Common Injuries of Elbow and Wrist

Question 1

Lateral Elbow Tendinopathy (Tennis Elbow) - MOI

Answer 1

Overuse and/or microtrauma.
Wrist stabilization (gripping) or wrist extension. + elbow ext., pronation -> higher stress for ext. carpi radialis brevis.
Excessive repetitive use or eccentric strain of wrist/forearm muscles.

Question 2

Lateral Elbow Tendinopathy (Tennis Elbow) - Risk Factors (5)

Answer 2

Manual occupation.
Office work.
40-60y peak. Older age.
Tobacco user.
Concurrent rotator cuff pathology.

Question 3

Lateral Elbow Tendinopathy (Tennis Elbow) - Signs and Symptoms (5)

Answer 3

Lateral elbow pain (extensor carpi radialis brevis)
Gradual onset (repetitive activity: bricking, screwing, sewing). OR
Sudden onset (lifting a heavy object).
Decreased grip strength.
Pain reproduced with resisted wrist ext./3rd finger ext./forced grip.

Question 4

Lateral Elbow Tendinopathy (Tennis Elbow) - Special Tests (3)

Answer 4

Cozen test (SN 85%)
Maudsley test (SN 88%)
Mill’s test (SP 100%)

Question 5

Medial Epicondyle Tendinopathy (Golfer’s elbow) - MOI

Answer 5

Chronic repetitive loading of wrist flexors and pronator teres, combined with valgus overload.

Question 6

Medial Epicondyle Tendinopathy (Golfer’s elbow) - Risk Factors (3)n

Answer 6

Athlete: golf, am football, archery…(improper technique, wrong equipment) >90% not sport related.
Occupation: heavy physical work, constant vibration, excessive repetitions.
General: Hight BMI, Tobacco, Diabetes mellitus.

Question 7

Medial Epicondyle Tendinopathy (Golfer’s elbow) - Signs and Symptoms (3)

Answer 7

Persistent localized pain on medial epicondyle.
Pain with resisted flex/pronation of forearm.
ROM normal most of the time.

Question 8

Medial Epicondyle Tendinopathy (Golfer’s elbow) - Special Tests (2)

Answer 8

Reverse cozen test
Medial epicondylitis stress test

Question 9

Cubital Tunnel Syndrome - Causes (5)

Answer 9

Ulnar nerve entrapment between olecranon and medial epicondyle.
Direct pressure on nerve or prolonged stretching.
Trauma
Rheumatic and degenerative joint disease.
Immobilization during surgery.
Repetitive elbow flex. and ext.

Question 10

Cubital Tunnel Syndrome - Signs and Symptoms (3)

Answer 10

Gradual onset numbness and paresthesia on 5th and half of 4th fingers and hypothenar.
Muscle atrophy and weakness of intrinsic muscles.
Decreased pinch strength.

Question 11

Cubital Tunnel Syndrome - Special Tests (3)

Answer 11

Tinel’s test
Elbow flexion test
ULNT3

Question 12

Carpal Tunnel Syndrome - Risk Factors (Extrinsic, Intrinsic, Environmental and Neuropathic)

Answer 12

Median nerve entrapment (compression and traction). Idiopathic.
45-60y.
Extrinsic: Female (smaller tunnel). Pregnancy, menopause. High BMI. Obesity.
Environmental: Repetitive tasks, vibration.
Intrinsic: trauma, OA.
Neuropathic: Diabetes mellitus, alcoholism.

Question 13

Carpal Tunnel Syndrome - Signs and Symptoms

Answer 13

First 3 fingers, half of 4th, lateral palm.
Pain in hand.
Numbness and tingling.
Clumsiness and weakness (driving, reading, typing).

Question 14

Carpal Tunnel Syndrome - Clinical Tests (2)

Answer 14

Phalen’s test.
Tinel’s sign

Question 15

Posterolateral Rotatory Instability - Cause and MOI

Answer 15

Disruption of LCL.
Fall on outstretched arm, shoulder abd., axial compression, forearm supination and forced flexion of elbow. Valgus stress.
Leading to radial head + proximal ulna subluxate posterolaterally.

Question 16

Posterolateral Rotatory Instability - Signs and Symptoms and Special Test

Answer 16

Recurrent painful clicking, snapping, clunking, or locking of elbow in ext. + supination.
Chair push up test.

Question 17

Varus Posteromedial Rotatory Instability - MOI

Answer 17

Traumatic injury of anteromedial facet of coronoid and LCL.
Fall on an outstretched hand with shoulder flexed and abd. resulting in axial loading and varus force at elbow with pronation.

Question 18

Varus Posteromedial Rotatory Instability - Special Tests (2)

Answer 18

Gravity assisted varus stress test.
Clicking, popping, slipping during elbow flexion and extension.

Question 19

Triangular Fibrocartilage Complex (TFCC) Tears - MOI (2)

Answer 19

Age.
Traumatic: fall on extended wrist with forearm pronation.
Chronic: degenerative changes due to repetitive motions.

Question 20

Triangular Fibrocartilage Complex (TFCC) Tears - Signs and Symptoms (4)

Answer 20

History of trauma.
Ulnar side wrist pain, worse with activity (rotation).
Catching, clicking, weakness.
Positive piano key sign (styloid process).

Question 21

Triangular Fibrocartilage Complex (TFCC) Tears - Special Tests (2)

Answer 21

TFCC load test
Chair press test

Question 22

De Quervain Tenosynovitis - Definition and Risk Factors

Answer 22

Tendon inflamed/irritated, reticulum thickening, narrowing of compartment of abductor pollicis longus and extensor pollicis brevis.
Women, 30-50, postpartum.

Question 23

De Quervain Tenosynovitis - MOI

Answer 23

Repetitive wrist motion, thumb radial abd. and ext. and radial wrist deviation.

Question 24

De Quervain Tenosynovitis - Signs and Symptoms and Special Test

Answer 24

Tenderness and swelling over tendons, along distal radius. Radial styloid process tender.
Pain aggravated by gripping, wringing, lifting a child.
Finkelstein test.

Question 25

OA of 1st Carpometacarpal Joint - Risk Factors

Answer 25

Post-menopausal women >50.
Laxity of CMC joint, excessive repetitive use.
Lesion of ligament.
Fracture.

Question 26

OA of 1st Carpometacarpal Joint - Signs and Symptoms (4) and Special Test

Answer 26

Pain, tenderness and stiffness at base of thumb.
Reduced grip strength.
Swelling around joint.
Deformity at base of thumb.
Axial load test/grind test