Elbow, wrist, hand ppt

Question 1

causes of anterior elbow pain

Answer 1

anterior capsule strain
osteoarthritis
bicep tendinopathy
gout
rhematoid arthritis

Question 2

causes of lateral elbow pain

Answer 2

lateral epicondylitis

posterolateral rotatory instability

Question 3

causes of medial elbow pain

Answer 3

medial epicondylitis
cubital tunnel syndrome
ulnar collateral ligament injury
valgus extension overload syndrome

Question 4

causes of posterior elbow pain

Answer 4

osteoarthritis
olecranon bursitis
posterior impingement
olecranon stress fracture
triceps tendinopathy

Question 5

toddler’s parents/babysitter swinging child by the arm. child keeps arm close to body. no trauma.

Answer 5

subluxation of the radial head

Question 6

subluxation of the radial head
other name
most common age
cause

Answer 6

annular ligament slips out of the radial head and gets trapped in the radiohumeral joint
nursemaid’s elbow
1-5 yo
sudden pulling, falling, and arm twisting

Question 7

PE findings for subluxation of the radial head

Answer 7

arm close to the body with elbow slightly flexed or fully extended with forearm pronated

Question 8

management of subluxation of the radial head

Answer 8

hyperpronation

supination/flexion

Question 9

medial epicondylitis
other name
cause

Answer 9

inner elbow pain - acute or chronic inflammation of flexor tendons due to some form of strenuous activity
golfer’s elbow
overuse injury from repeated motion (such as playing golf)

Question 10

PE findings of medial epicondylitis

Answer 10

pain on medial aspect of the elbow over the medial epicondyle, tenderness wtih passive extension of the wrist and resisted flexion of wrist

Question 11

management of medial epicondylitis

Answer 11

modify activity, bracing, NSAIDs

imaging, physical therpy, bracing/splinting

Question 12

lateral epicondylitis
other name
cause

Answer 12

lateral elbow pain - acute or chronic inflammation of extensor tendons due to incorrect stroke mechanics
tennis elbow
overuse injury from repeated motion such as playing tennis, excessive hyperextension

Question 13

PE findings of lateral epicondylitis

Answer 13

pain on the lateral aspect of the elbow

pain on palpation of the lateral epicondyle, tenderness with resisted wrist extension

Question 14

management of lateral epicondylitis

Answer 14

modify activity, bracing or NSAIDs

imaging, physical therapy, bracing/splinting

Question 15

olecranon bursitis
other name
causes

Answer 15

inflammation of the olecranon bursa which is located in the posterior aspect of the olecranon process of the ulna
miner’s elbow, student’s elbow
inflammatory arthritis, gout, trauma, hemorrhage, sepsis

Question 16

PE of olecranon bursitis

Answer 16

pain and swelling on olecranon bursa, may be inflammatory versus infectious
able to distinguish between bursitis versus effusion if able to extend at elbow without severe pain - bursitis without effusion.
if pain with extension - effusion present

Question 17

management of olecranon bursitis

Answer 17

RICE, NSAID, aspiration if fluid present with analysis of fluid

Question 18

carpal tunnel syndrome

causes

Answer 18

condition caused by compression of median nerve
multifactorial but risk includes obesity, hypothyroidism, DM, repetitive movement/workplace factors, pregnancy, genetic, connective tissue disorder, female gender

Question 19

PE findings of carpal tunnel syndrome

Answer 19

pain and paresthesia along the first three and half digits with the distribution along the route of median nerve is being compressed

Question 20

specialty exam for carpal tunnel syndrome

Answer 20

tinels

phalens

Question 21

treatment of carpal tunnel syndrome

Answer 21

wrist splint at night

EMG to evaluate extent of nerve degeneration, continued splinting, steroid injections, carpal tunnel release

Question 22

dequervain tenosynovitis

cause

Answer 22

recurrent inflammation of the tendon and synovial sheath covering extensor pollicis brevis and abductor pollicis longus
recurrent movement (new mother picking up child), idiopathic

Question 23

PE findings of dequervain tenosynovitis

Answer 23

radial wrist pain (over the radial styloid) at base of thumb especially with movement of thumb

Question 24

specialty exam for dequervain tenosynovitis

Answer 24

finkelstein test

Question 25

management of dequervain tenosynovitis

Answer 25

thumb spica splint, NSAIDs, glucocorticoids, surgery

Question 26

trigger finger
other name
causes
risk factors

Answer 26

thickening of the flexor tendon which causes the first annular pully to not work
stenosing flexor tenosynovitis
common, idiopathic
DM, amyloidosis, rheumatoid arthritis, hypothyroidism, over use, trauma

Question 27

PE findings for trigger finger

Answer 27

pain, locking and clicking of MCP joint, common in 5th and 6th decade of life. most common on ring finger, but can occur on any finger.

Question 28

management of trigger finger

Answer 28

splinting the MCP slightly flexed, NSAIDs, corticosteroid injection, surgery

Question 29

dupuytren’s contracture
cause
more common in?

Answer 29

fibrosis of the palmar fascia which causes progressive stiffening of the joint and inability to fully extend the finger
idiopathic fibroblastic proliferation and collagen deposition
white males

Question 30

PE findings of Dupuytren’s contracture

Answer 30

thickening on the palmar surface, painful, or painless

cord-like structrure and flexed digit with palpable cord

Question 31

management of dupuytren’s contracture

Answer 31

using gloves with padding across the palm, corticosteroid injection, surgery

Question 32

scaphoid fracture
cause
complication

Answer 32

common upper extremity injury
fall on outstretched hand causing hyperextension of wrist
poor blood supply, nonunion - necrosis

Question 33

PE finding scaphoid fracture

Answer 33

tenderness on anatomic snuff box

tenderness with scaphoid compression and on scaphoid tubercle

Question 34

management of scaphoid fracture

Answer 34

XR
short arm thumb spica 2 weeks
repeat XR

Question 35

boxer’s fracture

causes

Answer 35

fracture of the metacarpal neck (5th digit but can involve 4th)
direct injury/trauma to clenched fist

Question 36

PE findings of boxer’s fracture

Answer 36

pain on dorsum of hand after direct trauma
swelling and bruising may be present on dorsum of hand
tenderness over fracture site

Question 37

management of boxer’s fracture

Answer 37

XR to diagnose

initial splinting, closed reduction

Question 38

colles fracture
cause
risk factor

Answer 38

most common fracture of UE
FOOSH with wrist in extension
young pt - sports injury
osteoarthritis

Question 39

PE findings colles fracture

Answer 39

wrist pain with possible deformity (dinner fork)

tenderness over fracture site on radial aspect of wrist, possible bruising or swelling

Question 40

management of colles fracture

Answer 40

sugar tong splint, closed reduction

Question 41

rheumatoid arthritis
most commonly affects…
causes

Answer 41

inflammatory polyarthritis causing deformity of the joints through the damage of bone and cartilage.
MCP, PIP joints of finger, large and small joints
autoimmune, unknown etiology

Question 42

PE findings of rheumatoid arthritis

Answer 42

morning stiffness, swelling, and pain of MCP and PIP, 3 or more affected joints
deformity of the digits

Question 43

management of rheumatoid arthritis

Answer 43

test for antibodies and acute phase proteins

NSAIDs, corticosteroids, disease modifying antirheumatic drugs, monitor by rheumatologist