Elbow, Wrist, Hand (Exam 4)

Question 1

Repetitive overuse at lateral epicondyle. Especially extensor carpi radialis brevis tendon. Pain with palpation at lateral epicondyle. Pain with active and resistive wrist extension. Occasionally with grasping.

Answer 1

Lateral Epicondylitis “Tennis Elbow”

Question 2

Decrease pain and swelling. If no relief, may have steroid injection.

Answer 2

Acute Management of Tennis Elbow

Question 3

To dissipate the overload forces on the lateral epicondyle.

Answer 3

Brace Tennis Elbow Treatment

Question 4

Removal of angiofibroblastic tissue at lateral epicondyle.

Answer 4

Surgery Tennis Elbow Treatment

Question 5

Medial epicondyle. Less common than lateral epicondylitis by 7 to 1. Pain with palpation, active motion resisted wrist flexion, full passive wrist extension.

Answer 5

Meidal Epicondylitis “Golfer’s Elbow”

Question 6

Transverse fracture distal 1/3 humerus. Frequent, usually in children.

Answer 6

Supracondylar Fractures

Question 7

Usually closed reduction and immobilization 4-6 weeks.

Answer 7

Treatment for Supracondylar Fractures

Question 8

Nonunion, malunion, joint contractures, Volkmann’s ischemic contracture.

Answer 8

Possible Complications

Question 9

Fall or direct trauma. Injuries that extend between the condyles of the humerus and involve articular surfaces.

Answer 9

Intercondylar “T” or “Y”

Question 10

Fall on outstretched arm. 1/3 of all elbow fracture and 20% of all elbow trauma. Increased valgus deformity and varus elbow malalignment called “gunstock deformity”.

Answer 10

Radial Head Fracturess

Question 11

Direct: fall landing on olecranon. Indirect: forceful contraction of triceps.

Answer 11

Olecranon Fractures

Question 12

2nd most frequently dislocated. Radial head fracture in 10%. Neuromuscular injuries a concern.

Answer 12

Elbow Dislocation

Question 13

Hyperextension trauma. Likely injury to ligaments and other soft-tissue that will need to heal.

Answer 13

Posterior Elbow Dislocation

Question 14

Entrapment compression neuropathy of median nerve within wrist. Usually due to cumulative trauma (overuse injury).

Answer 14

Carpal Tunnel Syndrome (CTS)

Question 15

Repetitive motion injury/cumulative trauma disorder. Tendons of abductor pollicis longus and extensor policis brevis at first dorsal compartment.

Answer 15

DeQuervain’s Tenosynovitis

Question 16

Distal radius fractures within 1 inch of wrist with dorsal displacement of fragment. Middle-aged and elderly women most common. Generally closed reduction and rigid immobilization if only minimally displaced and stable. ORIF or external fixation if comminuted and unstable.

Answer 16

Colles Fracture

Question 17

Chronic progressive ideas characterized by severe pain, swelling, and changes in the skin. Type of Complex Regional Pain Syndrome. Cause: Unknown.

Answer 17

Reflex Sympathetic Dystrophy (RSD)

Question 18

Usually fall on dorsal aspect of hand with distal radial fragment displaced in palmar (volvar) direction.

Answer 18

Smiths Fracture

Question 19

Ability to heal spontaneously depends on location. Most common carpal bone fractured 60%. Fall with wrist hyperextended with ulnar deviation.

Answer 19

Scaphoid (Navicular) Fracture

Question 20

Acute sprain ulnar collateral ligament of thumb. Sudden valgus stress and hyperextension of the thumb.

Answer 20

Skier’s (Game Keepers) Thumb

Question 21

Grade I and II. Skier’s Thumb.

Answer 21

Partial Tears

Question 22

Grade III. Skier’s Thumb.

Answer 22

Complete Rupture

Question 23

2nd, 3rd, 4th, or 5th metacarpal fracture. Higher incidence of fracture among fighters.

Answer 23

Boxer’s Fractures (Fighter’s Fracture) Metacarpal Fractures

Question 24

Fracture of the 1st metacarpal which extends into the CMC joint. Often occurs with punching.

Answer 24

Bennett’s Fracture

Question 25

Disease process of palmar fascia where contracture develop progressively. Develop immature type III collagen. Generally not painful. Men over 40. 45% of cases are bilateral.

Answer 25

Dupuytren’s Contracture

Question 26

Tendon rupture or avulsion fracture of extensor tendon. Results in DIP flexion contracure. Usually direct trauma to distal phalanx.

Answer 26

Mallet Finger

Question 27

Direct trauma to terminal phalanx. Rupture or stretch of central extensor tendon at PIP joint. Causes PIP flexion with DIP extension.

Answer 27

Boutonniere Deformity

Question 28

_____ tendon injury more common.

Answer 28

Extensor

Question 29

_____ tendon injury more complicated and challenging.

Answer 29

Flexor

Question 30

Which elbow dislocation is the most common?

Answer 30

Posterior

Question 31

Pain Medial Epicondylitis (Golfer)

Answer 31

Palpation, active motion resisted wrist flexion, full passive wrist extension.

Question 32

Pain Lateral Epicondylitis (Tennis)

Answer 32

Palpation, active or resistive wrist extesion, occasionally grasping.