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PCM_MIDTERM 01 > Lecture 9: Elbow, Wrist, and Hand Complaint > Flashcards

Lecture 9: Elbow, Wrist, and Hand Complaint Flashcards

1
Q

What ranges of motions are you checking for elbow?

What muscles contribute to these ROM?

A

Flexion: Biceps brachii, Brachialis, Brachioradialis (140-150)

Extension: Triceps brachii, Anconeus (0- -5)

Pronation: Pronator Teres and Pronator Quadratus (90)

Supination: Biceps Brachii and Supinator (90)

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2
Q

What are some common causes of elbow pain?

A
  • Gout
  • Lateral Epicondylitis
  • Medial Epicondylitis
  • Cubital Tunnel Snydrome
  • Olecranon Bursitis
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3
Q

Valgus stress test

A

-Arm is slightly abducted and externally rotated. Forearm is supinated and flexted to 30 degrees. You apply slight medial directed valgus stress.

+ test: pain and tenderness with palpation and valgus stress

indication: Sprained medial (ulnar) collateral ligament
* Elbow toward body and forearm goes away*

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4
Q

What does a varus stress test indicate?

A

Arm slightly abducted and internally rotated. Elbow is flexed to 15 degrees and varus stress is is appliesd.

+ test: pain and tenderess with palpation and increasec lacity of LCL

Sprained lateral (radial) collateral ligament (LCL)

Elbow away from body and forearm toward body

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5
Q

What does a Tinnel test indicate?

A

-TAP between olecranon and medial epicondyle in ulnar groove

+ test: tingling senstion down forearm with ulnar nerve distribution

Ulnar Nerve Entrapment (Cubital Tunnel Snydrome)

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6
Q

What does Golfer’s Elbow indicate?

A

Medial Epicondylitis

  • Pain aggravated by resisted wrist flexion with elbow in full extension
  • Microtears or microavulsions in common flexor tendons

-you have pain/ tenderess around the medial epicondyle

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7
Q

What does Tennis Elbow indicate?

A

Lateral Epicondylitis

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

-you have pain/tenderness around the lateral epicondyle

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8
Q

What is Olecranon Bursitis?

  • what causes it?
  • is ROM normal
  • where is the bursa
A

Trauma in elbow that can have inflammatory or infectious etiologies.

ROM is normal

most common bursistis seen

-can be caused by leaning on elbow (students, miners, or dart throwers)

Septic or aseptic

-bursa lies superficial to posterior elbow joint

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9
Q

What does Phalen’s Sign indicate?

A

Carpal Tunnel Syndrome

  • Compression of Median nerve
  • place dorsal apsect of hands together and force wrist into flextion: hold for 60 seconds
  • positive test: any reproduction of symptoms paresthesia in the distribution of the median nerve
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10
Q

What does Tinel’s Sign indicate?

A

Carpal Tunnel Syndrome

  • Compression of Median nerve
  • tap over transpverse carpal ligament/ flexor retincaulum with the wrist extended

+ test: parathesia, numbness, tinglinga or pain

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11
Q

What does Finkelstein Test indicate?

A

if positive: de Quervain’s Tenosynovitis

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

-ask pt to make a fist with thumb in it and ulnar devate the wrist

+ test increased pain in first dorsal compartment (lateral wrist)

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12
Q

What is Rheumatoid Arthritis?

A

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

  • mostly in wrists, hands, feet, MCP, and PIP joints
  • pain improves with activity and last >1 hour after waking

+ exam findings are: swan neck, butonniere dfomties, Rhematoid nodules, and positive mcp squeeze test

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13
Q

What is Felty Syndrome?

A

extra atrticular manisfistiation: “Super Rheumatoid’’ Disease characterized by:

  1. Severe Rheumatoid Arthritis
  2. Splenomegaly
  3. Neutropenia (susceptibility to bacterial infections)
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14
Q

What lab tests can indicate Rheumatoid Arthritis?

A
  1. Rheumatoid Factor
  2. Anticyclic citrullinated peptide (Anti-CCP) antibodies
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15
Q

Seronegative RA patients have

A

1/3 of RA patients have negative RF or anti ccp

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16
Q

How would you treat Rheumatoid Arthritis?

A
  • anti-TNF alpha drugs
  • T cell inhibitors
  • Tradiotional Drugs (e.g. Methotrexate)
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17
Q

What is a Boutonniere Deformity?

A

PIP flexion and DIP hyperextension

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18
Q

What is a Swan Neck Deformity?

A

PIP hyperextension and DIP flexion

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19
Q

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

A

Ulnar deviation

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20
Q

X ray for RA patients will show what?

A

marginal bone erosions and ulnar deviations for MCP joints

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21
Q

What is osteoarthritis?

A

Most common form of arthiritis in adults

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
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22
Q

What are Heberden’s nodes?

A

Swelling at DIP joints

Asscoiated with Osteoarthritis

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23
Q

What are Bouchard’s nodes?

A

Swelling at PIP joints

Asscoiated with Osteoarthritis

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24
Q

What is a ganglion cyst?

A
  • cause irriation
  • it is a fluid filled sac along tenon sheath or joint capsule that is painless
  • found on dorsum of wrist usually
  • promient with wrist flection
  • resolves it self sopontanoeusly
  • also called bible cyst: they would beat that cyst with a book to treate it
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25
Q

What is a scaphoid (navicular) fracture?

A

Wrist pain on radial aspect, especially in anatomic snuff box

  • Normally seen in patients who Fall On an Outstretched Hand (FOOSH)
  • can result in avacular necrosis
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26
Q

What is Colle’s Fracture?

A

Distal wrist pain

-also seen FOOSH patients

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27
Q

What is a Trigger finger?

A

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

-mostly seen in ring finger or thumb

28
Q

What is Dupuytren’s Contracture?

A

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

29
Q

Dequervains tenosynovitis

A

pain and inflamation from repetitive overuse of tendons in the first dorsal compartment.

-complain of dorsolateral wrist and thumb pain and will occ will radiate to hand and thumb.

pain will be worse with tumb movements and grip weakness.

possible inflamation sites: tendon sheath, ab policis longus and ab policis brevis

30
Q

carpal tunnel syndrome (cts)

A

entrapment of median nerve at wrist will produce pain and parhtesias.

  • Hx of repeitive mvoements, pregnancy, connective tissue disorder
  • patients will also have grip weakness and weakness with tumb abdcution
31
Q

elbow flextion

A

140-150: biceps brachia, brachialis, bracioradialis, coracobrachialis

32
Q

elbow extension

A

0- -5

triceps, and aconeus

33
Q

supination

A

90

-supinator and biceps brachii

34
Q

pronation

A

90

-pronator teres

pronator quadratus

35
Q

ulnohumeral ab and adduction

A

5 degrees

36
Q

wrist flextion

A

80-90: flexor carpi radialis, flexor carpi ulnaris, palmaris longus

37
Q

extension

A

70 degrees

extensor carpi radialis longus, brevis, and extensor carpi ulnaris

38
Q

wrist adduction

A

30-40 degrees (flexor carpi ulnaris and extensor carpi ulnaris)

39
Q

wrist abduction

A

20-30: flexor carpi radialis, extensor carpi radialis longus and brevis

40
Q

male carrying angle vs females

A

m: 5 degrees
f: 10-15 degrees

allows foream to clear hip when swing during walking

-larger angle for adult women bc of wider hips and narrower shoulders

41
Q

cubitis varus:

A

<5 degrees (aduction of ulna)

42
Q

cubitius valgus

A

>15 degrees abduction of ulna

43
Q

Where would you plapate for an elbow exam?

A

Over olecranon process, lateral and medial epicondyles, cubital fossa and radial head.

44
Q

Cubital tunnel syndrome

A

also called unlar nerve entrapment

  • medial elbow pain with repetitive activity associated with paresthesias in ulnar border of forearm, hand and 4/5th digit
  • Tinels sign: Dx by tapping in ulnar groove between medial epicondyle and olecanon (+ test if elcits tingling in arm and hand)
45
Q

How do you test hand strength and neurovacular for hands?

A
  • strength: hand grip, resisted flexion and extenison of wrist, finger flexion and extension
  • neurovascular: sensation and radial pulse
46
Q

What type of finger infections are there?

A
  • paronychia
  • celulitis and absces
  • herpetic withlow
47
Q

How will people with carpal tunnel try to release their Sx?

How is carpal tunnel treated?

A
  • flick sign: try to relive pain by shaking hand
  • mild to moderate: spliting (nocturnal), steroid injections, oral steroids
  • sever: carpal tunnel release
48
Q

What are common causes for elbow pain

A

gout, lateral epicodylitis, cubtial tunnel syndrome, medial epicondylitis, olcranon bursisits

49
Q

nurse maid elbow

A
  • annular ligament tear or radial head subluxation from annular ligament
  • often caused when traction of child arm
  • pain with palpation of radial head with anterior displacemtn of radial head and restriction to posterior glide
50
Q

What is ulnar adduction with supination and wrist abduction

A

varus testing

51
Q

What is ulnar abduction with pronation and wrist adduction

A

valgus testing

52
Q

Radial head movement

A
  • posterior - pronation
  • anterior- supination
53
Q

Handle bar palsy

A
  • ulnar nerve gets entrapped in guyons canal (space between hook of hamate and pisisform)
  • irriation laeads to numbness, tingling, weakness and or pain in the ulnar nerve distribution
54
Q

game keepers thumb

A
  • tear of unar collateral ligament of MCP
  • Also called skiers thumb
55
Q

mallet finger

A

extensor tendon injury at DIP

56
Q

trigger finger

A

inflammation and narrowing of the flexor tendon sheath

57
Q

jersey finger

A

avulsion of flexor digitorum profucndus from fingertip

58
Q

dupuytren contracture

A

abnormal ct tissue thickening in palmar fascia

59
Q

scaphoid fracture

A
  • occurs dues to foosh
  • decreased grip strength and tenderness inside the anatomical snuff box
  • tenderness of scaphoid tubercle (extend wrist and apply pressure to tubercle to dx)
  • important to diagnose and treate due to risk of avascular necrosis
  • not always vissible so might have to repeat imiaging and can conform with ct or mri
  • treat with thumb cast/ splint
60
Q

colle fracture vs smith fracture

A
  • colle: distal radius goes dorsal
  • smiths: same fx, distal radius goes ventral
61
Q

boxer fx

A

-fracture of distal shaft of 5th metacarpal (at bar fights or punching something solid)

62
Q

monteggia fx

A

fracture of proximal ulna and dislocation of radial head

63
Q

galeazzi fx

A

fracture of distal radius and dslocation of ulna

64
Q

night stick fracture

A

isolated fracture of the midshaft/ distal ulna from a direct blow

65
Q
A
66
Q

What is the difference between trigger finger and Dupuytren’s contracture?

A

trigger finger is caused by disparity in size of flexor tendon to surrounding retinacular pulley system/sheath.

Dupuytren’s contracture is caused by progressive fibrosis of palmar fascia which results in gradual joint stiffness and inability to fully extend the finger

PCM_MIDTERM 01 (13 decks)

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