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PCM Exam 1 > Elbow, Wrist, and Hand complaint > Flashcards

Elbow, Wrist, and Hand complaint Flashcards

1
Q

What are some of the common causes of elbow pain?

A 
Gout 
Osteoarthritis 
Cubital tunnel syndrome 
Medial epicondylitis 
Lateral epicondylitis 
Olecranon bursitis

** there are more but these are the ones on the slide that have red stars next to them

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2
Q

Describe lateral epicondylitis including

  1. Classic presentation
  2. Etiology
  3. Dx
  4. Tx
A
  1. Gradual pain at the lateral elbow that is worsened with RESISTED wrist extension
  2. Repetitive motions that cause inflammation of the tendons
  3. usually exam but if needed, XRAY, MRI, US
  4. Rest, Ice, NSAIDS, steroids, physical therapy
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3
Q

Describe how you would physically test for lateral epicondylitis

A

Grab the patients lateral and medial epicondyles and have them straighten out their arm. Have them extend against your hand while holding force against them. If there is pain over the lateral epicondyle, the test is positive

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4
Q

Describe medial epicondylitis including

  1. Classic presentation
  2. Etiology
  3. Dx
  4. Tx
A
  1. Gradual pain at the medial elbow; worsened pain with RESISTED wrist flexion
  2. Repetitive movements, like golf, that inflame the tendons of the flexor muscles
  3. usually exam but if needed, XRAY, MRI, US
  4. Rest, Ice, Bracing, NSAIDS
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5
Q

Describe how you would physically test for medial epicondylitis

A

Gran the patients affected arm at the lateral and medial epicondyles. Have them straighten out their arm with the hand in a fist position. Place your hand behind the fist and have them flex AGAINST you with some resistance applied

If there is pain then the test is positive

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6
Q

Describe olecranon bursitis. What causes it? What is the treatment?

A

Usually following trauma or leaning on the elbow

can be treated with ice, compression, and avoiding aggravating factors

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7
Q

Describe cubital tunnel syndrome

  1. What is it?
  2. How does it present?
  3. How do you diagnose it?
  4. How do you treat it?
A
  1. Ulnar nerve entrapment which is typically in the cubital tunnel
  2. Medial elbow pain, paresthesia of the forearm, hand, and 4th and 5th digits; nighttime pain
  3. Tinels sign, Nerve conduction, Elbow MRI
  4. night splinting, elbow pads, surgical decompression
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8
Q

Describe carpal tunnel syndrome

  1. Cause
  2. Presentation
  3. Diagnosis
  4. Treatment
A
  1. Compression of the median nerve
  2. Wrist pain with parasthesia, worsened sx at night
  3. Phalens sign and Tinels sign, EMG, Imaging
  4. Splinting, steroids, in severe cases surgery
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9
Q

Describe the phalen test.

A

Have the patient hold the dorsal aspects of their palms together with the fingers pointing down for SIXTY seconds

A positive test is numbness and tingling which insinuates a problem in the median nerve

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10
Q

Describe the Tinels test

A

Tap on the patients affected hand at the flexor retinaculum to test for any pain or worsening sx

Can also

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11
Q

Describe de Quevains tenosynovitis

  1. Cause
  2. Presentation
  3. Diagnosis
  4. Treatment
A
  1. caused by inflammation of the tendon of the extensor pollicis braves and abductor pollicis longus
  2. Radial wrist pain at the thumb base with movement that is worsened with gripping
  3. Finkelstein test
  4. Spica splint, NSAIDS, steroids, surgery
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12
Q

Describe the finkelstein test

A

Have the patient flex their thumbs inward and cover the thumb with their fingers. Have them put their hands out in from of them and point the thumbs down

If there is pain, then the test is positive

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13
Q

Describe rheumatoid arthritis

  1. cause
  2. presentation
A
  1. autoimmune, inflammation
  2. Symmetric joint pain, joint stiffness particularly in the MCP and PIP joints
    edema is noted usually
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14
Q

What is the treatment for rheumatoid arthritis

A

Anti-TNF alpha drugs
T cell inhibitors
Methotrexate

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15
Q

Describe osteoarthritis arthritis

  1. Presentation
  2. Diagnosis
  3. Treatment
A
  1. Asymmetric joint pain, joint stiffness that lasts an hour after awakening and improves with activity
  2. Xrays; Heberdens nodes (DIP) and Bouchrds nodes (PIP)
  3. weight loss, exercise, NSAIDS
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16
Q

Describe a ganglion cyst including

  1. presentation
  2. diagnosis
  3. treatment
A
  1. Painful, smooth, firm to rubbery cystic lesion that can be in the wrist or feet, usually on the forum of the wrist and fingers
  2. clinical
  3. Ganglion cyst aspiration
17
Q

Describe a Colles fracture

  1. Presentation
  2. Dx
  3. Tx
A
  1. Distal wrist pain and swelling with a possible dinner fork deformity
  2. XRAY
  3. Depends on the extent; some can be cured with surgery others with reduction ad casting
18
Q

Describe trigger finger

  1. Cause
  2. Presentation
  3. Treatment
A
  1. stenosing flexor tenosynovitis; caused by the “inflamed pulley” (tendon surrounding the reticular pulley on the finger)
  2. Painless snapping, locking of fingers in flexion. Affects ring finger and thumb. Presents in the 5th decade of life
  3. Splinting, NSAIDS
19
Q

What is jersey finger?

A

Avulsion of the flexor digitorum profundus from the fingertip

20
Q

What is monteggia fracture?

A

fracture of the proximal ulna and dislocation of the radial head

21
Q

What is a galeazzi fracture?

A

Fracture of the distal radius and dislocation of the ulna

22
Q

what is a nightstick fracture?

A

Isolated fracture of the mid shaft distal ulna from a direct blood

23
Q

What are the dermatome landmarks of the arm?

A 
C4 over the top of the shoulder 
C5 right below that 
C6 to the radial aspect of the forearm 
C8 of the 5th digit 
T1 on the medial side of the upper arm and forearm
24
Q

Differentiate between cubitus varus and cubitus valgas

A

Cubitus varus is adduction of the ulna Less than or qual to 5 degrees

Cubitus valgus is greater than 15 degrees

25
Q

What does a positive valgus test indicate?

A

Since the patient has increased laxity of the joint, it insinuates a sprained medial (ulnar) collateral ligament

26
Q

What does a positive varus test indicate?

A

Sprained lateral collateral as the increased laxity of the joint going outwards laterally

PCM Exam 1 (10 decks)

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