Ch 6 MDT Elbow, Hand, & Wrist Flashcards by Chris Weber

Lateral Tendinosis is also known as:

Tennis Elbow

How well did you know this?

Not at all

Perfectly

Medial Tendinosis is also known as:

Golfer’s elbow or Bowler’s elbow

How well did you know this?

Not at all

Perfectly

Overuse injury involving excessive use of extensor tendons

Commonly seen in sports or activities that require excessive wrist and hand extension

Lateral Epicondylitis

How well did you know this?

Not at all

Perfectly

Overuse injury involving excessive use of flexor or pronator muscles

Activities that require excessive wrist and hand flexion

Medial Epicondylitis

How well did you know this?

Not at all

Perfectly

From activities that involve gripping and wrist extension

Lifting
Turning a screwdriver
Hitting backhand in tennis
Excessive typing

Lateral Epicondylitis

How well did you know this?

Not at all

Perfectly

Exacerbated by activities that involve wrist flexion and forearm pronation

Golf swing
Baseball pitching
Pull-through stroke swimming
Weight lifting
Bowling

Medial epicondylitis

How well did you know this?

Not at all

Perfectly

Lateral epicondylitis will have tenderness __ cm distal and slightly anterior to lateral epicondyle

1 cm

How well did you know this?

Not at all

Perfectly

Wrist extension and grip strength limited by pain

Lateral epicondylitis

How well did you know this?

Not at all

Perfectly

Wrist flexion and pronation limited by pain

Medial epicondylitis

How well did you know this?

Not at all

Perfectly

Diagnostic tests for Lateral/Medial epicondylitis

Diagnosed clinically

U/S or MRI in cases not responding to conservative management

How well did you know this?

Not at all

Perfectly

Treatment for medial/lateral epicondylitis

Light duty, limit repetitive activity to allow for healing

NSAIDs

Tennis elbow strap

Pain free stretching

How well did you know this?

Not at all

Perfectly

Treatment for medial/lateral epicondylitis if conservative management fails

Physical therapy

Ortho consult

Steroid injection

How well did you know this?

Not at all

Perfectly

Olecranon bursitis may occur secondary to:

Trauma

Inflammation

Infection

How well did you know this?

Not at all

Perfectly

Disease processes that can cause olecranon bursitis

Rheumatoid arthritis

Gout

Systemic inflammatory process

How well did you know this?

Not at all

Perfectly

Large mass over elbow

Tenderness over elbow

ROM limited by pain

Olecranon Bursitis

How well did you know this?

Not at all

Perfectly

Diagnostic tests for olecranon bursitis

Aspiration

Radiographs to rule out fracture

How well did you know this?

Not at all

Perfectly

Treatment for olecranon bursitis

NSAIDs

Pressure Wrap

Ice

How well did you know this?

Not at all

Perfectly

Moderate or severe cases of olecranon bursitis should under go:

Aspiration of fluid - refer for orthopedic evaulation

How well did you know this?

Not at all

Perfectly

Treatment for olecranon bursitis with signs of infection

Antibiotics

How well did you know this?

Not at all

Perfectly

Referral/Red Flags for olecranon bursitis

Septic bursitis or recurrence of fluid despite repeated aspirations

How well did you know this?

Not at all

Perfectly

Most common site of ulnar nerve compression

Groove on the posterior aspect of the medial epicondyle (cubital tunnel)

How well did you know this?

Not at all

Perfectly

Etiologies of ulnar nerve compression

Direct blow to cubital tunnel

Stretched nerve for prolonged periods of time

Cubitus valgus (carrying angle greater than 10 degrees)

Osteophytes or scar tissue

How well did you know this?

Not at all

Perfectly

Numbness and tingling in the 4th and 5th digits

Elbow pain/ache

May radiate to shoulder or neck

Unable to open jars or turn keys (late sign)

Muscle atrophy implies nerve compression of several months

Ulnar nerve compression

How well did you know this?

Not at all

Perfectly

Neurovascular test that will be affected on the 4th and 5th digits in patients with ulnar nerve compression

Two-point discrimination

How well did you know this?

Not at all

Perfectly

Special tests that are positive in ulnar nerve compression

Tinel sign

Diagnostic tests for ulnar nerve compression

Electromyographic/nerve conduction velocity (EMG/NCV) study Radiographs to see previous trauma

EMG/NCV study with velocity reduction of ___% or more suggests significant ulnar nerve compression

30%

Treatment for ulnar nerve compression

Modify activities that limit elbow flexion and direct pressure Splint elbow to avoid 90 degree flexion at night NSAIDs

Most important step in the treatment of ulnar nerve compression

Modify activities to limit elbow flexion and direct pressure

Ulnar nerve compression Surgical decompression and transposition of ulnar nerve if ___ months of conservative management failed

3-4 months

Primary structure that resists valgus stress at the elbow

Ulnar collateral ligament

Common injury to ulnar collateral ligament comes from:

Excessive overhead throwing motions (baseball pitcher)

"Pop" while throwing Gradual onset of symptoms with progressive medial elbow pain with valgus stresses May have symptoms consistent with ulnar neuritis

Ulnar collateral ligament tear

Tenderness over ulnar collateral ligament Possible loss of terminal elbow extension Positive moving valgus stress test

Ulnar collateral ligament tear

Valgus stress test is positive when more pain is felt between _____ degrees of flexion

70-120

Diagnostic tests for Ulnar collateral ligament tear

AP and Lateral radiographs to rule out fracture MRI with contrast

May be seen on X-ray for chronic cases of Ulnar collateral ligament tear

Posteromedial olecranon osteophytes, loose bodies, and spurring

Treatment for Ulnar collateral ligament tear

Light duty - Activity Modification Ice NSAIDs Pain free elbow and wrist stretching/strengthening exercises

Most common dislocation in children and third most in adults Results from a fall on an outstretched hand (FOOSH)

Elbow dislocation

__% of elbow dislocations are posterior

80%

What ligament is always disrupted in elbow dislocations

Lateral collateral ligament

Extreme pain, swelling of elbow, inability to bend elbow Obvious deformity No elbow flexion or extension Supination and pronation severely limited

Elbow Dislocation

What exam do you not want to over look in patients with elbow dislocations?

Neurovascular | -Check radial pulse and cap refill

Diagnostic tests for elbow dislocation

AP and lateral radiographs

Treatment for elbow dislocation

Ice Pain management Splint Consider emergency reduction if delayed MEDEVAC or neurovascular compromise

Steps to perform an elbow reduction

Elbow extended to 45 degrees Slow, steady downward traction of forearm in line with long axis of humerus Gentle pressure over olecranon tip Repeat neurovascular examination after reduction

Elbow reduction should be performed as soon as possible by:

Orthopedic surgeon

Most common neuropathy of the upper extremity Commonly affects middle aged or pregnant women Median nerve entrapment

Carpal Tunnel

Carpal tunnel can be caused by:

Tenosynovitis of flexor tendons Tumors Pregnancy Diabetes Mellitus Thyroid dysfunction

Numbness and tingling into radial three digits of hand (1st, 2nd, 3rd digits) Pain and paresthesia/numbness at median nerve distribution Worse at night, patient has to rub hands together to "get circulation back" Frequently drops objects and cannot open jars with twist lids Worse after repetitive motion

Carpal Tunnel

Atrophy of the thenar eminence in long standing cases Tenderness over carpal tunnel Weakness with thumb opposition Reduced grip strength

Carpal Tunnel

Special tests for Carpal Tunnel

Phalen Maneuver Tinel Sign

Diagnostic testing for carpal tunnel

Electrophysiologic testing

___% of patients with carpal tunnel syndrome have normal nerve conduction velocity studies

5-10%

Treatment for Carpal Tunnel

Splint wrist in neutral position - especially at night NSAIDs Light duty for activity modification Ergonomic modifications

Carpal Tunnel patients should be referred to Ortho if:

Failed conservative management Fixed sensory loss or weakness/atrophy of muscles

Swelling or stenosis of the sheath that surrounds the abductor pollicis longus and extensor pollicis brevis tendon of the wrist

de Quervain Tenosynovitis

Precipitated by repetitive use of thumb Pain, swelling and triggering phenomenon results in locking or sticking of tendon as the patient moves thumb

de Quervain Tenosynovitis

Pain at radial aspect of the wrist exacerbated by movement of thumb or wrist May have edema Tenderness over radial styloid

de Quervain Tenosynovitis

What test is positive in patients with de Quervain Tenosynovitis?

Finkelstein test

Diagnostic studies for de Quervain Tenosynovitis

Diagnosed clinically

Treatment for de Quervain Tenosynovitis

NSAIDs Thumb spica splint Light duty activity modification

Usually fractured from falls with outstretched hand Major blood supply enters the bone in the distal third

Scaphoid fracture

Scaphoid fracture Displacement greater than __ mm has a high rate of nonunion

1 mm

Patient describes a dorsiflexed wrist injury Edema and pain around distal radial aspect of wrist Decreased grip strength

Scaphoid Fracture

Diagnostic tests for Scaphoid Fracture

Scaphoid series radiographs

Scaphoid Fracture If scaphoid series X-rays are normal but pain persists for __ weeks then studies should be repeated

2-3 weeks

Treatment for Scaphoid Fracture

Thumb spica splint Light duty Imaging ASAP Consult to Orthopedics Analgesics

Scaphoid fracture with wrist ligament injuries require an urgent referral to:

Hand Surgeon

Most common soft-tissue tumors of the hand Affects 15-40 y/o Cystic structure that arises from capsule of a joint or a tendon synovial sheath

Ganglion of the wrist

Through degeneration or tearing of the joint capsule or tendon sheath, a connection to the joint or tendon sheath with a one-way valve established, synovial fluid can enter but cannot flow freely back into synovial cavity

Ganglion

Ganglion is usually directly over _______ joint

Scapholunate joint

How to tell the difference between a Ganglion and a Tumor?

Ganglion will transilluminate

Diagnostic imaging for Ganglion

US/MRI to differentiate ganglion from other masses

Treatment for Ganglion

Splint wrist or finger NSAIDs Consult to orthopedics for aspiration or surgical excision

Rupture of the flexor digitorum profundus tendon from its distal attachment Common in contact sports Flexed DIP joint is suddenly and forcefully hyperextended

"Jersey Finger"

Jersey Finger Ring finger involved in __% of cases

75%

Treatment for Jersey finger

Splint the finger with PIP and DIP joint slightly flexed Evaluation by Ortho Hand

Injury to the extensor tendon of the finger Direct blow to the finger causing sudden forced flexion of the of the DIP Flexed DIP at rest Inability to extend DIP joint fully

Mallet finger

Treatment for mallet finger

Maximize function, minimize discomfort Splint the finger in full extension

How long do you splint a Mallet finger?

6-8 weeks

Most cases of Mallet Finger can be managed by:

Primary Care

Extensor tendon rupture at insertion on middle phalanx - Flexion of PIP/Extension of DIP - History of trauma - Painful PIP joint - Deformity up to 3 weeks

Boutonniere Deformity

Treatment for Boutonniere Deformity

Splint PIP joint in extension for 3-6 weeks Allow DIP to move freely Physical therapy for ROM Ortho consult for ongoing deformity