Elbow, Wrist, & Hand

Question 1

Pain referral pattern of scalenes

Answer 1

• Medial border of scapula crossing the spine of scapula
• Posterior lateral aspect of upper arm
• Anterior lateral aspect of upper arm with two hot spots on the chest
• Back of the thumb and index fingers

Question 2

Pain referral pattern on infraspinatus

Answer 2

• Slightly underneath the medial border of the scapula
• Lateral deltoid
• Anterior shoulder into center of upper arm

Question 3

Pain referral pattern of teres major

Answer 3

• Posterior deltoid
• Slight on the posterior forearm
• Almost nothing on the anterior side of body/arm

Question 4

Anterior elbow conditions

Answer 4

• Capsule strain
• Biceps tendinopathy
• Pronator syndrome
• Joint OA, RA, Gout, Loose body

Question 5

Posterior elbow conditions

Answer 5

• Triceps tendinopathy
• Olecranon bursitis/stress Fx
• Posterior impingement
• OA

Question 6

Lateral elbow conditions

Answer 6

• Lateral epicondyalgia
• Osteochonral defect/Plica
• Radial tunnel/posterior IO nerve
• Posterolateral rotation instability

Question 7

Medial elbow conditions

Answer 7

• Medial epicondylitis
• UCL, Valgus extension overload
• Cubital tunnel
• Anterior interosseous nerve

Question 8

Normal elbow ROM

Answer 8

• Flexion: 140º
• Pronation: 75º
• Supination: 80º

Question 9

Illness crept of olecranon fractures

Answer 9

• ~ 10% of all UE Fx
• Young high energy injuries versus elderly low energy injuries from falls
• Posterior elbow pain
• Palpation able to locate a defect
• Unable to fully extend (elbow extension test)

Question 10

Illness script for elbow dislocation

Answer 10

• young 10-20 y/o
• After shoulder elbow is most common dislocation
• Posterior dislocation is most common
• MOI: axial load in supination with extended elbow combined with a valgus posterior-lateral force

Question 11

Management of an elbow dislocation

Answer 11

• Closed reduction, immobilization in 90º flexion for 1-2 wks then mobilize
• If immobilized 3+ wks then extension block is likely outcome
• Complications: elbow dislocation with Fx or conoid or radial head, elbow instability due to LCL/MCL tears (fix with surgery ORIF + reconstruction)

Question 12

Illness script for wrist fractures

Answer 12

• Younger due to high energy & older due to FOOSH
• Females affected more than males

Question 13

Describe a Die-Punch fracture

Answer 13

• Depressed fracture of the lunate fossa of the articular surface of the distal radius

Question 14

Describe a Barton’s fracture

Answer 14

• Fracture-dislocation of radoiocarpal joint with intra-articular Fx involving the solar or dorsal lip

Question 15

Describe a Chauffer’s fracture

Answer 15

• Radial styloid fracture

Question 16

Describe a Colle’s fracture

Answer 16

• Low energy
• Dorsally displaced (normal FOOSH)
• Extra-articular fracture

Question 17

Describe a Smith’s fracture

Answer 17

• Low energy
• Volarly displaced (FOOSH on back of hand)
• Extra-articular fracture
• Spade like

Question 18

Describe the elbow extension test

Answer 18

• Raise bilateral shoulders to 90º flexion
• Ask patient to fully extend elbows including locking out (hyperextension)
• If unable to hyperextend possible olecranon fracture

Question 19

Describe Kumer’s sign

Answer 19

• Screening test for median, radial, & ulnar nerves
• Radial: extend wrist
• Ulnar: ABD the middle, ring, & little finger (dorsal interossei)
• Median: oppose the thumb & 1st finger (FPL & FDP of 1st finger)

Question 20

Stopped on slide 18 for notes