Elbow, Wrist, and Hand Evaluation

Question 1

Flexion Elbow

Answer 1

biceps brachii, brachilais, brachioradialis

140-150

Question 2

Extension Elbow

Answer 2

triceps brachii, anconeous

0- -5

Question 3

Supination

Answer 3

supinator, biceps brachii

85-90

Question 4

Pronation

Answer 4

pronator teres, pronator quadratus

85-90

Question 5

Valus stress test

Answer 5

arm slightly abducted and externally
rotated. Forearm supinated and flexed to 30 deg. Slight
medial directed valgus stress is applied to elbow joint.
+) Test pain/tenderness with palpation and valgus
stress; increased laxity (degree of laxity correlates
to degree of injury to UCL)

Question 6

Varus stress test

Answer 6

arm slightly abducted and internally
rotated. Elbow flexed to 15 deg. A slight varus stress is
applied to the elbow joint
(+) Test = pain or increased laxity in LCL

Question 7

Tinel test for ulnar nerve entrapment

Answer 7

Tap between olecranon and medial epicondyle in ulnar
groove
(+) Test = eliciting tingling sensation down
forearm within ulnar nerve distribution
Indicates ulnar nerve entrapment, cubital tunnel
syndrome

Question 8

Golfer’s Elbow Test

Answer 8

Anterior forearm/flexor compartment
Patient’s elbow is flexed to 90° and forearm is placed in
supination with the wrist neutral and palm facing up. The
examiner places one hand under the proximal forearm for
stabilization and the other hand over the patient’s wrist to resist
movement. Instruct the patient to flex the wrist.
(+) Test = pain/tenderness around the medial
epicondyle

Question 9

Tennis Elbow Test (Cozen’s test)

Answer 9

Posterior forearm/extensor compartment
Patient’s elbow is flexed to 90° 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 patient’s hand to resist movement. Instruct
the patient to extend the wrist.
(+) Test = pain/tenderness around lateral epicondyle,
may radiate down lateral forearm

Question 10

Olecranon bursitis

Answer 10

Olecranon bursa lies superficial to posterior elbow joint.
Posterior elbow distention and discomfort due to overuse
(“students elbow”) or occupational (“miners elbow”) or
athletic injury. Region is often painless and range of
motion is normal.

Question 11

Little League Elbow 
 group of problems
related to stress of throwing in young athletes
 Medial Apophysitis (childhood)
Medial epicondyle avulsion fracture
(adolescence)
Medial collateral ligament tear (young
adulthood)

Answer 11

Pain over the medial epicondyle, initially after throwing
(repetitive valgus distraction forces), progresses to
persistent pain.
Most common elbow injury during childhood (growth
plates not fused/secondary ossification centers absent)
As bone development matures most common injury seen
evolves (apophysitis avulsion ligamentous injury)

Question 12

Radial head instability (Nursemaid’s elbow)

Answer 12

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

Question 13

Coupled Motions at Elbow

Answer 13

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

Question 14

Flexion Wrist

Answer 14

flexor carpi radialis, palmaris longus coupled movement dorsal/posterior carpal glide
80-90

Question 15

Extension

Answer 15

extensor carpi radialis longus and brevis coupled movement ventral/anterior carpal glide
70

Question 16

Adduction (ulnar deviation)

Answer 16

flexor and extensor carpi ulnaris
coupled movement ulnar abduction
30-40

Question 17

Abduction (radial deviation)

Answer 17

flexor carpi radialis, extensor carpi radialis longus and brevis coupled movement ulnar adduction
20-30

Question 18

OK sign - Anterior Interosseous N.

Answer 18

Motor branch of median nerve innervating:
Flexor pollicis longus
Deep flexors of digits 2 and 3
Pronator quadratus
On examination, if neuropathy present, patient cannot
make an “O” with thumb and forefinger pinched
together

Question 19

Tinel’s sign - Carpal Tunnel Syndrome

Answer 19

Indicates entrapment of Median Nerve or Carpal Tunnel
Syndrome.
Can be elicited by tapping over the transverse carpal ligament
(between thenar/hypothenar eminences) with either the tip of
the examiner’s finger or reflex hammer with the patient’s
wrist held in extension.
(+) Test = parasthesias/numbness/ tingling/pain radiating to
thumb, index and middle finger (median n. distribution); CTS

Question 20

Phalen’s sign

Answer 20

Place dorsal aspects of patient’s hands together and force into
wrist flexion. Hold for 60 seconds
(+) Test = any reproduction of symptoms/parasthesias in the
distribution of the median nerve; CTS

Question 21

Allen Test

Answer 21

Evaluates functioning of radial and ulnar arteries.
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.

Question 22

DeQuervian’s Tenosynovitis

Answer 22

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

Question 23

Finkelstein Test

Answer 23

Utilized to assess for tenosynovitis of the 1st dorsal
compartment, aka. DeQuervain’s syndrome.
Examiner asks patient to make a fist encompassing
their thumb and ulnar deviate the wrist.
(+) Test = increased pain in first dorsal compartment/
lateral wrist; DeQuervain’s tenosynovitis

Question 24

Scaphoid fracture

Answer 24

Most common carpal bone fracture, due to falling
forwards/backwards on outstretched hand. 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

Question 25

Colle’s Fracture

Answer 25

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