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MSK Redemption Arc > Elbow, Hand and Wrist MDT > Flashcards

Elbow, Hand and Wrist MDT Flashcards

1
Q

Overuse injury involving excessive use of the extensor tendons

A

Lateral epicondylitis

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2
Q

Sports or activities that require excessive wrist and hand extension are a common cause of what injury?

A

Lateral epicondylitis

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3
Q

Overuse injury involving excessive use of the flexor and pronator muscles

A

Medial epicondylitis

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4
Q

Activities that require excessive wrist and hand flexion can cause what injury

A

Medial epicondylitis

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5
Q

What is the difference in hand and wrist movement in medial and lateral epicondylitis

A

Medial= flexion
Lateral= extension

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6
Q

Pt presents with:
-gradual onset of pain in lateral elbow and forearm during activities involving gripping and wrist extension
-Lifting
-Turning screwdriver
-Hitting backhand in tennis
-Excessive typing
- Less common, results from direct blow to lateral aspect of elbow

A

Lateral epicondylitis

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7
Q

Pt presents with:
-gradual onset of pain in medial elbow and forearm during activities involving wrist flexion and forearm pronation
-Golf swing
-Baseball pitching
-Pull-through stroke of swimming
-Weight-lifting
-Bowling
-Many forms of manual labor

A

Medial epicondylitis

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8
Q

Pt PE:
- Tenderness over common extensor origin
- Wrist extension and grip strength limited by pain
- Pain with resisted extension of the wrist
- 1cm distal and slightly anterior to lateral epicondyle

A

Lateral epicondylitis

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9
Q

Pt PE:
- Wrist flexion and pronation limited by pain
- Tenderness just distal to medial epicondyle
- Pain with resisted flexion of the wrist

A

Medial epicondylitis

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10
Q

Are plain films needed to dx epicondylitis? What radiologic study should be done if not responding to conservative management?

A
  • Plain radiographs rarely needed in patients with elbow pain and no history of trauma
  • Ultrasound/MRI in cases not responding to conservative management
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11
Q

Conservative treatment of epicondylitis

A
  • Light Duty/ duty modifications
  • NSAIDs
  • Tennis elbow strap for comfort
  • HEP
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12
Q

If conservative treatment of epicondylitis fails, what should be done next?

A
  • PT
  • Ortho consult if no improvement for steroid injections
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13
Q

Pt presents with:
- Sudden (infection or trauma) or gradual (chronic) swelling
- Pain ranges in severity
- Limited ROM from pain and or pressure
- As mass diminishes in size patient may feel firm lumps or nodules that result from scar tissue
- May occur secondary to trauma, inflammation or infection
- Trauma may vary from a direct blow to excessive leaning on elbows

A

Olecranon bursitis

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14
Q

What procedure for olecranon bursitis maybe diagnostic and therapeutic?

A

Aspiration

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15
Q

Why would you order radiographs for olecranon bursitis?

A

r/o fracture of olecranon

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16
Q

Treatment of mild cases of bursitis

A
  • Light duty focused on activity modification to include avoiding hyperflexion against hard surfaces
  • NSAIDS
  • Pressure wrap
  • Ice
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17
Q

Treatment of moderate to severe cases of olecranon bursitis

A
  • should undergo aspiration of fluid-refer for orthopedic evaluation
  • Septic olecranon bursitis requires organism-specific antibiotics-refer for treatment
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18
Q

More common or less common nerve compression syndromes?
- Cubital tunnel syndrome
- Median Nerve Compression

A

More common

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19
Q

More common or less common nerve compression syndromes?
- Posterior interosseous nerve compression
- Pronator syndrome
- Radial Tunnel syndrome

A

Less common

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20
Q

Where is the most common site of ulnar nerve?

A

Cubital tunnel

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21
Q

What can these cause?
- Direct blow to cubital tunnel
- Nerve stretched from flexed elbow for prolonged periods of time
- Cubitus valgus(carrying angle greater than 10 degree)
- Osteophytes or scar tissue
- Ulnar nerve subluxation or dislocation

A

Cubital tunnel syndrome (Ulnar nerve compression)

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22
Q

Pt presents with:
- Aching to medial aspect of elbow with numbness and tingling in the 4th and 5th digits
- May radiate proximally to shoulder and neck
- Inability to do activities of daily living (ADL) such as opening jars or turning key in door are late signs
- Intrinsic muscle atrophy implies nerve compression of several months

A

Cubital tunnel syndrome (Ulnar nerve compression)

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23
Q

Pt PE:
- Carrying angle greater than 10 degrees
- Visible muscle wasting
- Vibration and light touch will be affected in the 5th digit and ulnar half of the 4th digit
- Two point discrimination will be affected with progressive nerve degeneration

A

Cubital tunnel syndrome (Ulnar nerve compression)

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24
Q

What special tests should done for Cubital tunnel syndrome (Ulnar nerve compression)

A

Tinel Sign

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25
Q

What diagnostic test should be done for Cubital tunnel syndrome (Ulnar nerve compression)

A

Electromyographic/nerve conduction velocity(EMG/NCV) study with velocity reduction of 30% or more suggests significant ulnar nerve compression

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26
Q

When are radiographs of the elbow indicated for Cubital tunnel syndrome (Ulnar nerve compression)

A

Previous elbow trauma has occurred

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27
Q

Treatment of Cubital tunnel syndrome (Ulnar nerve compression)

A
  • Modify activities to limit elbow flexion and direct pressure on the ulnar nerve is the most important step in treatment
  • Splint elbow or wrap towel around elbow to avoid greater than 90 degree flexion at night
    NSAIDS
  • Surgical decompression and transposition of ulnar nerve if 3-4 months of conservative management failed
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28
Q

What is the primary structure that:
- resists valgus stress at the elbow
- Trauma to this ligament is rare
-injury comes from excessive overhead throwing motions(baseball pitcher)

A

Ular collateral ligament

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29
Q

Pt presents with:
- With acute onset patient will describe a “pop” while throwing
- Most commonly patients experience a gradual onset of symptoms with progressive medial elbow pain with valgus stresses
- May experience symptoms consistent with ulnar neuritis

A

UCL tear

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30
Q

What special test will be positive with a UCL tear?

A

Moving valgus stress test

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31
Q

What is needed to r/o fracture for UCL tear?

A

Plain film radiographs

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32
Q

What is the only radiologic study that can diagnose UCL tear?

A

MRI w/contrast

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33
Q

Treatment of UCL tear

A
  • Light Duty- Activity Modification
  • Ice for acute injury
  • NSAIDS
  • Pain free elbow and wrist stretching and strengthening exercises
34
Q

When should UCL tear be referred and to whom?

A
  • Failed nonsurgical conservative management that results in valgus stress
  • Refer to ortho
35
Q

What is the Most common dislocation in children and third most common in adults

A

Elbow dislocation

36
Q

Which ligament is always disrupted during elbow dislocation?

A

Lateral collateral ligament

37
Q

Pt presents with:
- a fall on an outstretched hand (FOOSH)
- Extreme pain
- Swelling
- Inability to bend elbow

A

Elbow dislocation

38
Q

Pt PE:
- Obvious elbow deformity
- Tenderness noted throughout elbow joint
- No elbow flexion and extension
- Supination and pronation severely limited

A

Elbow dislocation

39
Q

What is the most important exam for elbow dislocation?

A

Neurovascular exam
-Possible median, radial and ulnar nerve neuropathy
- Check radial pulse and capillary refill

40
Q

What radiological studies is adequate for dx of elbow dislocation and to r/o fracture?

A

Plain films

41
Q

Treatment of elbow dislocation

A
  • Ice
  • Appropriate pain management
  • Splint
42
Q

When should you considered emergency reduction of elbow dislocation and what should be checked after?

A
  • Neurovascular compromise
  • delayed MEDEVAC
  • Repeat neurovascular check after
43
Q

Procedure for elbow reduction

A
  • Elbow extended to 45 degrees
  • Slow, steady downward traction of forearm in line with long axis of humerus
  • Gentle pressure over olecranon tip
  • Repeat neurovascular examination after reduction
44
Q

What is the most common neuropthy of upper extremity?

A

Carpal tunnel syndrome

45
Q

What neuroapthy commonly effects midde aged or pregnant women?

A

Carpal tunnel syndrome

46
Q

The following conditions reduce size or space of carpal tunnel resulting in
- Tenosynovitis of flexor tendons
- Tumors
-Pregnancy
- Diabetes Mellitus
- Thyroid dysfunction

A

Carpal tunnel syndrome

47
Q

Pt presents with:
- Worse at night, patients typically report the need to rub hands to “get circulation back”
- Frequently drops objects or cannot open jars with twist lids
- Worse after repetitive motion of the hand or stationary tasks of the wrist that require long term flexion or extension

A

Carpal tunnel syndrome

48
Q

Pt PE:
- Numbness and tingling into radial three digits of the hand(1st,2nd and 3rd digits)
- Pain and paresthesias or numbness of the median distribution(thumb, and index finger, long finger, and radial half of ring finger)
- Atrophy of the thenar eminence in long standing cases
- Weakness with thumb opposition
- Possible reduced grip strength

A

Carpal tunnel syndrome

49
Q

What special tests would likely be positive for carpal tunnel syndrome

A
  • Phalen maneuver
  • Tinel Sign
50
Q

WHat diagnostic testing should be done for carpal tunnel syndrome

A

Electrophysiologic testing is most useful to support history and physical findings

51
Q

Treatment of carpal tunnel syndrome

A

-Splint wrist in neutral position- especially at night
-NSAIDS
-Light duty for activity modification
-Ergonomic modifications

52
Q

What should be done if conservative treatment of carpal tunnel fails?

A

Ortho consult

53
Q

Swelling or stenosis of the sheath that surrounds the abductor pollicis longus and extensor pollicis brevis tendon at the wrist is called?

A

de Quervain Tenosynovitis

54
Q

Pt presents with:
- Precipitated by repetitive use of thumb
- Pain, swelling and triggering phenomenon results in locking or sticking of the tendon as the patient moves the thumb
- Commonly affects middle-aged women
- Pain at radial aspect of the wrist exacerbated by movement of thumb or wrist
- Occasionally may be edema

A

de Quervain Tenosynovitis

55
Q

Pt PE:
- Swelling may be present is the distal radius region
- Tenderness over the radial styloid

A

de Quervain Tenosynovitis

56
Q

What special test will be positive for de Quervain Tenosynovitis

A

Finkelstein test

57
Q

Treatment of de Quervain Tenosynovitis

A
  • NSAIDs
  • Thumb spica splint
  • Light duty- activity modification
58
Q

When would you refer a patient with de Quervain Tenosynovitis

A

Orthopedic consult with failed conservative management

59
Q

What is:
- Most commonly fractured carpal bone
- Usually fractured from falls with outstretched hand
- Diagnosis is often delayed or missed and has a significant incidence of nonunion and osteonecrosis
- Major blood supply enters the bone in the distal third and be disrupted with injury
- Displacement greater than 1mm has a high rate of nonunion

A

Scaphoid

60
Q

Patient presents with:
- dorsiflexed wrist injury
- Pain about the radial side of the wrist in the anatomical snuffbox
- Pain with wrist motion and gripping

A

Scaphoid fracture

61
Q

Pt PE:
- Edema focal to the distal radial aspect of the wrist
- Tenderness in the snuffbox region
Tenderness on the underside of wrist
- Decreased grip strength

A

Scaphoid fracture

62
Q

What is the timeline for scaphoid fracture radiographs and when should an MRI be ordered?

A
  • Scaphoid series radiographs should be obtained at time of injury
  • If normal but pain persists for 2-3 weeks then studies should be repeated
  • If radiographs are still normal, an MRI should be ordered
63
Q

Treatment of scaphoid fracture

A
  • Thumb spica splint
  • Light duty- no use of affected hand
  • Treatment strategy should focused on definitive diagnosis with radiographs or MRI as soon as possible
  • Consult to orthopedics
  • Analgesics as needed
64
Q

What condition describes the following:
- Most common soft-tissue tumors of the hand
- Affects ages 15-40 years old
- Cystic structure that arises from capsule of a joint or a tendon synovial sheath
- Through degeneration or tearing of the joint capsule or tendon sheath, a connection to the joint or tendon sheath with a one way valve established. Thus synovial fluid can enter but flow freely back into synovial cavity

A

Ganglion of the wrist

65
Q

Pt presents with:
Wrist
- Firm nodular swelling in wrist that may vary in size and increase in size
- May be painful and pain may increase with wrist motion
- Cyst may be recurrent
- May have sensory symptom if cyst compresses median or ulnar nerve
Hand and finger
- Bump at the MCP or on the dorsum of the finger distal to the DIP

A

Ganglion of the Wrist and Hand

66
Q

Pt PE:
- Smooth round multilobulated structure on the dorsoradial aspect of wrist that becomes more prominent with flexion
- Usually directly over scapholunate joint
- Volar radial ganglion usually is less well defined between the flexor carpi radialis tendon and the radial styloid

A

Ganglion of the wrist

67
Q

How do you differentiate between a ganglion of the wrist and a tumor?

A

Ganglion will transilluminate
Solid Tumors will not

68
Q

What radiologic study should be done for ganglion of the wrist

A

Ultrasound/MRI useful in differentiating ganglia from other types of masses

69
Q

Treatment of ganglion of the wrist

A
  • Splint wrist or finger
  • NSAIDS
  • Consult to orthopedics for aspiration or surgical excision
70
Q

What injury is described by the following:
- Flexed DIP joint is suddenly and forcefully hyperextended
- Ring finger involved in 75% of cases
- Rupture of the flexor digitorum profundus tendon from its distal attachment
- Common in contact sports
- Often overlooked as “jammed” finger

A

“Jersey Finger”

71
Q

Pt presents with:
- Acute pain and swelling of the DIP/distal phalynx
- Inability to actively flex the DIP joint

A

Jersey Finger

72
Q

What radioligc studies should be done for jersey finger?

A
  • Obtain plain films to rule out avulsion fracture
  • MRI if the diagnosis remains in question or in chronic cases
73
Q

Treatment of Jersey finger

A
  • Splint the finger with PIP and DIP joint slightly flexed
    Prevents extension of the DIP joint
  • Avoid extension of the DIP until eval by ortho hand
  • All cases require referral to ortho hand
74
Q

What injury is described by the following:
- Injury to the Extensor Tendon
- Rupture, laceration or avulsion of the insertion of the extensor tendon and base of distal phalanx
- Direct blow to the finger causing sudden forced flexion of the DIP/distal phalanx

A

Mallet finger

75
Q

Pt presents with:
- Pain at the DIP joint
- Possible swelling, ecchymosis, deformity
- Commonly a flexed DIP at rest
- Inability to extend the DIP joint fully

A

Mallet finger

76
Q

What are you looking for when obtaining plain films of mallet finger?

A

Avulsion fracture

77
Q

Treatment of mallet finger

A
  • Splint the finger in full extension
  • If fractured do not attempt to reduce fracture
  • Splint type does not affect outcome according to available clinical trials
  • 6-8 weeks of splinting!
  • Sleep with the splint on as well
78
Q

What condition is described by the following:
- Extensor tendon ruptures at the insertion onto the middle phalanx
- Causes flexion of PIP and extension of DIP

A

Boutonniere Deformity

79
Q

Pt presents with:
- Patient reports trauma to digit with painful PIP joint
- Deformity may not be present until 7 to 21 days post injury

A

Boutonniere Deformity

80
Q

Pt PE:
- With the finger extended, PIP will be flexed and DIP hyperextended
- Tenderness to PIP
- PIP flexed more than 30 degree when attempting to extend digit
- Hyperextended DIP
- Limited PIP and DIP extension

A

Boutonniere Deformity

MSK Redemption Arc (14 decks)

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