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PCM exam 1 > Elbow, Wrist and Hand Competency > Flashcards

Elbow, Wrist and Hand Competency Flashcards

1
Q

What is the normal carrying angle?

A
  • between the axis of humerus and axis of forearm
  • normal - 5-15 degrees
  • cubitus varus: 15 degrees
  • slightly larger in female
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2
Q

What are some observable/palpable things of elbow?

A
  • olecranon process
  • medial and lateral epicondyles
  • radial head
  • wrist flexors and pronators
  • wrist extensors and supinators
  • nodules, swelling, scars
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3
Q

ROM - flexion of elbow

A
  • biceps brachii, brachialis, brachioradialis

- 140-150 degrees

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4
Q

ROM - extension of elbow

A
  • triceps brachii, anconeus

- 0-(-5) degrees

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5
Q

ROM - supination of elbow

A
  • supinator, biceps brachii

- 85-90 degrees

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6
Q

ROM - pronation of elbow

A
  • pronator teres, pronator quadratus

- 85-90 degrees

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7
Q

Neurologic and sensory exam (mm reflex and dermatomes)

A
  • mm reflex: biceps (C5), brachioradialis (C6), triceps (C7)
  • dermatomes: C5-T1
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8
Q

Ligamentous stability test

A

Valgus Stress Test
- arm slightly abducted and externally rotated
- forearm supinated and flexed to 30 degrees
- slight medial directed valgus stress is applied to elbow joint
- if (+): pain/tenderness with palpation and valgus stress; increased laxity
- testing UCL (medial)
Varus Stress Test
- arm slightly abducted and internally rotated
- elbow flexed to 25 degrees
- a slight varus stress is applied to elbow joint
- if (+): pain or increased laxity in RCL (lateral)

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9
Q

Tinel test (elbow)

A
  • for ulnar nerve entrapment (cubital tunnel syndrome)
  • tap between olecranon and medial epicondyle in ulnar groove
  • if (+): eliciting tingling sensation down forearm within ulnar nerve distribution
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10
Q

Golfer’s elbow test

A
  • for medial epicondylitis
  • ant forearm/flexor compartment
  • patient’s elbow flexed to 90 degree & forearm placed in supination with wrist neutral and palm facing up
  • examiner places one hand under proximal forearm for stabilization and other hand over patient’s wrist to resist movement.
  • instruct patient to flex wrist
  • if (+): pain/tenderness around the medial epicondyle (strained and inflamed)
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11
Q

Tennis elbow test (aka Cozen’s test)

A
  • for lateral epicondylitis
  • post forearm/extensor compartment
  • patient’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 patient’s hand to resist movement
  • instruct patient to extend wrist
  • if (+): pain/tenderness around lateral epicondyle (strained and inflamed), may radiate down lateral forearm
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12
Q

Test for olecranon bursitis

A
  • inflammation of olecranon bursa
  • olecranon bursa lies superficial to posterior elbow joint
  • posterior elbow distention and discomfort due to overuse (student’s elbow) or occupational (miners elbow) or athletic injury
  • region is often painless and range of motion is normal
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13
Q

Little league elbow - what are some related problems?

A
  • medial apophysitis (childhood)
  • medial epicondyle avulsion fracture (adolescence)
  • medial collateral ligament tear (young adulthood)
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14
Q

Little league elbow - how to diagnose?

A
  • pain over medial epicondyle, initially after throwing (repetitive valgus distraction forces), progresses to persistent pain
  • most common elbow injury during childhood (growth plate not fused/secondary ossification centers absent)
  • as bone development matures most common injury seen evolves (apophysitis > avulsion > ligamentous injury)
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15
Q

Radial head instability - Nursemaid’s elbow

A
  • annular ligament tear and/or radial head subluxation from annular ligament
  • pain with palpation of radial head with anterior displacement of radial head and restriction to posterior glide
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16
Q

Coupled motions at elbow

A
  • ulnar adduction : supination
  • ulnar abduction : pronation
  • radial head anterior glide : supination
  • radial head posterior glide : pronation
17
Q

What are some observable/palpable things of wrist?

A
  • palmar and dorsal wrist
  • thenar and hypothenar eminences
  • flexor tendons
  • distal radius and ulna - styloid processes
  • anatomic “snuffbox” and carpal bones
  • MCP, PIP, DIP
18
Q

ROM - flexion of wrist

A
  • flexor carpi radialis, palmaris longus
  • coupled movement - dorsal/posterior carpal glide
  • 80-90 degrees
19
Q

ROM - extension of wrist

A
  • extensor carpi radialis longus and brevis
  • coupled movement - ventral/anterior carpal glide
  • 70 degrees
20
Q

ROM - adduction of wrist (ulnar deviation)

A
  • flexor and extensor carpi ulnaris
  • coupled movement - ulnar abduction
  • 30-40 degrees
21
Q

ROM - abduction of wrist (radial deviation)

A
  • flexor carpi radialis, extensor carpi radialis longus and brevis
  • coupled movement - ulnar abduction
  • 20-30 degrees
22
Q

What are the ROM of the thumb?

A
  • flexion/extension
  • abduction/adduction
  • opposition
23
Q

What are the ROM of the fingers?

A
  • flexion/extension

- abduction/adduction

24
Q

Dermatomes of the hand

A
  • ulnar n
  • radial n
  • median n
25
Q

OK sign

A
  • anterior interosseous n (motor branch of median n innervating): flexor pollicis longus; deep flexors of digits 2&3; pronator quadratus
  • on examination, if neuropathy present, patient cannot make an O with thumb and forefinger pinched together
26
Q

What are some tests for carpal tunnel syndrome?

A

Tinel’s sign, Phalen’s sign, Allen’s sign

  • entrapment of median n at the wrist in the carpal tunnel produces pain and parasthesias
  • chronic cases may develop atrophy of intrinsic mm of hand
27
Q

Tinel’s sign (hand)

A
  • indicates entrapment of median n (carpal tunnel syndrome)
  • can be elicited by tapping over transverse carpal ligament (between thenar and hypothenar eminences) with either the tip of the examiner’s finger or reflex hammer with the patient’s wrist held in extension
  • if (+): parasthesia/numbness/tingling/pain radiating to thumb, index and middle finger (median n distribution); CTS
28
Q

Phalen’s sign

A
  • place dorsal aspects of patient’s hands together and force into wrist flexion and hold for 60 seconds
  • if (+): any reproduction of symptoms/parasthesia in the distribution of the median n; CTS
29
Q

Allen test

A
  • evaluates functioning of radial and ulnar a
  • occlude both arteries while patient makes a fist - have patient open and close fist; palm should be pale
  • release pressure on ulnar artery and observe for color return to hand within 5-10 seconds - repeat with radial artery
30
Q

DeQuervain’s tenosynovitis

A
  • pain and inflammation from repetitive overuse of tendons in first dorsal compartment
  • patients complain of dorsal-lateral wrist and thumb pain, occasionally with radiation into lateral hand and thumb
  • get a careful hx about repetitive activities
  • will have positive Finkelstein test
  • possible inflammation sites - abductor pollicis longus, extensor pollicis brevis
31
Q

Finkelstein’s test

A
  • utilized to assess for tenosynovitis of 1st dorsal compartment, aka DeQuervain’s syndrome
  • examiner asks patient to make a fist encompassing their thumb and ulnar deviate their wrist
  • if (+): increased pain in 1st dorsal compartment/lateral wrist; DeQuervain’s tenosynovitis
32
Q

Scaphoid fracture

A
  • most common carpal bone fracture
  • FOOSH injury
  • patient complains of dull achiness deep in radial aspect of wrist after a fall
  • decreased ROM, decreased grip strength, tenderness in anatomical snuff box
  • important to diagnose and treat due to risk of avascular necrosis
  • pain in anatomical snuffbox following “FOOSH” treated as fracture with spica cast - immediate radiographic evidence not always visible; may require repeat imaging
  • can confirm with CT or MRI if necessary
33
Q

Colle’s fracture

A

fracture of distal radius in the forearm with dorsal (posterior) and radial displacement of the wrist and hand

PCM exam 1 (7 decks)

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