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PCM I Midterm > Elbow/Wrist/Hand > Flashcards

Elbow/Wrist/Hand Flashcards

1
Q

What is the normal carrying angle of the elbow?

A

5-15 degrees

[cubitus varus = less than 5, cubitus valgus = greater than 15]

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2
Q

Normal ROM for elbow flexion

A

140-150

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3
Q

Normal ROM for elbow extension

A

0 to -5

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4
Q

Normal ROM for elbow supination

A

90

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5
Q

Normal ROM for elbow pronation

A

90

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6
Q

What 3 muscles are tested during elbow flexion strength testing?

A

Biceps brachii m.
Brachialis m.
Brachioradialis m.

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7
Q

What 2 muscles are tested during strength testing in elbow extension?

A

Triceps brachii m.

Anconeus m.

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8
Q

What 2 muscles are tested in elbow supination strength testing?

A

Supinator

Biceps brachii

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9
Q

What 2 muscles are tested during elbow pronation strength testing?

A

Pronator teres m.

Pronator quadratus m.

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10
Q

What nerve root is tested with biceps reflex testing?

A

C5

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11
Q

What nerve root is tested with brachioradialis reflex testing?

A

C6

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12
Q

What nerve root is tested with triceps reflex testing?

A

C7

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13
Q

What are the 3 muscle reflexes that can be tested in the upper extremity?

A

Biceps (C5)
Brachioradialis (C6)
Triceps (C7)

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14
Q

What are the dermatomes associated with the upper extremity?

A

C5-T1

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15
Q

What are the 2 primary ligaments associated with the elbow that are tested for stability?

A

Medial (ulnar) collateral ligament

Lateral (radial) collateral ligament

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16
Q

Describe the following test including positive test and what this would indicate:

Valgus stress test

A

Arm slightly abducted and externally rotated; forearm supinated and flexed. Slight medial directed valgus stress is applied to elbow joint

+ test = pain/tenderness with palpation and valgus stress; increased laxity

Indicates: Sprained medial (ulnar) collateral ligament

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17
Q

Describe the following test including positive test and what this would indicate:

Varus stress test

A

Arm slightly abducted and internally rotated; elbow flexed. Slight varus stress applied to elbow joint

+ test = pain or increased laxity in LCL

Indicates: Sprained lateral (radial) collateral ligament

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18
Q

Describe the following test including positive test and what this would indicate:

Tinel Test for ulnar nerve entrapment

A

Tap between the olecranon and medial epicondyle in the ulnar groove

+ test = eliciting tingling sensation down forearm within ulnar nerve distribution

Indicates: ulnar nerve entrapment/cubital tunnel syndrome

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19
Q

What compartment of the arm is affected in Golfer’s elbow?

What is the technical term for this condition?

A

Anterior forearm/flexor compartment

Medial epicondylitis

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20
Q

What compartment of the arm is affected in Tennis elbow?

What is the technical term for this condition?

A

Posterior forearm/extensor compartment

Lateral epicondylitis

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21
Q

Describe the following test including positive test and what this would indicate:

Golfer’s elbow test

A

Patient’s elbow is flexed to 90 and forearm is placed in supination with the wrist neutral and palm facing up

Examiner places one hand under proximal forearm for stabilization, the other over patient’s wrist to resist movement. Instruct patient to flex the wrist

+ test = pain/tenderness around medial epicondyle

Indicates: Medial epicondylitis

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22
Q

Describe the following test including positive test and what this would indicate:

Tennis elbow test

A

Patient’s elbow flexed to 90 and forearm is placed in pronation with wrist neutral and palm facing down

Examiner places one hand under proximal forearm for stabilization and the other hand over the patient’s hand to resist movement. Instruct patient to extend the wrist

+ test = pain/tenderness around lateral epicondyle; may radiate down lateral forearm

Indicates: Lateral epicondylitis

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23
Q

Where is the olecranon bursa located?

A

Superficial to posterior elbow joint

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24
Q

What condition is characterized by posterior elbow distension and discomfort due to overuse, occupational, or athletic injury?

A

Olecranon bursitis

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25
Q

Describe the pain and ROM associated with an olecranon bursitis

A

Region is often painless and ROM is normal

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26
Q

What specific problems are associated with “Little League Elbow” as they pertain to different age groups?

A

Childhood = medial apophysitis

Adolescence = medial epicondyle avulsion fracture

Young adulthood = medial collateral ligament tear

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27
Q

What is the most common elbow injury during childhood and why?

A

Little League Elbow = medial apophysitis

The growth plate is not fused; secondary ossification centers absent

28
Q

What are the symptoms of Little League Elbow?

A

Pain over the medial epicondyle, initially after throwing (repetitive valgus distraction forces), progresses to persistent pain

29
Q

Radial head instability and/or Nursemaid’s Elbow occur with what type of injury?

A

Annular ligament tear and/or radial head subluxation from annular ligament

30
Q

What are the symptoms of radial head instability and/or Nursemaid’s elbow?

A

Pain with palpation of radial head with anterior displacement of the radial head, and restriction to posterior glide

31
Q

What coupled motions are present at the ulna and radius with supination of the elbow?

A

Ulnar adduction

Radial head anterior glide

32
Q

What coupled motions are present at the ulna and radius with pronation of the elbow?

A

Ulnar abduction

Radial head posterior glide

33
Q

Normal ROM for flexion of the wrist

A

80-90

34
Q

Normal ROM for extension of the wrist

A

70

35
Q

Normal ROM for adduction of the wrist

A

30-40

This is ulnar deviation

36
Q

Normal ROM for abduction of the wrist

A

20-30

This is radial deviation

37
Q

What is the coupled movement associated with wrist flexion?

A

Dorsal/poterior carpal glide

38
Q

What is the coupled movement associated with wrist extension?

A

Ventral/anterior carpal glide

39
Q

What is the coupled movement associated with wrist adduction?

A

Ulnar abduction

40
Q

What is the coupled movement associated with wrist abduction?

A

Ulnar adduction

41
Q

What muscles can you strength test with wrist flexion?

A

Flexor carpi radialis

Palmaris longus

42
Q

What muscles can you strength test with wrist extension?

A

Extensor carpi radialis longus

Extensor carpi radialis brevis

43
Q

What muscles can you strength test with wrist adduction?

A

Flexor carpi ulnaris

Extensor carpi ulnaris

44
Q

What muscles can you strength test with wrist abduction?

A

Flexor carpi radialis
Extensor carpi radialis longus
Extensor carpi radialis brevis

45
Q

What strength tests can you perform on the hand?

A

Hand grip strength

Thumb (flexon/extension, abduction/adduction, opposition)

Fingers (flexion/extension, abduction/adduction)

46
Q

Sensory testing of the dorsal lateral hand and lateral part of the thumb involves which nerve?

A

Radial n.

47
Q

Sensory testing of the dorsal distal phalanges 2, 3, and part of 4 are what nerve?

A

Median n.

48
Q

Sensory testing of the dorsal medial hand and digits 5 and part of 4 are what nerve?

A

Ulnar n.

49
Q

Sensory testing of the palmar aspect of the hand including phalanges 1, 2, 3, and part of 4 are what nerve?

A

Median n.

50
Q

Sensory testing of the lateral palmar hand including digits 5 and part of 4 are what nerve?

A

Ulnar n.

51
Q

What nerve is the “OK” sign test meant for? What muscles does this nerve innervate?

A

Anterior interosseus nerve (motor branch of median nerve)

Innervates flexor pollicis longus, deep flexors of digits 2 and 3, and pronator quadratus

52
Q

What is a positive “OK” sign test?

A

On examination, if neuropathy is present in the anterior interosseus branch of the median n., the patient cannot make an “O” with thumb and forefinger pinched together

53
Q

Carpal Tunnel Syndrome results from entrapment of what nerve at the wrist, producing pain and paresthesias?

A

Median n.

54
Q

Describe the following test including positive test and what this would indicate:

Tinel’s sign for CTS

A

Tap over the transverse carpal ligament between thenar and hypothenar eminences with patient’s wrist held in extension

+ test = paresthesias/numbness/tingling/pain radiating to thumb, index, and middle finger

Indicates: CTS

55
Q

Describe the following test including positive test and what this would indicate:

Phalen’s sign

A

Place dorsal aspects of patient’s hands together and force into wrist flexion; hold for 30-60 seconds

+ test = any reproduction of symptoms/paresthesias in distribution of median n.

Indicates: CTS

56
Q

Describe the following test including positive test and what this would indicate:

Allen test

A

Evaluates functioning of radial and ulnar aa.

Occlude both aa. while patient makes a fist. Have patient open and close fist; palm should be pale

Release pressure on ulnar a. and observe for color return to hand within 5-10 seconds. Repeat with radial a.

Indicates: Lack of dual blood supply to hand (negative indication for radial catheterization)

57
Q

What condition is characterized by pain and inflammation from repetitive overuse of tendons in the first dorsal compartment; patient’s typically complain of dorsal-lateral wrist and thumb pain, occasionally with radiation into lateral hand and thumb

A

DeQuervain’s tenosynovitis

58
Q

What are some possible inflammation sites associated with DeQuervain’s tenosynovitis?

A

Tendon sheath
Abductor pollicis longus
Extensor pollicis brevis

59
Q

Describe the following test including positive test and what this would indicate:

Finkelstein Test

A

Examiner asks patient to make a fist encompassing their thumb and ulnar deviate the wrist

+ test = increased pain in first dorsal compartment/lateral wrist

Indicates: DeQuervain’s tenosynovitis

60
Q

What is the most commonly fractured carpal bone? What is this usually due to?

A

Scaphoid

Usually due to falling out outstretched hand = FOOSH

61
Q

What are some of the symptoms of a scaphoid fracture?

A

Dull achiness deep in radial aspect of wrist after a fall

Decreased ROM, decreased grip strength, tenderness in anatomical snuff box

62
Q

Why is it important to diagnose and treat scaphoid fractures quickly?

A

Risk of avascular necrosis secondary to blood supply solely entering at distal end

63
Q

Describe Colle’s fracture

A

Fracture of distal radius in forearm with dorsal (posterior) displacement

64
Q

Describe Monteggia fracture

A

Fracture of proximal ulna

Dislocation of radial head

65
Q

Describe Galeazzi fracture

A

Fracture of distal radius

Dislocation of ulna

66
Q

Describe nightstick fracture

A

Isolated fracture of mid shaft of the ulnar from a direct blow

PCM I Midterm (5 decks)

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