus

39
Q

common MOI and presentation for MCL or MUCL sprain/tear

A

audible pop followed by pain and swelling one medial elbow

common in throwers, pitchers and racket sports

also consider ulnar nerve affectation

40
Q

usual presentation of distal bicep rupture

A

centralized pop c weakness of elbow flexion

41
Q

normal carrying angle

A

5-10° for males and 10-15° for females

42
Q

what to consider if swelling is extra-acrticular

A

bursitis or student’s elbow or repetitive strains

43
Q

what to consider if swelling is intra-acrticular

A

in triangular space in lat elbow - radial head, olecranon, lat epicondyle

44
Q

usual presentation of gunstock

A

Decrease in carrying angle

sheer stresses on lateral portions of the elbow = lateral sprain and compression on medial

usually secondary to severe disloc or trauma

45
Q

usual presentation of cubito valgus

A

Increase in carrying angle

Sprain on medial structures, compression on lateral structures

46
Q

compare loc of heberdens and bochards

A

usually late stage RA

bouchards - DIP
heberdens - PIP

47
Q

usual presentation of ulnar drift

A

Severe ulnar deviation of the MCP, PIP, and DIP = Concomitant zigzag of the metacarpals to radial
deviate

insufficiency’s of the grip

late stage RA

48
Q

usual presentation of dupuytrens

A

tightness of the anterior fascia of the MCP and DIP

fixed flexion in MCP and DIP usually ring and little

may cordlike structure na kita

genetic and progressive

49
Q

what to consider if pt has spoon shaped nails

A

Entail fungal, anemic, local injuries,
or diabetes

50
Q

what to consider if pt has clubbing of DIP

A

Entail respiratory compromise and other infection

51
Q

usual presentation of Boutonniere deformity

A

rupture of the central slip of the extensor hood

could be present in RA and due to trauma

ext of MCP and DIP but PIP is flexed

52
Q

usual presentation of swan neck

A

contracture of intrinsic muscles or torn volar plate due to trauma or RA

ext PIP but flexed MCP and DIP

usually one finger lang

53
Q

usual pres of Benediction’s hand deformity

A

wasting of the interossei muscles and 2 medial lumbricals d/t ulnar nerve palsy

inability to raise the fingers and there is contraction in structures below

tightening and they cannot properly extend the fingers because of the weakness and the contractures of the structures of the volar surface

54
Q

usual pres of ape hand

A

median nerve compromise (neck, shoulder, forearm or anterior interosseous nerve)

wasting of thenar eminence - thumb pulled or ext in line na with other fingers = unable to oppose or flex thumb

55
Q

usual pres of Claw hand or Intrinsic minus hand

A

MCP hyperextension, IP flexion

median and ulnar nerve palsy

Weak long flexors of the wrist and hand leading to overriding of the radial nerve subserved structures tas strong extensors

56
Q

what to consider in drop wrist

A

inability to actively extend = radial nerve palsy or saturday night

paralyzed extensor muscles

57
Q

usual pres of Zigzag deformity of the thumb

A

in RA

seen in ulnar drift

Bowstringing effect with the
dislocated CMC, hyperextended
MCP and flexed DIP

Volar plate avulsion and rupture of
the ligaments

58
Q

usual pres of mallet finger

A

common in sports

rupture or avulsion of extensor tendon sa distal phalanx = flexed DIP

59
Q
A
60
Q
A
60
Q
A

msk 2nd shift (6 decks)

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