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PCM 1 Midterm > Elbow, Wrist and Hand Joint Pain OSCE > Flashcards

Elbow, Wrist and Hand Joint Pain OSCE Flashcards

1
Q

Migratory

A

moves from one joint to another

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2
Q

Extra-articular

A 
bones
muscles
tendons 
bursa
skin
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3
Q

Arthralgia

A

joint pain

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4
Q

Sublaxation

A

Residual contact between 2 articular surfaces

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5
Q

Valgus deformity

A

the distal part of the limb is AWAY from the midline

Genu valgus–> knock knees

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6
Q

Varus deformity

A

distal part of the limb is directed TOWARDS the midline

Genus varus–> bow legged

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7
Q

Sprain

A

ligament injury

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8
Q

Strain

A

muscle injury

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9
Q

effusion

A

fluid in joint

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10
Q

carrying angle

A

men- 5

women- 10-15

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11
Q

cubutis varus

A

<5 degrees (adduction of ulna)

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12
Q

Cubitus valgus

A

> 15 degrees (ABduction of the ulna)

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13
Q

Joint vs extremity exam

A

In extremity exams; you also need to conduct

  1. REFLEXES
  2. NEUROVASCULAR STATUS
    - Neuro: motor/sensory
    - Vascular: pulses or capillary refill
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14
Q

If you have a extremity pain, where would you check the pulse or capillary refill?

A

DISTAL to the injury

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15
Q

During palpation, what do you look for?

A
  1. Temperature
  2. Tenderness
  3. Edema
  4. Effusion
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16
Q

Reflex scale

A

0/4–> no response
1/4–> diminishes response, low normal
2/4–> average, normal
3/4–> brisker than average, but not idicative of a dz
4/4–> very brisk, hyperactive with clonus (rhythmic oscillation between flexion and extension)

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17
Q

Bicep nerve root

A

C5

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18
Q

Brachioradialis nerve root

A

C6

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19
Q

Tricep nerve root

A

C7

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20
Q

Muscle strength scale

A

0/5–> no muscular contraction
1/5–> barely detectable muscle contraction
2/5–> active movement with gravity eliminated
3/5–> active movement AGAINST gravity
4/5–> active movement agaist gravity and some resistence
5/5–> active movement against full resistence without evidence of fatigue.

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21
Q

How to do hand grip strength.

A

tell patient to squeeze docs 2nd and 3rd finger

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22
Q

dermatome for top of shoulder

A

C4

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23
Q

dermatome for radial aspect of forearm

A

C6

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24
Q

dermatome for 5th digit

A

C8

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25
Q

Dermatome for nipple line

A

T4

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26
Q

Derm for belly button

A

T10

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27
Q

dermatome for big toe

A

L5

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28
Q

Dermatome for thumb

A

C6

29
Q

Dermatome for middle finger

A

C7

30
Q

Dermatome for deltoid muscle

A

C5

31
Q

Capillary refill

A

Compress index finger and cause blanching

Normal time is 2 seconds or less

Tests digital perfusion

32
Q

Pulse scale

A 
0/4--> absent pulse
1/4--> diminished, barely palpable
2/4--> average intensity, normal
3/4--> strong, full, increased
4/4--> bounding
33
Q

Examination for edema

A

press firmly for 5 seconds over

  1. dorsum of foot
  2. Anterior tibia
  3. behind the medial mallelous

0- no edema
1- barely detecable, slight pitting (2mm)
2. slight indentation (4mm) for 10-15 seconds
3. Deep indentation (6mm); >1 min
4. Very marked indentation (8mm) for 2-5 min

34
Q

Tinnel test for ulnar nerve entrapemtn

A

press between medial epicondyl and olecranon

+ tingling
indicates: ulnar nerve entrapment or cubital tubbel symdrom

35
Q

Golfers elbow tests

A

patient hand is supinated.
Tell patient to flex wrist against resistance

+: pain around medial epicondyle
Indicates: medial epicondiltis

GM

36
Q

Tennis elbow test

A

Pt hand is pronated
Tell pt to extend wrist against resistance

+ pain around lateral epicondyl
Indicates: lateral epicondiltitis

TL

37
Q

Olecranon bursitis is posterior elbow distension and discomfort due:

A

fall onto elbow

  1. Overuse (students elbow)
  2. Occupational (miners elbow)
  3. athletic injury

Painless and ROM is normal

38
Q

What is little league elbow

A

most common elbow injury during childhood, especially in young athletes that throw
Pain over medial epicondyl

Childhood- medial apophysitis
Adolescence–> medial epicondyle avulsion fx
Young adulthool–> medial collalteral tear

39
Q

Nursemaids elbow

A

annular ligament tear or radial head instability

often due to trauma with traction of childs extended arm

40
Q

coupled motions at elbow

ulnar adduction with _______

A

supination

41
Q

ulnar abduction with ________

A

pronation

42
Q

radial head anterior glide with ______

A

supination

43
Q

radial head posterior glide with _______

A

pronation

44
Q

OK sign

A

checks the anterior interosseous nerve of the median nerve

+- median nerve entrapment

45
Q

Tests for carpal tunnel syndrome

A
  1. Tinels sign–> tap over transverse carpal ligament
  2. Phalens sign

tingling in thumb, index and middle finger

46
Q

tests for DeQuervians Tenosynovitis

A
  1. Finkelsteins test
47
Q

What is DeQuervians Tenosynovitis

A

pain and inflammation from repetitive overuse of tendons in first dorsal compartment (lateral wrist)

thumb pain

abductor pollicis longus
extensor pollicis brevis

48
Q

Handlebar palsy

A

ulnar nerve gets entrapped in guyons canal

49
Q

Gamekeepers thumb/skiers thumb

A

Tear in ulnar collateral ligament of the MCP

50
Q

mallet finger

A

injury to extensor tendon at DIP

51
Q

trigger finger

A

inflammation and narrowing of flexor tendon sheath

Unable to extend/straighten finger.

52
Q

Jersey finger

A

avulsion of flexor digitorum profundus at the fingertip

Inability to flex finger.
Common
injury during athletic activities

53
Q

Depuytrens contracture

A

abnormal CT thickening in palmar fascia

54
Q

what is cubital tunnel syndrome

A

compression of ulnar nerve

55
Q

ganglian cyst

A

cyst over wrist and the cause is unknown

“bible cyst”

56
Q

rheumatoid arthritis

A

autoimmune inflammatory condition that causes inflammation in joints, esp in hands, wrists and knees

57
Q

sx of RA include

A 
Bouchard nodes (nodes over PIPs)
Heberden nodes (nodes over DIPs)
58
Q

clubbed fingers

A

bulb enlargement on terminal fingers

angle between the nail and proximal nail fold is >180 due to proliferation of CT

59
Q

colles fracture

A

Fracture of the distal radius with DORSAL (POSTERIOR)
displacement of the wrist and
hand

dinner fork deformity

60
Q

smith fx

A

Fracture of the distal radius with
VENTRAL (ANTERIOR) displacement of
the wrist and hand

61
Q

monteggio fx

A

fracture of the proximal ulna and dislocoation of radial head

62
Q

galeazzi fx

A

fracture of the distal radius and dislocation of the ulna

63
Q

nightstick fx

A

isolated fracture of the mid shaft/distal ulna

64
Q

medial arm dermatome

A

T1

65
Q 
What fracture is seen in FOOSH injuries?
Fall 
On 
Outstretched 
Hand injuries
A

Galleazi fracture

66
Q

best way to fix nursemaids elbow

A

hyperpronate!

67
Q

Coupled motion

Wrist extension

A

ventral carpal glide

68
Q

Coupled motion

Wrist flexion

A

dorsal carpal glide

69
Q

if you have NO pain in your anaomtical snuffbox with PRONATION AND ULNAR DEVIATION, can it be a scaphoid fx?

A

100% neg predictive value

(if no pain 100% NOT fx)*

PCM 1 Midterm (11 decks)

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