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NPTE > Elbow/Wrist/Hand > Flashcards

Elbow/Wrist/Hand Flashcards

1
Q

Lateral Epicondylitis: mm involved

A

ECRB

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2
Q

Medial Epicondylitis: mm involved

A

FCR
Pronator Teres

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3
Q

Lateral Epicondylitis: key sxs

A

*P! with wrist extension.
-Agg by wrist + elbow ext (ECRB max excursion).
-Agg by radial deviation.
-Agg by finger ext.
-Grip strength decreased.
-ROM intact (but may be pain-limited).

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4
Q

Lateral Epicondylitis: MOI

A

Repeated wrist EXT

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5
Q

Medial Epicondylitis: MOI

A

Repeated wrist FLEX

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6
Q

Lateral Epicondylitis: special tests

A

P! with resisted middle finger ext.
-Cozen’s
-Mill’s
-Maudsley’s

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7
Q

Medial Epicondylitis: key sxs

A

*P! with wrist flexion.
-Agg by wrist ext + elbow ext + supination (pronator mass stretched).

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8
Q

Medial Epicondylitis: special tests

A

-P! with resisted pronation.
-P! with wrist flex.
-Reverse Cozen’s
-Reverse Mill’s

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9
Q

Cozen’s Test: procedure, purpose, (+)

A

Lateral Epicondylitis.
Forearm pronated, wrist ext, slight RD.
Resist wrist flex + UD.
(+) = P! in lateral epicondyle.

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10
Q

Reverse Cozen’s Test: procedure, purpose, (+)

A

Medial Epicondylitis.
Forearm supinated, wrist flex, slight RD.
Resist wrist ext + UD.
(+) = P! in medial epicondyle.

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11
Q

Mill’s Test: procedure, purpose, (+)

A

Lateral Epicondylitis.
PROM forearm pronation, wrist flex, elbow ext.
(+) = P! in lateral epicondyle.

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12
Q

Reverse Mill’s Test: procedure, purpose, (+)

A

Medial Epicondylitis.
PROM forearm supination, wrist ext, elbow ext.
(+) = P! in medial epicondyle.

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13
Q

Maudsley’s Test: procedure, purpose, (+)

A

Lateral Epicondylitis, Radial N involvement.
Forearm pronated.
Lift middle finger up.
Resist middle finger ext (don’t let me push down to the table).
(+) = weak, painful.

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14
Q

Olecranon Bursitis: pathophysiology & key sxs

A

“Student’ Elbow”
Inflammation of olecranon bursa.
Swelling on posterior elbow.
Posterior elbow pain & tender to pressure.
Agg by max elbow flex/ext.

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15
Q

Cubital Tunnel: nerve involved & key sxs.

A

Ulnar N compression.
-Paresthesia in digits 4+5.
-Pain in medial elbow, radiates down.
-Decreased grip strength.
-Agg by elbow flexion (most pressure in cubital tunnel).

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16
Q

Sxs of prolonged or severe Cubital Tunnel

A

Thenar atrophy.
Clawing.
Pinky abducts.

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17
Q

Cubital Tunnel Special Test

A

Tinel’s: tapping on cubital tunnel (medial epi) & along Ulnar N.
(+) pain or numbness in digits 4+5.
Most distal point where abnormal sensation is felt indicates “how far” N has regenerated.

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18
Q

Cubital Tunnel treatments

A

-Ulnar N glides.
-Stretch flexors & pronators.
-Avoid max elbow flexion.
-Orthosis with flexion block; or splint at 45 flex.

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19
Q

Pronator Syndrome: nerve involved & key sxs

A

Median N compression (at elbow or forearm).
-Pain in prox forearm.
-Agg by repetitive elbow motion & forearm pro/sup.
-Paresthesia in thenar, thumb, digits 2-4.
-Weakness of FPL & FDP & pronator teres.

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20
Q

Pronator Syndrome special test

A

P! with resisted pronation.
(+) Tinel’s at pronator teres.
(-) Tinel’s at wrist.
(-) Phalen’s.

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21
Q

How to differentiate Pronator Syndrome from Carpal Tunnel?

A

Pronator = thenar eminence tingling & paresthesia (this is not common with carpal).

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22
Q

Pronator Syndrome treatments

A

-Median N glides.
-STM to biceps, pronator teres, FDS.
-If irritable: posterior gutter orthosis (holds elbow at 90 flex).

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23
Q

Radial Tunnel: location, nerves involved, mm borders

A

-Located near radiohumeral joint.
-Radial N branches into superficial & deep.
-Deep Branch becomes PIN in the radial tunnel.
-Borders: ECRB, ECRL, supinator, brachioradialis.

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24
Q

Radial Tunnel Syndrome sxs

A

-Can occur w/ lateral epicondylitis (ECRB compressing PIN).
-Weakness in supinator & wrist/finger extensors.
-Point tenderness ~4cm distal to lateral epi.
-Agg by stretching Radial N: elbow ext, pronation, wrist flex.

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25
Q

Radial Tunnel Syndrome special tests

A

-P! with resisted supination.
-Rule out TOS & proximal N impingement.

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26
Q

Radial Tunnel Syndrome treatments

A

-Radial N glides.
-Stretching supinator & ECRB.
-Custom orthosis with wrist in extension.

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27
Q

Elbow fx: possible sites & initial medical interventions

A

-Distal Humerus: cast (2wk) then hinged brace. ORIF if bad.
-Radial Head: sling (1wk) & early AROM. ORIF if bad.
-Olecranon: typically requires ORIF.
-Capitulum/Trochlea: custom orthosis & early AROM.

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28
Q

Potential complication of elbow fractures & key sign

A

Heterotopic Ossificiation
Significantly impaired ROM & hard end feel.

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29
Q

What may increase risk of Heterotopic Ossification?

A

Aggressive ROM too early

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30
Q

UCL injury risks

A

-Pitching velocity & volume (overuse).
-Throwing mechanics (esp curveballs).
-Humeral Retrotorsion (due to GIRD).

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31
Q

UCL injury sxs & special tests

A

-Ulnar N paresthesia.
-Pain during cocking phase.
-UCL tender to palp.
(+) Tinel’s
(+) Valgus Stress

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32
Q

Valgus Stress Test procedure & purpose

A

UCL stability.
-Elbow in slight flex.
-Stabilize above elbow.
-Valgus force (pull outward) below elbow.
(+) excess motion & P!

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33
Q

Varus Stress Test procedure & purpose

A

RCL stability.
-Elbow in slight flex.
-Stabilize above elbow.
-Varus force (push inward) below elbow.
(+) excess motion & P!

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34
Q

Moving Valgus Stress Test procedure & purpose

A

UCL stability (functional).
-Sh abd 90, elbow max flex.
-PROM elbow ext + apply valgus force (quick movement).
(+) P! typically at greater elbow flex.

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35
Q

Modified Milking Maneuver procedure & purpose

A

UCL stability (functional).
-Elbow at 90, forearm supinated (thumbs up).
-Pull by thumb into shoulder ER while stabilizing elbow.
(+) reproduces symptoms.

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36
Q

Distal Biceps Tendon Rupture: MOI & presentation

A

-MOI: violent pull into ext while biceps active.
-Pop at moment of rupture.
-Middle aged men.
-Reverse Popeye deformity.
-Weakness of elbow flex + sup.
(+) Hook Test

37
Q

Hook Test procedure & (+)

A

-Sh abd 90, elbow 90.
-Supinate against resistance (not a break test).
-Hook finger to palpate for distal biceps tendon.
(+) = tendon cannot be felt.

38
Q

Distal Biceps Tendon Rupture treatments

A

Initial strengthening of triceps & shoulder.
Strengthen biceps later once ROM restored.

39
Q

Elbow capsular tightness pathophysiology & interventions

A

-Stiffness can happen quickly after immob, fx, surgery, etc.
-Serial casts or splinting (using creep).
Example: JAS splint = cranks into ext until stretch felt, hold there, crank more once it’s relaxed, continue.

40
Q

Myositis Ossificans: definition & common locations

A

-Same as HO, but specifically bone growing into mm.
-UE flexors & LE extensors.

41
Q

Myositis Ossificans: sxs

A

-Significant ROM decrease (often ext more affected than flex).
-Lymphedema.
-Weakness.
-Compression of neurovascular; paresthesia.

42
Q

Myositis Ossificans: treatment & prevention

A

-Avoid aggressive stretching/ROM after period of immobilization or trauma.
-Immob for a few days.
-Cryotherapy, RICE.

42
Q

Distal Radius Fractures: types, MOIs, & deformities

A

Colle’s: radius goes dorsal.
-MOI = FOOSH
-Dinner Fork deformity.

Smith’s: radius goes volar.
-MOI = fall on back of hand.
-Garden Spade deformity.

43
Q

Common causes of ulnar wrist pain

A

-TFCC ligament or disc tear.
-Degenerative (RA).
-ECU instability.
-FCU/FCR tendonitis.
-Ulnar Tunnel Syndrome: Ulnar N compression at Guyon’s Canal.

44
Q

Ulnar N Compression (wrist) special test & treatment

A

(+) Tinel’s at Guyon’s Canal.
Orthosis to maintain neutral wrist position.

45
Q

Scaphoid Fx: MOI & possible complication

A

-FOOSH + radial deviation.
-Avascular Necrosis (very likely if proximal part)

46
Q

Lunate Fx: MOI & possible complication

A

-FOOSH
-Avascular Necrosis

47
Q

Hamate Fx: MOI & presentation

A

-Force thru base of palm during forceful grip (racket sports, golf).
-Ulnar neuropathy.
-Flexor tendon rupture often also occurs.

48
Q

Carpal Fractures: which is most common?

A

Scaphoid most common.
Hamate kinda common.
Lunate rare.

49
Q

Carpal Fractures: treatment

A
  1. Long-term immob.
  2. Once cast removed, ROM & control edema.
  3. Strengthen once bone & ligament healed.
50
Q

Carpal Malalignment common patterns

A

Distal (DISI) vs. Volar Intercalated Segment Instability (VISI).
DISI = lunate abnormally extended.
VISI = lunate abnormally flexed.

51
Q

DISI causes…

A

Capitate displaces, creating gap btwn scaphoid & lunate.

52
Q

VISI causes…

A

Gap btwn lunate & triquetrum

53
Q

Scaphoid Shift Test purpose, procedure, & (+)

A

Integrity of scaphoid-lunate ligament & DISI.
Feel Scaphoid movement during RD/UD.
(+) = audible thunk when scaphoid relocates & subluxes.

54
Q

Ballotment Test purpose, procedure, & (+)

A

Integrity of lunate-triquetrum ligament & VISI.
Wiggle lunate & triquetrum back & forth dorsally & volarly.
(+) = pain.

55
Q

Structures within the Carpal Tunnel

A

Median N
Flexor Retinaculum
FPL
FDP
FDS

56
Q

Carpal Tunnel Syndrom key symptoms

A

-Paresthesia along Median N distribution (volar thumb & digits 2+3).
-No paresthesia in thenar eminence or palm (key sign of Pronator Syndrome).
-Later stages: thenar atrophy, loss of dexterity.

57
Q

Carpal Tunnel Syndrome risk factors

A

Repeated forceful gripping + wrist flex (typing, construction).

58
Q

Carpal Tunnel Syndrome special tests

A

(+) Tinel’s
(+) Phalen’s
(+) Carpal Compression

59
Q

Carpal Tunnel Syndrome treatment

A

Median N glides
Splint to maintain neutral wrist
FDS/FDP tendon glides

60
Q

Phalen’s Test procedure & (+)

A

Hold max wrist flex for 1min.
(+) = reproduces symptoms.

61
Q

Carpal Compression Test procedure & (+)

A

Apply direct pressure to Carpal Ligament for 30sec.
(+) = reproduces symptoms.

62
Q

Radial N Injury deformity

A

Wrist drop

63
Q

High vs Low Radial N Injury: key symptom to differentiate

A

Low = no sensory loss bc PIN is motor only.
High = sensory and motor loss.

64
Q

Ulnar N Injury deformity

A

Claw hand

65
Q

Thumb UCL injury MOI

A

Hyperext + radial deviation.
May be acute rupture (Skier’s Thumb) or chronic overuse (Gamekeeper’s Thumb).

66
Q

Thumb UCL Stress Test procedure & (+)

A

Valgus stress to MCP (push away from other fingers).
When thumb ext = assessing UCL + accessory ligament.
When thumb slightly flexed = assessing UCL only.
(+) = excess valgus.
>30deg = complete rupture.
>15deg = partial tear or sprain.

67
Q

Boutonniere Deformity: what does it look like & what causes it?

A

Flexed PIP
Extended DIP
Extensor tendon injury

68
Q

Swan Neck Deformity: what does it look like & what causes it?

A

Extended PIP
Flexed DIP
RA & cerebral palsy

69
Q

Mallet Finger: deformity & what causes it?

A

Flexed DIP
DIP tendon injury

70
Q

DeQuervain’s: involved structures, MOI, key sxs

A

APL & EPB
MOI = repeated UD + thumb abduction.
P! with UD.
P! with thumb flexion & adduction (stretching tendon).
(+) Finklestein’s Test

71
Q

Dupuytren’s Disease: deformity & pathophysiology

A

Digits 4+5 contracted in flex.
Fibrosis of fascia.

72
Q

Trigger Finger deformity & presentation

A

Flexed PIP + DIP.
Not completely stuck in a contracture, but difficult & painful to extend.
Popping/clicking when extending.

73
Q

Proximal RUJ Posterior Glide: procedure & promotes what motion?

A

Pronation.
Push posteriorly on radial head at elbow.

74
Q

Proximal RUJ Anterior Glide: procedure & promotes what motion?

A

Supination.
Push anteriorly on radial head at elbow.

75
Q

Distal RUJ Posterior Glide: procedure & promotes what motion?

A

Supination.
Supinate forearm, push down on radius at wrist.

76
Q

Distal RUJ Anterior Glide: procedure & promotes what motion?

A

Pronation.
Pronate forearm, push down on radius at wrist.

77
Q

Radiocarpal Dorsal glide: procedure & promotes what motion?

A

Wrist extension.
Move prox carpal row dorsally.
Stabilize radius/ulna.

78
Q

Radiocarpal Palmar glide: procedure & promotes what motion?

A

Wrist flexion.
Move prox carpal row palmarly.
Stabilize radius/ulna.

79
Q

Radiocarpal Radial glide: procedure & promotes what motion?

A

Ulnar Deviation.
Hand off edge of table, thumb up.
Stabilize radius/ulna.
Pull upward on prox carpal row (and slightly distally bc radial styloid in the way).

80
Q

Radiocarpal Ulnar glide: procedure & promotes what motion?

A

Radial Deviation.
Hand off edge of table, thumb up.
Stabilize radius/ulna.
Push down on prox carpal row (and slightly distally bc ulnar styloid in the way).

81
Q

Mid-Carpal Palmar Glide: procedure & promotes what motion?

A

Wrist extension.
Stabilize radius/ulna.
Push palmarly on distal carpal row.

82
Q

Mid-Carpal Dorsal Glide: procedure & promotes what motion?

A

Wrist flexion.
Stabilize radius/ulna.
Push dorsally on distal carpal row.

83
Q

Thumb CMC Radial Glide: procedure & promotes what motion?

A

Extension.
Hand positioned w/ thumb up.
Stabilize radius/ulna.
Glide 1st MCP towards radius.

84
Q

Thumb CMC Ulnar Glide: procedure & promotes what motion?

A

Flexion.
Hand positioned w/ thumb up.
Stabilize radius/ulna.
Glide 1st MCP towards ulna.

85
Q

Thumb CMC Palmar Glide: procedure & promotes what motion?

A

Adduction.
Hand positioned w/ palm down.
Stabilize radius/ulna.
Glide 1st MCP towards palm.

86
Q

Thumb CMC Dorsal Glide: procedure & promotes what motion?

A

Abduction.
Hand positioned w/ palm down.
Stabilize radius/ulna.
Glide 1st MCP dorsally.

87
Q

MCP & IP Dorsal Glide: procedure & promotes what motion?

A

Extension.
Stabilize proximal bone.
Glide distal bone dorsally.

88
Q

MCP & IP Palmar Glide: procedure & promotes what motion?

A

Flexion.
Stabilize proximal bone.
Glide distal bone palmarly.

NPTE (23 decks)

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