Elbow, wrist, hand special tests and injuries

Question 1

valgus stress test for elbow
+?
indicates?

Answer 1

arm slightly abducted and externally rotated. forearm supinated and flexed to approximately 30 degrees. slight valgus stress test applied to elbow joint.
+ pain/tenderness with palpation and valgus stress; increased laxity
indicated sprained medial (ulnar) collateral ligament

Question 2

varus stress test for elbow
+?
indicates?

Answer 2

arm slightly abducted and internally rotated. elbow flexed to approx 15 degrees. slight varus stress applied to the elbow joint.
+ pain/tenderness with palpation; increased laxity
indicates sprained lateral (radial) collateral ligament

Question 3

tinel test for ulnar nerve entrapment
+?
indicates?

Answer 3

tap between olecranon and medial epicondyle in ulnar groove
+ elicits tingling sensation down forearm within ulnar nerve distribution
indication: ulnar nerve entrapment/cubital tunnel syndrome

Question 4

golfer’s elbow test
+?
indicates?

Answer 4

anterior forearm/flexor compartment
patient’s elbow is flexed to 90 and forearm is placed in supination with the wrist neutral palm facing up. the examiner places one hand under the proximal forearm for stabilization and the other hand over the patient’s wrist to resist movement. instruct pt to flex wrist.
+ pain/tenderness around medial epicondyle
indicates medial epicondylitis

Question 5

tennis elbow test (cozen’s test)
+?
indicates?

Answer 5

posterior forearm/extensor compartment
patient’s elbow is flexed 90 and forearm placed in pronation with wrist neutral and palm facing down. examiner places one hand under proximal forearm for stabilization and the other hand over the patient’s hand the resist movement. instruct pt to extend wrist.
+ pain/tenderness around lateral epicondyle, may radiate down lateral forearm
indicates lateral epicondylitis

Question 6

little league elbow
childhood
adolescence
young adulthood

Answer 6

pain over medial epicondyle initially after throwing (repetitive valgus distraction forces) progresses to persistent pain
medial apophysitis
medial epicondyle avulsion fracture
medial collateral ligament tear

Question 7

radial head instability

Answer 7

pain with palpation of radial head with anterior displacement of radial head and restriction to posterior glide

Question 8

ulnar adduction is coupled to…

ulnar abduction with coupled with…

Answer 8

supination

pronation

Question 9

radial head anterior glide with…

radial head posterior glide with…

Answer 9

supination

pronation

Question 10

OK sign

Answer 10

anterior interosseous nerve - flexor pollicis longus, deep flexors of digits 2 and 3, pronator quadratus
pt cannot make O with thumb and forefinger pinched together

Question 11

tinel’s sign
+?
indicates

Answer 11

tap over the transverse carpal ligament/flexor retinaculum (between thenar/hypothenar eminences) with either the tip of examiner’s finger or reflex hammer while pt holds wrist in extension
+ paresthesia, numbness, tingling, pain radiating to thumb, index and middle finger
indicates carpal tunnel syndrome

Question 12

phalen’s sign
+?
indicates

Answer 12

place dorsal aspects of patient’s hands together and force into wrist flexion. hold for 60 s.
+ any reproduction of symptoms, paresthesia in the distribution of median nerve
indicates carpal tunnel syndrome

Question 13

Finkelstein test
+?
indicates

Answer 13

examiner asks pt to make a fist encompassing their thumb and ulnar deviate wrist
+ increased pain in first dorsal compartment
indicates DeQuervian’s tenosynovitis

Question 14

possible inflammation sites of DeQuervian’s tenosynovitis

Answer 14

tendon sheath
abductor pollicis longus
extensor pollicis brevis

Question 15

handlebar palsy

Answer 15

ulnar nerve entrapped in Guyon’s canal - space between hook of hamate and pisiform covered by flexor retinaculum at the base and superficial palmar carpal ligament at the roof
irritation leads to numbness, tingling, weakness, and / or pain in the distribution of the ulnar nerve

Question 16

gamekeep’s thumb/skier’s thumb

Answer 16

tear of the ulnar collateral ligament of MCP

pain on medial side of MCP

Question 17

mallet finger

Answer 17

extensor tendon injury at DIP

Question 18

trigger finger

Answer 18

inflammation and narrowing of flexor tendon sheath

Question 19

jersey finger

Answer 19

avulsion of flexor digitorum profundus from fingertip

Question 20

Dupuytren’s contracture

Answer 20

abnormal connective tissue thickening in the palmar fascia

Question 21

Ganglion's cyst
other name 
cause
common site
more prominent with...
treatment

Answer 21

fluid filled sac along the tendon sheath or joint capsule, mobile, transilluminates, nontender
Bible cyst
unknown
dorsum of wrist
wrist flexion
spontaneous resolution

Question 22

rheumatoid arthritis

Answer 22

ulnar deviation of fingers, bouchard nodules (PIP), Heberden nodules (DIP) subcutaneous nodules along extensor surface of proximal ulna or around olecranon bursa

Question 23

clubbed fingers

associated with…

Answer 23

focal bulbous enlargement of terminal fingers
angle between nail and proximal nail fold >180
proliferation of CT between nail matrix and distal phalanx along with vasodilation with increased blood flow to digits
…lung cancer, liver cirrhosis, cyanotic heart disease, bronchiectasis

Question 24

scaphoid fracture

Answer 24

tenderness inside anatomical snuff box (sensitivity)

tenderness of scaphoid tubercle (specificity)

Question 25

colles fracture

Answer 25

fracture of distal radius in the forearm with dorsal (posterior) and radial displacement of the wrist and hand

Question 26

smith fracture

Answer 26

fracture of distal radius in the forearm with ventral displacement of the wrist and hand

Question 27

monteggia fracture

Answer 27

fracture of the proximal ulna, dislocation of the radial head

Question 28

galeazzi fracture

Answer 28

fracture of the distal radius, dislocation of the ulna

Question 29

nightstick fracture

Answer 29

isolated fracture of the mid shaft/distal ulna from a direct blow