Elbow, wrist and hand

Question 1

Tinel test

Answer 1

This test is for ulnar nerve entrapment. Tap between olecranon and medial epicondyle in ulnar groove. A (+) test = tingling sensation down forearm. This indicates ulnar nerve entrapment/cubital tunnel syndrome.

Question 2

Golfer’s elbow

Answer 2

• Medial epicondylitis due to overactive flexors/pronators.
• Flex pt’s elbow to 90 with wrists supinated. Patient is instructed to flex the wrist against resistance.

(+) test = pain at medial epicondyle

Question 3

Tennis elbow

Answer 3

• Lateral epicondylitis due to overactive extensors/supinators.
• Examiner places one hand under proximal forearm and the other hand over the hand over the wrist for counterforce. Pt is instructed to extend against resistance.
• (+) test = pain at Lateral epicondyle

Question 4

Olecranon bursitis

Answer 4

Superficial inflammation/distention at posterior elbow joint. Often painless and ROM is normal.

This is similar to an effusion… however, if an effusion occurs, the patient will have increased pain with extension because we are increasing pressure at the joint

Question 5

Little League Elbow

Answer 5

Pain over the medial epicondyle, because throwing a baseball is a repetitive valgus distraction force.

As we age, injuries go from being bone-related to ligamentous:
Medial apophysitis –> medial epicondyle avulsion fracture –> MCL tear.

Question 6

Nursemaid’s elbow

Answer 6

Annular ligament is torn and/or radial head is subluxed away from the annular ligament

Question 7

Coupled motions at the elbow

Answer 7

SAPP: Radial head goes Anterior with Supination, and radial head goes Posterior with Pronation.

Question 8

Abnormal OK sign

Answer 8

Due to compression/problem with anterior interosseous N. (branch of median n.). This nerve innervates the flexor pollicis longus, deep flexors of digits 2 and 3 and the pronator quadratus.

Therefore, thumb remains extended and can’t flex DIP of digits 2 and 3.

Question 9

Tests for carpal tunnel

Answer 9

Entrapment of median nerve –> pain and paresthesia.

• Tinel’s sign –> tap on the flexor retinaculum, should elicit pain/numbness to thumb, index and middle finger.
• Phalen’s sign –> “reverse prayer”. Place dorsal aspect of patients hands together and force wrist into flexion. Downside= they need to hold this for 60 seconds which is hella awkward and long…

Tx: Splint at night… if this doesn’t help, then consider steroid injection or EMG to evaluate extent of nerve degeneration.
Surgery is last step…

Question 10

Finkelstein test

Answer 10

This is a test for Dequervain’s Tenosynovitis, which is commonly seen in young mothers who are constantly picking up their kiddo. This results from pain and overuse of dorsal tendons. Will also see grip weakness. NOT TO BE CONFUSED WITH DUPUYTREN’S CONTRACTURE.

• Finkelstein test: Make a fist and ulnar deviate the wrist.
  (+) test = pain along the lateral wrist.

Question 11

Handlebar palsy

Answer 11

Compression of the ulnar N. from biking.

Question 12

Skier’s thumb/Jerry thumb

Answer 12

Torn ulnar collateral ligament of the thumb, because you fell on your ski pole.

Question 13

Mallet finger

Answer 13

Damage to extensor tendon at DIP, often from baseball.

Question 14

Trigger finger

Answer 14

Inflammation and narrowing of flexor tendon sheath. Patient will present with pain, locking of MCP joint.
Able to grip, but can’t fully extend.
Ultimately due to thickening of the flexor tendon, which causes it to not work properly.

Question 15

Jersey finger

Answer 15

Avulsion from flexor digitorum profundus from the fingertip

Question 16

Dupuytren’s contracture

Answer 16

abnormal thickening of connective tissue in the palmar fascia.

Question 17

Ganglion cyst

Answer 17

Fluid filled sac along the tendon sheath of joint capsule, usually non-tender. Bulges out more with wrist flexion.

Question 18

Rheumatoid arthritis

Answer 18

Autoimmune condition, we will see ulnar deviation of fingers, bouchard nodes, hebereden nodes and nodules along the extensor surface of the proximal ulna.

Question 19

Scaphoid fracture

Answer 19

Commonly from FOOSH
- Patient presents with decreased ROM, grip strength and tenderness near the snuff box or near the scaphoid tubercle

• This is prone to avascular necrosis.

Question 20

Smith fracture

Answer 20

Results in distal radius fracture with ventral displacement.

Question 21

Boxer’s fracture

Answer 21

Fracture of the 5th metacarpal

Question 22

Monteggia fracture

Answer 22

Fracture of proximal ulna and dislocation of the radial head

Question 23

Galeazzi fracture

Answer 23

Fracture of distal radius with dislocation of the ulna

Question 24

Nightstick fracture

Answer 24

Isolated fracture of the midshaft/distal ulna from a direct blow.

Question 25

Coupled motions at the wrist/hand

Answer 25

Ulnar deviation (adduction 30-40) is associated with abduction of the ulnar head.

Radial deviation (abduction 20-30) is associated with adduction of the ulnar head.

Flexion (80-90) of the wrist is associated with dorsal/posterior carpal glide.

Extension (70) is coupled with ventral/anterior carpal glide