Elbow/ wrist/ hand

Question 0

Components of UCL and ROM with most stress at each band

Answer 0

Anterior band: the strongest, Todd from full extension to 60° of flexion
Posterior band taught from 60 to 100° of flexion
Transverse band a.k.a. Cooper’s ligament variably present

Question 1

The Trochlea and it’s effect on the carrying angle

Carrying angle males and females

Answer 1

Trochlea extends more distantly then lateral consuls

Female = 13° to 60° male = 11° to 14°

Question 2

RCL components and range of motion that most stress each component

Answer 2

Annular ligament: stabilizes PRUJ
Radio portion: taut through flexion and extension
Ulnar portion taught through both flexion and extension provide stability to humeral owner joint
Accessory portion: assists RCL and stabilizing the annular ligament against Varus stress, variably present

Question 3

Radial head’s influence on stability for valgus stress

Answer 3

With UCL insufficiency Radial head plays a strong role as a stabilizer to valgus stress

Question 4

Terrible Triad of the elbow

Answer 4

Posterior elbow dislocation with Radial head fracture in a coronoid fracture

Question 5

Nerve injury and elbow dislocation

Answer 5

Ulnar and median nerve injuries more common with simple dislocations

Radial nerve injury more common with complex dislocations involving the radial head

Question 6

Goals of nonoperative management of a simple dislocation

Answer 6

First: achieve stable joint immediate functional mobility is recommended
Secon:d if joint is unstable immobilization for less than 14 days

Question 7

Five considerations for elbow dislocation

Answer 7

One – timing
Two – articulations involved
Three – direction of displacement
Four – degree of displacement
Five – presence or absence of fractures

Question 8

Three core principles of operative management elbow fracture

Answer 8

One – restoration of integrity of humeralulnar joint
Two – restoration of Radial head position
Three – repair of collateral ligaments

Question 9

Post surgical plan of care for terrible Triad injury

Answer 9

Immobilization – at 90° for 0 to 10 days
Active range of motion- begin between three and 15 days postoperatively
Strengthening – begin at eight weeks/when radiograph indicates fx healed

Question 10

Radial head fracture three Common mechanisms of injury

Answer 10

Ask your road on a pronated forearm, direct blow to the elbow, hyper flexion injury

Question 11

Indications for a total elbow arthroplasty

Answer 11

Advanced age, low physical demand, chronic instability, advanced rheumatoid arthritis, posttraumatic osteoarthritis, ankylosis of the elbow, stiffness, functional range of motion last, and pain

Question 12

Heterotropic ossificans in three conditions that contribute to its formation

Answer 12

The appearance of ectopic bone in the para particular soft tissues

Osteogenic precursor cells, inducing agents, and a permissive environment

Question 13

Indications for operative management of elbow stiffness

Answer 13

Failure of nonoperative management, chronic contracture present for up to 12 months, and lack of functional range of motion

Question 14

Three mechanisms of injury for RCL

Answer 14

Elbow dislocation, varus elbow stress or iatrogenic cause

Question 15

Presentation of our RCL or PLRI injury

Answer 15

Vague about his comfort, lateral elbow pain, clicking, snapping, or clicking it is worse with supination of the forearm

Question 16

Special tests for posterolateral rotary instability

Answer 16

Lateral pivot shift of the elbow, push-up sign, chair sign, press up maneuver

Question 17

Phases of throwing with most strain on UCL

Answer 17

Late cocking/cocking to the acceleration phases

Question 18

Special Tests for UCL insufficiency

Answer 18

Moving valgus stress test – SN = 1.0, SP = .75

Milking test
Valgus stress test

Question 19

Little leaguers elbow risk factors

Answer 19

Number pitches thrown in the game, less than 25 pitches increased elbow injury to 21% 75 to 99 pitches increased risk to 35%

Question 20

Valgus extension overload syndrome definition, testing, and signs

Answer 20

Compression of the olecranon against humerus with a valgus stress generating a posterior medial impingement

Milking maneuver with elbow flexed to 90°

Flexion contracture, painful active extension with crepitus, passive range of motion painful and pronation valgus and extension
Tenderness to palpation at posteromedial olecranon

Question 21

Indications for ucl surgical intervention

Answer 21

Chronic instability, failure of nonoperative rehab, continued pain, sense of movement in elbow with valgus loads, inability to return to previous level of function

Question 22

Rehabilitation of UCL reconstruction

Answer 22

First one to two weeks range of motion restriction with hinged brace, strengthening introduced after 4 to 6 weeks, throwing not introduced until after four months, not allowed to return to sport until 9 to 12 months

Question 23

Risk factors for lateral tendinosis

Answer 23

35 to 50 years of age, female, high levels of physical work on a low social support at work, workers belonging to a profession classified as strenuous

Question 24

Special tests for medial and lateral tendinopathy

Answer 24

Medial – palpation of the medial epicondyles, grip strength, passive positioning test

Lateral – isometric contraction of wrist extension, grip strength, cozen test, mill test, three finger resistance test, handshake test

Question 25

Nonoperative management of elbow tendinopathy recommendations of evidence

Answer 25

Manual therapy – Mulligan mobilizations, cervical manual therapy
Exercise – eccentric, progressive exercises
Soft tissue mobilization- marginal evidence
Bracing/orthotics – short-term relief
Modalities – short-term relief
Corticosteroid injection- short-term relief
Low level laser – moderate benefit
Shockwave therapy- little or no benefit

Question 26

Special test for distal biceps tendon rupture

Answer 26

Hook test – SN/SP equals 1.0

Biceps crease interval test – SN = .92, SP = 1.0

Question 27

Cluster for cervical spine radiculopathy

Answer 27

Cervical spine active range of motion limited in rotation towards involved side
Cervical spine distraction decrease in symptoms
Sperling’s test increase his symptoms
Upper limb tension test difference of greater than 10° elbow extension between extremities

Four out of four = 90% possibility
Three out of four= 65%

Question 28

Cubital tunnel syndrome mechanisms of injury

Answer 28

Traction, long-standing valgus deformity, or strained postures of flexion contracture

Question 29

Patient education for nonoperative management of Cubital tunnel syndrome

Answer 29

Avoid activities of elbow flexion greater than 90°, excessive use of wrist and finger flexion, position of valgus stress at elbow

Question 30

Special test for cubital tunnel syndrome

Answer 30

Tinel test at cubital tunnel – Sn = .70, SP = .98

Elbow flexion test – Sn = .75, SP= .99

Question 31

Clinical presentation of pronator versus anterior interosseous syndromes

Answer 31

Pronator syndrome – pain volar proximal forearm/sensory changes on Palmar surface/weakness of thumb, index, middle/positive compression at pronator border

Interior interosseous syndrome – pain volar proximal forearm/no sensory symptoms in finger/weak flexor pollicis longus, lateral flexor digitorum profundas, thenar sparing/negative compression at pronator border

Question 32

Clinical presentation of radial tunnel syndrome

Answer 32

Deep aching distal to lateral epicondyles, pain at belly at brachioradialis, pain with resisted supination, pain with repetitive wrist flexion/pronation, No motor or sensation loss

Question 33

Clinical presentation of posterior interosseous syndrome

Answer 33

Lateral forearm elbow pain, wrist extension with radio deviation, weakness of finger extensors, extension elicits pain at lateral epicondyle, no sensation loss

Question 34

Clinical presentation of osteochondritis desiccans

Answer 34

Swelling, limited range of motion and extension, lesser loss of range of motion flexion/supination/pronation and tenderness to palpation at radiocapitular joint

Question 35

Five Ps of compartment syndrome

Answer 35

Pain, pallor, pain with passive stretch of muscles, paresthesias, pulselessness

Pulse will typically be present until and stage of syndrome

Question 36

Pronator syndrome versus anterior interosseous syndrome

Answer 36

Pronator syndrome – paid volar proximal forearm, sensory changes on Palmar surface, weakness of thumb index middle, positive compression at pronator border

AIN – pain volar proximal forearm, no sensory symptoms, weakness flexor pollicius longus/ lateral flexor digitorum profundus, thenar sparing, negative compression pronator border

Question 37

Spontaneous recovery time for AIN syndrome

Answer 37

12 months – therefore surgical intervention will not be administered until after this

Question 38

Compression sites for AIN

Answer 38

Bicipital aponeurosis, accessory head of the FPL, palmaris profundus muscle, or FCR muscle

Question 39

Radio tunnel syndrome versus PIN syndrome

Answer 39

RTS – deep ache distal to lateral epicondyle, pain at belly brachioradialis, pain with resisted supination, pain with repetitive flexion and pronation, no loss of motor or sensory

PIN – lateral forearm elbow pain, wrist extension with radial deviation, pain at lateral epicondyle with extension, no sensation loss

Question 40

Differential diagnosis of lateral tendinopathy versus RTS

Answer 40

Consider RTS with failure for armband with increase in symptoms and loss of grip strength

Hi correlation between the two diagnoses

Question 41

Indications for surgical intervention for carpal tunnel syndrome

Answer 41

Conservative treatment not affective in three months, thenar atrophy, Simmons Weston monofilament testing exceeds 3.16