E,W&H Pathologys Flashcards
tennis elbow - lateral epicondylitis
Pathology
- is swelling of the tendons that extend wrist - extensor carpi radialis brevis
Aetiology
- overuse injury that may result in hyaline degeneration of the origin of the extensor tendon, swelling of the tendons that flex the wrist
- Improper technique, weak shoulder and wrist muscles
Clinical signs
- Pain when: Lifting or bending arm, gripping objects, twisting your forearm
- Mills test & Power/pincer/tap grip test
- Common wrist extensor tendon palpation
- Pain at the end of the day after being used
Epidemiology
- Tennis players, racket sport men and women between 30-50
- painters decoraters
- people wo use their hand alot for work
golfers elbow- medial epicondylitis
Pathology
- Medial side of the elbow, pain is from the wrist flexors on the medial epicondyle to the humerus.
- pronator teres
- flexor carpi radialis/ulnaris
- palmaris longus
Aetiology
- Medial epicondylitis is caused by the excessive force used to bend the wrist toward the palm. This can happen when swinging a golf club. Another possible causes of medial epicondylitis is having weak shoulder and wrist muscles.
Clinical signs
- Pain at the end of the day after been continuously using the muscle
- Common wrist flexor tendon palpation
- pain on reisited wrist flexion and pronation
Epidemiology
- Most common in ages 45 to 64 & Also more common in women
- Common in sports which involve repetitive motions, such as a golf swing. Although this condition is commonly seen in golfers, it also occurs in athletes who perform repetitive motions that place stress on the medial epicondyle of the forearm, like throwing or hitting a tennis ball.
carpal tunnel
Pathology
- an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist’s carpal tunnel.
Aetiology
- results from increased pressure in the carpal tunnel and subsequent compression of the median nerve.
- flexor retinaculum creates superior border and carpal bones form inferior boundary. Attaches to schaphoid & trapezium to pisiform & hook of hamate
- carpal tunnel contains the median nerve (between the flexor dig sup and flex poll long) and 9 flexor tendons
- Four tendons from the flexor digitorum profundus, Four tendons from the flexor digitorum superficialis, One tendon from the flexor pollicis longus
Clinical signs
- Phalen’s test - fully flex the wrists, hold dorsal aspect of the hands together.
- Tinel’s - palms facing up, then tap over the carpal tunnel at the base of the wrist.
- pain, numbness, and paraesthesia (pins & needles) in the thumb, index finger, middle finger, and the radial half (thumb side) of the ring finger. Pain also can radiate up the affected arm. With further progression, hand weakness, decreased fine motor coordination, clumsiness, and thenar atrophy can occur.
Epidemiology
- genetic predisposition, history of repetitive wrist movements such as typing, or machine work as well as obesity, autoimmune disorders such as rheumatoid arthritis, and pregnancy, more common in women.
de Quervain tenosynovitis
pathology
- inflammatory condition of the tendons at the base of the thumb
- affects the extensor pollicis brevis (EPB) tendon and the abductor pollicis longus (APL) tendon, located on the dorsal side of the forearm and go to the lateral side of the thumb through a fibrous-osseous tunnel made of the processus styloideus radii and the extensor retinaculum
atieology
- chronic overuse
- Overuse injury vs acute trauma
- Repetitive movements of the upper extremity with work or activities of daily living (ADL)
clinical signs
- tenderness over the base of the thumb and/or first dorsal compartment extensor tendons on the thumb side of the wrist, particularly over the radial styloid process
- Swelling in the anatomical snuffbox
- Decreased carpometacarpal (CMC) abduction range of motion (ROM) of the first digit
- The primary complaint is radial sided wrist pain (base of thumb and dorsolateral aspect of the wrist near the radial styloid process) that radiates up the forearm with grasping or extension of the thumb
- Described as a “constant aching, burning, pulling sensation.”
Aggravated by repetitive lifting, gripping, or twisting motions of the hand (such as opening a jar lid)
- Weakness and paraesthesia in the hand
- finklesteins
epidemiology
- 40 -50 years
- common with people with a history of medial/lateral epicondylitis
- post partumn- lifting child alot
scaphoid fracture
Pathology
- Fracture of the scaphoid bone (5th carpal bone) located at the base of the thumb
- Scaphoid Fractures are the most common carpal bone fracture, often occurring after a fall onto an outstretched hand.
Aetiology
- Commonly the result of axial load applied to a hyperextended and radially deviated wrist which most commonly occurs when falling onto an outstretched hand
Clinical signs
- Patients will typically present with pain around the dorsal wrist and/or the anatomical snuffbox after a fall on an outstretched hand
- Palpate anatomical snuffbox
- X-ray
Epidemiology
Most common in contact sports such as American football, rugby, hockey etc when people get knocked over a lot with force
smiths fracture
Pathology
- Fracture of the distal end of the radius caused by a fall of the back of the hand(flexed)
- Results in volar (anterior) displacement
Aetiology
- a fall on a flexed wrist or a direct blow to the dorsal aspect of the wrist.
Clinical signs
- Pain, swelling & reduced rom
- A deformed wrist with swelling visible on the volar palm side and the prominence of the ulna along the dorsal of the wrist.
- X-rays can identify injury
Epidemiology
- Rare fractures, often seen in young males and elderly females- osteoporosis
colles fracture
Pathology
- complete fracture of the radius close to the wrist resulting in an upward (posterior) displacement of the radius.
- The distal radius forms the proximal side of the wrist joint.
- Radius articulates with the proximal row of carpal bones (allowing flexion and extension); it also articulates with the distal ulna (creating a joint for pronation and supination).
Aetiology
- The fracture originates from a fall on the outstretched hand and is usually associated with dorsal and radial displacement of the distal fragment, and disturbance of the radial-ulnar articulation.
Clinical signs
- X-rays would be the most reliable way to diagnose the fracture.
- With a fracture there is usually a dull ache in the area and radiation of the ache on surrounding bone structures.
Epidemiology
- Mainly adults, common in patients with osteoporosis; elderly women
- Younger patients who sustain Colles fractures have usually been involved in high impact trauma or have fallen, e.g. during contact sports, skiing, horse riding, motorcycle accidents, falls from a height.
tinels test
Why- test for carpal tunnel syndrome/ compression neuropathy
How- light tapping over the nerve which gives a positive test if a sensation of pins and needles occurs
sensitivity - 25% - 75%
specificity - 70% - 90%
finklesteins
Why- tests for de Quervains tendosynovitis
How- bend thumb into palm of hand and fingers over thumb, the bend wrist towards little finger, over a side or a surface. Positive test indicates pain on thumb side of wrist
- extensor pollicis brevis attaches distally to the dorsal side of the proximal phalanx and extensor mechanism of the thumb
- abductor pollicis longus attaches distally to the radial-dorsal side of the 1st metacarpal.
- The combination of maximum finger flexion and wrist ulnar deviation elongates these tendons and produces pain in symptomatic individuals.
glides
index or middle finger on the radial head
thumb pointing in the direction to lie ontop on the radius
proximal hand fixing the other bone
glides for assessment
assess avalible ROM
