Chapter Twenty One: Orthoses for overuse disorders of the upper limb

Question 1

What pain does a patient with tennis elbow usually experience?

Answer 1

Pain with wrist extension or with gripping.

Question 2

Lateral epicondylitis is often accentuated by what?

Answer 2

Extreme wrist flexion from passive stretch of the extensor carpi radialis brevis (ECRB). or by active contraction of the wrist extensors.

Question 3

What is lateral epicondylitis?

Answer 3

A tendinosis of the origin of the ECRB

Question 4

What causes lateral epicondylitis?

Answer 4

Microtears at the origin of the common extensor muscle mass, involving the extensor digitoru communis, extensor carpi radiallis longus, supinator, and ECRB.

Question 5

What orthosis can be used for lateral epicondylitis?

Answer 5

Cock up wrist splint
Forearm support band (counterforce brace)
Long arm splint for full immobilization

Question 6

What is cubital tunnel syndrome?

Answer 6

Ulnar nerve compression at the the medial elbow.

Question 7

What is the cubital tunnel?

Answer 7

A fibroosseous tunnel at the elbow situated between the humerus and ulnar heads of the flexor carpi ulnaris.
It is bordered laterally by the ulnohumeral collateral ligament and anteriorly by the medial epicondyle.

Question 8

What are the most common symptoms of cubital tunnel syndrome?

Answer 8

Paresthesias presenting as numbness and tingling of the ring and small fingers, especially at night.
Tenderness or sharp pain at the medial epicondyle

Question 9

What is the cause of cubital tunnel?

Answer 9

Prolonged elbow flexion or repetitive elbow flexion and extension.

Question 10

What orthoses can be used for cubital tunnel syndrome?

Answer 10

Long spint immobilizing elbow in extension
Elbow pads
Night splint to prevent elbow flexion of 90 degrees

Question 11

What is the carpal tunnel?

Answer 11

A small narrow space in the volar wrist that houses the median nerve, flexor pollicis longus, four flexor digitorum profundus tendons, and four flexor digitorum superficialis tendons as they course through the forearm into the hand.
The tunnel is formed by the concave arch of the carpal bones and the transverse carpal ligament, which extends from the scaphoid tuberosity and trapezium radially, and attaches to the pisiform and the hook of the hamate on the ulnar side of the hand.

Question 12

What are the common symptoms of carpal tunnel syndrome?

Answer 12

Numbness and tingling, paresthesias, or pain and burning typically in the radial three and a half digits of the hand. Often symptoms are worse at night.

Question 13

Why is carpal tunnel syndrome worse at night?

Answer 13

Often the wrist is flexed increasing the pressure on the median nerve in the carpal tunnel.

Question 14

What is De Quervain tenosynovitis?

Answer 14

A stenosing tenosynovitis of the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) as the tendons course through the first dorsal compartment of the wrist.

Question 15

What is the most common cause of De Quervain Tenosynovitis?

Answer 15

Overuse or repetitive stress of the wrist and hand cuasing inflammation of the tendons or hypertrophy of the flexor retinaculum.

Question 16

What are the symptoms of De Quervain Tenosynovitis?

Answer 16

Radial wrist pain.

Tenderness over the radial styloid and irst dorsal compartment

Question 17

Which test is commonly used to diagnose de Quervain disease?

Answer 17

The Finkelstein test

Question 18

How is the Finkelstein test performed?

Answer 18

Patient is asked to fully flex and adduct the thumb with the wrist in ulnar deviation, he or she may experience sharp pain in the first dorsal compartment because the tendons are simultaneously stretched and compressed over the radius in an already inflammed Melieu.

Question 19

What is trigger finger or stenosing tenosynovitis?

Answer 19

Overuse or repetitive trauma causes inflammation and thickening at the A1 pulley. This constricts the tendon sheath inhibiting friction-free gliding through the pulley system. This usually prevents glide during flexion, which causes clicking or popping in the finger. The finger will lock in flexion. Usually this clicking and popping occurs in the proximal Ip joint, put it is actually occuring in the MCP joint.

Question 20

What type of splint should be used for trigger finger?

Answer 20

It should immobilize the MP joint in extension and leaves the IP joints free.

Question 21

80% of triggering occurs in which fingers?

Answer 21

The Long and ring fingers.

Question 22

What is the most common arthritis of the hand?

Answer 22

Trapeziometacarpal joint or CMC joint of the thumb

Question 23

What is the basilar joint complex?

Answer 23

The four-joint complex involving the trapeziometacarpal, and articulation of the trapezium with the scaphoid, trapezoid, and radial facets of the index metacarpal.

Question 24

What is another name of the trapeziometacarpal joint?

Answer 24

Basilar joint

Question 25

What are the symptoms of CMC arthritis?

Answer 25

Mild stiffness or decreased ROM
Pain 
decrease in function
CMC joint tendor to touch
Crepitance while the patient performs a grind test.

Question 26

What is a grind test?

Answer 26

Axially loading the basilar joint while rotating the metacarpal on the trapezium.

Question 27

What is the shoulder sign?

Answer 27

Priminence at the base of the radial thumb from dorsal subluxation of the metacarpal off the trapezium.

Question 28

How do you differentiate CMC arthritis and De Quervain’s tenosynovitis?

Answer 28

The grind test.

Question 29

What are the splints for Basilar joint arthritis?

Answer 29

A long opponens splint
Short opponens splint
Comfort Cool