Lecture 9: Approach to Elbow, Wrist, Hand Complaint Flashcards
Lateral Epicondylitis (Tennis Elbow)
- gradual onset of lateral elbow pain (aggravated by resisted wrist extension)
- microtears/microavulsions of common extensor tendons
Medial Epicondylitis (Golfer’s Elbow)
- gradual onset of medial elbow pain (aggravated by resisted wrist flexion)
- microtears/microavulsions of common flexor tendons
Olecranon Bursitis
- most common bursitis seen (septic or aseptic)
- seen after trauma from leaning on elbow, but can have inflammatory or infectious etiologies
- fluid aspiration only needed if concerned about infection or crystal disease (Gout)
Ulnar Nerve Entrapment (Cubital Tunnel Syndrome)
- 2nd most common compressive neuropathy in upper extremity (Median N. compression or Carpal Tunnel Syndrome is MOST common)
- common impingement as it passes through cubital tunnel of medial elbow
Carpal Tunnel Syndrome
- most common clinical compression neuropathy
- compression of median nerve
- wrist pain w/paresthesia (numbness/tingling) along 1st 3 digits and half of 4th; symptoms worse at night
- shake hands to relieve pain
- use Phalen and Tinel tests
de Quervain’s Tenosynovitis
- inflammation of tendon and synovial sheath covering extensor pollicis brevis/adductor pollicis longus
- subacute radial wrist pain at thumb base and distal radius with thumb movement (worsens w/gripping or holding objects)
- use Finkelstein test –> flexion of thumb elicits pain
Rheumatoid Arthritis (RA) and extra-articular manifestation
- autoimmune, inflammatory arthritis of unclear etiology
- symmetric joint pain, joint swelling, stiffness of hands, wrists, feet (lasts > 1 hr after awakening and improves)
- commonly involved joints: wrists, MCP, PIP
- EA manifestations: Felty Syndrome (severe RA, neutropenia, splenomegaly)
Rheumatoid Arthritis X-Rays
- joint space narrowing
- marginal bone erosions
- ulnar deviation of MCP joints
Boutonniere Deformity and Swan Neck Deformity (RA)
B: PIP flexion, DIP hyperextension
SN: PIP hyperextension, DIP flexion
Osteoarthritis Arthritis (OA) and X-Rays
- most common arthritis in adults
- asymmetric joint pain and stiffness in DIP/PIP
- stiffness lasts < 1 hr after awakening and improves w/activity
X Rays –> Heberdens nodes (DIP joint) and Bouchards nodes (PIP joint)
Ganglion Cyst
- common soft tissue finding of hand/wrist
- 2nd to 4th decade of life
- herniation of CT from tendon sheaths, ligaments, joint capsules, bursa
- typically on dorsal wrist but can be on palmar and over fingers
- 50% spontaneously resolve, 50% will reoccur within 1 year; surgical removal
Scaphoid (Navicular) Fracture
- most commonly fractured carpal bone (FOOSH)
- can result in avascular necrosis
- wrist pain on radial aspect in anatomical snuff box, decreased grip strength
Distal Radial Fracture (Colle’s)
- most common fracture site in upper extremity (FOOSH)
- distal wrist pain and swelling with dinner fork deformity
- volar/sugar-tong splinting
Trigger Finger
- stenosing flexor tenosynovitis
- disparity in size of flexor tendon to surrounding retinacular pulley system/sheath, impairing gliding of flexor tendon
- commonly affects ring finger and thumb (5th decade)
- painless/painful snapping, catching, locking of fingers during flexion
Dupuytren’s Contracture
- progressive fibrosis of palmar fascia resulting in gradual joint stiffness and inability to fully extend the finger
- most common in white males over 50 yo, gradual loss of finger extension, palpable cord or discrete nodules present (thickening or nodule in palm)
Elbow/Wrist/Hand Dermatomes (5)
C5 - lateral arm C6 - lateral forearm and thumb C7 - middle finger C8 - medial forearm and little finger T1 - medial arm
Valgus Stress Test (positive test and what it indicates)
positive test = inc. laxity, pain/tenderness
indicates: sprained medial collateral ligament
Varus Stress Test (positive test and what it indicates)
positive test = inc. laxity, pain/tenderness
indicates: sprained lateral collateral ligament
Tinel Test for Ulnar Nerve Entrapment
- between olecranon and medial epicondyle
positive = tingling sensation down forearm
indicates: ulnar nerve entrapment/cubital tunnel syndrome
Golfer’s Elbow (Medial Epicondylitis) Test
- pain w/resisted elbow flexion
positive = pain/tenderness medial epicondyle
indicates: medial epicondylitis
Tennis Elbow (Lateral Epicondylitis) Test
- pain w/resisted elbow extension
positive = pain/tenderness lateral epicondyle
indicates: lateral epicondylitis
Tinel’s Sign
- tap over transverse carpal ligament/flexor retinaculum
positive = numbness/tingling to thumb/index/middle finger
indicates: carpal tunnel syndrome
Phalen’s Sign
positive = any reproduction of symptoms paresthesai in distribution of medial nerve
indicates: carpal tunnel syndrome
Finkelstein Test
- make fist w/thumb inside and ulnar deviate wrist
positive = inc. pain in first dorsal compartment
indicates: deQuervain’s tenosynovitis
