Elbow/Forearm 1 Flashcards
What kind of stress of the elbow predominates with athletes?
valgus stress
overuse of the elbow (pronation/supination)
muscle strain, trigger points, or peripheral nerve entrapment
overuse of the elbow (cocking or medial stretch)
consider medial collateral ligament sprain, flexor muscle strain, ulnar nerve stretch irritation
when do you refer out for an elbow problem?
fracture/dislocation
infection, unresolving butsitis, gout
inflammatory joint disease
soft tissue and articular disorders if unresponsive
if there is a history of hyperextension due to FOOSH injury or a direct blow to antecubital fossa, what should you always consider?
supracondylar fracture in child
radial head fracture in adult
if there is a sudden valgus force of the elbow, what do you consider?
potential avulsion of the medial epicondyle
medial collateral ligament sprain
capitulum fracture
direct fall onto the tip of the elbow with elbow flexed may result in?
olecranon fracture or olecranon bursitis
nursemaid’s elbow
sudden traction on the forearm of a young child that can result in radial head entrapment
medial epicondylitis
repetitve flexion and medial elbow pain
lateral epicondylitis
repetitive extension associated with lateral elbow pain
weakenss at the elbow without associated pain is a possibility of?
biceps tendon rupture
instability is a consequency of?
past fracture, dislocation or sudden valgus force
restricted passive flexion or extension coupled with trauma is suggestive of?
joint effusion or fracture
nontraumatic restriction to passive extension suggest what?
tight biceps or anterior capsule, history of overuse is usual
nontraumatic restriction to passive flexion suggests?
tight triceps or posterior capsule adhesion
locking/creptius in young patients
suggestive of osteochrondritis desiccans
locking/crepitus in older patients
degenerative changes
swelling at the elbow is suggestive of?
gouty tophi
rheumatoid nodules/arthritis
olecranon bursitis
Mill’s test
passive wrist flexion with elbow extended
for lateral epicondylitis
reverse Mill’s
passive wrist extension with elbow extended
medial epicondylitis
Cozen’s test
resisted wrist extension (with elbow flexed and extended)
increases lateral epicondylitis pain
tinel’s test
ulnar nerve irritation
lateral epicondylitis
lateral pain on resisted wrist extension &/or passive flexion of wrist with elbow extended/forearm pronated &/or resisted finger extension
medial epicondylitis
medial pain on resisted wrist flexion with elbow extended &/or passive wrist extension with the elbow extended/fore arm supinated &/or reissted finger flexion
lateral elbow pain worsened by? What is the name for this?
resisted wrist extension and gripping
tennis elbow
motions that cause tennis elbow
repetitive motion (computer keyboardists, carpenters, golfers, meat cutters, etc) cause forceful wrist extension, radial deviation and supination
what muscles are mainly involved in tennis elbow?
extenor carpi radialis brevis*
extensor digitorum communis
extensor carpi radialis longus
how will someone with lateral elbow pain present?
cozen’s, mill’s will be positive
pain on resisted wrist extension or 3rd finger extension with extended elbow causes pain
lifting a chair with pronated hand
pain, often sharp, in the lateral elbow occurs upon extension of the wrist or supination of the forearm
may cause inability to lift or hold objects
medial epicondylitis has pain following what?
repetitive activity
inciting activity for medial epicondylitis?
wrist flexion and pronation
what are the other names for medial epicondylitis?
golfer’s elbow
little leaguer’s elbow
what muscle tendons are involved in meidal epicondylitis?
wrist flexors
pronators
what motion reproduces pain for medial epicondylitis?
resisted wrist flexion
pronation and grasping
what test exacerbates medial epicondylitis?
mill’s
monteggia fracture
ulnar shaft fracture with associated proxial dislocated radius
galeazzi fx
fracture distal radius and dislocated distal radial ulnar articulation
greenstick/torus
incomplete fracture
colles fx
distal radial fracture with dorsal and radial angulation
smith’s fx
distal radial fracture with volar/palmar angulation
how do wrist complaints usually occur?
direct trauma, falls, over use, arthritic conditions
when do we send someone out for a wrist complaint?
fracture dislocation disassociation AVN soft tissue/articular disorders that don't resolve in 2-3 months
most common carpal fracutred
scaphoid fracture at the waist
how is the scaphoid usually fractured?
FOOSH injury
what is teh most common site for an occult fracture?
scaphoid
where is the pain in a scaphoid fracutre?
in the anatomic snuffbox after a FOOSH injury
AVN of the lunate
Kienbock’s disease
history and clinical presentation of kienbock’s
stiff and painful wrist
often no history of trauma
repetitive minor truama is supected as a commin initiator
how might someone acquire a scapholunate disassociation?
radial or dorsal wrist pain following FOOSH
what is the sign associated with scapholunate disassociation?
terry thomas sign
or david etterman’s sign
signet ring sign
rotatory subluxation of the scaphoid with scapholunate instability
dequervain’s tenosynovitis
presents as radial wrist pain
forceful gripping with ulnar deviation or repetitive use of the thum
stenosis tenosynovitits of abductor ppollicis longus and extensor pollicis brevis resulting from chronic microtrauma
what test is positie with dequervain’s tenosynovitis
resisted thumb extension with wrist in radial deiation
finkelstein’s
patient presents with forearm pain with hand and wrist numbness/tingling and weakness. what should you look for?
dequarvain tenosynovitis
if median nerve is involved, what should you look for?
CTS, pronator syndrome
if ulnar nerve is inolved, what should you look for?
cubital tunnel syndrome, tunnel of guyon
if radial nerve is involved, what should you look for?
radial tunnel syndrome
what is the most common nerve entrapment syndrome?
carpal tunnel
what will patient complain of if they have carpal tunnel?
numbness/tingling in palmar surface of thumb and radial 2 1/2 fingers
when would someone have median nerve involvement?
direct external pressure on the tunnel or history of prolonged full flexion or extension
most common cause of “nonspecific flexor tenosynovitis”
repetitive motion*
swelling in carpal tunnel
compression of the median nerve can be compressed by?
wrist flexor retinaculum
what test should you do for wrist complaints?
tinel sign phalan's test reversed phalan's pressure provocative test electrodiagnostic studies flick sign****
what might someone with pronator syndrome complain of?
volar forearm pain, usually no history of trauma
what history might someone with pronator syndrome have?
repetitive pronation and wrist flexion such as incurred by carpenters, assembly-line workers and weightlifters
how do you provoke the pain of someone with pronator syndrome
resisted pronoation with elbow extended and wrist flexed (from hypertrophy)
resisted middle finger flexion (compression at flrxor digitorum superficialis
where can the median nerve be compromised?
at the wrist, or at the level of the pronator teres
most common entrapment sites for median nerve
between two heads of pronator teres and arch of flexor digitorum superficialis
ulnar nerve/cubital tunnel syndrome
complaint of medial forearm pain and paresthesia into the ring and little finger
throwing history
where does the ulnar nerve usually get compressed/stretched?
elbow(cubital tunnel or ulnar groove)
how are symptoms reproduced with cubital tunnel syndrome
passive or reissted elbow flexion with the elbow in a maximally flexed pposition
tunnel of guyon
complaint of numbness/tingling or pain in the 4th or 5th digits
what is the tunnel of guyon?
osseofibrous tunnel formed by a groove between the pisiform and hook of the hamate
handlebar palsy
chronic compression at the tunnel of guyon
provocative tests for tunnel of guyon?
tinel’s or presser at the pisiform hamate area
radial tunnel syndrome
complaint of dull aching pain over the lateral forearm
compression of the radial nerve
tenderness is distal to the lateral epicondyle
provocative measures are based on the site of entrapment
finger and thumb complaints are usually due to?
trauma
what are non traumatic conditions that cause finger and thumb complaints?
arthridities, CT disease, vascular problems (raynaud’s, relfex sympathetic dystrophy)
hand fracture examples
mallet finger metacarpal fracutre volar plate fracture gamekeeper's thumb bennett's fracture rolanto's
baseball/mallet finger
avulsion of the extensor tendon at its insertion on the dorsal surface of the base of the distal phalynx
results from a blow to the end of the finger causing a hyperflexion to a forcibly extended finger
may have partial or complete tendon tear or bony avulsion
bennett’s fracutre
oblique intra-articular fx at the base of the thumb with radial deviation fo the distal fragment
rolando’s fracutre
intraarticular comminuted fracture at the base of the 1st metacarpal with radial displacement
