Approach to Elbow, Wrist, & Hand Complaint

Question 1

C4 Dermatome

Answer 1

acromioclavicular joint

Question 2

C5 Dermatome

Answer 2

lateral aspect of the lower deltoid muscle

Question 3

C6 Dermatome

Answer 3

radial side of forearm

Question 4

C7 Dermatome

Answer 4

palmar side of the middle finger

Question 5

C8 Dermatome

Answer 5

5th digit

Question 6

T1 Dermatome

Answer 6

medial aspect of the antecubital fossa, proximal to medial epicondyle of the humerus

Question 7

Common Causes of Elbow Pain

Answer 7

• subluxation of the radial head
• medial epicondylitis
• lateral epicondylitis
• olecranon bursitis

Question 8

Subluxation of the Radial Head (Nursemaid’s Elbow)

Answer 8

• common in children
• cause: sudden pulling, falling and arm twisting
• radial head slips out from under the annular ligament and gets trapped in the radiohumeral joint
• presentation: arm close to body with elbow slightly flexed or fully extended with the forearm pronated

Question 9

Medial Epicondylitis (Golfer’s Elbow)

Answer 9

• cause: overuse injury from repeated motion
• acute or chronic inflammation of FLEXOR tendons due to some form of strenuous activity
• presentation: pain on medial elbow, tenderness with passive extension of the wrist, resisted flexion of wrist

Question 10

Lateral Epicondylitis (Tennis Elbow)

Answer 10

• cause: overuse injury from repeated motion, excessive hyperextension
• acute or chronic inflammation of EXTENSOR tendons due to incorrect stroke mechanisms
• presentation: lateral elbow pain, pain on palpation, tenderness with resisted wrist extension

Question 11

Olecranon Bursitis

Answer 11

• causes: inflammatory arthritis, trauma, hemorrhage, infection
• inflammation of the olecranon bursae which is located in the posterior aspect of the olecranon
• presentation: pain and swelling of olecranon
• bursitis vs elbow effusion – able to extend elbow without severe pain = bursitis, with pain = suggestive of effusion

Question 12

Common Causes of Hand and Wrist Pain

Answer 12

• Carpal Tunnel Syndrome
• De Quervain Tenosynovitis
• Trigger Finger
• Scaphoid Fx
• Boxer’s Fx
• Colle’s Fx

Question 13

Carpal Tunnel Syndrome

Answer 13

• condition that is caused by compression of the medial nerve
• risk factors: obesity, endocrine disorders (DM), repetitive movements/workplace factors, pregnancy, genetic, female,
• presentation: pain and paresthesia along the first 3 and a half digits
• specialty tests: Tinels, Phalens

Question 14

De Quervain Tenosynovitis

Answer 14

• recurrent inflammation of the tendon and synovial sheath covering extensor pollicis brevis and abductor pollicis longus
• causes: recurrent movements (new mothers picking up child), idiopathic
• presentation: radial wrist pain at base of thumb especially with movement of the thumb
• specialty exam: Finkelstein Test

Question 15

Stenosing Flexor Tenosynovitis (Trigger Finger)

Answer 15

• thickening of the flexor tendon which cause the first annular pulley to not work properly
• risk factors: over-use trauma, DM, autoimmune conditions
• presentation: pain, locking and clicking of MCP joint; common in the 5th and 6th decade of life; most common on ring finger

Question 16

Dupuytren’s Contracture

Answer 16

• fibrosis of the palmar fascia which causes progressive stiffening of the joint and inability to fully extend the finger
• cause: thickening of the palmer fascia due to fibroblastic proliferation and collagen deposition
• presentation: thickening on the palmer surface, painful or painless, cord-like structure and flexed digit with palpable cord on exam

Question 17

Scaphoid Fracture

Answer 17

• scaphoid has poor blood supply so nonunion is complication of this
• cause: fall on outstretched hand which causes hyperextension of the wrist
• presentation: pain on radial aspect of wrist and reduced grip strength after fall on outstretched hand
• exam findings: tenderness on anatomical snuffbox, tenderness with scaphoid compression and on scaphoid tubercle

Question 18

Boxer’s Fracture

Answer 18

• fracture of the metacarpal neck (usually fifth digit)
• causes: direct injury/trauma to clenched fist
• presentation: pain on dorsum of hand after direct trauma), swelling and bruising, tenderness over fx site

Question 19

What is the most common fx of the UE?

Answer 19

Colles

Question 20

Colles Fracture

Answer 20

• fracture of the distal radius
• causes: falling on outstretched hand with wrist in extension
• risk factors: osteoporosis in older patients

Question 21

Rheumatoid Arthritis

Answer 21

• inflammatory polyarthritis causing deformity of the joints through the damage of the bone and cartilage; most commonly affects the MCP and PIP joints of the finger but can effect large and small joints
• causes: autoimmune, unknown etiology
• presentation: morning stiffness, swelling nad pain of the MCP and PIP, 3 or more joints affected, deformity of the digit

Question 22

Motion at Ulnar Humoral Joint

Answer 22

Flexion and Extension

Question 23

Motion at Radial Ulnar Joint

Answer 23

• Pronation and Supination
• Glide motion at radial head

Question 24

Wrist pronation -> __ radial head

Answer 24

Posterior

Question 25

Wrist supination -> ___ radial head

Answer 25

Anterior

Question 26

Fall Prone = ___ radial head somatic dysfunction

Answer 26

Posterior

Question 27

Fall Supine = ___ radial head somatic dysfunction

Answer 27

Anterior