Elbow, Wrist, and Hand Evaluation Flashcards
Flexion Elbow
biceps brachii, brachilais, brachioradialis
140-150
Extension Elbow
triceps brachii, anconeous
0- -5
Supination
supinator, biceps brachii
85-90
Pronation
pronator teres, pronator quadratus
85-90
Valus stress test
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)
Varus stress test
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
Tinel test for ulnar nerve entrapment
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
Golfer’s Elbow Test
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
Tennis Elbow Test (Cozen’s test)
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
Olecranon bursitis
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.
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)
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)
Radial head instability (Nursemaid’s elbow)
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
Coupled Motions at Elbow
Ulnar adduction with supination
Ulnar abduction with pronation
Radial head anterior glide with supination
Radial head posterior glide with pronation
Flexion Wrist
flexor carpi radialis, palmaris longus coupled movement dorsal/posterior carpal glide
80-90
Extension
extensor carpi radialis longus and brevis coupled movement ventral/anterior carpal glide
70
Adduction (ulnar deviation)
flexor and extensor carpi ulnaris
coupled movement ulnar abduction
30-40
Abduction (radial deviation)
flexor carpi radialis, extensor carpi radialis longus and brevis coupled movement ulnar adduction
20-30
OK sign - Anterior Interosseous N.
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
Tinel’s sign - Carpal Tunnel Syndrome
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
Phalen’s sign
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
Allen Test
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.
DeQuervian’s Tenosynovitis
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
Finkelstein Test
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
Scaphoid fracture
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
