Elbow, Wrist, And Hand

Question 1

Carrying angle

Answer 1

5 degrees males, 10-15 degrees females
Cubitus Varus-less than 5 degrees (gunstock)
Cubitus Valgus-more than 15 degrees

Question 2

Varus stress test

Answer 2

Arm slightly abducted and internally rotated
Elbow flexed to approximately 15 degrees
Slight lateral directed varus stress is applied to elbow
(+) test: pain/tenderness with Palpation; increased laxity to LCL
Indication: sprained lateral collateral ligament

Question 3

Valgus stress test

Answer 3

Arm slightly abducted and externally rotated
Forearm supinate and flexed to approximately 30 degrees
Slight medial directed valgus stress is applied to elbow joint
(+) test: pain/tenderness with Palpation and valgus stress; increased laity
Indication: sprained medial collateral ligament

Question 4

Cubital tunnel syndrome

Answer 4

Compression of the ulnar N. By flexor carpi ulnaris M.

Pain, loss of strength, coordination, mobility, numbness/tingling in the ulnar N. Distribution

Question 5

Tinel’s test at the elbow

Answer 5

Tap between olecranon and medial epicondyle in ulnar groove
(+) test elicits tingling sensation down forearm with ulnar N. Distribution
Indicates: ulnar N.. entrapment/Cubital tunnel syndrome

Question 6

Golfer’s elbow test

Answer 6

Anterior forearm/flexor compartment
Pt’s elbow is flexed to 90 degrees and forearm is placed in supination with wrist neutral and palm facing up
One hand under proximal forearm for stabilization and the other hand over the pt’s wrist to resist movement
Instruct pt to flex wrist
(+) test: pain/tenderness around the medial epicondyle
Indication: medial epicondylitis

Question 7

Tennis elbow test (Cozen’s test)

Answer 7

Posterior forearm/extensor compartment
Pt’s elbow is flexed to 90 degrees and forearm is placed in pronation with wrist neutral and palm facing down
Examiner places one hand under proximal forearm for stabilization and the other hand over the pt’s hand to resist movement
Instruct pt to extend wrist
(+) test: pain/tenderness around lateral epicondyle
Indication: lateral epicondylitis

Question 8

Olecranon bursitis

Answer 8

Superficial to posterior elbow joint
Posterior elbo distinction and discomfort due to overuse (“student’s elbow”) or occupational (“miner’s elbow”) or athletic injury
Region is often painless and ROM is normal

Question 9

Little league elbow

Answer 9

Medial apophysitis
Medial epicondyle avulsion fracture
Medial collateral L. Tear
Pain over medial epicondyle
Most common elbow injury during childhood

Question 10

Nursemaid’s elbow

Answer 10

Annular L. Tear and/or radial head subluxation from annular L.
Results from trauma with traction of child’s extended arm
Pain with Palpation of radial head with anterior displacement of radial head and restriction to posterior glide

Question 11

Coupled motions at elbow

Answer 11

Ulnar adduction with supination
Ulnar abduction with pronation
Radial head anterior glide with supination
Radial head posterior glide with pronation

Question 12

“OK” sign

Answer 12

Anterior interosseous N.

On exam, if neuropathy present, pt cannot make an “O” with thumb and forefinger pinched together

Question 13

Carpal tunnel syndrome

Answer 13

Entrapment of median N. At the wrist in the carpal tunnel—>pain and parenthesis

Question 14

Tinel’s sign

Answer 14

Indicates: entrapment of median nerve or CTS
Tap over transverse carpal L.
(+) test: paresthesia/numbness/tingling/pain radiating to thumb, index, and middle finger
Indication: CTS

Question 15

Phalen’s sign

Answer 15

Place dorsal aspects of pt’s hands together and force into wrist flexion-hold for 60 seconds
(+) test: any reprodctuion of symptoms paresthesia in the distribution of the median N.
Indication: CTS

Question 16

DeQervain’s Tenosynovitis

Answer 16

Pain and inflammation from repetitive overuse of tendons in first dorsal compartment
Pt complains of dorsolateral wrist and thumb pain, occasionally with radiation into lateral hand and thumb
Grip weakness; pain may be worsened with thumb movements
Possible inflammation sites: tendon sheath, abductor pollicis longus, extensor pollicis brevis
Finkelstein test

Question 17

Finkelstein test

Answer 17

Indication: DeQuervain’s Tenosynovitis
Ask pt to make fist encompassing their thumb and ulnar deviate the wrist
(+) test: increased pain in lateral wrist

Question 18

Ulnar N. Entrapment

Answer 18

Handlebar palsy
Trapped in guyon’s canal: space betweeen hook of hamate and pisiform
Irritation leads to numbness, tingling, weakness, and/or pain in the Ulnar N. Distribution

Question 19

Gamekeeper’s/ Skier’s thumb

Answer 19

Tear of ulnar collateral L. Of the MCP

Pain on medial aspect of MCP

Question 20

Mallet finger

Answer 20

Extensor tendon injury at DIP

Question 21

Trigger finger

Answer 21

Inflammation and narrowing of flexor tendon sheath

Question 22

Jersey finger

Answer 22

A lesion of flexor digitorum profundus from fingertip

Question 23

Dupuytren’s contracture

Answer 23

Abnormal CT thickening in the palmar fascia

Question 24

Ganglion cyst

Answer 24

Fluid filled sac along the tendon sheath or joint capsule, mobile, transilluminates, nontender (painless)
Dorsum of wrist

Question 25

Rheumatoid arthritis

Answer 25

Autoimmune inflammatory condition
Causes inflammation of joints
Inflammation in lining of joint and tissue damage
Chronic pain and deformity
Ulnar deviation of fingers, Bouchard nodes (PIP), Heberden nodes (DIP), subcutaneous nodules along the extensor surface of proximal ulna or around the olecranon bursa

Question 26

Clubbed finger

Answer 26

Focal bulbous enlargement of terminal fingers
Angle between nail and proximal nail fold is greater than 180 degrees
Proliferation of CT between nail matrix and distal phalanx along with vasodilation with increased blood flow to digits
Lung cancer, liver cirrhosis, cyanosis heart disease

Question 27

Scaphoid fracture

Answer 27

FOOSH
Dull Achilles deep in radial aspect of wrist after a fall
Decreased ROM, decreased grip strength, and tenderness inside the anatomical snuff box
Tenderness of the scaphoid tubercle-physician extends wrist and apply pressure to tubercle

Question 28

Colle’s fracture

Answer 28

Fracture of the distal radius in the forearm with dorsal (posterior) and radial displacement of the wrist and hand
Dinner fork deformity with bony step off

Question 29

Smith fracture

Answer 29

Same fracture as Colle’s but with ventral displacement

Question 30

Boxer’s fracture

Answer 30

Distal shaft of the 5th metatarsal

Due to punching a solid surface

Question 31

Monteggia fracture

Answer 31

Fracture of the proximal ulna

Dislocation of the radial head

Question 32

Galeazzi fracture

Answer 32

Fracture of the Distal radius

Dislocation of the ulna

Question 33

Nightstick fracture

Answer 33

Isolated fracture of the mid shaft/distal ulna from a direct blow