Elbow Wrist and Hand Evaluation Flashcards
carry angle
normal, cubitus varus and cubitus valgus
5-15
cubitus varus <5
cubitus calgus >15
flexion ROM
140-150
extension ROM
0- -5
supination and pronation ROM
90
nerve root tested for biceps reflex test
C5
nerve root tested for with brachioradialis reflex test
C6
nerve root tested for with triceps reflex test
C7
valgus stress test assesses
medial (ulnar) collateral ligament
arm slightly abducted and externally rotated
forearm supinated and flexed to 30
slight medial valgus stress to elbow joint
+ with pain/tenderness and laxity
varus stress test assesses
lateral (radial) collateral ligament
arm slightly abducted and internally rotated. elbow flexed to 15
varus stress applied to elbow joint
tinel test assesses
ulnar nerve entrapment/cubital tunnel syndrome
tap between olecranon and medial epicondyle in ulnar groove
+ test = tingling sensation down forearm within ulnar n distribution
golfers elbow test assesses
medial epicondylitis
anterior forearm/flexor compartment
golfers elbow test
elbow flexed to 90 and forearm placed in supination with wrist neutral and palm facing up
stabilize proximal forearm and resist flexion
+ = pain/tenderness around medial epicondyle
cozen’s test assesses
tennis elbow test
lateral epicondylitis
cozen’s test
flex elbow to 90 and pronate forearm
stabilize proximal forearm and have patient extend wrist
+ = pain/tenderness around lateral epicondyle
olecranon bursitis can result from
overuse (students elbow)
occupational (miners elbow)
athletic injury
region is often painless and ROM is normal
Little league elbow refers to
a group of problems related to stress of throwing in young adults
medial apophysitis occurs during
childhood
medial epicondyle avulsion fractures typically happen during
adolescence
medial collateral ligament tears typically occur during
young adulthood
little league elbow characteristics
pain over medial epicondyle after throwing (repetitive valgus distraction force) progresses to persistent pain
most common elbow injury during childhood as growth plates are not fused
bone development changes characteristic of little league elbow
nursemaids elbow
tear of ______ ligament
_____ is typically _______ displacement
annular ligament tear and/or radial head subluxation from annular ligament
pain with palpation of radial head with anterior displacement
restriction to posterior glide
Coupled motions at elbow
ulnar adduction and radial head anterior glide with supination and vice versa
wrist ROM
flexion 80-90
extension 70
ulnar deviation 30-40
radial deviation 20-30
compression of the ulnar n is typically due to
flexor carpi ulnaris
ok sign test assesses
anterior interosseous nerve - motor branch of median n
innervates flexor pollicis longus, deep flexors of digit 2 and 3, pronator quadratus
carpal tunnel syndrome
entrapment of median n at the wrist in the carpal tunnel produces pain and parasthesias
chronic use may develop atrophy of intrinsic muscles of hand
tinel’s sign assesses
entrapment of median n or carpal tunnel syndrome
tinel’s sign test
tap transverse carpal ligament between thenar and hypothenar eminences
with patients hand held in extension
+ = parasthesias/numbness/tingling/pain radiating to thumb, index and middle finger (median n distribution)
phalen’s sign test assesses
carpal tunnel syndrome
phalen’s sign test
force patients hands into flexion and press the dorsal aspects together
+ = any reproduction of symptoms/parasthesias in the distribution of the median n
indicates carpal tunnel syndrome
allen test assesses
lack of dual blood supply to the hand
allen test
evaluates functioning of radial and ulnar arteries
occlude both arteries while patient makes a fist - have patient open/close fist (palm will be pale)
release pressure on ulnar artery and observe color return - repeat with radial a
no color return would indicate a lack of dual blood supply to the hand
Dequervain’s tenosynovitis
pain and inflammation from reptitive overuse of tendons in first dorsal compartment
dorso-lateral wrist and thumb pain, might radiate into lateral hand and thumb
possible inflammation of tendon sheaths
abductor pollicis longus
extensor pollicis brevis
Finkelstein test assesses for
dequervain’s tenosynovitis
finkelstein test
patient makes fist enclosing thumb and performs ulnar deviation
+ = increased pain in first dorsal compartment/lateral wrist
scaphoid fracture
most common carpal bone fracture
FOOSH
dull achiness deep in radial aspect of wrist after fall
decreased ROM, grip strength, tender snuff box
risk of avascular necrosis
colle’s fracture
fracture of distal radius in forearm with dorsal (posterior) and radial displacement of the wrist and hand
Monteggia fracture
fracture of proximal ulna
dislocation of radial head
galeazzi fracture
fracture of distal radius
dislocation of ulna
nightstick facture
isolated fracture of the mid shaft of the ulna from a direct blow
