Lecture 9: Elbow, Wrist, and Hand Complaint

Question 1

What ranges of motions are you checking for elbow?

What muscles contribute to these ROM?

Answer 1

Flexion: Biceps brachii, Brachialis, Brachioradialis

Extension: Triceps brachii, Anconeus

Pronation: Pronator Teres and Pronator Quadratus

Supination: Biceps Brachii and Supinator

Question 2

What are some common causes of elbow pain?

Answer 2

• Gout
• Lateral Epicondylitis
• Medial Epicondylitis
• Cubital Tunnel Snydrome
• Olecranon Bursitis

Question 3

What does a valgus stress test indicate?

Answer 3

Sprained medial (ulnar) collateral ligament

Elbow toward body and forearm goes away

Question 4

What does a varus stress test indicate?

Answer 4

Sprained lateral (radial) collateral ligament

Elbow away from body and forearm toward body

Question 5

What does a Tinel test indicate?

Answer 5

Ulnar Nerve Entrapment (Cubital Tunnel Syndrome)

Question 6

What does Golfer’s Elbow indicate?

Answer 6

Medial Epicondylitis

• Pain aggravated by resisted wrist flexion
• Microtears or microavulsions in common flexor tendons

Question 7

What does Tennis Elbow indicate?

Answer 7

Lateral Epicondylitis

• Pain aggravated by resisted wrist extension
• Microtears or microavulsions in common extensor tendons

Question 8

What is Olecranon Bursitis?

Answer 8

Trauma in elbow that can have inflammatory or infectious etiologies

Septic or aseptic

Question 9

What range of motions are you checking in the wrist?

Answer 9

Flexion and Extension

Abudction and Adduction

Question 10

What does Phalen’s Sign indicate?

Answer 10

Carpal Tunnel Syndrome

-Compression of Median nerve

Question 11

What does Tinel’s Sign indicate?

Answer 11

Carpal Tunnel Syndrome

-Compression of Median nerve

Question 12

What does Finkelstein Test indicate?

Answer 12

de Quervain’s Tenosynovitis

-Inflammation of tendon and synovial sheath covering Extensor Pollicis Brevis and Abductor Pollicis Longus

Question 13

What is Rheumatoid Arthritis?

Answer 13

Autoimmune disorder characterized by symmetric joint pain, swelling, and stiffness in joints

• mostly in wrists, MCP, and PIP joints
• pain improves with activity

Question 14

What is Felty Syndrome?

Answer 14

“Super Rheumatoid’’ Disease characterized by:

1. Severe Rheumatoid Arthritis
2. Splenomegaly
3. Neutropenia (susceptibility to bacterial infections)

Question 15

What lab tests can indicate Rheumatoid Arthritis?

Answer 15

1. Rheumatoid Factor
2. Anticyclic citrullinated peptide (Anti-CCP) antibodies

Question 16

How would you treat Rheumatoid Arthritis?

Answer 16

• anti-TNF alpha drugs
• T cell inhibitors
• Traditional Drugs (e.g. Methotrexate)

Question 17

What is a Boutonniere Deformity?

Answer 17

PIP flexion and DIP hyperextension

Question 18

What is a Swan Neck Deformity?

Answer 18

PIP hyperextension and DIP flexion

Question 19

Will you tend to see ulnar or radial deviation with Rheumatoid Arthritis?

Answer 19

Ulnar deviation

Question 20

What is osteoarthritis?

Answer 20

Gradual onset of asymmetric joint pain and stiffness

• Commonly seen in DIP, PIP, and 1st carpometacarpal joint
• Pain worsens with activity and relieved with rest
• Joint stiffness lasts less than an hour and improves with activity

Question 21

What are Heberden’s nodes?

Answer 21

Swelling at DIP joints

Asscoiated with Osteoarthritis

Question 22

What are Bouchard’s nodes?

Answer 22

Swelling at PIP joints

Asscoiated with Osteoarthritis

Question 23

What is a ganglion cyst?

Answer 23

Potentially painful yet smooth/firm rubbery cystic lesion that can be normally seen on wrist (dorsal and palmar) as well as over fingers

-thought to arise from herniation of connective tissue

Question 24

What is a scaphoid (navicular) fracture?

Answer 24

Wrist pain on radial aspect, especially in anatomic snuff box

-Normally seen in patients who Fall On an Outstretched Hand (FOOSH)

Question 25

What is Colle’s Fracture?

Answer 25

Distal wrist pain

-also seen FOOSH patients

Question 26

What is a Trigger finger?

Answer 26

Pain, stiffness, and a sensation of locking or catching when you bend and straighten your finger

-mostly seen in ring finger or thumb

Question 27

What is Dupuytren’s Contracture?

Answer 27

Progressive fibrosis of palmar fascia, which results in gradual joint stiffness and inability to extend the finger