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SCS Mine > Elbow, Wrist, Hand > Flashcards

Elbow, Wrist, Hand Flashcards

1
Q

Golfer presents w/ dorsal wrist pain?

A

Dequervain’s syndrome

APL & EPB tendinitis

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2
Q

cubital tunnel- throwing phase most stressful to elbow

A

late cocking is greatest stress to the ulnar nerve

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3
Q

common dorsal wrist injury in golfers

A

APL/EPB tendinitis, or DeQuervain’s syndrome is the most common sports overuse injury along the dorsoradial wrist region.

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4
Q

indicators of MCL injury with throwing

A

loss of power but with little to no pain

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5
Q

medial elbow pain- structures most likely involved

A

PT
FCR

these are main tendons along the medial aspect of the elbow. When they are activated, they assist in minimizing valgus stress to the medial elbow region.

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6
Q

lateral epicondylitis- structures involved most to least

A

ECRB, EDC, ECRL, ECU

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7
Q

biceps brachii

A

short head: coracoid process of scap
long head: supraglenoid tubercle of scap
insertion: radial tuberosity, fascia of forearm

musculocutaneous C5-6

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8
Q

brachialis

A

distal half of anterior humerus -> coronoid process & ulnar tuberosity

musculocutaneous & radial nerve C5-7

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9
Q

pronator teres

A

ulnar head: coronoid process
humeral head: medial epicondyle

median nerve C6-7

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10
Q

Flexor carpi radialis

A

medial epicondyle -> base of 2nd MC

median nerve C6-7

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11
Q

palmaris longus

A

medial epicondyle->distal half of flexor retinac & apex of palmar aponeurosis

median nerve C7-8

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12
Q

flexor digitorum superficialis

A

humeroulnar head: medial epicondyle
radial head: superior half of anterior border of radius
-> shafts of middle phalanges

median nerve C7-T1

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13
Q

flexor digitorum profundus

A

meidal/lateral parts: proximal 3/4 of medial & anterior surfaces of ulnar & interosseous membrane
–> medial part: base of distal phalanges of 4/5th digits
lateral part: bases of distal phalanages of 2nd & 3rd digits

lateral half n: median nerve
medial half n: ulnar nerve
C7-8

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14
Q

flexor pollicis longus

A

anterior radius /interosseous membrane –> base of distal phalanx of thumb

median nerve C7-8

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15
Q

pronator quadratus

A

distal 1/4 ulnar –> distal 1/4 of radius

median nerve C7-8

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16
Q

flexor carpi ulnaris

A

humeral head: medial epicondyle
ulnar head: olecranon & posterior border
–> pisiform, hook of hamate, 5th MC

ulnar nerve C7-8

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17
Q

triceps brachii

A

long head: infraglenoid tubercle of scap
lateral head: posterior humerus superior to radial groove
medial head: posterior surface of humerus inferior to radial groove

–> proximal olecranon of ulnar and fascia of forearm

radial nerve C6-8

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18
Q

anconeous

A

lateral epicondyle –> lateral olecranon & superior posterior ulnar

radial nerve C6-8

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19
Q

brachioradialis

A

proximal 2/3 supracondylar ridge humerus –> lateral surface of distal radius proximal to styloid process

radial nerve C5-6

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20
Q

extensor carpi radialis longus

A

lateral supracondyle ridge humerus –> dorsal aspect of base of 2nd MC

radial nerve
C5-6

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21
Q

extensor carpi radialis brevis

A

latearl epicondyle–> dorsal aspect of 3rd MC base

radial nerve C7-8

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22
Q

supinator

A

lateral epicondyle, radial collateral & annular ligaments, supinator fossa, crest of ulna –> lateraal/post/anterior sufraces of proximal 1/3 of radius

radial nerve C6-7

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23
Q

extensor digitorum

A

lateral epicondyle –> extensor expansion of medial 4 digits
radial C7-8

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24
Q

extensor digiti minimi

A

lateral epicondyle

radial nerve C7-8

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25
Q

extensor carpi ulnaris

A

lateral epicondyle, posterior border of ulnar –> dorsal aspect of 5th MC

radial C7-8

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26
Q

abductor pollicus longus

A

radial nerve C7-8

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27
Q

ext pollicis longus

A

dorsal aspect of base of thumb insertion
radial nerve C7-8

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28
Q

xtensor pollicis brevis, ext pollicis brevis

A

radial nerve C7-8

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29
Q

abductor pollicus longus

A

median nerve C8-T1

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30
Q

opponens pollicis

A

flexor retinaculum of scaphoid, trapezium –> lateral side of 1st MC

median nerve C8-T1

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31
Q

flexor pollicis brevis

A

superficial head: median nerve
deep head: ulnar nerve
C8-T1

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32
Q

adductor pollicis

A

oblique & transverse heads

ulnar nerve C8-T1

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33
Q

abd digiti minimi

A

pisiform –> medial base of 5th phalanx

ulnar nerve C8-T1

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34
Q

flexor digiti minimi

A

hook of hamate/flexor retinaculum –> medial base of prox phalanx

ulnar nerve C8-T1

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35
Q

opponens digiti minimi

A

ulnar nerve C8-T1

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36
Q

lumbricals

A

1/2: lateral 2 tendons of FDS
3/4: medial 3 tendons of FDS
–> lateral sides of extensor expansions of digits 2-5

1/2: median nerve
2/3: ulnar nerve
C8-T1

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37
Q

dorsal interossei

A

adjacent sides of 2 MC –> base of prox phalanges, extensor expansions of digits 2-5

ABDuction

ulnar nerve C8-T1

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38
Q

palmar interossei

A

palmar surfaces of 2/4/5th MC –> bases of proximal phalanges, extensor expansions of digits 2/4/5

ADDuction

ulnar C8-T1

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39
Q

elbow fracture testing

A

elbow extension test SP/SN 1.0
supination test SP 0.97

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40
Q

lateral epicondyalgia findings, test

A

more common >40 yrs, 4x more in Men
pain with”
-palpation wrist extensor origin
-gripping
-passive wrist flexion
-resisted wrist extension

Cozens test

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41
Q

CPR for lateral epicondylitis

A

-Age >49
-affected side pain free grip >112 N (25.2lb)
-unaffected side pain free grip <335 N (75.3 lb)
-change in pain >25% following MWM

*1.0 sP if 3 variables present

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42
Q

medial epicondylagia test/findings

A

pain at wrist flexor, gripping
passive wrist extension, resisted wrist flexion

moving valgus test SN 1.0
press test (wrist) SN 1.0

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43
Q

Carpal tunnel special testing

A

wrist flexion-compression (SN .86, SP .95)
median nerve compression (SN 1, SP 0.97)
carpal compression test (.83 SN, .97 SP)
phalens .92 SP
ultrasound .94 SP

44
Q

carpal tunnel CPR

A

-shaking hands for symptoms relief
-wrist ratio index >0.67
-symptom severity scale >1.9
-reduced median sensory field of digit 1
-age >45

  • 3+ variables = SN .98
45
Q

C8 radiculopathy muscles effected

A

pronator quadratus
FDS
FDP

*all innervated by median nerve

46
Q

weakness of T1 nerve root- muscles affected

A

adductor pollicis
adductor pollicis brevis
opponens pollicis
flexor pollicis brevis
interossei
lumbricals 1 & 2

47
Q

posterior interosseous nerve- muscles

A

motor nerve only
part of deep branch of radial nerve

wrist extensors

48
Q

posterior interosseous entrapment vs C7 radiculopathy

A

C7 radiculopathy - would have weakness in: triceps, pronator teres, FCR
sensory deficits

posterior interosseous involvement: motor only, wrist extensors

49
Q

C8 radiculopathy- muscles affected

A

paresthesia at medial elbow, into 4-5th digit

weakness of: pronator quadratus, FDS, first 2 FDP

^all associated with median nerve

50
Q

Panners disease

A

disruption of growth plate of capitellum secondary to repetitive valgus force
<10 years old

*OCD- common in 10+ yrs

51
Q

UCL ligament branches

A

anterior, transverse oblique, posterior

52
Q

ulnar nerve entrapment site at elbow

A

cubital tunnel

53
Q

ulnar nerve entrapment site at wrist

A

guyons canal

54
Q

entrapment site for posterior interosseous nerve

A

arcade of Frohse

55
Q

lateral pivot shift test

A

test for posterolateral rotary instability

56
Q

kilo nevins syndrome

A

compression of anterior interosseous nerve - motor only nerve that leads patient unable to make OK sign

57
Q

pronator teres syndrome

A

compression of median nerve which leads to motor AND sensory deficits

58
Q

wartenbergs syndrome

A

superficial branch of radial nerve

-dorsal radial sensory nerve issue

-traction occurs with FA pronation, wrist flexion & UD
-compression occurs with FA pronation between ECRL & brachioradialis

-Finkelstein test

59
Q

posterior interossoeous nerve syndrome

A

deep branch of radial nerve

60
Q

trigger finger- annular pulley

A

A1 most commonly affected (second digit with compromised flexor tendon)

61
Q

UQS strength

A

C5 elbow flex
C6 wrist ext
C7 elbow ext
C8 finger flex
T1 hand instrinsics

62
Q

UCL - 3 bands

A

anterior
transverse/oblique
posterior

63
Q

carpal tunnel s/s

A

-pain/N/T in at least 2 digits of 1/2/3 and in palm or dorsum of hand
-thenar muscle atrophy
-Numbness but not tingling/weakness: SN 92
-Noctural pain: SN 94

64
Q

Colles fracture

A

distal radius & ulna with dorsal angulation, displacement & shortening

“dinner fork”

65
Q

carpal instability
VISI
DISI

A

-VISI- disruption between trapezoid & lunate, allowing volar drift of lunate
-problems with flexion

-DISI- disruption between scaphoid & lunate, allowing scaphoid to float into volar flexion
-dorsiflexion problems

66
Q

scapulounate angle
normal
VISI
DISI

A

normal = 30-60 deg

VISI < 30
DISI >70

SL gap <3 mm

67
Q

-tendinopathy vs tenosynovitis

A

-tendinopathy- resisted test most painful
-tenosynovitis – stretch test most painful

68
Q

Flexor carpi radialis injury findings

A

-full/swollen thenar eminence
-MOST pain with resisted test: wrist flexion and radial deviation

-wrist flexion activities- guitar, tennis

69
Q

ulnar nerve compression at wrist- special test

A

froments sign - add pollicis brevis weakness, excess thumb flexion with pinching

first dorsal interossei strength

70
Q

lateral UCL

A

-NOT a strong stabilizer but helps prevent PLRI posterior lateral rotary instability

-lateral epico –> proximal ulnar

taut in both flexion & extension

limit valgus from 0-140

*pain most with extension + supination

71
Q

medial UCL

A

-bundles: anterior, posterior, intermediate (aka transverse)

-if you have instability, can cause pain laterally

-anterior – restrains pronation of ulna on humerus-test at 30-40 deg as this is most unstable is anterior is injured

test in pron,supination and moving valgus stress test

72
Q

pathway, entrapment of radial nerve

A

across lateral elbow, ECRL innervated before it splits. Deep portion becomes posterior interosseous nerve to innervate rest of extensors. Superficial portion becomes dorsal radial sensory nerve

most common entrapment: -arcade of frohse tendinous portion of supinator

supinator, ECRB, fascia superficial to HRJ

73
Q

Posterior lateral rotatory instability (PLRI)

A

MOI: dislocation- combo of valgus and supination with axial compression (hand planted) during flexion

74
Q

radial tunnel syndrome

A

-localized tenderness over radial nerve, approx. 5cm distal to lateral epicondyle
-typically pain at night that may interfere with sleeping; arm fatigue common
-symptoms increase with use of tennis elbow strap
-ECRB & supinator will compress nerve with elbow in extension+pronation+wrist flexion

75
Q

cubital tunnel syndrome

A

-Tinel test
-Elbow flexion test- pressure on ulnar nerve with elbow in terminal flexion
-scratch collapse test- resist ER, medial elbow is stroked, then retest ER
+ test Is sudden loss in strength
-neurodynamic test- fingers over eye (nerve glide position- owl or waiter

-ulnar nerve T8/C1 passes through at medial elbow

76
Q

elbow capsular pattern

A

greater loss of flexion:extension at 4:1 ratio

77
Q

Most commonly dislocated carpal

A

-lunate

prone to pathology- keinbocks, CAN, lunatomalacia

78
Q

Carpal Bone anatomy

A

SLTPTTCH
Some Lovers Try Positions
That They Cannot Handle

Radial-> Ulnar
Proximal-> Distal

Scaphoid
Lunate
Triquetrum (important TFCC attachment)
Pisiform (sesamoid for FCU)
Hamate (ulnar nerve/a/v under hook)
Capitate (largest)
Trapezoid
Trapezium

79
Q

Mallet finger

A

injury to DIP extensor tendon
avulsion at base of DIP
DIP “drooping”

80
Q

Game keepers/ skiiers thumb

A

UCL injury
acute or chronic hyperextension
causing weakened grasp/pinch of thumb

81
Q

Galeazzi Fracture

A

distal radius fracture & dislocate ulnar head from wrist

82
Q

Swan neck deformity

what is it
treatment

A

finger stuck in DIP flexion & PIP hyper extension

FDS tendon glide

83
Q

monteggia

A

proximal ulnar & dislocate radial head

84
Q

night stick fracture

A

mid ulna

85
Q

greenstick fracture

A

incomplete fracture due to young flexible bones (other bones too but common in forearm)

86
Q

scapulounate angle
normal
VISI
DISI

A

normal = 30-60 deg

VISI < 30
DISI >70

SL gap <3 mm

87
Q

nursemaids elbow

A

dislocated radial head. most common elbow trauma in peds 2-4 years

88
Q

elbow ossification sequence
CRITOE

A

capitulum 6 mo-2 yr
radial head 4-7 yr
Internal (medial) epicon
trochlea 7-10 yr
olecranon 6-12yr
ext (lateral) epicon 10-14 yr

complete by mid teens

89
Q

smith fracture

A

opposite of colles
distal fragment angled palmar or volarly
distal radius fracture

90
Q

tolar fracture

A

buckle/compression fracture usually in peds

91
Q

scaphoid fracture CPR

A

all 4 = 91% risk

Male
sport
anatomic snuffbox w/ ulnar deviation in 72 hr
scaphoid tubercle tenderness at 2 weeks

*NO fracture if NO pain with ulnar dev

92
Q

scaphoid fracture “cluster”

A

if all 3 = 100% SN
snuffbox tenderness
scaphoid tubercle tenderness
longitudinal compression

93
Q

boxers fracture

A

5th MC

94
Q

bennet fracture

A

1st MC (thumb)

95
Q

rolando fracture

A

MC base with 3 fragments

96
Q

boutonneire deformity
what is it
treatment

A

finger is in PIP flexion & DIP extension due to torn central slip

tx: DIP flexion with goal to maintain length of lateral bands

97
Q

TFCC components

A

articular disc
volar radioulnar ligament
extensor carpi ulnaris tendon
ulnar collateral ligament
meniscus homologue
dorsal radioulnar ligament

98
Q

after flexor tendon repair of digit, what type of splint should be applied

A

dorsal splint with wrist in 20 deg flexion
MCP in 50 flexion
IP in extension

99
Q

flexor tendon in which zone has poor px

A

zone II of hand is “no mans land”

100
Q

what is most common fractured carpal bone

A

scaphoid

101
Q

de quervains tenosynovitis

A

pain at base of thumb
turn your wrist, grasp anything or make a fist.

102
Q

Dupuytren contracture

A

one or more fingers to bend toward the palm of the hand.

103
Q

muscles innervated by median n

A

C6-7
pronator teres
FCR

C7-8
palmaris longus
FDS (C7-T1)
FDS lateral half
Flexor pollicis longus
pronator quadratus

C8-T1
abd pollicis brevis
opponens pollicis
lumbricals 1-2

104
Q

muscles innervated by ulnar nerve

A

C7-8
FDS medial half
FCU

C8-T1
flexor poll brevis deep head
add pollicis
abd digiti minimi
flexor digiti minimi brevis
opponens digit minimi
lumbricals 3/4
dorsal interossei
palmar interossei

105
Q

hand intrinsic muscles only innervated by median nerve

A

FOAL:
F: flexor pollicis brevis
O: opponens pollicis
A: abductor pollicis brevis
L: lateral two lumbricals

rest of hand by ulnar nerve

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