Elbow, Wrist and Hand Exam Competency

Question 1

What is a normal Carrying Angle for the upper extremity? Abnormal Angles?

Answer 1

5-15 Degrees

Cubitus Varus: <5 Degrees

Cubitus Valgus: >15 Degrees

Question 2

Describe the different motions that can be performed at the elbow and the muscles associated with each motion.

Answer 2

1. Flexion: 140-150 Degrees (Biceps Brachii, Brachioradialis, Brachialis)
2. Extension: -5-0 Degrees (Triceps Brachii, Anconeus)
3. Supination: 90 Degrees (Supinator, Biceps Brachii)
4. Pronation: 90 Degrees (Pronator Teres, Pronator Quadratus)

Question 3

When you are doing a neurologic/sensory exam, which are the roots for the main muscles in the arm?

Answer 3

Biceps: C5
Brachialis: C6
Triceps: C7

Question 4

What structures are you testing with Varus and Valgus Stress Tests in the upper extremity?

Answer 4

Valgus Stress Test: Ulnar Collateral Ligament (UCL)

Varus Stress Test: Radial Collateral Ligament (RCL)

Question 5

Which test would you use if you were testing for Ulnar N. entrapment at the Cubital Tunnel?

Answer 5

TINELS Test

Positive Sign: Eliciting a Tingling sensation down the forearm

Question 6

Differentiate between Golfer’s and Tennis Elbow Tests.

Answer 6

Golfer’s Elbow: Supinate and FLEX against resistance. Positive Test = Pain @ MEDIAL Epicondyle

Tennis Elbow: Pronate and EXTEND wrist against resistance. Positive Test = Pain @ LATERAL Epicondyle

Question 7

What are some other names for Olcecranon Bursitis?

Answer 7

“Student’s Elbow”

“Miner’s Elbow”

Question 8

What is the common pathological progression of Little League Elbow throughout life as the bone develops?

Answer 8

Childhood: Medial APOPHYSITIS (Growth plates not fused/secondary ossification centers absent)

Adolescence: Medial EPICONDYLE AVULSION fracture

Young Adulthood: MCL Tear

Question 9

Explain “Nursemaid’s Elbow”.

Answer 9

ANNULAR Ligament Tear (and/or Radial Head SUBLUXATION from the annular ligament)

Question 10

Explain the four coupled Motions at the Elbow.

Answer 10

1. Ulnar ADduction with SUPINATION
2. Ulnar ABduction with PRONATION
3. Radial Head ANTERIOR glide with SUPINATION
4. Radial Head POSTERIOR glide with PRONATION

Question 11

List the different ranges of motion at the wrist.

Answer 11

Flexion: 80-90 Degrees

Extension: 70 Degrees

ADduction: 30-40 Degrees

ABduction: 20-30 Degrees

Question 12

Where are the boundaries of the Radial, Median, and Ulnar N. when performing a sensory exam on the hand?

Answer 12

Radial: (Dorsal) Proximal End of Digit 1, 2, and 1/2 of 3; (Ventral) A little bit of Thenar Eminence

Median: (Dorsal) Distal End of Digit 2, 3, and 1/2 of 4; (Ventral) Digits 1, 2, 3, and 1/2 of 4

Ulnar: (Dorsal) Digits 1/2 of 4, 5; (Ventral) Digits 1/2 of 4, 5

Question 13

What are you testing for with the “OK” sign?

Answer 13

Function of the ANTERIOR INTEROSSEOUS NERVE

Question 14

What are the three tests you can perform when assessing Carpal Tunnel’s syndrome?

Answer 14

1. Tinel’s Test
2. Phalen’s Test (Hold for 60 seconds)
3. Allen Test (Blood Flow)

Question 15

Where are the two possible inflammation sites that are associated with Dequervian’s Tenosynovitis? What is a test that you can see if you have Dequervian’s Tenosynovitis?

Answer 15

1. Abductor Pollicis Longus
2. Extensor Pollicis brevis

Finkelstein’s Test

Question 16

Why is it important to get an X-ray after a FOOSH injury?

Answer 16

Looking for Scaphoid Fracture

Question 17

Describe the Colle’s Fracture.

Answer 17

Fracture of the Distal Radius with DORSAL (posterior) and RADIAL displacement of the wrist and hand