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MSK > ELBOW, FOREARM, WRIST, AND HAND > Flashcards

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

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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

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3
Q

Functional ROM of the Wrist

A

40 flex, 40 ext, 15 radial dev, 20 ulnar dev

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4
Q

Monteggia Fracture (MUGR)

A

proximal ulnar fracture
rotational torsion

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5
Q

Galeazzi Fracture (MUGR)

A

distal radial fracture
rotational torsion

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6
Q

Little Leaguer’s Elbow/ Medial Epicondylitis

A

valgus strain
excessive compression or bumping / severe contusion on the opposite side
younger population

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7
Q

What phase of pitching is valgus increased?

A

Late cocking phase

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8
Q

MCL/ UCL Sprain

A

audible pop + pain + swelling

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9
Q

Distal Biceps Rupture

A

centralized pop + weakness of elbow

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10
Q

Higher Cubital Valgus (sex)

A

females
higher ligamentous laxity
RA predisposition

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11
Q

Locking/ Feeling of Instability

A

TFCC or ligament

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12
Q

Weakness with pain

A

low grade strain

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13
Q

Weakness without pain

A

rupture

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14
Q

Double Crush Syndrome

A

combination of proximal and distal symptoms

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15
Q

Nerve Root Pain

A

sharp shooting

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16
Q

Nerve Pain

A

sharp, bright, lightning like

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17
Q

Sympathetic Pain

A

burning, pressure like

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18
Q

Bone Pain

A

deep, boring, localized

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19
Q

Fracture Pain

A

sharp, severe, intolerable

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20
Q

Muscle Pain

A

cramping, dull, hard to localize

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21
Q

Vascular Pain

A

throbbing, diffuse

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22
Q

Acute

A

24-72 hours

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23
Q

Subacute

A

> 2 weeks

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24
Q

Chronic

A

2-6 months

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25
Q

Functional Volar Hand Resting Splint

A

30-40 wrist extension
slight MCP flexion
slight thumb abduction and flexion

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26
Q

Ocular Inspection

A

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

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27
Q

Cyanotic

A

decreased blood flow

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28
Q

Redness/ Erythema

A

persistent inflammation

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29
Q

Bruising/ Hematoma

A

after dislocation; redness –> black tone
note extent in OI

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30
Q

Scleroderma

A

systemic condition
increased calcium deposits
toughened and shiny skin

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31
Q

Dry and Scaly Skin

A

decreased sympathetic

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32
Q

Shiny, smooth, and glossy skin

A

increased sympathetic

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33
Q

Extra articular swelling

A

outside the synovium
bursitis of olecranon, repetitive strain on flexion and extension

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34
Q

Intra articular swelling

A

generalized swelling
circumferential
system
most evident in the triangular space

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35
Q

Carrying Angle

A

M: 11-14
F:13-16

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36
Q

Cubito Varus/ Gunstock Deformity

A

5-10

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37
Q

Cubito Valgus

A

10-15

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38
Q

Bouchard’s Nodes

A

PIP

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39
Q

Heberden’s Nodes

A

DIP

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40
Q

Ulnar Shift

A

ulnar shift of MCP, DIP, PIP, and zig zag deformity of MCP (radial shift)
seen in late RA

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41
Q

Spoon Shaped Nails

A

fungal, anemic, local injuries, and diabetic

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42
Q

Dupuytren’s Contracture

A

contracture of the anterior fascia of the PIP and MCP (ring and little finger; 50-70 y/o)

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43
Q

Clubbing of DIP

A

respiratory or cardiac problems

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44
Q

Swan Neck Deformity

A

flexed MCP, extended PIP, flexed DIP
torn volar plate d/t trauma or RA
contraction of intrinsic muscles

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45
Q

Boutonniere Deformity

A

rupture of central slip d/t trauma or RA
extension of MCP and DIP, flexion of PIP

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46
Q

Claw Hand/ Intrinsic Minus

A

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)

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47
Q

Bishop’s Hand (Ulnar Nerve)

A

inability to raise 4th and 5th finger d/t contracture and weakness of interossei and medial lumbricals

48
Q

Ape Hand Deformity (Median Nerve/ Anterior Interosseous Nerve)

A

pull on extensor muscles
lack of strength of thumb, wrist, and hand flexors, no opposition/flexion of thumb

49
Q

Syndactyly

A

webbing of ring and middle fingers

50
Q

Drop Wrist Deformity

A

impairment of the radial nerve
saturday night palsy
paralyzed extension

51
Q

Zigzag Deformity

A

flexed CMC and DIP, extended MCP
along with ulnar drift

52
Q

Mallet finger

A

avulsion of extensor tendon
flexed DIP

53
Q

Carpometacarpal bossing

A

overgrowth of hard bone on posterior aspect (index and middle meets trapezoid and capitate)

54
Q

Dinner Fork Deformity

A

colle’s fracture
dorsal displacement
malunion of distal radius
angulation of dorsiflexion

55
Q

Extensor Plus Deformity

A

adhesions on extensor communis tendon
inability to simultaneously flex MCP and PIP joints (hyperextended)

56
Q

Myelopathy Hand

A

cervical spinal cord pathology
cervical spondylosis
inability to extend and adduct ring and little finger

57
Q

Polydactyly

A

more than the normal fingers

58
Q

Triphalangism

A

three phalanges

59
Q

Trigger Finger

A

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
Q

Functional Position of the Wrist

A

wrist extension: 20-35; ulnar deviation: 10-15

61
Q

Radial Nerve

A

extension and opening of thumb

62
Q

Ulnar Nerve

A

adduction; closure of pinch; power grip

63
Q

Median Nerve

A

flexion and opposition; precision grip

64
Q

Thumb

A

intrinsic > extrinsic

65
Q

Fingers

A

extrinsic > intrinsic

66
Q

Edema

A

fluids on lymphatic level
diffused and centralized

67
Q

Swelling

A

intra or extra articular
localized

68
Q

Kaltenborn’s Technique

A

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
Q

Anatomical Snuff Box

A

dorsal aspect
scaphpid and radial styloid
radial artery

70
Q

Scaphoid tubercle

A

Most commonly fractured
outside EXPOBRE
tenderness in snuffbox after FOOSH

71
Q

Radial Artery

A

proximal and medial to scaphoid tubercle

72
Q

Radial (Lister’s) Tubercle

A

aligned with 3rd MCP (ExPoLo)

73
Q

Ulnar Snuff Box

A

fovea distal to ulnar styloid
triquetrum lies here

74
Q

TFCC

A

ulnar styloid, pisiform, FCU, triquetrum
(ulnar fovea sign)

75
Q

ABPOLO EXPOBRE

A

tenderness= tenosynovitis/ De Quervain’s

76
Q

De Quervain’s

A

tenosynovitis of the extensor tendon of the wrist

77
Q

Extensor Tendon Tunnels

A

1: APBOLO EXPOBRE
2: ECRB and ECRL
3: EPL
4: ED and EI
5: EDM
6: ECU

78
Q

Scaphoid

A

most commonly injured by trauma

79
Q

Lunate

A

most commonly dislocated

80
Q

Volumetric Measurement of the Hand

A

normal = 10 mL difference
significant difference: 30-50 mL

81
Q

Optimal Functional ROM of the wrist

A

10 deg flexion, 35 deg extension, 10 deg rad dev, 15 deg, ulnar dev

82
Q

Dermatomes

A

C5: elbow extension
C6: wrist extension
C7: wrist flexion
C8: finger flexion
T1: finger abduction

83
Q

Grip and Pinch Strength Test Normal

A

5-10% difference

84
Q

Grip and Pinch Strength Test Position

A

shoulder adduction, 90 elbow flexion, wrist in neutral and functional position

85
Q

Correlation of Pain and Strength

A

strong and painless= normal
strong and painful= minor lesion
weak and painless= neurologic
weak and painful= major lesion

86
Q

Most important digit

A

thumb
loss of function= 40-50% functional loss in hand; 90% in UE

87
Q

Second most important digit

A

index finger (loss= 20% functional deficit)

88
Q

Strongest digit in flexion

A

middle finger (precision and power grips) (loss= 20% functional deficit)

89
Q

Stages of Grip

A

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
Q

Most common grips used for ADLs

A

pulp to pulp
three lateral pinch

91
Q

Power Grip

A

ulnar and radial deviation; thumb may or may not be involved
standard fist grip
extrinsic muscles

92
Q

Types of Power Grip

A

hook: ulnar deviation, slightly extended wrist, finger flexion,
cylindrical: palmar apprehension
spherical: more opposition
fist: narrower object; digital palmar apprehension
crimp grip: climbers

93
Q

Precision Grip

A

MCP joints
intrinsic muscles
radial side
accuracy and precision
ulnar and median nerve lesions
thumb: stability and direction

94
Q

Types of Precision Grip

A

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
Q

Semmes Weinstein / Von Frey Test

A

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
Q

2 point tactile discrimination

A

less than 6 mm
proximal to distal

97
Q

Stereognosis

A

identify common objects by touch within 3 seconds of contact

98
Q

Median Nerve Functional Loss

A

flexors, pronation, thumb abduction, flexion, opposition, radial deviation

99
Q

Median Nerve Roots

A

C6-C8, T1

100
Q

Ulnar Nerve Roots

A

C7-C8, T1

101
Q

Ulnar Nerve Functional Loss

A

intrinsic muscles, ulnar deviation, thumb adduction

102
Q

Radial Nerve Roots

A

C5-C8, T1

103
Q

Radial Nerve Functional Loss

A

extensors, supination, thumb abduction

104
Q

Reflexes and Cutaneous Distribution

A

biceps and brachioradialis: C5-C6
triceps: C7-C8

105
Q

Carpal Tunnel Syndrome

A

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
Q

Cubital Tunnel Syndrome/ Canal of Guyon

A

ulnar nerve
compression from trauma

107
Q

Ulnohumeral Joint

A

OPP: 70 elbow flexion, 10 supination
CPP: full extension and supination
CP: flexion, extension

108
Q

Radioulnar Joint

A

OPP: 70 elbow flexion, 35 supination
CPP: 5 supination
CP: equal limitation of pronation and supination

108
Q

Radiohumeral Joint

A

OPP: full extension and full supination
CPP: 90 elbow flexion, 5 supination
CP: flexion, extension, supination, pronation

109
Q

Functional Position of the Elbow

A

90 elbow flexion, midway between supination and pronation

110
Q

First movement lost after injury to elbow

A

Extension

111
Q

Terminal Flexion

A

more disabling in elbow

112
Q

Pronation and Supination

A

75% superior radioulnar
15% inferior radioulnar

113
Q

Functional ADL of elbow

A

30-130 elbow flexion, 50 pronation - 50 supination

114
Q

Kiloh Nevin Syndrome

A

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)

MSK (7 decks)

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