Elbow, Wrist, Hand Exam Flashcards
Elbow Observation/Palpation
Olecranon process Medial epicondyle Lateral epicondyle Radial head Wrist flexors and pronators Wrist extensors and supinator so Nodules, swelling, scars
Elbow ROM
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)
Elbow Ligamentous Stability
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
Tinsel Test (Elbow)
Ulnar nerve entrapment
Eliciting tingling sensation down forearm within ulnar nerve distribution
Indicates: ulnar nerve entrapment, cubital tunnel syndrome
Golfer’s Elbow Test
Medial epicondylitis
Pain/tenderness around medial epicondyle
Anterior forearm/flexor compartment
Tennis Elbow Test (Cozen’s Test)
Lateral epicondylitis
Pain/tenderness around lateral epicondyle, may radiate down lateral forearm
Posterior forearm/extensor compartment
Olecranon Bursitis
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
“Little League Elbow”
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
Radial Head Instability
“Nursemaid’s Elbow”
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
Coupled Motions at Elbow
Ulnar adduction + supination
Ulnar abduction + pronation
Radial head anterior glide + supination
Radial head posterior glide + pronation
Wrist/Hand Observation/Palpation
Palmar and dorsal wrist Thenar and hypothenar eminences Flexor tendons Distal radius and ulna (styloid processes) Anatomic "snuffbox" and carpal bones MCP, PIP, DIP
Wrist/Hand ROM
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
Wrist/Hand Strength Testing
Hand grip strength
Thumb: Flexion/extension, abduction/adduction, opposition
Finger: Flexion/extension, abduction/adduction
“Ok” Sign
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
Carpal Tunnel Syndrome
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
DeQuervain’s Tenosynovitis
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
Scaphoid Fracture
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
Colle’s Fracture
Fracture of the distal radius in the forearm with dorsal (posterior) and radial displacement of the wrist and hand
Other Wrist/Hand Conditions
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
Carrying Angle
Normal = 5-15 degrees
Cubitus Varus: 15 degrees
