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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
Dermatome for nipple line
T4
26
Derm for belly button
T10
27
dermatome for big toe
L5
28
Dermatome for thumb
C6
29
Dermatome for middle finger
C7
30
Dermatome for deltoid muscle
C5
31
Capillary refill
Compress index finger and cause blanching Normal time is 2 seconds or less Tests digital perfusion
32
Pulse scale
``` 0/4--> absent pulse 1/4--> diminished, barely palpable 2/4--> average intensity, normal 3/4--> strong, full, increased 4/4--> bounding ```
33
Examination for edema
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
Tinnel test for ulnar nerve entrapemtn
press between medial epicondyl and olecranon + tingling indicates: ulnar nerve entrapment or cubital tubbel symdrom
35
Golfers elbow tests
patient hand is supinated. Tell patient to flex wrist against resistance +: pain around medial epicondyle Indicates: medial epicondiltis GM
36
Tennis elbow test
Pt hand is pronated Tell pt to extend wrist against resistance + pain around lateral epicondyl Indicates: lateral epicondiltitis TL
37
Olecranon bursitis is posterior elbow distension and discomfort due:
fall onto elbow 1. Overuse (students elbow) 2. Occupational (miners elbow) 3. athletic injury Painless and ROM is normal
38
What is little league elbow
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
Nursemaids elbow
annular ligament tear or radial head instability | often due to trauma with traction of childs extended arm
40
coupled motions at elbow | ulnar adduction with _______
supination
41
ulnar abduction with ________
pronation
42
radial head anterior glide with ______
supination
43
radial head posterior glide with _______
pronation
44
OK sign
checks the anterior interosseous nerve of the median nerve +- median nerve entrapment
45
Tests for carpal tunnel syndrome
1. Tinels sign--> tap over transverse carpal ligament 2. Phalens sign tingling in thumb, index and middle finger
46
tests for DeQuervians Tenosynovitis
1. Finkelsteins test
47
What is DeQuervians Tenosynovitis
pain and inflammation from repetitive overuse of tendons in first dorsal compartment (lateral wrist) thumb pain abductor pollicis longus extensor pollicis brevis
48
Handlebar palsy
ulnar nerve gets entrapped in guyons canal
49
Gamekeepers thumb/skiers thumb
Tear in ulnar collateral ligament of the MCP
50
mallet finger
injury to extensor tendon at DIP
51
trigger finger
inflammation and narrowing of flexor tendon sheath | Unable to extend/straighten finger.
52
Jersey finger
avulsion of flexor digitorum profundus at the fingertip Inability to flex finger. Common injury during athletic activities
53
Depuytrens contracture
abnormal CT thickening in palmar fascia
54
what is cubital tunnel syndrome
compression of ulnar nerve
55
ganglian cyst
cyst over wrist and the cause is unknown | "bible cyst"
56
rheumatoid arthritis
autoimmune inflammatory condition that causes inflammation in joints, esp in hands, wrists and knees
57
sx of RA include
``` Bouchard nodes (nodes over PIPs) Heberden nodes (nodes over DIPs) ```
58
clubbed fingers
bulb enlargement on terminal fingers | angle between the nail and proximal nail fold is >180 due to proliferation of CT
59
colles fracture
Fracture of the distal radius with DORSAL (POSTERIOR) displacement of the wrist and hand dinner fork deformity
60
smith fx
Fracture of the distal radius with VENTRAL (ANTERIOR) displacement of the wrist and hand
61
monteggio fx
fracture of the proximal ulna and dislocoation of radial head
62
galeazzi fx
fracture of the distal radius and dislocation of the ulna
63
nightstick fx
isolated fracture of the mid shaft/distal ulna
64
medial arm dermatome
T1
65
``` What fracture is seen in FOOSH injuries? Fall On Outstretched Hand injuries ```
Galleazi fracture
66
best way to fix nursemaids elbow
hyperpronate!
67
Coupled motion Wrist extension
ventral carpal glide
68
Coupled motion Wrist flexion
dorsal carpal glide
69
if you have NO pain in your anaomtical snuffbox with PRONATION AND ULNAR DEVIATION, can it be a scaphoid fx?
100% neg predictive value | (if no pain 100% NOT fx)*

PCM 1 Midterm (11 decks)

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