Elbow, Wrist, and Hand

Question 1

What is a carrying angle and what is the typical carrying angle range of a person?

Answer 1

Carrying angle is the angle between the axis of the humerus and the axis of the forearm.

Typical carrying angle: 5-15*

Question 2

What are the ranges of motion of the elbow joint/forearm for:
Flexion:
Extension:
Supination:
Pronation:

Answer 2

Flexion: 140-150*
Extension: -5 - 0*
Supination: 90*
Pronation: 90*

Question 3

What nerve roots do the following reflexes test?
Biceps reflex tests _____
Brachioradialis reflex tests ____
Triceps reflex tests ____

Answer 3

Biceps: C5
Brachioradialis: C6
Triceps: C7

Question 4

What are the dermatome nerve roots of the following areas?
Biceps:
Thumb:
Middle 3 fingers:
Pinky:
Triceps/posterior arm:

Answer 4

Biceps: C5
Thumb: C6
Middle 3 fingers: C7
Pinky: C8
Triceps/posterior arm: T1

Question 5

Valgus stress tests apply a force in what direction and test what ligament?

Varus stress tests apply a force in what direction and test what ligament?

Answer 5

Valgus: Medial/inward force and test Medial Collateral Ligaments

Varus: Lateral/outward force and test Lateral Collateral Ligaments

Question 6

The Tinel test can be done to test for ____ nerve entrapment by tapping between the olecranon and medial epicondyle, in which a positive test showing tingling down the forearm indicates _____ _____ Syndrome.

Answer 6

Ulnar nerve entrapment = Cubital Tunnel Syndrome

Question 7

Name the test: Patient elbow flexed to 90* and supinated. Examiner stabilized at the forearm and resists patient’s wrist flexion.

Answer 7

Golfer’s Elbow Test –> Medial Epicondylitis

Question 8

Name the test: Patient elbow flexed to 90* and pronated. Examiner stabilizes at the forearm and resists patient’s wrist extension.

Answer 8

Tennis Elbow Test (AKA: Cozen’s Test) –> Lateral Epicondylitis

Question 9

What is the most common elbow injury during childhood?

Answer 9

“Little League Elbow” - pain over the medial epicondyle due to repetitive valgus distraction forces (e.g. throwing). Often due to growth plates not being fused/secondary ossification centers being absent.

Question 10

What is “Nursemaid’s Elbow” and how would this most commonly be presented in a patient?

Answer 10

An annular ligament tear and/or radial head subluxation. Positive test is pain with palpation of radial head during anterior displacement and restriction to posterior glide.

Patient typically presents with flexed arm and supinated hand.

Question 11

What are the coupled motions of the elbow (regarding ulnar/radial movement with pronation/supination)?

Answer 11

Supination = ulnar adduction and anterior glide of radial head

Pronation = ulndar abduction and posterior glide of radial head (Keep the P’s together)

Question 12

What are the ranges of motion of the wrist joint for:
Flexion:
Extension:
Adduction (ulnar deviation):
Abduction (radial deviation):

Answer 12

Flexion: 80-90*
Extension: 70*
Adduction: 30-40*
Abduction: 20-30*

Question 13

The “Ok” Sign tests _____ nerve, which innervates what three muscles?

What indicates a positive “Ok” Sign test?

Answer 13

It tests the Anterior Interosseous Nerve, which innervates flexor pollicis longus, deep flexors of digits 2/3, and pronator quadratus.

A positive “Ok” Sign Test is when the patient cannot make an “O” with their thumb; their thumb/forefinger will be pinched together instead.

Question 14

What are three tests for Carpal Tunnel Syndrome (CTS -median nerve entrapment)?

Answer 14

Tinel Sign, Phalen’s Sign, and Allen Test

Question 15

What is the Phalen’s Sign test?

Answer 15

Place dorsal aspects of patient’s hands together and force into wrist flexion; hold for up to 60 sec. Pain/parasthesias = CTS

Question 16

What is the Allen Test?

Answer 16

Occlude both ulnar and radial artery while patient makes a fist (opens/closes until pale). Release pressure on either side and observe for color return (normal is 5-10 seconds)

Question 17

What is the Finkelstein Test used for and how is it done?

Answer 17

It is used to assess for tenosynovitis of the 1st dorsal compartment (AKA: DeQuervain’s Syndrome).

Examiner has patient to make a fist encompassing their thumb and ulnar deviate the wrist. Positive test = pain in 1st dorsal compartment/lateral wrist (DeQuervain’s tensosynovitis)

Question 18

What is the most common carpal bone fracture, how does it often happen, and what is the presentation, and what is result if it is not treated?

Answer 18

Scaphoid fracture due to FOOSH injury

Presentation: pain in snuff box and can result in avascular necrosis can occur if not treated

Question 19

What is a Colle’s Fracture

Answer 19

Common FOOSH injury; fracture of distal radius in forearm with dorsal and radial displacement of the wrist and hand

Question 20

Which muscle is responsible for compression of the ulnar nerve in Cubital Tunnel Syndrome?

Answer 20

Flexor Carpi Ulnaris

Question 21

Wrist extension is coupled with what type of carpal glide?

Answer 21

Ventral

Question 22

Anterior interosseus nerve is a terminal branch of what nerve?

Answer 22

Median n