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PCM-exam 1 + 2 > Elbow, Wrist, & Hand Pain > Flashcards

Elbow, Wrist, & Hand Pain Flashcards

1
Q

Inspection of the Elbow

A

-Look for soft tissue swelling, nodules, erythema, indentation, hypotrophy, hypertrophy of muscles, scars, etc
-Observe how the patient carries the elbow
(normal carrying angle is 5-10° Male/ 10-15° Female)

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2
Q

Palpation of the Elbow

A
  • Olecranon process posteriorly
  • Lateral epicondyle
  • Medial epicondyle
  • Radial head while pronating and supinating the forearm -Cubital fossa
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3
Q

Reflexes

A

-Bicep (C5)
-Brachioradialis (C6)
-Tricep (C7)
(Scale 0 to 4, know what is normal

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4
Q

Strength

A

Scale 0-5/5, know what is normal

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5
Q

Neurovascular

A
  • brachial pulse

- sensation

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6
Q

Common Causes of Elbow Pain: Medial

A
  • Medial epicondylitis
  • Cubital tunnel syndrome
  • Ulnar collateral ligament injury
  • Valgus extension overload syndrome
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7
Q

Common Causes of Elbow Pain: Posterior

A
  • Osteoarthritis
  • Olecranon bursitis
  • Posterior impingement
  • Olecranon stress fracture
  • Triceps tendinopathy
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8
Q

Common Causes of Elbow Pain: Anterior

A
  • Anterior capsule strain
  • Osteoarthritis
  • Bicep tendinopathy
  • Gout
  • Rheumatoid arthritis
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9
Q

Common Causes of Elbow Pain: Lateral

A
  • Lateral epicondylitis

- Posterolateral rotatory instability

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10
Q

Tinel’s Sign

A

-flex elbow to tape where ulnar nerve goes through, and if you have a trapping it will send pain through the arm

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11
Q

Valgus/Varus Stress Testing

A

-checks collateral ligaments at the elbow

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12
Q

Subluxation of the Radial Head

A
  • “Nursemaid’s Elbow”
  • Most common in children, ages 1 to 5
  • Cause: sudden pulling, falling or arm twisting
  • The annular ligament slips off of the radial head and gets trapped in the radiohumeral joint
  • Classic presentation/ exam findings:
    1. arm close to the body w/ elbow slightly flexed or fully extended with the forearm pronated
    2. Management: Manual Reduction
  • Hyperpronation – better success rates -Supination/flexion method
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13
Q

Medical Epicondylitis

A

-“golfer’s elbow”
-Cause: Overuse injury from repeated wrist flexion
-Acute or chronic inflammation of flexor tendons
-Classic presentation/ Exam findings:
1. Pain on medial aspect of the elbow over the medial epicondyle, tenderness with passive extension of the wrist and resisted flexion of wrist
2. Management:
Initially: Modify activity, bracing or NSAIDs unless contraindicated
-Worsening pain: imaging, Physical therapy, bracing/splinting (the brace changes the fulcrum)

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14
Q

Lateral Epicondylitis

A
  • “Tennis Elbow”
  • Cause: Overuse injury from repeated extension of the wrist
  • Acute or chronic inflammation of extensor tendons
  • Classic presentation/ Exam findings :
    1. Pain on lateral aspect of the elbow
  • Pain on palpation of the lateral epicondyle, tenderness with resisted wrist extension
    2. Management same as golfer’s elbow
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15
Q

Olecranon Bursitis

A

-“miner’s elbow, students elbow”
-Causes: inflammatory arthritis, gout, trauma, hemorrhage or sepsis
-Inflammation of the olecranon bursa which is located on the posterior aspect of the olecranon process of the ulna
-Classic presentation/ Exam findings:
1. Pain and swelling of olecranon bursa (inflammatory versus infectious)
-Bursitis vs. Effusion (fluid in joint):
Bursitis: able to fully extend at elbow without severe pain
Effusion: pain with extension due to increased pressure at the joint May have both concurrently
2. Management: RICE, NSAID, aspiration if fluid present with analysis of fluid (therapeutic and diagnostic tap)

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16
Q

Inspection of the Wrist

A

-Inspect dorsal, ventral/volar, dorsal and ulnar aspects
of wrist
-Check for swelling, masses, skin discoloration, bony prominence, deformity, nodules, contractures, etc.

17
Q

Palpation of the Wrist

A
  • Palpate the carpal bones

- Palpate scaphoid , place thumb in the anatomical snuff box

18
Q

Strength of the Wrist

A

-Resisted flexion and extension of wrist

19
Q

Phalens

A

flexion of the wrist to compress the nerve

  • for carpal tunnel
  • hold palms together for 30 seconds to bring back symptoms
20
Q

Tinels

A

compression of the median nerve by tapping on the nerve

  • for carpal tunnel
  • extend wrist, tap over extensor retinaculum, lead
21
Q

Finkelstein

A
  • wrap fingers around thumb, ulnar deviate

- for De Quervain Tenosynovitis

22
Q

Scaphoid shift/Watson’s

A
  • dislocations of scaphoid

- palpate scaphoid, ulnar deviate, dislocates scaphoid bone

23
Q

Inspection of the Hand, Fingers, and Thumb

A
  • Inspect dorsal and palmar aspect of hand

- Check for swelling, masses, skin discoloration, bony prominence, deformity, nodules, contractures, etc.

24
Q

Palpation of the Hand, Fingers, and Thumb

A
  • Palpate the palmer fascia
  • Palpate the MCP, PIP and DIP joints
  • Palpate the flexor tendons
  • Check for Trigger Finger
25
Q

Strength of the Hand, Fingers, and Thumb

A

Resisted flexion and extension of individual fingers Grip strength

26
Q

Neurovascular of the Hand, Fingers, and Thumb

A
  • radial pulse

- sensation

27
Q

Carpal Tunnel Syndrome

A
  • compression of the median nerve
  • Causes: multifactorial but risk factors includes, obesity, hypothyroidism, DM, repetitive movement/workplace factors, pregnancy, genetic, connective tissue disorder, female gender
  • Classical presentation/ Exam findings:
    1. pain and paresthesia along the first three and half digits which the distribution of along the route of median nerve is being compressed
  • *Specialty exam:
  • Tinels
  • Phalens
    2. Treatment
  • Mild: wrist splint at night, cold compress, Tylenol if necessary
  • Moderate to severe: EMG to evaluate extent of nerve degeneration, continued splinting, steroid injections, carpal tunnel release
28
Q

De Quervain Tenosynovitis

A

-Recurrent inflammation of the tendon and synovial sheath covering extensor pollicis brevis and abductor pollicis longus
-Classic presentation/ exam findings:
1. Radial wrist pain (over the radial styloid) at base of thumb especially with
movement of thumb
**Specialty examine: Positive Finkelstein test
Causes: recurrent movements, idiopathic
2. Management: thumb spica splint, NDAIDs, glucocorticoids, surgery

29
Q

Trigger Finger

A
  • “stenosing flexor tenosynovitis”
  • Classic presentation/Exam finding:
  • Pain, locking and clicking of MCP joint. Common in the 5th and 6th decade of life. Most common on ring finger but may occur on any finger
  • Thickening/ inflammation of the flexor tendon which causes the first annular pulley to not work properly
    1. Causes: common, idiopathic, risk factors include Diabetes, amyloidosis, rheumatoid arthritis hypothyroidism, over use, trauma, etc.
    2. Management: Splinting the MCP slightly flexed, NSAIDS, corticosteroid injection, surgery for severe cases
30
Q

Dupuytren’s Contracture

A
  • Fibrosis of the palmar fascia which causes progressive stiffening of the joint and inability to full extend the finger.
  • Cause: idiopathic; thickening of palmer fascia due to fibroblastic proliferation and collagen deposition
  • Classic Presentation/exam findings:
    1. More common in white males and presents as a thickening on the palmer surface, painful, or painless
  • Exam: cord-like structure and flexed digit with palpable cord
    2. Management: using gloves with padding across the palm, corticosteroid injection, surgery
31
Q

Scaphoid Fracture

A
  • Classic presentation:
  • Pain on the radial aspect of the wrist and reduced grip strength after fall on outstretch hand (FOOSH) .
  • Specialty test/ exam finding:
  • Tenderness on anatomic snuff box
  • Tenderness with scaphoid compression and on scaphoid tubercle is also sensitive but more specific
  • Cause: fall on outstretched hand which causes hyperextension of the wrist
  • The scaphoid has poor blood supply therefore displaced fractures require surgery
  • Management: Initial XR may not indicate fracture; place patient on short arm thumb spica for 2 weeks, then repeat XR
32
Q

Boxer’s Fracture

A

-Fracture of the metacarpal neck (usually the fifth digit but can involve the fourth)
-Classic Presentation/exam finding:
-pain on the dorsum of the hand after direct trauma
-Swelling and bruising
-Tenderness over fracture site
1. Causes: caused by direct injury/trauma to the clenched fist
XR used to diagnose fracture
2. Management: initial splinting, closed reduction

33
Q

Colle’s Fracture

A
  • Classic Presentation:
  • Wrist pain with possible deformity
  • Tenderness over fracture site, possibly bruising or swelling
    1. Cause: falling on outstretched Hand (FOOSH) with wrist in extension.
  • Risk factor is osteoarthritis in older patients
    2. Management based on degree of fracture: sugar tong splint, closed reduction
34
Q

Rheumatoid Arthritis

A

-inflammatory polyarthritis causing deformity
-Most commonly affects the MCP and PIP joints of the finger
-Classic Presentation/ exam findings:
-morning stiffness, swelling and pain of the joints affected Deformity of the digit
1. Causes: autoimmune, unknown etiology
Test for antibodies (RF, CCP, ANA), Acute phase reactants
2. Management: NSAIDS, corticosteroids, disease modifying antirheumatic drugs (DMARDs), monitor by rheumatologist

PCM-exam 1 + 2 (14 decks)

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