Elbow, Wrist And Hand Competency Flashcards
What is the carrying angle for cubitus varus?
Less than 5 degrees
What is the carrying angle for cubitus valgus?
More than 15 degrees
What do wrist extensor muscles attach to on the humerus ?
The lateral epicondyle
What do wrist flexor muscles attach to on the humerus?
Medial epicondyle
What nerve runs between medial the epicondyle of the humerus and the olecranon?
Ulnar nerve
What is the normal ROM for flexion at the elbow?
140-150
What is the normal ROM for extension at the elbow?
0 - -5
What is the normal ROM for supination and pronation at the elbow?
90 degrees for both
What spinal nerve supplies the majority of the hand?
C7
What spinal nerve supplies the lateral forearm and thumb?
C6
What spinal nerve supplies the lower medial forearm and pinky?
C8
What spinal nerve suplies the middle of the forearm and arm?
C6
What spinal nerve supplies the majority of the shoulder?
C4
What spinal nerve supplies the axilla?
T2
What spinal nerve supplies the very top of the shoulder/neck region
C3
What spinal nerve is responsible for the biceps reflex
C5
What spinal nerve is responsible for the brachioradialis reflex?
C6
What spinal nerve is responsible for the triceps reflex?
C7
How do you perform a Tinel’s test?
Tap between olecranon and medial epicondyle in ulnar groove
What is indicative of a positive Tinel test and what does this mean?
+ test = tingling sensation down forearm -> indicates ulnar nerve entrapment/cubital tunnel syndrome
How do you perform a golfer’s elbow test?
Elbow flexed to 90, forearm supinated with wrist neutral and palm facing up. Dr places 1 hand under proximal forearm to stabilize and thoter over the pts wrist to resist movement -> instruct pt to flex the wrist
What is indicative of a positive golfer’s elbow test and what does this mean?
+ test = pain/tenderness around the medial epicondyle -> indicative of medial epicondylitis
Testing anterior forearm/flexor compartment
How do you perform a tennis elbow test (Cozen’s test)?
Pts elbow flexed to 90 and forearm pronated with wrist neutral and palm facing down. Dr places one hand under proximal forearm to stabilize and the other over the pts wrist to resist movement -> instruct pt to extend wrist
Opposite of golfer’s elbow test
What is indicative of a positive tennis elbow test (Cozen’s test) and what does this mean?
+ test = pain/tenderness around lateral epicondyle that may radiate down lateral forearm -> indicative of lateral epicondylitis
Golfer’s elbow test and Tennis elbow test (Cozan’s test) are the opposite of each other, what is each one testing for?
Golfer's = medial epicondylitis Tennis = lateral epicondylitis
Where s the olecranon bursa found?
Lies superficial to posterior elbow joint -> olecranon bursitis can occur
What is students elbow and miners elbow?
Posterior elbow distension and discomfort due to…
Overuse = students elbow
Occupational = miners elbow
What is “little league elbow?”
Pain over the medial epicondyle, initially after throwing (repetitive valgus distraction forces)that progresses to persistent pain
Most common elbow injury during childhood
What are the most common elbow injuries evolving from childhood -> adolescence -> young adulthood?
Childhood = medial apophysitis
Adolescence = medial epicondyle avulsion fracture
Young adulthood = medial collateral ligament tear
What causes radial head instability/Nursemaids elbow?
Annular ligament tear and/or radial head sublaxation from annular ligament
- Pain with palpation of radial head with anterior displacement of radial head and restriction to posterior glide
What are the 4 coupled motions that can occur at the elbow?
1) Ulnar aDduction with supination
2) Ulnar aBduction with pronation
3) Radial head anterior glide with supination
4) Radial head posterior glide with pronation
What makes up the medial, lateral and proximal borders of the “snuffbox?”
Medial = extensor pollicus longus Lateral = extensor pollicus brevis and aBductor pollicus longus Proximal = radial styloid process
What is the normal ROM for wrist flexion?
80-90
What is the normal ROM of wrist extension?
70
What is the normal ROM for wrist aDduction?
30-40
What is the normal ROM for wrist aBduction?
20-30
What is the coupled movement for wrist flexion?
Dorsal/posterior carpal glide
What is the coupled movement for wrist extension?
ventral/anterior carpal glide
What is the coupled movement for wrist aDduction?
ulnar aBduction
wrist aDduction = ulnar deviation
What is the coupled movement for wrist aBduction?
Ulnar adduction
Wrist aBduction = radial deviation
What nerve innervates the medial side of the hand (dorsal and palmer) including the pinky and medial side of the ring finger?
Ulnar nerve
What nerve innervates the lateral side of the dorsal hand and thumb?
Radial nerve
What nerve innervates the lateral side of the palmar hand including palmer side of the thumb and both sides of the digits 2-3 and lateral side of the 4th digit?
Median nerve
How is indicative of a positive “OK” sign test and what does this mean?
Pt cant make an “O” with thumb and forefinger pinched together -> indicative of neuropathy of the anterior interosseous nerve (branch of median nerve)
What 3 muscles does the anterior interosseous nerve (branch of median nerve) innervate?
Flexor pollicis longus
Deep flexors of digits 2 and 3
Pronator quadratus
What 2 tests are used to test for carpal tunnel syndrome?
Tinel’s sign
Phalen’s sign
How do you perform a phalen’s sign test?
Place dorsal aspects of pts hands together and force wrst flexion. Hold for 60 seconds
How do you perform an Allen test?
Occlude radial and ulnar arteries while pt makes a fist then have pt open and close fist -> palm should be pale. Release pressure on ulnar artery and observe for color to return to hand within 5-10 seconds, repeat with radial artery
What is indicative of a positive Allen test and what does this mean?
+ test = color doesnt return to hand within 5-10 seconds of releasing pressure from artery -> indicative of lack of dual blood supply to the hand
What is DeQuervain’s tenosynovitis?
Pain and inflammation from repetitive overuse of tendons in first dorsal compartment. Pts comlain of dorsal-lateral wrist and thumb pain, occassionally with radiation into lateral hand and thumb
Get a careful history about repetitive activities
What are the 3 possible inflammation sites for DeQuervain’s tenosynovitis?
Tendon sheath
ABductor pollicis longus
Extensor pollicis brevis
Whaat test is used to test for DeQuervain’s tenosynovitis?
Finkelstein test
How do you perform a Finkelstein test?
Ask pt to make a fist encompassing their thumb and ulnar deviate wrist (aDduct wrist)
What is indicative of a positive Finkelstein test and what does this mean?
+ test = increased pain in first dorsal compartment/lateral wrist -> indicative of DeQuervain’s tenosynovitis
What is a scaphoid fracture?
Due to FOOSH -> pt complains of dull achiness deep in radial aspect of wrist after a fall, decreased ROM, decreased grip strength, tenderness in snuffbox
Most common carpal bone fracture
What is a scaphoid fracture important to diagnose and treat?
Due to risk of avascular necrosis secondary to blood supply solely entering at distal end
Immediate radiographic evidence not always available and may need repeat imaging. -> can confirm with CT or MRI if necessary
How is pain in anatomical snuffbox following FOOSH treated?
As a fracture with Spica cast
What is a Colle’s fracture?
Fracture of the distal radius in the forearm with posterior and radial displacement of the wrist and hand
- Results from FOOSH onto extended wrist
What is a Monteggia fracture?
Fracture of the proximal ulna and dislocation of the radial head
What is a Galeazzi fracture?
Fracture of the distal radius and dislocation of the ulna
What is a nightstick fracture?
Isolated fracture of the mid shaft of the ulna from a direct blow
Cubital tunnel syndrome is compression of what nerve and loss of function of what muscle?
Ulnar nerve; flexor carpi ulnaris
What is a common presentation of radial head subluxation/dislocation?
Elbow slightly pronated, flexed and held close to trunk with history of sudden pull of extended arm
