Clinical Exam Elbow, Wrist, Hand

Question 1

which side of the elbow is most prone to injury?

Answer 1

lateral epicodyle

Question 2

the lateral epicondyle is the origin of which muscles?

Answer 2

wrist extensors

Question 3

what is the elbow joint space bounded by?

Answer 3

it is a triangular gap bound by the olecranon, lateral epicondyle, and radial head

Question 4

where do most nerve entrapments occur?

Answer 4

wrist extensor region

Question 5

what muscles attach to the medial epicondyle?

Answer 5

flexor tendons

Question 6

what nerve runs through the medial elbow?

Answer 6

ulnar

Question 7

how many bones are in the wrist?

Answer 7

8

Question 8

what is special about the scaphoid?

Answer 8

it spans the proximal and distal rows and is the most common carpal bone to fracture

Question 9

what type of injury usually causes wrist fracture?

Answer 9

FOOSH - fall on outstretched hand

Question 10

what two tendons does the most dorsal compartment of the wrist hold?

Answer 10

abductor policis longus, extensor policis brevis - that together can cause DeEuervian’s tenosynovities

Question 11

how many tendons in the carpal tunnel?

Answer 11

9 flexor tendons

Question 12

what nerve runs through the carpal tunnel?

Answer 12

median

Question 13

the deep flexor tendon goes to which phalynx?

Answer 13

distal phalynx

Question 14

the superficial flexor goes to which phalynx?

Answer 14

middle phalynx

Question 15

what are the 5 palpations for the elbow exam?

Answer 15

lateral epicondyle, radial head, olecranon, lateral triangular space, biceps tendon

Question 16

what is the special test for the elbow?

Answer 16

resisted long finger extension
elbow in near full extension, wrist in neutral
press on 3rd dorsal finger to force flexion while patient resists
positive test - pain at lateral epidicondyle - suggests lateral epicondylitis

Question 17

what are the two node inspections in the fingers?

Answer 17

heberdon’s (DIP) and bouchard’s (PIP)

Question 18

what side is thenar atrophy on

Answer 18

thumb side

Question 19

what four things are you palpating in the hand/wrist?

Answer 19

distal radius, distal ulna, anatomic snuffbox, scaphoid tubercle

Question 20

what is the test for rotational abnormality

Answer 20

flex fingers - all should point towards scaphoid

Question 21

how do you test flexor profundis?

Answer 21

(DIP) isolate dip and ask patient to flex only dip

Question 22

how do you test flexor superficialis?

Answer 22

(PIP) hold hand down on table in extension, as patient to flex finger - should flex at PIP

Question 23

what could weakness in thumb abduction indicate?

Answer 23

median nerve injury

Question 24

what are the three special tests for the hand and wrist?

Answer 24

carpal tunnel phalen maneuver, tinel’s test median nerve, dequervain’s tenosynovitis

Question 25

what is carpal tunnel phalen maneuver?

Answer 25

put dorsums of hands together and hold for 30s

numbness and tingling in distribution of median nerve is positive test

Question 26

what is tinel’s test median nerve?

Answer 26

lightly tap median nerve at distal palmar crease; parasthesias in median nerve distribution is a positive test

Question 27

what is dequervain’s tenosynovitis test?

Answer 27

(aka finkelstein’s test)
fist with thumb inside and push fist in ulnar deviation
pain in dorsoradial aspect of wrist indicates positive test and dequervain’s tenosynovitis