ELbow, WRist, Hand Exam Tests Flashcards
1
Q
What is carrying angle?
A
-normally 5-15 degrees
- cubitus varus= less then 5
- cubitus valgus= greater than 15
2
Q
Elbow ROM
A
- flexion= 140-150
- extension= 0- -5
- supination adn pronation= 90
3
Q
What are the 3 muscle reflexes you test in the arm?
A
- biceps= C5
- brachioradialis= C6
- triceps= C7
4
Q
What test do you persofrm for ligamentous stability at the elbow?
A
-valgus and varus stress tests for ulnar and radial collateral ligaments
5
Q
What is valgus stress test of the elbow?
A
- arm slightly abducted and externally rotated
- forarm supinated and flexed about 30 and slight medial valgus stress applied (pushing on lateral side elbow–>medial)
- positive test= pain/tenderness with palpation, increased laxity
- indicates= injury to ulnar collateral ligament
6
Q
What is a varus stress test for the elbow?
A
- arm slightly abducted and internally rotated
- elbow flexed about 15 degrees and slight varus stress applied on medial side of elbow (push medial–>lateral)
- positive test= pain or increase laxity
- indicates= injury to radial collateral ligament
7
Q
What is tinsel test for ulnar nerve entrapment?
A
- tap between olecranon and medial epicondyle in ULNAR GROOVE
- positive test= tingling sensation down forearm with ulnar nerve disruption
- indicates= ulnar nerve entrapment, cubital tunnel symdrome
8
Q
What is the golfers elbow test?
A
- for medial epicondylitis
- anterior forearm/flexor compartment
- pt elbow flexed to 90 and forearm placed in supination with wrist neutral and palm up
- place one hand under proximal forarm to stabilize and other over the wrist to resist movement
- pt flexes wrist against resistance
- positive test= pain/tenderness around ME
9
Q
What is the tennis elbow test? Aka Cozens test
A
- for lateral epicondylitis
- posterior forearm/extensor compartment
- pt elbow flexed 90 degrees, forearm placed pronation with wrist neutral palm down
- 1 Hand under proximal forarm to stabilize and other hand over pt hand to resist movement
- pt extend wrist against resistance
- positive test= pain/tenderness around LE
10
Q
What is olecranon bursitis?
A
- region painless and ROM normal
- soft tissue inflammation
- olecranon bursa lies superficial to posterior elbow joint
- students elbow= posterior elbow distension/discomfort from overuse
- miners elbow= due to occupational injury
11
Q
What is little league elbow?
A
- group of problems related to stress of throwing in young athletes
- pain over ME initially after throwing (repetative valgus distraction force) progresses to persistent pain
- most common elbow injury during childhood b/c growth plate not fused
- as bone development matures most common injury seen evolved MCL (UCL) tear
12
Q
What are teh 3 phases of little league elbow based on age?
A
- Apophysitis
- Avulsion
- Ligamentous injury
13
Q
What is radial head instability?
A
- nursemaids elbow
- annular ligament tear and/or radial head subluxation from annular ligament
- pain with palpation of radial head w/anterior displacement of radial head and restriction to posterior glide
14
Q
What is ulnar abduction and ulnar adduction motion coupled with?
A
Ulnar abduction= pronation
Ulnar adduction= supination
Radial head anterior glide= supination
Radial head posterior glide= pronation
15
Q
ROM of the wrist/hand
A
- flexion= 80-90 coupled with posterior carpal glide
- extension= 70 coupled with anterior carpal glide
- adduction= 30-40 coupled with ulnar abduction
- abduction= 20-30 coupled with ulnar adduction
16
Q
What muscles contribute to flexion adn extension at the wrist?
A
- flexion= flexor carpi radialis and palmaris longus
- extension= extensor carpi radialis longus and brevis
17
Q
What does teh OK sign test for?
A
- motor branch of median n- inervating FPL, pronator quadratus, FDP digits 2/3
- on exam if neuropathy present pt cannot make an O with thumb and forefingers
18
Q
What is carpel tunnel syndrome and what are tests for it?
A
- entrapment of the median n at the wrist in the carpel tunnel
- pain/paresthesias
- atrophy of hand muscles
- tests:
1. Tinels sign
2. Phalens sign
19
Q
What is tinels sign?
A
- indicates entrapment of median n or carpal tunnel syndrome
- elicited by tapping over the transverse carpal ligament with finger or reflex hammer with patient wrist in extension
- positive test= paresthesias/numbness/tingling/pain radiates to thumb index middle finger
- indicates= CTS
20
Q
What is phalens sign?
A
- dorsal aspect of patients hands together and force into wrist flexion
- hold for 60 sec
- positive test= any reproduction of sx/parasthesias in distribution of median N
- indicates= CTS
21
Q
What is allens test for?
A
- evaluates functioning of radial and ulnar a
- occlude both arteries while patient makes a fist
- have patient open and close fist (palm should be pale)
- release pressure on Ulnar a and observe color return within 5-10 sec
- then repeat and release radial a. And observe color return
22
Q
What is dequervains tenosynovitis
A
- get careful history about REPETATIVE activites
- pain/inflammation from repetative overuse of tendons in 1st dorsal compartment
- patient complain of dorsal-lateral wrist and thumb pain (w/radiation to hand and thumb)
- positive finkelstein test
- possible inflammation sites= AbPL or EPB (snuff box)
23
Q
What is the finkelstein test?
A
- assess tenosynovitis of 1st dorsal compartment (used to test for dequervians syndrome)
- patient make a fist encompassing their thumb and ulnar deviate the wrist
- positive test= increase pain in the first dorsal compartment/lateral wrist
- indicates= dequervains
24
Q
What is a scaphoid fracture?
A
- most common carpal bone fracture due to falling foward or backward on outstretched hand (FOOSH)
- patient complains dull achiness deep in radial aspect of wrist after fall
- decrease ROM, decrease grip strength, tenderness in snuff box
- immediate radiographyic evidence not always visible/may repeat image (confirm with CT or MRI)
- important to treat due to risk of avascular necrosis
25
What is a colles fracture?
-fracture of distal radius in forearm with posterior and radial displacement of the wrist and hand
26
What is mallet finger?
- Jammed finger
- forced flexion
- distal extensor disruption at DIP
27
What is trigger finger?
-flexor tendon restriction
28
What is jersey finger?
- forced extension of DIP
| - flexor tendon rupture-FDP
29
Where is a boxers fracture?
-shaft of 5th metatarsal
30
What is skiers thumb?
- tear of ulnar collateral ligament
| - aka gamekeepers thumb
31
Where is ulnar nerve entrapment?
- guyons canal
| - between hook of hamate adn pisiform
