ELBOW, FOREARM, WRIST, AND HAND Flashcards
1
Q
Tennis Elbow/ Lateral Epicondylitis
A
> or equal to 25
radiating, aching pain
varus strain
wrist flexion and extension
overuse or repetitive stress= inflammation
2
Q
Nursemaid’s Elbow
A
young age
underdeveloped annular ligament (superior pull) –> dislocation of radial head
dec supination and pain on lateral side of elbow
3
Q
Functional ROM of the Wrist
A
40 flex, 40 ext, 15 radial dev, 20 ulnar dev
4
Q
Monteggia Fracture (MUGR)
A
proximal ulnar fracture
rotational torsion
5
Q
Galeazzi Fracture (MUGR)
A
distal radial fracture
rotational torsion
6
Q
Little Leaguer’s Elbow/ Medial Epicondylitis
A
valgus strain
excessive compression or bumping / severe contusion on the opposite side
younger population
7
Q
What phase of pitching is valgus increased?
A
Late cocking phase
8
Q
MCL/ UCL Sprain
A
audible pop + pain + swelling
9
Q
Distal Biceps Rupture
A
centralized pop + weakness of elbow
10
Q
Higher Cubital Valgus (sex)
A
females
higher ligamentous laxity
RA predisposition
11
Q
Locking/ Feeling of Instability
A
TFCC or ligament
12
Q
Weakness with pain
A
low grade strain
13
Q
Weakness without pain
A
rupture
14
Q
Double Crush Syndrome
A
combination of proximal and distal symptoms
15
Q
Nerve Root Pain
A
sharp shooting
16
Q
Nerve Pain
A
sharp, bright, lightning like
17
Q
Sympathetic Pain
A
burning, pressure like
18
Q
Bone Pain
A
deep, boring, localized
19
Q
Fracture Pain
A
sharp, severe, intolerable
20
Q
Muscle Pain
A
cramping, dull, hard to localize
21
Q
Vascular Pain
A
throbbing, diffuse
22
Q
Acute
A
24-72 hours
23
Q
Subacute
A
> 2 weeks
24
Q
Chronic
A
2-6 months
25
Functional Volar Hand Resting Splint
30-40 wrist extension
slight MCP flexion
slight thumb abduction and flexion
26
Ocular Inspection
manner or arrival
mental status/ orientation
body type
adaptive device
change in color
scar wounds
bruising/ hematoma
change in texture
dry and scaly skin
smooth, shiny, glossy
swelling
deformities/ asymmetries
carrying angle
27
Cyanotic
decreased blood flow
28
Redness/ Erythema
persistent inflammation
29
Bruising/ Hematoma
after dislocation; redness --> black tone
note extent in OI
30
Scleroderma
systemic condition
increased calcium deposits
toughened and shiny skin
31
Dry and Scaly Skin
decreased sympathetic
32
Shiny, smooth, and glossy skin
increased sympathetic
33
Extra articular swelling
outside the synovium
bursitis of olecranon, repetitive strain on flexion and extension
34
Intra articular swelling
generalized swelling
circumferential
system
most evident in the triangular space
35
Carrying Angle
M: 11-14
F:13-16
36
Cubito Varus/ Gunstock Deformity
5-10
37
Cubito Valgus
10-15
38
Bouchard's Nodes
PIP
39
Heberden's Nodes
DIP
40
Ulnar Shift
ulnar shift of MCP, DIP, PIP, and zig zag deformity of MCP (radial shift)
seen in late RA
41
Spoon Shaped Nails
fungal, anemic, local injuries, and diabetic
42
Dupuytren's Contracture
contracture of the anterior fascia of the PIP and MCP (ring and little finger; 50-70 y/o)
43
Clubbing of DIP
respiratory or cardiac problems
44
Swan Neck Deformity
flexed MCP, extended PIP, flexed DIP
torn volar plate d/t trauma or RA
contraction of intrinsic muscles
45
Boutonniere Deformity
rupture of central slip d/t trauma or RA
extension of MCP and DIP, flexion of PIP
46
Claw Hand/ Intrinsic Minus
hyperextension of MCP and flexion of IP joints
overaction of extrinsic on proximal phalanx
arches disappear
median and ulnar nerve palsy
weak long flexors of wrist and hand (overriding of radial nerve)
47
Bishop's Hand (Ulnar Nerve)
inability to raise 4th and 5th finger d/t contracture and weakness of interossei and medial lumbricals
48
Ape Hand Deformity (Median Nerve/ Anterior Interosseous Nerve)
pull on extensor muscles
lack of strength of thumb, wrist, and hand flexors, no opposition/flexion of thumb
49
Syndactyly
webbing of ring and middle fingers
50
Drop Wrist Deformity
impairment of the radial nerve
saturday night palsy
paralyzed extension
51
Zigzag Deformity
flexed CMC and DIP, extended MCP
along with ulnar drift
52
Mallet finger
avulsion of extensor tendon
flexed DIP
53
Carpometacarpal bossing
overgrowth of hard bone on posterior aspect (index and middle meets trapezoid and capitate)
54
Dinner Fork Deformity
colle's fracture
dorsal displacement
malunion of distal radius
angulation of dorsiflexion
55
Extensor Plus Deformity
adhesions on extensor communis tendon
inability to simultaneously flex MCP and PIP joints (hyperextended)
56
Myelopathy Hand
cervical spinal cord pathology
cervical spondylosis
inability to extend and adduct ring and little finger
57
Polydactyly
more than the normal fingers
58
Triphalangism
three phalanges
59
Trigger Finger
thickening of flexor sheath (Notta's Nodule)
sticking when flexing finger
swelling in distal flexor sheath
3rd-4th finger
RA (worse in morning)
low grade inflammation of proximal fold
60
Functional Position of the Wrist
wrist extension: 20-35; ulnar deviation: 10-15
61
Radial Nerve
extension and opening of thumb
62
Ulnar Nerve
adduction; closure of pinch; power grip
63
Median Nerve
flexion and opposition; precision grip
64
Thumb
intrinsic > extrinsic
65
Fingers
extrinsic > intrinsic
66
Edema
fluids on lymphatic level
diffused and centralized
67
Swelling
intra or extra articular
localized
68
Kaltenborn's Technique
fixate capitate to move the trapezoid
fixate capitate to move the scaphoid
fixate capitate to move the lunate
fixate capitate to move the hamate
fixate scaphoid to move trapezium
fixate scaphoid to move trapezoid
fixate radius to move scaphoid
fixate radius to move lunate
fixate ulna to move triquetrum
fixate triquetrum to move pisiform
fixate triquetrum to move hamate
69
Anatomical Snuff Box
dorsal aspect
scaphpid and radial styloid
radial artery
70
Scaphoid tubercle
Most commonly fractured
outside EXPOBRE
tenderness in snuffbox after FOOSH
71
Radial Artery
proximal and medial to scaphoid tubercle
72
Radial (Lister's) Tubercle
aligned with 3rd MCP (ExPoLo)
73
Ulnar Snuff Box
fovea distal to ulnar styloid
triquetrum lies here
74
TFCC
ulnar styloid, pisiform, FCU, triquetrum
(ulnar fovea sign)
75
ABPOLO EXPOBRE
tenderness= tenosynovitis/ De Quervain's
76
De Quervain's
tenosynovitis of the extensor tendon of the wrist
77
Extensor Tendon Tunnels
1: APBOLO EXPOBRE
2: ECRB and ECRL
3: EPL
4: ED and EI
5: EDM
6: ECU
78
Scaphoid
most commonly injured by trauma
79
Lunate
most commonly dislocated
80
Volumetric Measurement of the Hand
normal = 10 mL difference
significant difference: 30-50 mL
81
Optimal Functional ROM of the wrist
10 deg flexion, 35 deg extension, 10 deg rad dev, 15 deg, ulnar dev
82
Dermatomes
C5: elbow extension
C6: wrist extension
C7: wrist flexion
C8: finger flexion
T1: finger abduction
83
Grip and Pinch Strength Test Normal
5-10% difference
84
Grip and Pinch Strength Test Position
shoulder adduction, 90 elbow flexion, wrist in neutral and functional position
85
Correlation of Pain and Strength
strong and painless= normal
strong and painful= minor lesion
weak and painless= neurologic
weak and painful= major lesion
86
Most important digit
thumb
loss of function= 40-50% functional loss in hand; 90% in UE
87
Second most important digit
index finger (loss= 20% functional deficit)
88
Strongest digit in flexion
middle finger (precision and power grips) (loss= 20% functional deficit)
89
Stages of Grip
opening of the hand= intrinsic and long extensor muscles
positioning and closing of fingers and thumb to grasp and adapt= intrinsic and extrinsic flexor, opposition muscles
exerted force= intrinsic and extrinsic flexor, opposition muscles
release of hand: intrinsic and long extensor muscles
90
Most common grips used for ADLs
pulp to pulp
three lateral pinch
91
Power Grip
ulnar and radial deviation; thumb may or may not be involved
standard fist grip
extrinsic muscles
92
Types of Power Grip
hook: ulnar deviation, slightly extended wrist, finger flexion,
cylindrical: palmar apprehension
spherical: more opposition
fist: narrower object; digital palmar apprehension
crimp grip: climbers
93
Precision Grip
MCP joints
intrinsic muscles
radial side
accuracy and precision
ulnar and median nerve lesions
thumb: stability and direction
94
Types of Precision Grip
three point chuck: pulp to pulp with opposition
lateral or key pinch (lateral apprehension): lateral side of index finger; no opposition
tip to tip: tip of fingers brought in opposition with tip of another finger
95
Semmes Weinstein / Von Frey Test
blindfolded or unable to see hand; filament is applied perpendicularly (smallest to largest) in the palmar aspect (primarily tested area)
2.44-2.83 are the normal values
96
2 point tactile discrimination
less than 6 mm
proximal to distal
97
Stereognosis
identify common objects by touch within 3 seconds of contact
98
Median Nerve Functional Loss
flexors, pronation, thumb abduction, flexion, opposition, radial deviation
99
Median Nerve Roots
C6-C8, T1
100
Ulnar Nerve Roots
C7-C8, T1
101
Ulnar Nerve Functional Loss
intrinsic muscles, ulnar deviation, thumb adduction
102
Radial Nerve Roots
C5-C8, T1
103
Radial Nerve Functional Loss
extensors, supination, thumb abduction
104
Reflexes and Cutaneous Distribution
biceps and brachioradialis: C5-C6
triceps: C7-C8
105
Carpal Tunnel Syndrome
median nerve
pregnant, F, 30-60 y/o
trauma, overuse of fingers and wrist, arthritis
dominant hand
young: repetitive wrist motions & vibration
worse at night, burning, tingling, pins and needles, numbness
primary sx: motor loss
106
Cubital Tunnel Syndrome/ Canal of Guyon
ulnar nerve
compression from trauma
107
Ulnohumeral Joint
OPP: 70 elbow flexion, 10 supination
CPP: full extension and supination
CP: flexion, extension
108
Radioulnar Joint
OPP: 70 elbow flexion, 35 supination
CPP: 5 supination
CP: equal limitation of pronation and supination
108
Radiohumeral Joint
OPP: full extension and full supination
CPP: 90 elbow flexion, 5 supination
CP: flexion, extension, supination, pronation
109
Functional Position of the Elbow
90 elbow flexion, midway between supination and pronation
110
First movement lost after injury to elbow
Extension
111
Terminal Flexion
more disabling in elbow
112
Pronation and Supination
75% superior radioulnar
15% inferior radioulnar
113
Functional ADL of elbow
30-130 elbow flexion, 50 pronation - 50 supination
114
Kiloh Nevin Syndrome
anterior interosseous syndrome
entrapment between the pronator teres muscle
impairment of the FPL, lateral half of the FDP, and pronator quadratus muscle
inability to do an OK sign (pulp to pulp rather than tip to tip)
