Elbow Wrist Hand Lecture Flashcards
What is the carrying angle of the elbow?
- In anatomical position (palms up), slightly valgus
- 5 degrees in males, 10 in females
What does a carrying angle greater than 15 degrees indicate?
Possible history of a lateral epicondylar fracture and epiphyseal damage as a child
What does a decrease in the carrying angle or a varus angle indicate?
Supracondylar fx as a child w/epiphyseal injury
What is a gunstock deformity?
Varus carrying angle
Inspection of elbow:
- Localized or diffuse swelling
- Ecchymosis (traumatic injury)
- Obvious deformity d/t fx or dislocation
- Scars, burns, needle marks
Palpation of elbow (medial aspect)
- Medial epicondyle (ME)
- Ulnar groove (gently) b/w ME and olecranon
- Flexor muscles
How is the hand affected by ulnar nerve compression?
Numbness and tingling in ring finger and pinky
Palpation of elbow (posterior aspect)
- Olecranon (bursa should NOT be felt normally)
- Triceps
How can you make the triceps more prominent for palpation?
Have pt lean on table w/elbow slightly flexed
Palpation of elbow (lateral aspect)
- Lateral epicondyle
- Extensor muscles
- Brachioradialis muscle
How to make brachioradialis more prominent for palpation?
- Close fist, place it under edge of table
- Lift fist against table
Palpation of elbow (anterior aspect)
- Biceps tendon in cubital fossa
- Brachial artery
- Median nerve
4 movements at elbow for both PROM and AROM?
- Flexion (135 degrees)
- Extension (0 to -5 degrees)
- Supination (90 degrees)
- Pronation (90 degrees)
How to test ligamentous instability in the elbow?
- Pt slightly flex elbow w/forearm supinated
- Face pt and cup posterior aspect just above elbow
- Force elbow medially and then laterally (note any instability)
What is Tinel’s sign of the elbow?
- Test for ulnar nerve compression
- Tap in ulnar groove
- Positive if pt feels numbness and tingling in ring and pinky fingers
What is the tennis elbow test?
- Pt makes fist and dorsiflexes wrist
- Apply resistance to dorsiflexed wrist
- Pain at lateral epicondyle is positive
Inspection of hand and wrist:
- Fingers slightly flexed at rest (normal)
- Joint swelling
- Gouty tophi
- Thickened palmar fascia
- Bouchard’s or Heberden’s nodes
- Mallet finger
Bouchard’s nodes
PIP joint (sign of OA)
Heberden’s nodes
DIP joint (sign of OA)
What is trigger finger?
Painless nodule on palmar side near MC head - finger “pops” into extension w/extra effort or assistance
What is felon?
Small closed space infection at distal pulp of finger
When does atrophy of the thenar eminence occur?
Median nerve injury or carpal tunnel
When does atrophy of the hypothenar eminence occur?
Ulnar nerve injury
What is “no man’s land” of the hand?
From distal palmar crease to proximal interphalangeal crease
What is the MC fractured carpal bone?
Scaphoid
What is the largest carpal bone?
Capitate
Tenderness over the anatomical snuffbox indicates:
Scaphoid fracture
What makes the scaphoid easier to palpate?
Ulnar deviation
What is Tinel’s sign of the wrist?
- Percussion over carpal ligament
- Positive if numbness/tingling in first and second digits
Dermatomes of the hand
C6: Thumb, index finger, radial side of palm
C7: central palm, middle finger
C8: ulnar side of palm, ring, pinky fingers
Purest area of median nerve sensation in the hand:
Palmar tip of index finger
Purest area of ulnar nerve sensation in the hand:
Volar surface of tip of pinky
What is Phalen’s test?
- Test for carpal tunnel
- Pt hold wrists together in flexed position
- Positive is numbness or tingling in median nerve distribution
What is Finkelstein’s test?
- Used to determine presence of DeQuervain’s disease (tenosynovitis of 1st dorsal compartment aka snuffbox)
- Close fist w/thumb inside and ulnar deviate the wrist
- Palpate snuffbox
- Positive if painful
