Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinic - Common Conditions Overview > Elbow, Wrist & Hand > Flashcards

Elbow, Wrist & Hand Flashcards

1
Q

What are the red flags for elbow, hand and wrist pain?

A

Fracture

  • trauma (including FOOSH)
  • exquisite point tenderness

Infection:

  • fever
  • night sweats
  • open wound / exposure to infection / underlying disease process / immunocompromised

Malignancy:

  • over 50
  • Hx malignancy
  • unexplained weight loss
  • failure to improve
  • vomiting

CVD (DVT)

  • unilateral UL oedema
  • unilateral UL fatigue / heaviness
  • unilateral UL discolouration
  • visible veins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the signs of an upper limb DVT?

A

Unilateral:

  • UL pain
  • UL fatigue
  • UL heaviness
  • UL oedema
  • UL discolouration
  • visible veins
  • SOB / dyspnoea
  • palpitations / tachycardia
  • fatigue
    (systemic signs exacerbated by activity)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the signs of a fracture in the wrist, hand or elbow?

A
  • traumatic onset (including FOOSH)
  • sharp pain on impact
  • oedema
  • bruising

Exquisite point tenderness:

  • over snuffbox (scaphoid)
  • over distal radius (wrist)
  • over elbow joint line (elbow)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 4 serious conditions that need to be considered in elbow, wrist or hand pain?

A

DVT
Malignancy
Osteomyelitis
Fracture (carpals, wrist, elbow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the 3 major soft tissue pathologies that need to be considered in elbow, wrist or hand pain?

A

De Quervain’s
Medial epicondylitis
Lateral epicondylitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the major PROMs that can be used in a case of elbow, wrist or hand pain?

A
  • DASH (disabilities of the arm, shoulder and hand) or Quick DASH
  • UEFI (upper extremity functional index)
  • BCTQ (Boston Carpal Tunnel Questionnaire)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are 6 neurological conditions that need to be considered in elbow, wrist or hand pain?

A 
Cx radiculopathy
Thoracic outlet syndrome
Median nerve neuropathy
Radial nerve neuropathy
Ulnar nerve neuropathy
Carpal tunnel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 4 hand signs that can be used to quickly screen for peripheral nerve function?

A
  1. Peace sign (ulnar)
  2. Thumbs up (radial)
  3. Fist (median)
  4. OK (median - anterior interosseous)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 3 major bony injuries that can be caused by a FOOSH?

A

Scaphoid fracture
Distal radial fracture
Elbow dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the presentation of a scaphoid fracture including mechanism, pathology, presentation and prognosis

A

Mechanism: FOOSH

Pathology:
- fracture of scaphoid bone, can also cause necrosis of scaphoid by damaging arterial supply to bone

Presentation:

  • deep, dull aching pain over snuffbox
  • pain agg. by pinching, gripping, palpation over scaphoid
  • oedema / bruising

Findings:

  • increased pain with passive and active movements
  • pain on palpation
  • pain with grip
  • decreased strength gripping / squeezing

Prognosis:

  • referral for imaging
  • surgical fixation and immobilization 6-12 weeks to avoid risk of scaphoid necrosis and achieve healing
  • full recovery expected, can increase risk of OA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the presentation of a distal radial fracture, including mechanism, pathology, findings, and prognosis

A

Mechanism:

  • FOOSH
  • sharp pain and maybe audible or tangible snap at onset

Pathology:

  • fracture of distal radius
  • Colle’s fracture (over-extension of wrist) or Smiths fracture (over flexion of wrist)

Presentation:

  • visible deformity
  • oedema / bruising
  • sharp pain with wrist movement
  • may have numbness or an inability to move hand

Findings:

  • increased pain and decreased motion with passive and active wrist movements, esp. supination
  • point tenderness at radial head

Prognosis:

  • referral for imaging
  • immobilization and fixation 6-12 weeks
  • full recovery expected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the condition of an elbow dislocation, including mechanism, pathology, presentation, findings and prognosis

A

Mechanism:

  • FOOSH
  • traumatic impact to elbow (valgus, varus, hyperextension)

Pathology:

  • dislocation of humeroulnar and/or humeroradial joints
  • can injure nerves and arteries passing around elbow joint

Presentation:

  • sharp pain and popping sensation at onset
  • visible deformity
  • oedema / bruising
  • pain with elbow movements and elbow palpation
  • elbow instability

Findings:

  • pain with elbow movements and palpation
  • need to do peripheral CVD and UL neuro: may have vascular or neuro deficits if vessels around elbow injured (numbness, coldness, motor deficit)

Prognosis:

  • immobilization for 1-3 weeks
  • ligaments will not fully heal but return to function expected within 4-8 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which medical tests need to be conducted in a suspected elbow dislocation?

A

Peripheral vascular
UL neuro

(injury can damage nerves or blood vessels around elbow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are risk factors for De Quervain’s tenosynvitis?

A
  • overuse of thumb abduction with radial deviation (racquet sports, golfing, phone use, musicians, office workers)
  • previous injury
  • arthritis
  • pregnant or post-partum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which tendons are affected in De Quervain’s tenosynovitis?

A

EPB (extensor pollicis brevis)

APL (abductor pollicis longus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the condition of De Quervain’s including mechanism, pathology, presentation, findings and prognosis

A

Mechanism:

  • usually an overuse injury of the thumb caused by repetitive abduction and radial deviation (this compresses the EPB and APL tendons against the styloid process)
  • can also be caused by trauma, scar formation, or inflammatory arthritis

Pathology:
- inflammation of EPB and APL tendons as they pass under the extensor retinaculum reduces space in tunnel, if untreated inflammation and progressive stenosis can cause permanent scarring

Presentation:

  • pain over radial wrist
  • insidious becoming constant
  • agg by: thumb abduction, gripping, ulnar deviation

ADLs:
- difficulty gripping, lifting and twisting with hand

Findings:

  • oedema at snuffbox
  • pain at radial styloidi process
  • decreased strength and increased pain in resisted isometric thumb abduction, thumb extension, grip and radial deviation

Tests:

  • WHAT
  • Finkelsteins

Prognosis:

  • return to activity 4-6 weeks
  • requires relative rest and may need splinting
17
Q

Which 5 tendons attach to the common flexor origin at the medial epicondyle?

A 
Flexor carpi radialis
Pronator teres
Palmaris longus
Flexor carpi ulnaris
Flexor digitorum superficialis (humeral head)
18
Q

Which 4 tendons attach to the common extensor origin at the lateral epicondyle?

A

Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor carpi ulnaris
Extensor digitorum

19
Q

Describe the pathology of medial and lateral epicondylitis, and the findings and prognosis for each

A

Mechanism:
- chronic overuse of forearm flexors (medial) or extensors (lateral)

Risk factors:
- overuse at work or sport, manual professions, diabetes, heavy lifting

Pathology:
- inflammation of tendons can cause degeneration, and irreparable fibrosis, thickening and calcification if untreated

Presentation:

  • insidious onset pain becoming persistent
  • pain over medial or lateral epicondyle

Medial:

  • pain agg. by wrist flexion, carrying, gripping
  • decreased strength grip, wrist flexion, pronation
  • decreased ROM elbow and forearm

Lateral:

  • pain agg. by wrist extension, elbow extension
  • decreased strength elbow extension, elbow flexion, finger grip, finger extension
  • decreased ROM wrist flexion, ulnar deviation, pronation, finger extension

Prognosis:

  • 90% have full recovery within 1 year non-surgically
  • reduce inflammation 2 weeks - 4 months
  • rehab and return to activity 2 weeks - 2 years
20
Q

What are the healing timeframes and prognosis for lateral and medial epicondylitis?

A
  • 90% achieve full recovery within 1 year non-surgically
  • return to activity can take anywhere from 2 weeks to 2 years depending on degree of inflammation and tendon degeneration
21
Q

What are the contents of the carpal tunnel?

A

Median nerve
4 x FDS tendons
4 x FDP tendons
1 x flexor pollicis longus tendon

22
Q

What are the two most common sites of compression for the ulnar nerve, and which aspects of the hand does the ulnar nerve supply?

A

Compression sites:

  • cubital tunnel (medial elbow)
  • ulnar tunnel (Guyon’s canal, medial wrist)

Cutaneous hand:
- medial one and a half digits and corresponding area of skin over hand (hypothenar eminence and same area dorsally)

Motor:

  • flexor carpi ulnaris
  • flexor digitorum profundus (medial half)
  • intrinsic muscles of hand (except thenar mm and 2 lateral lumbricals)
23
Q

What are the 3 most common sites for median nerve compression, and what is the motor and cutaneous supply of the motor nerve?

A

Compression sites:

  • carpal tunnel
  • between two heads of pronator teres
  • anterior interosseous compartment

Cutaneous:

  • palmar surface of hand, except lateral one and a half digits and corresponding area of palm / dorsum
  • dorsal tips of digits 1-3

Motor:

  • anterior forearm (except FCU and median half of FDP)
  • thenar mm and lateral 2 lumbricals
24
Q

What is the most common site of compression for the radial nerve, and what is the motor and cutaneous supply of the radial nerve?

A

Compression:

  • radial tunnel (anterior to proximal radius, between heads of supinator)
  • compression of posterior interosseous branch only

Motor:
- posterior forearm

Cutaneous:
- dorsal surface digits 1-3 (except tips)

25
Q

Which peripheral nerves supply cutaneous innervation to which areas of the hand?

A

Ulnar:
- lateral one and a half digits and corresponding areas of skin (palmar and dorsal)

Median:

  • palmar surface (except hypothenar eminence and medial one and a half digits)
  • dorsal tips of digits 1-3

Radial:
- dorsum of hand (except medial one and a half digits and corresponding area of skin, and tips of digits 1-3)

26
Q

Which peripheral nerves provide motor innervation to the forearm and hand?

A

Radial:

  • posterior forearm
  • dorsum of hand

Ulnar:

  • FCU and medial half of FDP
  • intrinsic hand mm (except thenar and lateral 2 lumbricals)

Median:

  • anterior forearm (except FCU and medial half of FDP)
  • thenar mm
  • lateral 2 lumbricals
27
Q

Describe the conditions of ulnar nerve compression including mechanism, pathology, presentation, findings and prognosis

A

Mechanism:

  • cubital tunnel compression can b caused by leaning on elbow for prolonged periods, inflammation or bursitis in elbow or elbow trauma
  • Guyon’s canal compression can be caused by leaning on wrist for prolonged periods (ie: typing), compression caused by inflammation (arthritis, diabetes, pregnancy), cyst or dislocation

Pathology:
- compression of ulnar nerve at the cubital tunnel (elbow) or Guyon’s canal (wrist)

Findings:

  • sensory deficit / paraesthesia digits 4-5 and skin over hypothenar eminence and corresponding area of dorsum
  • atrophy intrinsic mm hand / hypothenar eminence
  • ‘claw’ posture dig 4-5

Tests:

  • ULNT3
  • Tinel’s

Prognosis:

  • 90% have SSX resolution in 2-3 months without surgery
  • relative rest and may need splinting
28
Q

Describe the conditions of carpal tunnel syndrome, pronator teres syndrome and anterior interosseous syndrome including mechanism, pathology, presentation, findings and how to differentiate between the conditions, and prognosis

A

Pathology:
- compression of the median nerve in the carpal tunnel, between the heads of the pronator teres in the forearm, or in the anterior interosseous compartment of the forearm

Mechanism:

  • carpal tunnel: overuse and associated hypertrophy / inflammation of tendons in the carpal tunnel (FDP, FDS and flexor pollicis longus)
  • pronator teres syndrome: overuse and associated hypertrophy of pronator teres (weight lifting, gripping, medial epicondylitis)
  • anterior interossous syndrome: often secondary to elbow dislocation / fracture or biceps tendon bursitis

Differentiating:

  • if sensory deficits present: carpal tunnel or pronator teres (not anterior interosseous)
  • carpal tunnel: sensory in digits 1-3 only
  • pronator teres: sensory in digits 1-3 and thenar eminence

Motor:

  • clumsiness / weakness / difficulty with fine movements in thumb and fingers (all)
  • pain resisted pronation (pronator teres only)
  • can’t form OK sign (anterior interosseous only)
  • positive pinch test (anterior interossous only)

Tests:

  • carpal compression
  • Tinel’s
  • ULNT1
  • Phalen’s

Prognosis:
- 90% have resolution non-surgically within 2-3 months and return to activity within 4-6 weeks

29
Q

How can you differentiate between compression of the median nerve at the carpal tunnel, in pronator teres syndrome, and in anterior interossous syndrome?

A

Anterior interosseous:

  • motor only (no sensory)
  • can’t form OK sign
  • positive pinch test

Carpal tunnel:

  • sensory in digits 1-3 but not thenar eminence
  • positive carpal compression test

Pronator Teres:

  • sensory in digits 1-3 and thenar eminence
  • increased pain isometric resisted pronation
30
Q

Describe the presentation of radial tunnel syndrome including pathology, mechanism, presentation, findings and prognosis

A

Pathology:
- compression of anterior interossous nerve in radial tunnel (between heads of supinator)

Mechanism:
- overuse of supinator mm, inflammation or trauma

Presentation:

  • lateral elbow pain (dull, aching)
  • agg by: elbow and wrist extension, elbow traction, forearm pronation, wrist flexion, finger extension

Findings:

  • paraesthesia digits 1-3
  • decreased strength finger extension, wrist extension, thumb abduction, grip
  • altered triceps and brachioradialis reflexes
  • tenderness over supinator
  • pain with wrist flexion, resisted pronation, resisted supination, resisted extension dig 3

Tests:

  • Cozens
  • ULNT2
  • Tinels (supinator)

Prognosis:
- resolution in 3 months

31
Q

Which nerve roots are tested in the biceps, triceps and brachioradialis reflexes?

A

Biceps and brachioradialis C5-6

Triceps C7-8

Clinic - Common Conditions Overview (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions