Approach to Elbow/ Wrist/ Hand Complaint

Question 1

what is another name for nursemaid’s elbow?

Answer 1

subluxation of the radial head

Question 2

what happens in cases of subluxation of the radial head?

Answer 2

the annular ligament slips out of the radial head and gets trapped in the radiohumeral joint

Question 3

what is another name for golfer’s elbow?

Answer 3

medial epicondylitis

Question 4

what is medial epicondylitis caused from?

Answer 4

inflammation of the flexor tendons

Question 5

what is another name for tennis elbow?

Answer 5

lateral epicondylitis

Question 6

what is the cause of lateral epicondylitis?

Answer 6

excessive hyperextension/ inflammation of extensor tendons

Question 7

how are you able to distinguish between bursitis versus effusion?

Answer 7

if you are able to fully extend at the elbow without severe pain then it is bursitis without effusion

Question 8

what is the distribution of the radial nerve on the hand?

Answer 8

the dorsal aspect covering the thumb and proximal portions of the index and middle finger and half of the proximal ring finger

Question 9

what is the distribution of the ulnar nerve?

Answer 9

the dorsal and palmar aspect of the 5th digit and the other half of the ring finger

Question 10

what is the distribution of the median nerve?

Answer 10

the palmar aspect of the hand covering the thumb and the index, middle, and half of the ringer finger as well as the dorsal aspect of the distal index and middle finger as well as the distal 1/2 of the ring finger

Question 11

what is carpal tunnel caused by?

Answer 11

compression of the median nerve

Question 12

what is the classical presentation of carpal tunnel syndrome?

Answer 12

pain and paresthesia along the first three and half digits

Question 13

What are the specialty tests used for carpal tunnel syndrome?

Answer 13

tinels and phalens

Question 14

what does tinels test look like?

Answer 14

compression of the median nerve by tapping on the nerve

Question 15

what does phalens test look like?

Answer 15

flexion of the wrist to compress the median nerve

Question 16

what is de quervain tenosynovitis?

Answer 16

recurrent inflammation of the tendon and synovial sheath covering the extensor pollicis brevis and abductor pollicis longus

Question 17

what is the classical presentation of de quervain tenosynovitis?

Answer 17

radial wrist pain (over the radial styloid) at the base of the thumb especially with movement of the thumb

Question 18

what specialty test is used for de quervain tenosynovitis?

Answer 18

finkelstein’s test

Question 19

what is the classical presentation of trigger finger?

Answer 19

pain, locking, and clicking of the MCP joint

Question 20

what is the classical presentation of dupuytren’s contracture?

Answer 20

thickening on the palmer surface (painful or painless), cord-like structure and flexed digit with palpable cord

Question 21

what is the classic presentation of a scaphoid fracture?

Answer 21

pain on the radial aspect of the wrist and reduced grip strength after FOOSH

Question 22

what would be an exam finding of a scaphoid fracture?

Answer 22

tenderness on anatomic snuff box

Question 23

what is a boxer’s fracture?

Answer 23

fracture of the metacarpal neck (usually 5th digit but can involve the 4th)

Question 24

what is the classic presentation of colles fracture?

Answer 24

wrist pain with possible deformity as well as tenderness over fracture site on radial aspect of wrist

Question 25

what does rheumatoid arthritis most commonly affect?

Answer 25

the MCP and PIP joints of the finger

Question 26

what happens to the radial head when the wrist pronates?

Answer 26

it will glide posteriorly

Question 27

what happens to the radial head when the wrist supinates?

Answer 27

it will glide anteriorly

Question 28

if you have a radial head anterior/ wrist supination somatic dysfunction, where is the direct barrier of the wrist?

Answer 28

wrist pronation

Question 29

what is the mechanism for a posterior radial head somatic dysfunction?

Answer 29

fall prone/ forwards

Question 30

what is the mechanism for an anterior radial head somatic dysfunction?

Answer 30

fall supine/ backwards