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MSK T3 > Elbow, Wrist, and Hand > Flashcards

Elbow, Wrist, and Hand Flashcards

1
Q

What is the primary functional role of the elbow in the upper limb?

A

The elbow works with the shoulder complex to position the hand for functional tasks. It allows adjustments in height and length and enables forearm rotation for optimal hand placement.

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2
Q

What are the consequences of losing elbow flexion?

A

It interferes with tasks like grooming, eating, and carrying objects.

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3
Q

What are the consequences of losing elbow extension?

A

It restricts the ability to push up from a seated position or reach for objects.

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4
Q

What are the three articulations of the elbow joint?

A

• Ulnohumeral joint (hinge joint)
• Radiohumeral joint (hinge joint)
• Proximal radioulnar joint (pivot joint allowing pronation/supination)

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5
Q

What do all three elbow articulations have in common?

A

They share one continuous joint capsule.

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6
Q

What provides stability to the elbow joint?

A

Strong ligamentous support.

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7
Q

What is the function of the medial (ulnar) collateral ligament?

A

Supports the medial elbow and checks valgus stress.

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8
Q

What is the function of the lateral (radial) collateral ligament?

A

Supports the lateral elbow and checks varus stress.

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9
Q

What is the function of the annular ligament?

A

Encircles the radial head, supporting it within the radial notch of the ulna, allowing pivoting movement.

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10
Q

What are the available ROMs at the elbow?

A

• Flexion: 140-150° (Tissue Approximation)
• Extension: 0-15° (Bony End Feel)
• Pronation: 90° (Tissue Stretch)
• Supination: 80-90° (Tissue Stretch)

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11
Q

What are the available ROMs at the elbow?

A

• Flexion: 140-150° (Tissue Approximation)
• Extension: 0-15° (Bony End Feel)
• Pronation: 90° (Tissue Stretch)
• Supination: 80-90° (Tissue Stretch)

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12
Q

What are the spinal segments of the musculocutaneous nerve?

A

C5-C6

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13
Q

What muscles does the musculocutaneous nerve innervate?

A

Biceps brachii, brachialis, coracobrachialis

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14
Q

What sensory area does the musculocutaneous nerve supply?

A

Lateral forearm

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15
Q

What are the common compression sites of the musculocutaneous nerve?

A

Rarely entrapped

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16
Q

What are the spinal segments of the median nerve?

A

C6-T1

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17
Q

What muscles does the median nerve innervate?

A

• Flexor carpi radialis, flexor digitorum superficialis, palmaris longus, pronator teres
• Flexor digitorum profundus (I, II), flexor pollicis longus, pronator quadratus
• Lumbricals (I, II), opponens pollicis, abductor pollicis brevis, flexor pollicis brevis

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18
Q

What sensory areas does the median nerve supply?

A

• Dorsal aspect of distal/middle phalanges of digits 2-3, proximal half of digit 4
• Radial aspect of the palm, palmar aspect of digits 1-3, proximal half of digit 4

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19
Q

What are common compression sites of the median nerve?

A

Pronator teres, carpal tunnel

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20
Q

What are common compression sites of the median nerve?

A

Pronator teres, carpal tunnel

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21
Q

What are the spinal segments of the ulnar nerve?

A

C7-T1

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22
Q

What muscles does the ulnar nerve innervate?

A

• Flexor carpi ulnaris, flexor digitorum profundus (III, IV)
• Abductor digiti minimi, flexor digiti minimi, abductor pollicis, flexor pollicis brevis
• Interosseous muscles, lumbricals (III, IV)

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23
Q

What muscles does the ulnar nerve innervate?

A

• Flexor carpi ulnaris, flexor digitorum profundus (III, IV)
• Abductor digiti minimi, flexor digiti minimi, abductor pollicis, flexor pollicis brevis
• Interosseous muscles, lumbricals (III, IV)

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24
Q

What sensory areas does the ulnar nerve supply?

A

• Skin over the hypothenar eminence
• Dorsal ulnar aspect of hand, dorsal aspect of digit 5 and half of digit 4

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25
Q

What are common compression sites of the ulnar nerve?

A

Cubital tunnel, tunnel of Guyon

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26
Q

What are the spinal segments of the radial nerve?

A

C5-C8

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27
Q

What muscles does the radial nerve innervate?

A

• Triceps, brachioradialis, extensor carpi radialis longus/brevis
• Abductor pollicis longus, extensor carpi ulnaris, extensor digiti minimi
• Extensor digitorum, extensor indices, extensor pollicis brevis/longus, supinator

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28
Q

What muscles does the radial nerve innervate?

A

• Triceps, brachioradialis, extensor carpi radialis longus/brevis
• Abductor pollicis longus, extensor carpi ulnaris, extensor digiti minimi
• Extensor digitorum, extensor indices, extensor pollicis brevis/longus, supinator

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29
Q

What sensory areas does the radial nerve supply?

A

• Skin of posterior arm and forearm
• Radial aspect of dorsum of hand and dorsal surface of digits 1-4
• Skin over the 1st interosseous space

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30
Q

What are common compression sites of the radial nerve?

A

Axilla, Arcade of Frohse (supinator)

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31
Q

What is the main cause of repetitive strain injuries (RSI)?

A

Sub-threshold microtrauma and chronic micro-inflammation leading to tendon degeneration.

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32
Q

What happens when a muscle is repeatedly overused in RSI?

A

The affected muscle cannot handle the loading, so the load transfers to the tendon, leading to gradual degeneration.

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33
Q

What happens when a muscle is repeatedly overused in RSI?

A

The affected muscle cannot handle the loading, so the load transfers to the tendon, leading to gradual degeneration.

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34
Q

What are the common characteristics of RSI onset?

A

• Slow, insidious onset
• Minor repetitive microdamage and partial tears initially unnoticed
• Chronic inflammation due to immobile scar tissue

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35
Q

What are the 5 grades of repetitive strain injuries?

A

• Grades 1-3: Minimal pain that subsides before returning to activity
• Grade 4: Pain interferes with activity and persists between sessions
• Grade 5: Pain seriously interferes with ADLs, constant even at rest

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36
Q

What is the order of testing for RSI?

A

• AF → PR → AR
• Resisted testing of the affected muscle/tendon should provoke pain.

37
Q

Can passive testing also provoke pain in RSI? Why?

A

Yes, because lengthening inflamed/adhered tissue can irritate the affected structures.

38
Q

What PR and AR movements would be painful in a patient with forearm flexor pain?

A

• PR: Wrist extension (stretching inflamed flexors)
• AR: Wrist flexion (contracting the injured flexors)

39
Q

What factors contribute to RSI development?

A

• Weak muscles (causing load transfer to musculotendinous junction)
• Joint laxity (muscles work harder to stabilize an unstable joint)
• Rapid/excessive eccentric loading
• Sudden increase in usual activities
• Returning to activity too soon after an injury
• Sustained faulty posture/workstation ergonomics

40
Q

What are common impairments and functional limitations associated with elbow repetitive strain injuries (RSIs)?

A

• Gradually increasing pain in the elbow region after excessive wrist activities
• Decreased muscle strength and endurance
• Decreased grip strength limited by pain
• Tenderness with palpation at the site of inflammation
• Inability to participate in provoking activities
• Possible peripheral nerve compression/irritation (e.g., cubital tunnel syndrome with medial epicondylitis)

41
Q

What are the treatment goals and techniques for acutely inflamed tennis elbow or golfer’s elbow?

A

• Patient education: Encourage limiting or modifying exacerbating behaviors to reduce stress on tissues
• Decrease inflammation: Use hydrotherapy, elevation, lymphatic drainage, and superficial techniques
• Decrease tone/tension in agonist muscles: Gentle Swedish massage, reflex techniques (e.g., reciprocal inhibition, Golgi tendon organ (GTO) release of the unaffected tendon)
• Decrease tone/tension in antagonist muscles: Use all Swedish and myofascial techniques
• Address compensating limb: Maintain ROM and strength

42
Q

What are the treatment goals and techniques for acutely inflamed tennis elbow or golfer’s elbow?

A

• Patient education: Encourage limiting or modifying exacerbating behaviors to reduce stress on tissues
• Decrease inflammation: Use hydrotherapy, elevation, lymphatic drainage, and superficial techniques
• Decrease tone/tension in agonist muscles: Gentle Swedish massage, reflex techniques (e.g., reciprocal inhibition, Golgi tendon organ (GTO) release of the unaffected tendon)
• Decrease tone/tension in antagonist muscles: Use all Swedish and myofascial techniques
• Address compensating limb: Maintain ROM and strength

43
Q

What are the treatment goals and techniques for subacute or chronic tennis elbow or golfer’s elbow?

A

• Decrease tension/tone/trigger points in agonist and antagonist muscles: Use deeper/specific petrissage techniques
• Decrease myofascial restrictions: Use myofascial release (MFR)
• Decrease or re-align scar tissue/adhesions: Use MFR and frictions
• Increase range of motion: Utilize stretching, high-grade joint mobilizations, and muscle energy techniques (MET)
• Increase strength: Begin challenging the tissues

44
Q

What self-care techniques are recommended for tennis elbow and golfer’s elbow?

A

• Remedial exercises to strengthen muscles and prevent recurrence of tendon irritation
• Start with muscle setting
• Progress to endurance exercises to prevent load transference to tendons
• Introduce concentric/eccentric loading exercises in later rehab stages
• Self-stretching to prevent length/strength imbalances
• Address causative factors (e.g., workplace ergonomics)

45
Q

What are key anatomical features of the wrist?

A

• Loose joint capsule
• Numerous ligaments maintain stability

Three rows of joints:
• Radiocarpal joint: Distal radius articulates with scaphoid and lunate; the ulna does not directly articulate with lunate and triquetrum due to an interposed disc
• Midcarpal joint

46
Q

Why is the hand and wrist vulnerable to injury?

A

• Composed of 28 bones, numerous articulations, 19 intrinsic muscles, and 20 extrinsic muscles
• Used for communication, protection, and both motor and sensory functions

47
Q

What major nerves are susceptible to compression in the wrist?

A

• Median nerve: Commonly compressed in the carpal tunnel
• Ulnar nerve: Commonly compressed in the Tunnel of Guyon

48
Q

What is Carpal Tunnel Syndrome (CTS), and what are its symptoms?

A

• Compression of the median nerve in the carpal tunnel
• Results in numbness/tingling in the median nerve distribution (lateral 3½ digits)

49
Q

What structures pass through the carpal tunnel?

A

•Median nerve
• Four tendons of flexor digitorum superficialis
• Four tendons of flexor digitorum profundus
• Tendon of flexor pollicis longus

50
Q

How does median nerve compression occur in CTS?

A

• Decreased tunnel size
• Increased size of contents passing through the tunnel
• Combination of both (e.g., rheumatoid arthritis causing bony changes and swelling)

51
Q

What are common causes of CTS?

A

• Repetitive wrist movements (flexion/extension) → edema, fibrosis, thickened tendons
• Thickened flexor retinaculum
• Systemic conditions (e.g., diabetes, RA, pregnancy) → edema/fluid retention
• Bony callus formation after carpal/distal radius fracture
• Arthritis-related bony changes

52
Q

What are common causes of CTS?

A

• Repetitive wrist movements (flexion/extension) → edema, fibrosis, thickened tendons
• Thickened flexor retinaculum
• Systemic conditions (e.g., diabetes, RA, pregnancy) → edema/fluid retention
• Bony callus formation after carpal/distal radius fracture
• Arthritis-related bony changes

53
Q

What medical interventions are used for CTS?

A

• NSAIDs
• Splinting the wrist in a neutral position
• Diuretics
• Corticosteroid injections
• Surgery

54
Q

What medical interventions are used for CTS?

A

• NSAIDs
• Splinting the wrist in a neutral position
• Diuretics
• Corticosteroid injections
• Surgery

55
Q

What are common observations/palpation findings in CTS?

A

• Possible edema (localized or diffuse)
• Weakness of thenar muscles, difficulty holding a pen/utensils
• Tenderness/inflammation over carpal tunnel
• Increased resting tone, trigger points, and fascial restrictions in the forearm (from overuse)

56
Q

What are common observations/palpation findings in CTS?

A

• Possible edema (localized or diffuse)
• Weakness of thenar muscles, difficulty holding a pen/utensils
• Tenderness/inflammation over carpal tunnel
• Increased resting tone, trigger points, and fascial restrictions in the forearm (from overuse)

57
Q

What conditions can mimic CTS?

A

• C6/C7 radiculopathy: Sensory symptoms in thumb/middle finger
• Thoracic outlet compression: Nerve entrapment at scalenes, under clavicle, or pectoralis minor
• Pronator teres syndrome: Median nerve compression in the forearm
• Double Crush Syndrome: Compression at multiple locations along the nerve pathway

58
Q

What special tests should be used to differentiate CTS from other conditions?

A

• Cervical nerve root compression tests
• Peripheral nerve compression tests
• Thoracic Outlet Syndrome tests
• Pronator Teres Syndrome tests
• CTS special tests

59
Q

How does treatment for CTS depend on the cause?

A

• If fluid accumulation/inflammation → focus on reducing fluid buildup
• If tendon inflammation due to RSI → treat acute symptoms at wrist & forearm
• Strengthening exercises to prevent load transfer to tendons

60
Q

What self-care is recommended for CTS?

A

• Educate on posture and ergonomics
• Stretching and strengthening to correct imbalances and prevent RSI recurrence

61
Q

What is osteoarthritis (OA) and what causes it?

A

Progressive degeneration of articular cartilage
Causes: Aging, repetitive joint use, previous joint trauma

62
Q

What are signs and symptoms of OA?

A

• Achiness/stiffness relieved by movement
• Too much or stressful movement → joint swelling & pain
• Bouchard’s nodes (PIPs) and Heberden’s nodes (DIPs) (calcific spurs for joint stabilization)
• Progression leads to contractures and ROM limitations
• Firm capsular end feel on ROM testing

63
Q

What are the treatment goals for OA?

A

• Pain control: Reduce inflammation and mechanical pain
• Improve mobility: Identify and treat restrictions (adhesions, tension, capsular limitations, muscle weakness) using palpation, functional testing, and end feel assessments

64
Q

What is rheumatoid arthritis?

A

RA is an autoimmune disease affecting the joints, causing swelling, pain, inflammation, and joint degeneration.

65
Q

Which joints are most commonly affected by RA?

A

RA most commonly affects the elbows, wrists, fingers, knees, ankles, and toes in a symmetrical pattern.

66
Q

Can RA spread to other joints in the body?

A

Yes, RA can spread to other joints over time.

67
Q

How does RA progress?

A

RA has periods of flare-ups and remission.

68
Q

What happens during an acute RA flare-up?

A

Joints become painful, swollen, and have limited ROM.

69
Q

What are the consequences of chronic RA flare-ups in the hands if left untreated?

A

Chronic flare-ups can lead to permanent joint degeneration, joint capsule weakening, and subluxations/deformities such as Boutonniere and swan neck deformities.

70
Q

What are the massage considerations for RA during a flare-up?

A

Focus on managing inflammatory pain.

71
Q

What are the massage considerations for RA between flare-ups?

A

Use specific techniques to maintain or improve ROM, decrease muscle tone, and apply pain-free low-grade joint play to promote joint health.

72
Q

What remedial exercises are recommended for RA?

A

Isometric exercises to maintain strength and joint stability, gentle self-stretching, and AROM movements to prevent contractures.

73
Q

What is DeQuervain’s Tenosynovitis?

A

It is a repetitive strain injury (RSI) affecting the tendon sheath of the abductor pollicis longus and extensor pollicis brevis.

74
Q

What general treatment considerations apply to DeQuervain’s Tenosynovitis?

A

All RSI treatment considerations apply, similar to the treatment of Tennis Elbow and Golfer’s Elbow.

75
Q

What is Trigger Finger?

A

A condition where the fingers become stuck in a flexed position but can be passively extended.

76
Q

What causes Trigger Finger?

A

Overuse or RSI of the flexor tendon, leading to thickening or nodular development of the tendon and/or thickening of the tendon sheath.

77
Q

Which fingers are most commonly affected by Trigger Finger?

A

The 3rd and 4th digits.

78
Q

What sensation may be felt with Trigger Finger?

A

A ‘pop’ may be felt as the tendon slips past the narrowed spot.

79
Q

What is Dupuytren’s Contracture?

A

A contracture of the palmar fascia that pulls the fingers into a permanently flexed position, making it difficult to perform tasks.

80
Q

Is Dupuytren’s Contracture commonly painful?

A

No, the contracture itself is not commonly painful.

81
Q

How does Dupuytren’s Contracture develop?

A

It has an insidious onset and is primarily idiopathic.

82
Q

Which fingers are most commonly affected by Dupuytren’s Contracture?

A

The 4th and 5th digits.

83
Q

What conditions may contribute to Dupuytren’s Contracture?

A

Diabetes, epilepsy, and alcoholism may contribute, though the association is not clear.

84
Q

Can prolonged immobilization contribute to Dupuytren’s Contracture?

A

Yes, prolonged immobilization may contribute to its development.

85
Q

Is Dupuytren’s Contracture caused by overuse, RSI, or inflammation?

A

No, it is not caused by overuse, RSI, or an inflammatory process.

86
Q

How does Dupuytren’s Contracture clinically present?

A

• Often bilateral
• Palmar fascia may be tender and thickened
• Progressive increase in digit flexion
• Myofascial restrictions in the palmar fascia and anterior forearm
• Increased forearm muscle tone
• Trigger points in the forearm and hand muscles
• Adhesions in the palm and palmar fascia attachments
• Wrist/finger ROM restrictions, especially in extension

87
Q

Can massage resolve Dupuytren’s Contracture?

A

No, massage is unlikely to resolve the condition.

88
Q

What are the treatment goals for Dupuytren’s Contracture?

A

• Promote connective tissue mobility
• Maintain ROM
• Support soft tissue and joint health

89
Q

When might surgery be needed for Dupuytren’s Contracture?

A

In some cases, surgery is required to correct the contracture.

MSK T3 (10 decks)

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