Hand/Wrist/Elbow Exam

Question 1

Origin of most elbow pain

Answer 1

Lateral epicondyle - also origin of wrist extensor tendons

Resisted Long Finger Extension (lateral epicondylitis test - aka tennis elbow)

Question 2

Joint space of elbow

Answer 2

Triangular gap (bounded by olecranon, lateral epicondyle, and radial head)

Question 3

Where nerve entrapments commonly occur

Answer 3

Wrist extensor region (lateral epicondyle)

Question 4

Medial elbow vs lateral

Answer 4

Flexor tendons instead of extensors

Question 5

Snuffbox tenderness

Answer 5

Rule out scaphoid fracture - important to PALPATE

Question 6

Most common carpal bone to fracture

Answer 6

Scaphoid (usually from a FOOSH - fall on outstretched hand)

Question 7

Scaphoid blood supply runs (not very important)

Answer 7

Distal to proximal (back towards the wrist); this compromises fracture healing

Question 8

First dorsal component of hand

Answer 8

2 tendons (abductor policus longus & extensor policus brevis)

Together can cause DeQuervain’s tenosynovitis –> Finkelstein test

Question 9

Carpal tunnel

Answer 9

big bony “C” w/ tough transverse ligament running across the top

“C” stand for compact cuz 9 flexor tendons and the median nerve run through the compacted space

Pressure can cause median nerve to get irritated (Carpal Tunnel Syndrome) –> Phalen Maneuver and Tinel’s test

Question 10

Flexor tendons course

Answer 10

Deep flexor goes all the way to the distal phalynx

Superficial flexor stops at the middle phalynx

Question 11

Elbow Inspection

Answer 11

Swelling (intra-articular triangle)
Erythema
Bruising
Deformity

Question 12

Elbow Palpation

Answer 12

Lateral epicondyle
Radial Head
Olecranon
Lateral Triangular space
Medial epicondyle
Biceps tendon

Question 13

Elbow ROM

Answer 13

Flexion/ Extension

Pronation/ Supination

Question 14

Elbow Strength Tests + Neurovascular

Answer 14

Flexion/Extension
Pronation/ Supination (done through handshake)
Radial and ulnar pulses

Question 15

Elbow Special Tests

Answer 15

Resisted Long Finger Extension (for lateral epicondylitis)

–resist flexion of middle finger and check for pain in lateral elbow

Question 16

Hand/Wrist Inspection

Answer 16

Swelling
Erythema
Bruising
Deformity
Heberdon's/ Bouchard's nodes --> cysts on knuckles
Thenar atrophy

Question 17

Hand/Wrist Palpation

Answer 17

Distal radius (styloid)
Distal ulna (styloid and head)
Anatomic snuffbox
Scaphoid tubercle (volar)

Question 18

Wrist ROM

Answer 18

Flexion/ extension

Ulnar/ radial deviation

Question 19

Hand ROM

Answer 19

Flexion/ extension

Test for rotational abnormality of fingers (flex all fingers and they all should be pointing towards scaphoid)

Question 20

Hand/Wrist Strength

Answer 20

Wrist flexion/ extension
Grip strength
Thumb abduction
Flexor profundis
Flexor superficialis
Extensor
Finger ab/adduction

Question 21

Hand/Wrist Neurovascular

Answer 21

2 pt discrimination (radial, medial, ulnar)

Radial/ ulnar pulses

Question 22

Hand/Wrist Special Tests

Answer 22

Carpal Tunnel - Phalen (numbness in median nerve region is + test) and Tinel’s

Cubital Tunnel - Tinel’s (Parastesias in median nerve distribution is + test)

DeQuervain’s Tenosynovitis - Finkelstein’s (pain at dorsoradial aspect of wrist is + test)