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General Orthopedics > Elbow, Wrist, Hand > Flashcards

Elbow, Wrist, Hand Flashcards

1
Q

Describe the symptoms of lateral epicondylitis (Writer’s cramp/tennis elbow)

A
  • progressively worsening dull ache of proximal elbow
  • numbness or tinging of the hand
  • radiating pain down the distal forearm
  • aggravated by repetitive tasks - wrist extension and lifting
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2
Q

Clinical tests for lateral epicondylitis

A
  • positive chair lift test
  • cozen
  • positive hand shake
  • pain on palpation 2cm anterior and distal to the lateral epicondyle’s center
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3
Q

What indicates poor prognosis of lateral epicondylitis

A

if pain not alleviated when repeated with elbow in 90 degrees

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4
Q

What causes medial epicondylitis (golfer/little league elbow)

A
  • overuse of wrist flexors
  • repetitive throwing, curling wrist during weight lifting, carpentry and other occupational
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5
Q

Describe the symptoms of medial epicondylitis

A
  • pain with movement and making a fist
  • weakness of wrist and hand
  • tingling and numbness of ring and 5th finger
  • stiffness, edema, erythema of elbow
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6
Q

clinical test for medial epicondylitis

A
  • supinate and extend wrist while extending the elbow
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7
Q

which nerve might be compressed in medial epicondylitis

A

ulnar nerve

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8
Q

What is a bursa?

A

Synovial cavity over boney prominences when the overlying skin is subject to friction and pressure

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9
Q

Describe the presentation of olecranon bursitis

A

swelling, pain over the posterior elbow

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10
Q

Describe the two different types of olecranon bursitis and their incidence

A
  • septic - 30%
  • aseptic - 70%
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11
Q

Describe the three causes of aseptic olecranon bursitis

A
  • idiopathic
  • traumatic
  • crystal induced
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12
Q

Describe the symptoms of aseptic olecranon bursitis

A
  • painless ROM
  • peribursal edema and warmth
  • no systemic complaints
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13
Q

Describe the symptoms of septic olecranon bursitis

A
  • fever, chills,
  • history of abrasion
  • pain of bursal sac
  • edema
  • erythema
  • warmth
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14
Q

What are the 2 MOI for radial head and neck fracture

A
  • falling onto outstretched pronated hand - resists elbow dislocation and produces a valgus load, drives forearm posterior to the upper arm
  • falls with direct hit to elbow - produces fractures of olecranon and distal humerus
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15
Q

How to diagnose radial head and neck fracture

A
  • x-ray
  • CT scan
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16
Q

Are radial head and neck fractures benign?

A

no - will result in loss of terminal extension, instability, loss of strength, arthritis and neurovascular injury

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17
Q

Describe the carpal tunnel

A

made up of carpal bones which form a C shaped ring dorsally and the transverse carpal ligament volarly attaching to the scaphoid and trapezium radially and pisiform and hook of the hamate ulnarly

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18
Q

Describe the contents of the carpal tunnel

A

median nerve and nine flexor tendons

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19
Q

Clinical tests for carpal tunnel syndrome

A
  • phalen maneuver
  • reverse phalen maneuver
  • tinnel sign
  • thenar atrophy
  • light touch
  • two-point discrimination
  • decreased sweat patterns
20
Q

Differential diagnosis for carpal tunnel

A
  • C6-C7 radiculopathy
  • pronator teres syndrome
  • forearm compression of medial nerve
  • polyneuropathy -
21
Q

Diagnostic tests for carpal tunnel

A

x-ray
lab work
EMG-NCV

22
Q

which test confirms carpal tunnel

A

EMG-NCV

23
Q

What are the 3 treatment options for carpal tunnel

A
  • eliminate specific medial conditions
  • conservative - only 25% long term relief with injection of ulnar bursa
  • surgery
24
Q

what are the indications for surgery for carpal tunnel

A
  • acute progressive condition following trauma
  • persistent progressive symptoms
  • two-point discrimination greater than 7mm
  • weakness of abductor pollicis brevis
25
Q

What is De Quervain Tendinitis

A

Stenosing tenosynovitis of the first extensor compartment - considered entrapment tendinitis

26
Q

What are the clinical symptoms of De Quervain Tendinitis

A
  • localized swelling
  • tenderness
  • prominent tendon sheath
  • ganglion
  • limited wrist ROM especially ulnar deviation
27
Q

How to diagnose De Quervain Tendinitis

A
  • Finkelstein: make a fist around the deviate the wrist
  • Hitch hiker sign: abduct the thumb against resistance
  • Brunelli test: active abduction of thumb with wrist in radial deviation
  • Thumb grinding to rule out OA at the carpo metacarpal joint
  • X-ray
  • MRI
28
Q

Differentials for De Quervain tendinitis

A
  • JV
  • Mocking bird
  • intersection syndrome
29
Q

Stenosing Flexor Tenosynovitis - “trigger finger” presentation

A
  • achy tender nodule on the metacarpal head at the palm
  • inability to smoothly flex or extend the digit
  • morning stiffness of one or more fingers
  • achy palm
  • symptoms can progress to severe pain, triggering and the inability to fully extend the finger
30
Q

Etiology of trigger finger

A

Tenosynovitis of superficial and deep flexor tendons leading to:
- nodular thickening on the distal edge of the A1 pulley
- diffuse thickening of the tenosynovium

31
Q

Exam for trigger finger

A
  • lump at the metacarpal head
  • triggering or locking
  • x-ray for:
    • trauma
    • thumb involvement as degenerative changes are found
32
Q

What is Dupuytren Contracture

A
  • progressive fibrosis and contracture of the palmar fascia
33
Q

Describe the clinical findings of Dupuytren Contracture

A
  • Thick longitudinal cords with skin dimpling
  • Loss of full extension
  • MCPJ, PIPJ stiffness
  • Rarely painful
  • B/L involvement starting on the ulnar side
  • Web space contracture thumb-index web’-
34
Q

Clinical exam for Dupuytren Contracture

A
  • skin dimpling over flexor tendons exaggerated by passive extension
  • nodules over the flexor tendons
  • thickening of the palm
  • decreased extension
  • flexion contracture - “the claw” ***
35
Q

At which joint is finger dislocation most common?

A

PIPJ

36
Q

Describe the MOI for a finger dislocation

A
  • hyper extension - injury of the velar plate and collateral ligaments
  • less forceful ligaments sprain: jammed finger
  • severe: capsule and tendon avulsion
37
Q

Describe the how finger dislocation happens

A

Dorsal translation
- Volar plate rupture
- central slip rupture of extensor tendon (attachment to base and middle phalynx)
- rotary subluxation (by looking at the nails in the same plane)
- instability

38
Q

What are some things to look for during finger dislocation evaluation

A
  • extensor or flexor avulsion and/or collateral damage
  • rupture of flexor profundus tendon at the base of distal phalynx
39
Q

Which ligament is usually ruptured in thumb dislocation

A

Ulnar collateral ligament
- radial collateral injury in 10-25% of injuries

40
Q

What are the most common finger avulsion fractures

A
  • avulsion of the volar plate at phalynx base
  • avulsion of the extensor at dorsal base of phalynx
41
Q

When do you do an open reduction for a finger dislocation?

A
  • if its non reducible due to soft tissue interposition or patient is a few days late in presentations
  • unstable joint after reduction due to collateral ligament laxity
  • complex fracture
  • volar dislocation with loss of complete extension
42
Q

What are diffuse enlargement of the DIPJ due to idiopathic OA of the hand called?

A

Heberden nodes

43
Q

What are diffuse enlargement of the PIPJ due to idiopathic osteoarthritis in the hand called

A

Bouchard nodes

44
Q

Which joints does erosive OA affect and which does it spare?

A

Affect the DIPJ and PIPJ
Spares the MCPJ

45
Q

What are some classic x-ray signs for heberden nodes

A
  • Joint narrowing
  • osteophytes formation
  • sclerosis
  • subchondral cysts
46
Q

What is the most common joint in the hand dot be affected by OA

A

CMCJ
- it is a saddle joint with low intrinsic stability which makes it able to move in flexion, extension, abduction and opposition
-

47
Q

What are the 4 stages of OA

A

1 - effusion
2 - narrowing <2mm and osteophytes
3 - narrowing >2mm and osteophytes
4 - pan trapezoidal arthritis

General Orthopedics (5 decks)

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