Approach to Elbow-Hand Complaint Final Exam

Question 1

Palpate the elbow with a purpose means to?

Answer 1

• Look at olecranon process
• Palpate lateral and medial epicondyle
• Palpate radial head can feel with supinate and pronate
• Palpate cubital fossa

Question 2

Range of motion to test for the elbow?

Answer 2

• Flex
• Extend
• Pronate
• Supinate

Question 3

Sensation of the elbow?

Answer 3

• extensor surface medial middle and lateral so covers C5-T1
• Flexor surface lateral medial and middle

Question 4

Reflexes of elbow with their corresponding nerve roots?

Answer 4

• Bicep C5-6
• Tricep C6-7
• Brachioradialis C5-6

Question 5

Vasculature to check in upper extremeity?

Answer 5

• Radial pulse
• Brachial pulse

Question 6

3 yo male in ER with pain to right elbow. Won’t allow touch elbow, father denies kid falling, swelling, fever or chills. Child is in good health and vaccines are up to date. The father states that before this they were at the park and the father was swinging the boy around. What is likely cause of the pain and treatment?

Answer 6

Treatment not in exam

• Nurse maids elbow
• Radial head subluxation!
• Most common in kids due to sudden pulling, falling and arm twisting, the annular ligament slips out of radial head

Hyperpronation better success rates

Supinate and flex also works to fix

Question 7

68 yo male with HTN has severe pain on rightinner elbow. He golfs daily and is healthy. What is injry?

Answer 7

Medial Epicondylitis aka golfers elbow

• Due to over use from playing golf
• Pain on medial aspect of elbow over medial epicondyole and tenderness with passive extesion of th wrost and resisted flexion of wrist

Question 8

23 yo male no significant medical history. He has been busy all summer playing tennis. Has lateral elbow pain, what is wrong?

Answer 8

• Lateral epiciondylitis aka tennis elbow
• Oversuese from excessive hyperextension
• acute or chronic inflammation of extensor tendons
• Presents with pain on lateral aspect of elbow and pain on palpation of lateral epicondyle and tenderness with resisted wrist extension

Question 9

72 yo male with HTN Gout and sleep apnea, presents with pain swelling at elbow. Palpataion is tender slightly warm and erythematous. Posterior elbow reveals possible fluid, what is diagnosis?

Answer 9

Olecranon bursitis aka miners elbow students elbow

• Inflammatory arthritis gout trauma hemorrhage or sepsis can cause this
• presents with pain swelling on olecrananon bursa
• if can fully extend elbow at risk withouot severe pain then it is bursisits without effusion

Question 10

Palpate with a purpose on the hand means what?

Answer 10

• Palmate palmer fascia
• DIP MCP and PIP joints
• Flexor tendons
• Carpal bones
• Scaphoid-adduct thumb and place yours in anatomical snuff box

Question 11

What are the ROM for the hand and thumb?

Answer 11

• Extension
• flexion
• abduct
• addcut
• oppositon
• adduct and abduct fingers

Question 12

ROM for wrist?

Answer 12

• Palmar flex and extend
• radial devication abduction
• ulnar deviation adduction

Question 13

Sensation of the hand to test?

Answer 13

• ULnar nerve
• Median nerve
• radial nerve

Question 14

Vasculature to check for wrist hand?

Answer 14

Radial pulse

Question 15

28 yo G2P1 wo sig PMH at 32 week gestation has arm and wrist pain numbness and tingling in first 3 digists. Pain worse at night what is issue?

Answer 15

• Carpal tunnel syndrome causing compression of medial nerve
• Causes are obesity HTN hypothyroidism DM repetitive movement pregnancy CT disorder, females higher risk
• Pain and paresthesia first three and half digits
• Specialty exam:
  
  • Tinels: compression of medial nerve by tapping
  • Phalens: flexion of wrist to compress nerve

Question 16

26 yo female wit hPMH of astma presents with r side lateral wrist pain progressively increase intensity Pain radiates over thumb especially with gripping and picking things up. Specifically her 7 mo. Dennies niumbness and dtingling. Milkd swelling on lateral aspect wrist aon anatomical snuff box. What is this

Answer 16

De Quervian tenosynovitis

• Presents with radial wrist pain at base of thumb especially with movement
• Caused by recurrent inflammation of tendon and sy;novial sheath covering extensor pollicis brevis and abductior pollicis longus
• Causes recurrent movemennt mother picking up child, idiopathic

Specialty exam positive finkelstein test

Question 17

53 yo male w PMH of hypothyroidism DM CAD and HTN presents with hand pain. Pt sates for one year his right 3rd digit has been locking and causing mild pain for 6 months now. He can grip but cant fully extend digit. What is this?

Answer 17

• Trigger finger aka stenosis flexor tenosynovitis
• Presents with locking and clicking of MCP joint common in 5th or 6th decade of life. thickening of flexor tendon which causes first annular pulley to not work properly.
• Causes common idiopathic risk factors are DM amyloidosis RA hypothyroidism over use

Question 18

What is dupuytrens contracture?

Answer 18

• Fibrosis of plmar fascia which causes progressive stiffening of joint and inablity to fully extend the finger
• Cause is idiopathic thiekening of palmar fascia due to fibroelastic proliferation and collagen deposition
• Classically presents:
  
  • white men
  • Thickening on palmar surface
  • Pain or no pain
  • cord like structrure and flexeddigit with palpable cord

Question 19

21 yo soldier presents to ER with wrist pain. Pt was in basica and FOOSH. SIgnificant pain on thumb and anatomic snuff box. What is this?

Answer 19

• Scaphoid fracture
• presents with FOOSH and pain on radial aspect of wrist and reduced grip strength
• specialty test:
  
  • tenderness on anatomic snufff box
  • tenderness with scaphoid compression and on scaphoid tubercle
    *

Question 20

28 yo male no PMH brought to ER after bar fight. Pt is drunk and ocmplains of pain on knuckles. You suspect fracture of ___?

Answer 20

• 5th metatarsal neck boxers fracture
• presents with pain on dorsum of hand after direct trauma
• swelling and bruising can be present on dorsum of hand
• tenderness over fracture site
• Caused by direct injury trauma to clenched fist

Question 21

Collees fractue?

Answer 21

fracture of raedial head aka dinner fork deformity

• Tenderness over fracture site on radial aspect
• young patients in sports
• white female over 50 increasaed risk of OA
• wrist pain withdeformity like dinner fork

Question 22

64 female with Hypothyroid afib htn with bilateral hand pain. Says it has been getting worse last few years and sometimes pain is severe. She is avid knitter and hasn’t been able to for the last two years now. She is having trouble performing daily activities and cant open and clsoe fingers completely. She has noticed slow deformation of her hands and fingers. Her mothers side has this issue. What is it?

Answer 22

• Rheumatoid arthritis
• Inflamatory polyarthritis causing deformity ofo joints through damage of bone and cartilage. Most common affects MCP PIP of fingers.
• Causes: autominnune unknown etiology
• Classic presentation:
  
  • Morning stiffness swelling and pain of MCP and PIP, or 3+ joints affected
  • Deformity of digits

Question 23

Radial ulnar joint what happens with wrist pronation and supination?

Answer 23

• Radial head moves posterior with pronation
• Radial head moves anterior with supination

Common Test question and boards

Question 24

Fall prone (FOOSH) what is most likely with SD?

what about supine fall?

Answer 24

• Posteior radial head
• Supinated radial head

Question 25

Wrist biomechanics and carpal tunnel?

Answer 25

• Flex extend
• abduct or radial deviation
• adduct or ulnar deviation

Carpal tunnel:

• Carpal bones must form and maintain arch

Transverse carpal lig musut stay flexible and can be stretched by flexor tendons.

Question 26

Hand finer biomechanics?

Answer 26

• Metacarpophalangeal and interphalangeal joints
  
  • Flex ext
  • add and abd
  • ir and er