Elbow, Wrist, and Hand Pain

Question 1

What are some things you should palpate on the elbow?

Answer 1

Olecranon process, Lateral and medial epicondyles, radial head while pronating and supinating the forearm, and cubital fossa.

Question 2

What are some things you should inspect on the elbow?

Answer 2

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°)

Question 3

What’s the ROM in the elbow?

Answer 3

Flexion: 140-150°
Extension: 0 to -5°
Supination/pronation: 90°
Ulnohumeral abduction/adduction: 5°

Question 4

What are the nerve roots for the three reflexes of the arm?

Answer 4

Bicep (C5)
Brachioradialis (C6)
Tricep (C7)

Question 5

What are a couple special tests you can perform on the elbow?

Answer 5

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

Question 6

Anterior capsule strain, OA, bicep tendinopathy, gout, and RA are all causes of […] elbow pain

Answer 6

Anterior

Question 7

Lateral epicondylitis and posterolateral rotatory instability are causes of […] elbow pain

Answer 7

Lateral

Question 8

Medial epicondylitis, cubital tunnel syndrome, ulnar collateral ligament injury, and valgus extension overload syndrome are all causes of […] elbow pain

Answer 8

Medial

Question 9

OA, olecranon bursitis, posterior impingement, olecranon stress fracture, and tricep tendinopathy are all causes of […] elbow pain

Answer 9

Posterior

Question 10

Tennis elbow is caused by what?

Answer 10

Lateral epicondylitis

Question 11

Golfer’s elbow is caused by what?

Answer 11

Medial epicondylitis

Question 12

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.

Answer 12

Subluxation of the radial head (AKA nursemaid’s elbow)

Question 13

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?

Answer 13

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.

Question 14

What should you palpate when examining the wrist?

Answer 14

Carpal bones, the scaphoid, and place thumb in the anatomical snuff box.

Question 15

What’s ROM for wrist?

Answer 15

Extension: 70°
Flexion: 80-90°
wrist abduction: 20-30°
wrist adduction: 30-40°

Question 16

What are some specialty tests you can do on the wrist?

Answer 16

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

Question 17

What are the motions of the thumb?

Answer 17

Flexion/extension
Abduction/adduction
opposition

Question 18

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

Answer 18

Carpal tunnel syndrome

Question 19

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?

Answer 19

De Quervain’s tenosynovitis

This is recurrent inflammation of the tendon and synovial sheath covering extensor pollicis brevis and abductor pollicis longus

Question 20

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

Answer 20

Trigger Finger (AKA stenosing flexor tenosynovitis)

Question 21

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

Answer 21

Dupuytren’s contracture

Question 22

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

Answer 22

Scaphoid fracture

Question 23

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.

Answer 23

Boxer’s fracture

Fracture of the metacarpal neck (usually the 5th digit, but can involve the 4th)

Question 24

What’s considered the most common fracture of the UE?

Answer 24

Colles fracture

Question 25

What presents with wrist pain and possible dinner fork deformity, tenderness on radial aspect of the wrist, possible bruising and swelling, and is seen primarily in young patients due to sports injury.

Caused by FOOSH injury with wrist in extension.

Answer 25

Colles fracture

Question 26

What presents with morning stiffness, swelling and pain of the MCPs and PIPs, is affecting 3 or more joints, and causes deformity of the digits?

Answer 26

Rheumatoid arthritis