Elbow, wrist, hand Flashcards
Carrying angle of elbow
5 degrees for males
10-15 for females.
Allows forearm and hands to clear hips when walking.
Elbow flexion (ROM and muscle involved)
140-150
biceps brachii, brachialis, brachioradialis, coracobrachialis
Elbow extension (ROM and muscle involved)
0- -5
triceps brachii, anconeus
Elbow supination (ROM and muscle involved)
90
supinator, biceps brachii
Elbow pronation (ROM and muscle involved)
90
pronator teres, pronator quadratura
Ulnohumeral adduction and abduction
5
Wrist flexion (ROM and muscle involved)
80-90
flexor carpi radialis, flexor carpi ulnaris, palmares longus
Wrist extension (ROM and muscle involved)
70
extensor carpi redials longus and brevis, extensor carpi ulnaris
Wrist adduction (ROM and muscle involved)
30-40
flexor carpi ulnaris, extensor carpi ulnaris
Wrist abduction (ROM and muscle involved)
20-30
Flexor carpi radialis, extensor carpi radialis longus and brevis
C5 dermatome
lateral arm
C6 dermatome
lateral forearm and thumb
C7 dermatome
middle finger
C8 dermatome
medial forearm and little finger
T1 dermatome
medial arm
Principle governing the elbow joint
- SD is found in minor gliding movements of joints
- SD of ulnohumeral joint is usually primary and SD of radioulnar joint is secondary.
- Impaired function of any joint of the arm produces compensatory changes in nearby/distal joints.
Valgus stress test
arm slightly abducted and externally rotated. supinate forearm. slight medial directed values stress is applied to elbow.
+ test= pain/tenderness. increased laxity.
Indicates: sprained medial (ulnar) collateral ligament
Varus stress test
Arm slightly abducted and internally rotated. Elbow flexed to 15. slight lateral directed various stress is applied.
+ test= pain/tenderness, increased laxity.
Indicates: sprained lateral (radial) collateral ligament
Tinel test for ulnar nerve entrapment
Tap between olecranon and medial epicondyle in ulnar groove.
+ test= elicits tingling sensation down forearm.
Indicates: ulnar nerve entrapment/ cubital tunnel syndrome
Golfer’s elbow
Pain with resisted wrist flexion with elbow in full extension.
+ test= pain/tenderness around medial epicondyle.
indicates: medial epicondylitis
Tennis elbow
pain with resisted wrist extension with elbow in full extension.
+ test= pain/tenderness around lateral epicondyle
indicates: lateral epicondylitis
Olecranon Bursitis
bursa superficial to posterior elbow joint. Students elbow. Usually painless and ROM unaffected.
Little league elbow
group of problems related to stress of throwing in young athletes: medial apophysitis (childhood0, medial epicondyle avulsion fracture (teen), Medial collateral ligament tear (young adult)
Nuresmaids elbow
Annular ligament tear and or radial head subluxation from annular ligament. Pain with palpation of radial head.
Carpal tunnel syndrome
entrapment of median nerve at wrist.
Chronic cases develop atrophy of intrinsic muscles of hand (thenar).
Pt has grip weakness.
Tinel’s sign
indicates CTS.
Tap over transverse carpal ligament.
+ test= numbness/pain radiating to thumb, index and middle finger.
Phalen’s sign
Place dorsal aspects of patients hands together and force into wrist flexion. Hold for 60 seconds.
+ test= any reproduction of symptoms of paresthesia in distribution of median nerve.
Indicates: CTS
DeQuervain’s Tenosynovitis
Pain and inflammation from repetitive overuse of tendons in first dorsal compartment. Pt complain of dorsolateral wrist and thumb pain.
Posible inflammation sites: tendon sheath, abductor policies longus, extensor pollicis brevis
Finkelstein test
Pt makes a fist encompassing their thumb and ulnar deviate the wrist.
+ test= pain in first dorsal compartment (lateral wrist)
Indicates: DeQuervain’s syndrome
Ulnar Nerve Entrapment “handlebar palsy”
Ulnar nerve gets entrapped in Guyon’s canal.
Irritation leads to numbness, tingling, weakness and pain
Gamekeeper’s thumb/ skier’s thumb
Tear of ulnar collateral ligament of MCP. Due to hand position when killing game or falling on a ski pole. Pain on medial aspect of MCP
Ganglion Cyst
fluid filled sac along tendon sheath or joint capsule. contender (painless). Commonly found on dorsal of wrist.
Mallet finger
extensor tendon injury at DIP
Trigger finger
Inflammation and narrowing of flexor tendon sheath
Jersey finger
Avulsion of flexor digitorum profundus from fingertip
Dupuytren’s contracture
abnormal connective tissue thickening in the palmer fascia
Rheumatoid arthritis
Autoimmune inflammatory condition. inflammation of joints. chronic pain and deformity.
Osteoarthritis
Most common in 1st CMC joint, hands, knee, cervical or lumbar spine.
Signs: heerden’s nodes and Bouchard’s nodes.
Xray: joint space narrowing
Joint stiffness that lasts one hour after waking up
Colle’s fracture
Fracture of distal radius in the forearm with posterior and radial displacement of wrist and hand.
Smith’s fracture
Fracture of distal radius with ventral displacement
Boxer’s fracture
fracture of distal shaft of 5th metacarpal. usually due to punching solid surface.
Monteggia Fracture
Fracture of proximal ulna. dislocation of radial head.
Galeazzi fracture
fracture of distal radius, dislocation of ulna.
Nightstick fracture
isolated fracture of the mid shaft/distal ulna from a direct blow.
