Elbow, Wrist, and Hand Pain Flashcards
What are some things you should palpate on the elbow?
Olecranon process, Lateral and medial epicondyles, radial head while pronating and supinating the forearm, and cubital fossa.
What are some things you should inspect on the elbow?
Look for soft tissue swelling, nodules, erythema, indentation, scars, and the carrying angle (normal for men is 5-10° and for women is 10-15°)
What’s the ROM in the elbow?
Flexion: 140-150°
Extension: 0 to -5°
Supination/pronation: 90°
Ulnohumeral abduction/adduction: 5°
What are the nerve roots for the three reflexes of the arm?
Bicep (C5)
Brachioradialis (C6)
Tricep (C7)
What are a couple special tests you can perform on the elbow?
Tinel’s sign, where you lightly flex the elbow while tapping on the ulnar nerve. Positive if it elicits pain.
Also varus and valgus stress testing for ligament integrity
Anterior capsule strain, OA, bicep tendinopathy, gout, and RA are all causes of […] elbow pain
Anterior
Lateral epicondylitis and posterolateral rotatory instability are causes of […] elbow pain
Lateral
Medial epicondylitis, cubital tunnel syndrome, ulnar collateral ligament injury, and valgus extension overload syndrome are all causes of […] elbow pain
Medial
OA, olecranon bursitis, posterior impingement, olecranon stress fracture, and tricep tendinopathy are all causes of […] elbow pain
Posterior
Tennis elbow is caused by what?
Lateral epicondylitis
Golfer’s elbow is caused by what?
Medial epicondylitis
What is caused by sudden pulling, falling or arm twisting of a child’s arm? This would present with child having arm close to the body w/ elbow slightly flexed or fully extended w/ forearm pronated.
Subluxation of the radial head (AKA nursemaid’s elbow)
What presents with pain and swelling of the olecranon bursa, and is caused by inflammatory arthritis, gout, trauma, hemorrhage, or sepsis?
How would you distinguish between bursitis and effusion?
Olecranon bursitis.
Bursitis would allow them to fully extend the elbow w/o any pain
Effusion means there would be pain when trying to extend due to increased pressure at the joint.
What should you palpate when examining the wrist?
Carpal bones, the scaphoid, and place thumb in the anatomical snuff box.
What’s ROM for wrist?
Extension: 70°
Flexion: 80-90°
wrist abduction: 20-30°
wrist adduction: 30-40°
What are some specialty tests you can do on the wrist?
Phalen’s (have patient place dorsum of hands together and hold it like that)
Tinel’s (tap on median N between thenar and hypothenar)
Finkelstein (wrap fingers around thumb and adduct the wrist)
Scaphoid shift/Watson;s
What are the motions of the thumb?
Flexion/extension
Abduction/adduction
opposition
What will present with pain and paresthesia along the first three and a half digits and could be caused by obesity, hypothyroidism, DM, repetitive movement/workplace factors, pregnancy, genetic, CT disorder, or being female
Carpal tunnel syndrome
What would present with radial wrist pain over the radial styloid at the base of the thumb, especially during movement and is caused by recurrent movements like a mother picking up a child?
De Quervain’s tenosynovitis
This is recurrent inflammation of the tendon and synovial sheath covering extensor pollicis brevis and abductor pollicis longus
What presents with pain, locking, and clicking of MCP joint, common in the 5th or 6th decade of life, and is most common on ring finger, but may occur in any finger.
Caused by diabetes, amyloidosis, RA, hypothyroidism, overuse, and trauma
Trigger Finger (AKA stenosing flexor tenosynovitis)
What presents with a pt having the inability to fully extend the finger, thickening of the palmar fascia, and on exam will have a palpable cord-like structure with the flexed digit?
Caused by a thickening of the palmar fascia due to fibroblastic proliferation and collagen deposition
Dupuytren’s contracture
What presents with pain on the radial aspect of the wrist and reduced grip strength after a FOOSH injury resulting in hyperextension of the wrist? Special testing showed increased tenderness in anatomical snuff box
Scaphoid fracture
What would present with pain on the dorsum of the hand after direct trauma, swelling and bruising on the dorsum of the hand?
Caused by direct injury/trauma to the clenched fist.
Boxer’s fracture
Fracture of the metacarpal neck (usually the 5th digit, but can involve the 4th)
What’s considered the most common fracture of the UE?
Colles fracture
