Elbow, Wrist, and Hand evaluation

Question 1

What is the carrying angle?

Answer 1

angle b/w axis of humerus and the axis of the forearm

• normal is 5-15 degrees
• Cubitus varus if 15

Question 2

What nerve roots are being tested for the following reflexes?:
-Biceps, Brachioradialis, and triceps

Answer 2

C5, 6, and 7 respectively

Question 3

Valgus stress test

Answer 3

arm slightly abducted and externally rotated. Forearm supinated and flexed to 30 deg.
-Valgus is for UCL

Question 4

Varus stress test

Answer 4

arm slightly abducted and internally rotated. Elbow flexed to 15 degrees. A slight varus stress is applied to the elbow joint
-tests for LCL

Question 5

Tinel test

Answer 5

tap b/w the olecranon and medial epicondyle in ulnar groove

• • if tingling down forearm
• indicates ulnar n. entrapment, cubital tunnel syndrome

Question 6

Golfer’s elbow test

Answer 6

• anterior forearm/flexor compartment
• pt’s elbow is flexed to 90 degrees 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 pt. to flex the wrist
• • if pain/ tenderness around the medial epicondyle

Question 7

Tennis elbow (cozen’s test)

Answer 7

• posterior forearm/extensor compartment
• pt’s elbow flexed to 90 and forearm is place in pronation w/ 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 pt. to extend the wrist.
• • if pain/tenderness around the lateral epicondyle, may radiate down lateral forearm

Question 8

What are the coupled motions at the wrist?

Answer 8

• ulnar adduction with supination
• ulnar abduction with pronation
• radial head anterior glide with supination
• radial head posterior glide with pronation

Question 9

OK sign

Answer 9

• tests anterior IO n.

- motor branch of median n. innervating FPL, Deep flexors of digints 2 and 3, and pronator quadratus

Question 10

Tinel’s sign

Answer 10

tap on the transverse carpal ligament

• • if numbness or tingling happens
• indicates entrapment of median n. or carpal tunnel syndrome

Question 11

Phalen’s sign

Answer 11

place dorsal aspects of patient’s hands together and force inot wrist flexion. hold for 60 sec.

• +if there is parasthesias in the distribution of the median nerve
• Indicates Carpal tunnel syndrome

Question 12

Allen Test

Answer 12

evaluates functioning of radial and ulnar arteries

• occlude both arterise 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 withing 5-10 sec. Repeat with radial artery

Question 13

Finkelstein test

Answer 13

pt. makes fist encompassing their thumb and ulnar deviate the wrist
- + if increase pain in first dorsal compartment/lateral wrist; Dequervain’s tenosynovitis