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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
What is a scaphoid (navicular) fracture?
**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
26
What is Colle's Fracture?
Distal wrist pain -also seen FOOSH patients
27
What is a Trigger finger?
Pain, stiffness, and a sensation of locking or catching when you bend and straighten your finger -mostly seen in _ring finger_ or _thumb_
28
What is Dupuytren's Contracture?
Progressive fibrosis of **palmar fascia**, which results in gradual joint stiffness and inability to extend the finger
29
Dequervains tenosynovitis
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
carpal tunnel syndrome (cts)
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
elbow flextion
140-150: biceps brachia, brachialis, bracioradialis, coracobrachialis
32
elbow extension
0- -5 triceps, and aconeus
33
supination
90 -supinator and biceps brachii
34
pronation
90 -pronator teres pronator quadratus
35
ulnohumeral ab and adduction
5 degrees
36
wrist flextion
80-90: flexor carpi radialis, flexor carpi ulnaris, palmaris longus
37
extension
70 degrees extensor carpi radialis longus, brevis, and extensor carpi ulnaris
38
wrist adduction
30-40 degrees (flexor carpi ulnaris and extensor carpi ulnaris)
39
wrist abduction
20-30: flexor carpi radialis, extensor carpi radialis longus and brevis
40
male carrying angle vs females
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
cubitis varus:
\<5 degrees (aduction of ulna)
42
cubitius valgus
\>15 degrees abduction of ulna
43
Where would you plapate for an elbow exam?
Over olecranon process, lateral and medial epicondyles, cubital fossa and radial head.
44
Cubital tunnel syndrome
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
How do you test hand strength and neurovacular for hands?
- strength: hand grip, resisted flexion and extenison of wrist, finger flexion and extension - neurovascular: sensation and radial pulse
46
What type of finger infections are there?
- paronychia - celulitis and absces - herpetic withlow
47
How will people with carpal tunnel try to release their Sx? How is carpal tunnel treated?
- flick sign: try to relive pain by shaking hand - mild to moderate: spliting (nocturnal), steroid injections, oral steroids - sever: carpal tunnel release
48
What are common causes for elbow pain
gout, lateral epicodylitis, cubtial tunnel syndrome, medial epicondylitis, olcranon bursisits
49
nurse maid elbow
- 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
What is ulnar adduction with supination and wrist abduction
varus testing
51
What is ulnar abduction with pronation and wrist adduction
valgus testing
52
Radial head movement
- posterior - pronation - anterior- supination
53
Handle bar palsy
- 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
game keepers thumb
- tear of unar collateral ligament of MCP - Also called skiers thumb
55
mallet finger
extensor tendon injury at DIP
56
trigger finger
inflammation and narrowing of the flexor tendon sheath
57
jersey finger
avulsion of flexor digitorum profucndus from fingertip
58
dupuytren contracture
abnormal ct tissue thickening in palmar fascia
59
scaphoid fracture
- 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
colle fracture vs smith fracture
- colle: distal radius goes dorsal - smiths: same fx, distal radius goes ventral
61
boxer fx
-fracture of distal shaft of 5th metacarpal (at bar fights or punching something solid)
62
monteggia fx
fracture of proximal ulna and dislocation of radial head
63
galeazzi fx
fracture of distal radius and dslocation of ulna
64
night stick fracture
isolated fracture of the midshaft/ distal ulna from a direct blow
65
66
What is the difference between trigger finger and Dupuytren's contracture?
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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