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MSK > Ch 6 MDT Elbow, Hand, & Wrist > Flashcards

Ch 6 MDT Elbow, Hand, & Wrist Flashcards

1
Q

Lateral Tendinosis is also known as:

A

Tennis Elbow

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2
Q

Medial Tendinosis is also known as:

A

Golfer’s elbow or Bowler’s elbow

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3
Q

Overuse injury involving excessive use of extensor tendons

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

A

Lateral Epicondylitis

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4
Q

Overuse injury involving excessive use of flexor or pronator muscles

Activities that require excessive wrist and hand flexion

A

Medial Epicondylitis

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5
Q

From activities that involve gripping and wrist extension

  • Lifting
  • Turning a screwdriver
  • Hitting backhand in tennis
  • Excessive typing
A

Lateral Epicondylitis

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6
Q

Exacerbated by activities that involve wrist flexion and forearm pronation

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

Medial epicondylitis

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7
Q

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

A

1 cm

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8
Q

Wrist extension and grip strength limited by pain

A

Lateral epicondylitis

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9
Q

Wrist flexion and pronation limited by pain

A

Medial epicondylitis

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10
Q

Diagnostic tests for Lateral/Medial epicondylitis

A

Diagnosed clinically

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

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11
Q

Treatment for medial/lateral epicondylitis

A

Light duty, limit repetitive activity to allow for healing

NSAIDs

Tennis elbow strap

Pain free stretching

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12
Q

Treatment for medial/lateral epicondylitis if conservative management fails

A

Physical therapy

Ortho consult

Steroid injection

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13
Q

Olecranon bursitis may occur secondary to:

A

Trauma

Inflammation

Infection

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14
Q

Disease processes that can cause olecranon bursitis

A

Rheumatoid arthritis

Gout

Systemic inflammatory process

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15
Q

Large mass over elbow

Tenderness over elbow

ROM limited by pain

A

Olecranon Bursitis

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16
Q

Diagnostic tests for olecranon bursitis

A

Aspiration

Radiographs to rule out fracture

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17
Q

Treatment for olecranon bursitis

A

NSAIDs

Pressure Wrap

Ice

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18
Q

Moderate or severe cases of olecranon bursitis should under go:

A

Aspiration of fluid - refer for orthopedic evaulation

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19
Q

Treatment for olecranon bursitis with signs of infection

A

Antibiotics

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20
Q

Referral/Red Flags for olecranon bursitis

A

Septic bursitis or recurrence of fluid despite repeated aspirations

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21
Q

Most common site of ulnar nerve compression

A

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

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22
Q

Etiologies of ulnar nerve compression

A

Direct blow to cubital tunnel

Stretched nerve for prolonged periods of time

Cubitus valgus (carrying angle greater than 10 degrees)

Osteophytes or scar tissue

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23
Q

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

A

Ulnar nerve compression

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24
Q

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

A

Two-point discrimination

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25
Q

Special tests that are positive in ulnar nerve compression

A

Tinel sign

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26
Q

Diagnostic tests for ulnar nerve compression

A

Electromyographic/nerve conduction velocity (EMG/NCV) study

Radiographs to see previous trauma

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27
Q

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

A

30%

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28
Q

Treatment for ulnar nerve compression

A

Modify activities that limit elbow flexion and direct pressure

Splint elbow to avoid 90 degree flexion at night

NSAIDs

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29
Q

Most important step in the treatment of ulnar nerve compression

A

Modify activities to limit elbow flexion and direct pressure

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30
Q

Ulnar nerve compression

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

A

3-4 months

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31
Q

Primary structure that resists valgus stress at the elbow

A

Ulnar collateral ligament

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32
Q

Common injury to ulnar collateral ligament comes from:

A

Excessive overhead throwing motions (baseball pitcher)

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33
Q

“Pop” while throwing

Gradual onset of symptoms with progressive medial elbow pain with valgus stresses

May have symptoms consistent with ulnar neuritis

A

Ulnar collateral ligament tear

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34
Q

Tenderness over ulnar collateral ligament

Possible loss of terminal elbow extension

Positive moving valgus stress test

A

Ulnar collateral ligament tear

35
Q

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

A

70-120

36
Q

Diagnostic tests for Ulnar collateral ligament tear

A

AP and Lateral radiographs to rule out fracture

MRI with contrast

37
Q

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

A

Posteromedial olecranon osteophytes, loose bodies, and spurring

38
Q

Treatment for Ulnar collateral ligament tear

A

Light duty - Activity Modification

Ice

NSAIDs

Pain free elbow and wrist stretching/strengthening exercises

39
Q

Most common dislocation in children and third most in adults

Results from a fall on an outstretched hand (FOOSH)

A

Elbow dislocation

40
Q

__% of elbow dislocations are posterior

A

80%

41
Q

What ligament is always disrupted in elbow dislocations

A

Lateral collateral ligament

42
Q

Extreme pain, swelling of elbow, inability to bend elbow

Obvious deformity

No elbow flexion or extension

Supination and pronation severely limited

A

Elbow Dislocation

43
Q

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

A

Neurovascular

-Check radial pulse and cap refill

44
Q

Diagnostic tests for elbow dislocation

A

AP and lateral radiographs

45
Q

Treatment for elbow dislocation

A

Ice

Pain management

Splint

Consider emergency reduction if delayed MEDEVAC or neurovascular compromise

46
Q

Steps to perform an elbow reduction

A

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

47
Q

Elbow reduction should be performed as soon as possible by:

A

Orthopedic surgeon

48
Q

Most common neuropathy of the upper extremity

Commonly affects middle aged or pregnant women

Median nerve entrapment

A

Carpal Tunnel

49
Q

Carpal tunnel can be caused by:

A

Tenosynovitis of flexor tendons

Tumors

Pregnancy

Diabetes Mellitus

Thyroid dysfunction

50
Q

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

A

Carpal Tunnel

51
Q

Atrophy of the thenar eminence in long standing cases

Tenderness over carpal tunnel

Weakness with thumb opposition

Reduced grip strength

A

Carpal Tunnel

52
Q

Special tests for Carpal Tunnel

A

Phalen Maneuver

Tinel Sign

53
Q

Diagnostic testing for carpal tunnel

A

Electrophysiologic testing

54
Q

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

A

5-10%

55
Q

Treatment for Carpal Tunnel

A

Splint wrist in neutral position - especially at night

NSAIDs

Light duty for activity modification

Ergonomic modifications

56
Q

Carpal Tunnel patients should be referred to Ortho if:

A

Failed conservative management

Fixed sensory loss or weakness/atrophy of muscles

57
Q

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

A

de Quervain Tenosynovitis

58
Q

Precipitated by repetitive use of thumb

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

A

de Quervain Tenosynovitis

59
Q

Pain at radial aspect of the wrist exacerbated by movement of thumb or wrist

May have edema

Tenderness over radial styloid

A

de Quervain Tenosynovitis

60
Q

What test is positive in patients with de Quervain Tenosynovitis?

A

Finkelstein test

61
Q

Diagnostic studies for de Quervain Tenosynovitis

A

Diagnosed clinically

62
Q

Treatment for de Quervain Tenosynovitis

A

NSAIDs

Thumb spica splint

Light duty activity modification

63
Q

Usually fractured from falls with outstretched hand

Major blood supply enters the bone in the distal third

A

Scaphoid fracture

64
Q

Scaphoid fracture

Displacement greater than __ mm has a high rate of nonunion

A

1 mm

65
Q

Patient describes a dorsiflexed wrist injury

Edema and pain around distal radial aspect of wrist

Decreased grip strength

A

Scaphoid Fracture

66
Q

Diagnostic tests for Scaphoid Fracture

A

Scaphoid series radiographs

67
Q

Scaphoid Fracture

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

A

2-3 weeks

68
Q

Treatment for Scaphoid Fracture

A

Thumb spica splint

Light duty

Imaging ASAP

Consult to Orthopedics

Analgesics

69
Q

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

A

Hand Surgeon

70
Q

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

A

Ganglion of the wrist

71
Q

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

A

Ganglion

72
Q

Ganglion is usually directly over _______ joint

A

Scapholunate joint

73
Q

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

A

Ganglion will transilluminate

74
Q

Diagnostic imaging for Ganglion

A

US/MRI to differentiate ganglion from other masses

75
Q

Treatment for Ganglion

A

Splint wrist or finger

NSAIDs

Consult to orthopedics for aspiration or surgical excision

76
Q

Rupture of the flexor digitorum profundus tendon from its distal attachment

Common in contact sports

Flexed DIP joint is suddenly and forcefully hyperextended

A

“Jersey Finger”

77
Q

Jersey Finger

Ring finger involved in __% of cases

A

75%

78
Q

Treatment for Jersey finger

A

Splint the finger with PIP and DIP joint slightly flexed

Evaluation by Ortho Hand

79
Q

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

A

Mallet finger

80
Q

Treatment for mallet finger

A

Maximize function, minimize discomfort

Splint the finger in full extension

81
Q

How long do you splint a Mallet finger?

A

6-8 weeks

82
Q

Most cases of Mallet Finger can be managed by:

A

Primary Care

83
Q

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
A

Boutonniere Deformity

84
Q

Treatment for Boutonniere Deformity

A

Splint PIP joint in extension for 3-6 weeks

Allow DIP to move freely

Physical therapy for ROM

Ortho consult for ongoing deformity

MSK (14 decks)

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