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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
extensor carpi ulnaris
lateral epicondyle, posterior border of ulnar --> dorsal aspect of 5th MC radial C7-8
26
abductor pollicus longus
radial nerve C7-8
27
ext pollicis longus
dorsal aspect of base of thumb insertion radial nerve C7-8
28
xtensor pollicis brevis, ext pollicis brevis
radial nerve C7-8
29
abductor pollicus longus
median nerve C8-T1
30
opponens pollicis
flexor retinaculum of scaphoid, trapezium --> lateral side of 1st MC median nerve C8-T1
31
flexor pollicis brevis
superficial head: median nerve deep head: ulnar nerve C8-T1
32
adductor pollicis
oblique & transverse heads ulnar nerve C8-T1
33
abd digiti minimi
pisiform --> medial base of 5th phalanx ulnar nerve C8-T1
34
flexor digiti minimi
hook of hamate/flexor retinaculum --> medial base of prox phalanx ulnar nerve C8-T1
35
opponens digiti minimi
ulnar nerve C8-T1
36
lumbricals
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
37
dorsal interossei
adjacent sides of 2 MC --> base of prox phalanges, extensor expansions of digits 2-5 ABDuction ulnar nerve C8-T1
38
palmar interossei
palmar surfaces of 2/4/5th MC --> bases of proximal phalanges, extensor expansions of digits 2/4/5 ADDuction ulnar C8-T1
39
elbow fracture testing
elbow extension test SP/SN 1.0 supination test SP 0.97
40
lateral epicondyalgia findings, test
more common >40 yrs, 4x more in Men pain with" -palpation wrist extensor origin -gripping -passive wrist flexion -resisted wrist extension Cozens test
41
CPR for lateral epicondylitis
-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
42
medial epicondylagia test/findings
pain at wrist flexor, gripping passive wrist extension, resisted wrist flexion moving valgus test SN 1.0 press test (wrist) SN 1.0
43
Carpal tunnel special testing
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
carpal tunnel CPR
-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
C8 radiculopathy muscles effected
pronator quadratus FDS FDP *all innervated by median nerve
46
weakness of T1 nerve root- muscles affected
adductor pollicis adductor pollicis brevis opponens pollicis flexor pollicis brevis interossei lumbricals 1 & 2
47
posterior interosseous nerve- muscles
motor nerve only part of deep branch of radial nerve wrist extensors
48
posterior interosseous entrapment vs C7 radiculopathy
C7 radiculopathy - would have weakness in: triceps, pronator teres, FCR sensory deficits posterior interosseous involvement: motor only, wrist extensors
49
C8 radiculopathy- muscles affected
paresthesia at medial elbow, into 4-5th digit weakness of: pronator quadratus, FDS, first 2 FDP ^all associated with median nerve
50
Panners disease
disruption of growth plate of capitellum secondary to repetitive valgus force <10 years old *OCD- common in 10+ yrs
51
UCL ligament branches
anterior, transverse oblique, posterior
52
ulnar nerve entrapment site at elbow
cubital tunnel
53
ulnar nerve entrapment site at wrist
guyons canal
54
entrapment site for posterior interosseous nerve
arcade of Frohse
55
lateral pivot shift test
test for posterolateral rotary instability
56
kilo nevins syndrome
compression of anterior interosseous nerve - motor only nerve that leads patient unable to make OK sign
57
pronator teres syndrome
compression of median nerve which leads to motor AND sensory deficits
58
wartenbergs syndrome
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
posterior interossoeous nerve syndrome
deep branch of radial nerve
60
trigger finger- annular pulley
A1 most commonly affected (second digit with compromised flexor tendon)
61
UQS strength
C5 elbow flex C6 wrist ext C7 elbow ext C8 finger flex T1 hand instrinsics
62
UCL - 3 bands
anterior transverse/oblique posterior
63
carpal tunnel s/s
-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
Colles fracture
distal radius & ulna with dorsal angulation, displacement & shortening "dinner fork"
65
carpal instability VISI DISI
-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
scapulounate angle normal VISI DISI
normal = 30-60 deg VISI < 30 DISI >70 SL gap <3 mm
67
-tendinopathy vs tenosynovitis
-tendinopathy- resisted test most painful -tenosynovitis – stretch test most painful
68
Flexor carpi radialis injury findings
-full/swollen thenar eminence -MOST pain with resisted test: wrist flexion and radial deviation -wrist flexion activities- guitar, tennis
69
ulnar nerve compression at wrist- special test
froments sign - add pollicis brevis weakness, excess thumb flexion with pinching first dorsal interossei strength
70
lateral UCL
-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
medial UCL
-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
pathway, entrapment of radial nerve
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
Posterior lateral rotatory instability (PLRI)
MOI: dislocation- combo of valgus and supination with axial compression (hand planted) during flexion
74
radial tunnel syndrome
-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
cubital tunnel syndrome
-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
elbow capsular pattern
greater loss of flexion:extension at 4:1 ratio
77
Most commonly dislocated carpal
-lunate prone to pathology- keinbocks, CAN, lunatomalacia
78
Carpal Bone anatomy
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
Mallet finger
injury to DIP extensor tendon avulsion at base of DIP DIP "drooping"
80
Game keepers/ skiiers thumb
UCL injury acute or chronic hyperextension causing weakened grasp/pinch of thumb
81
Galeazzi Fracture
distal radius fracture & dislocate ulnar head from wrist
82
Swan neck deformity what is it treatment
finger stuck in DIP flexion & PIP hyper extension FDS tendon glide
83
monteggia
proximal ulnar & dislocate radial head
84
night stick fracture
mid ulna
85
greenstick fracture
incomplete fracture due to young flexible bones (other bones too but common in forearm)
86
scapulounate angle normal VISI DISI
normal = 30-60 deg VISI < 30 DISI >70 SL gap <3 mm
87
nursemaids elbow
dislocated radial head. most common elbow trauma in peds 2-4 years
88
elbow ossification sequence CRITOE
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
smith fracture
opposite of colles distal fragment angled palmar or volarly distal radius fracture
90
tolar fracture
buckle/compression fracture usually in peds
91
scaphoid fracture CPR
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
scaphoid fracture "cluster"
if all 3 = 100% SN snuffbox tenderness scaphoid tubercle tenderness longitudinal compression
93
boxers fracture
5th MC
94
bennet fracture
1st MC (thumb)
95
rolando fracture
MC base with 3 fragments
96
boutonneire deformity what is it treatment
finger is in PIP flexion & DIP extension due to torn central slip tx: DIP flexion with goal to maintain length of lateral bands
97
TFCC components
articular disc volar radioulnar ligament extensor carpi ulnaris tendon ulnar collateral ligament meniscus homologue dorsal radioulnar ligament
98
after flexor tendon repair of digit, what type of splint should be applied
dorsal splint with wrist in 20 deg flexion MCP in 50 flexion IP in extension
99
flexor tendon in which zone has poor px
zone II of hand is "no mans land"
100
what is most common fractured carpal bone
scaphoid
101
de quervains tenosynovitis
pain at base of thumb turn your wrist, grasp anything or make a fist.
102
Dupuytren contracture
one or more fingers to bend toward the palm of the hand.
103
muscles innervated by median n
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
muscles innervated by ulnar nerve
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
hand intrinsic muscles only innervated by median nerve
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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