Elbow, Wrist, Hand Exam

Question 1

Elbow Observation/Palpation

Answer 1

Olecranon process
Medial epicondyle
Lateral epicondyle
Radial head
Wrist flexors and pronators
Wrist extensors and supinator so
Nodules, swelling, scars

Question 2

Elbow ROM

Answer 2

Flexion: 140-150 degrees (biceps brachii, brachialis, brachioradialis)
Extension: 0 - (-5) degrees (triceps, brachii, anconeus)
Supination: 85-90 degrees (supinator, biceps brachii)
Pronation: 85-90 degrees (pronators teres, pronators quadratus)

Question 3

Elbow Ligamentous Stability

Answer 3

Medial (ulnar) Collateral Ligament
- valgus stress test (pain/tenderness with palpation and valgus stress, increased laxity) - injury to UCL

Lateral (radial) Collateral Ligament
- varus stress test (pain or increased laxity of LCL) - injury to LCL

Question 4

Tinsel Test (Elbow)

Answer 4

Ulnar nerve entrapment
Eliciting tingling sensation down forearm within ulnar nerve distribution

Indicates: ulnar nerve entrapment, cubital tunnel syndrome

Question 5

Golfer’s Elbow Test

Answer 5

Medial epicondylitis
Pain/tenderness around medial epicondyle
Anterior forearm/flexor compartment

Question 6

Tennis Elbow Test (Cozen’s Test)

Answer 6

Lateral epicondylitis
Pain/tenderness around lateral epicondyle, may radiate down lateral forearm
Posterior forearm/extensor compartment

Question 7

Olecranon Bursitis

Answer 7

Superficial to posterior elbow joint
Posterior elbow distention and discomfort due to overuse (“students elbow”) or occupational (“miners elbow”) or athletic injury
Region is often main less and range of motion is normal

Question 8

“Little League Elbow”

Answer 8

Childhood = medial apophysitis
Adolescence = medial epicondyle avulsion fracture
Young adulthood = medial collateral ligament tear

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

Question 9

Radial Head Instability

“Nursemaid’s Elbow”

Answer 9

Annular ligament tear and/or radial head subluxation from annular ligament
Pain with Palpation of radial head with anterior displacement of radial head and restriction to posterior glide

Question 10

Coupled Motions at Elbow

Answer 10

Ulnar adduction + supination
Ulnar abduction + pronation

Radial head anterior glide + supination
Radial head posterior glide + pronation

Question 11

Wrist/Hand Observation/Palpation

Answer 11

Palmar and dorsal wrist
Thenar and hypothenar eminences
Flexor tendons
Distal radius and ulna (styloid processes)
Anatomic "snuffbox" and carpal bones
MCP, PIP, DIP

Question 12

Wrist/Hand ROM

Answer 12

Flexion: 80-90 degrees (flexor carpi radialis, palmaris longus) - coupled w/ dorsal/posterior carpal glide

Extension: 70 degrees (extensor carpi radialis longus and brevis) - coupled w/ ventral/anterior carpal glide

Adduction (ulnar deviation): 30-40 degrees (flexor and extensor carpi ulnaris) - coupled w/ ulnar abduction

Abduction (radial deviation): 20-30 degrees (flexor carpi radialis, extensor carpi radialis longus and brevis) - coupled w/ ulnar adduction

Question 13

Wrist/Hand Strength Testing

Answer 13

Hand grip strength
Thumb: Flexion/extension, abduction/adduction, opposition
Finger: Flexion/extension, abduction/adduction

Question 14

“Ok” Sign

Answer 14

Anterior interosseous nerve
Can't make an "O" with thumb and forefinger pinched together
Flexor pollicis longus
Deep flexors of digits 2 and 3
Pronators quadratus

Question 15

Carpal Tunnel Syndrome

Answer 15

Entrapment of median nerve at resist in carpal tunnel
Pain and parasthesias

Tinel’s Sign (parasthesias/numbness/tingling/pain radiating to thumb, index, and middle finger)

Phalen’s Sign (reproduction of symptoms/parasthesias in distribution of median nerve)

Allen Test (color return in hand greater than 10-15 secs) - function of radial and ulnar arteries

Question 16

DeQuervain’s Tenosynovitis

Answer 16

Pain and inflammation from repetitive overuse of tendons in first dorsal compartment
Dorsal-lateral wrist and thumb pain occasionally with radiation into lateral hand and thumb

Finkelstein Test (increased pain in first dorsal compartment/lateral wrist)

Inflammation sites: abductor pollicis longus, extensor pollicis brevis

Question 17

Scaphoid Fracture

Answer 17

Most common carpal bone fracture from a FOOSH injury
Dull achiness deep in radial aspect of wrist after a fall
Decreased ROM, decreased grip strength, tenderness in anatomical snuff box
Risk of avascular necrosis

Question 18

Colle’s Fracture

Answer 18

Fracture of the distal radius in the forearm with dorsal (posterior) and radial displacement of the wrist and hand

Question 19

Other Wrist/Hand Conditions

Answer 19

Scapholunate Ligament Injury
- FOOSH, unstable joint

Triangular Fibrocartilage Complex (TFCC) Tear
- radioulnar and ulnocarpal ligaments, fibrocartilage disc

Ulnar Collateral Ligament
- gamekeepers/skiers thumb

Ulnar nerve entrapment
- Guyons canal - between hook of hamate and pisiform

Fractures
- carpal, MC, phalynx

Mallet Finger
- jammed finger, distal extensor disruption at DIP

Trigger Finger
- flexor tendon restriction

Jersey Finger
- forced extension of DIP, flexor tendon rupture-FDP

Question 20

Carrying Angle

Answer 20

Normal = 5-15 degrees

Cubitus Varus: 15 degrees