Elbow, wrist, and hand

Question 1

radial head TP: location

Answer 1

anterolateral part of radial head

Question 2

radial head TP: treatment

Answer 2

1. patient supine
2. physician seated facing patient
3. patient’s elbow fully flexed and forearm pronated until palm is facing forward
4. humerus internally rotated by taking forearm medially so that the back of the patient’s hand approximates chest
5. follow steps of C/CS

Question 3

coronoid TP: location

Answer 3

either side of coronoid process of ulna on either side of biceps tendon

Question 4

coronoid TP: treatment

Answer 4

1. patient supine
2. physician seated facing patient
3. elbow markedly flexed
4. forearm is pronated until the palm is forward
5. forearm is taken laterally to cause external rotation of humerus
6. follow steps of C/CS

Question 5

anterior interosseus TP: location

Answer 5

anterior aspect of proximal to middle 1/3 of forearm in midline

Question 6

anterior interosseus TP: treatment

Answer 6

1. patient supine
2. physician seated facing patient
3. forearm fully supinated
4. elbow markedly flexed
5. wrist fully flexed
6. fine tune with further supination or pronation
7. follow steps of C/CS

Question 7

medial / lateral olecranon TP: location

Answer 7

on either side of olecranon process of ulna

Question 8

medial / lateral olecranon TP: treatment

Answer 8

1. patient supine
2. physician seated facing patient
3. elbow extended and arm just distal to elbow resting on physician’s knee, causing mild hyperextension
4. take forearm into supination and slight abduction or adduction to fine tune
5. follow steps of C/CS

Question 9

thumb TP: location

Answer 9

palmar surface of hand, distal to proximal end of first metcarpal bone on thenar eminence side of palm

Question 10

thumb TP: treatment

Answer 10

1. patient supine
2. physician seated facing patient
3. approximate patient’s thumb to the palm of patient’s hand
4. flexion - flex first MCP
5. rotation - internally or externally rotate thumb to find point of maximum comfort
6. fine tune with adduction
7. follow steps of C/CS

Question 11

what are the steps of the osteopathic structural exam for the elbow, wrist, and hand?

Answer 11

1. diagnose radial head
2. diagnose distal radio-ulnar joint
3. diagnose MCP, PIP, DIP
4. diagnose first MCP restriction , carpal restriction (and/or CTS)

Question 12

what is indicated by the ability to touch tips of thumbs to each of the other finger tips?

Answer 12

radial, median, and ulnar nerves are intact

Question 13

anterior radial head ME

Answer 13

1. patient supine
2. physician monitors radial head between thumb and index finger of one hand
3. physician takes patient’s forearm into pronation to a barrier
4. patient attempts to supinate forearm against physician’s resistance
5. physician takes patient’s forearm farther into pronation to 4th barrier
   6 recheck

Question 14

posterior radial head ME

Answer 14

1. patient supine
2. physician monitors radial head between thumb and index finger
3. physician takes patient’s forearm into supination to a barrier
4. patient attempts to pronate forearm against physician’s resistance
5. physician takes patient’s forearm farther into supination to 4th barrier
6. recheck

Question 15

anterior radial head correction: HVLA

Answer 15

1. patient supine
2. physician stands or sits on affected side of patient and places two fingers anterior to radial head
3. physician fully flexes patient’s pronated forearm to a barrier
4. physician gives quick HVLA thrust by approximating forearm toward shoulder - brings radial head posteriorly
5. recheck for symmetry

Question 16

posterior radial head correction: HVLA

Answer 16

1. patient supine
2. physician stand or sits on affected side
3. physician stabilizes patient’s wrist in one hand to maintain arm extension
4. physician controls elbow with fingers on antecubital fossa and thumb on posterior aspect of radial head - patient’s humerus is internally rotated so that anterior portion of arm faces medially
5. patient’s arm fully supinated and elbow is placed in exension
6. an anteriorly directed HVLA thrust directed toward patient’s midline is made by physician’s thumb to articular the radial head (short distance)
7. recheck for symmetry

Question 17

radial head SD correction with ROM

Answer 17

1. patient supine
2. physician sits on table between patient’s arm and body
3. patient’s arm placed across physician’s thigh, which acts as fulcrum
4. physician’s thumb is placed over anterior aspect of the radial head and index / middle fingers placed on posterior aspect of radial head
5. physician’s other hand grasps the patient’s supinated wrist
6. while monitoring radial head, physician moves forearm into pronation and full elbow flexion, then through circumduction and into supination and extension
7. recheck for symmetry

Question 18

mobilization of distal radioulnar joint

Answer 18

1. patient supine
2. with patient’s forearm in pronation, physician holds distal end of radius and ulna with both hands and resists the patient’s efforts in supination of the forearm - applied to 4th barrier
3. repeat procedure in supination, as patient tried to take forearm into pronation - to 4th barrier
4. mobilizes distal radioulnar articulation and helps to decongest forearm
5. recheck for symmetry

Question 19

when is mobilization of distal radioulnar joint contraindicated?

Answer 19

positive piano key sign

Question 20

reduction of partial dislocation of radial head

Answer 20

1. rule out fracture or full dislocation
2. patient supine
3. physician cups elbow with one hand while holding radial head with thumb and index finger
4. physician’s other hand holds distal end of the radius by extending wrist
5. using compression, forearm is taken into pronation and supination as one would “chalk a cue stick”
6. recheck by reevaluating radial head motion and/or pain free active ROM of elbow / forearm

Question 21

twisting / wringing of the arm and forearm

Answer 21

1. patient supine
2. physician initially stabilizes patient’s UE by firmly holding elbow between arm and thorax
3. physician places both hands on patient’s arm and moves them as if “wringing out a towel”