Physical Exam-Elbow, Wrist, Hand Flashcards
What is the origin of most elbow pain?
The lateral epicondyle. This is coincidently to origin of the wrist extensor tendons.
A patient has pain in the triangular gap of the elbow. What structures are in this area and what is likely the cause of pain?
The olecranon, lateral epicondyle and radial head. These are all bony structures so osteoarthritis is a likely cause of pain.
A patient tells you their wrist hurts after falling on an out stretched hand. What do you examine in your physical examination?
The anatomical snuffbox, the scaphoid.
What tendons contribute to DeQuervain’s tenosynovitis?
The APL and the EPB (abductor pollicus longus and extensor pollicus brevis)
What causes carpal tunnel syndrome?
9 flexor tendons crammed into the space surrounded by the carpal bones and enclosed by the transverse carpal ligament. This allows for easy compression of the median nerve that also goes through this space.
What nerves innervated the different areas of the dorsal and ventral sides of the hand?
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Where do the superficial and deep flexors of the hand go?
Deep = distal phalynx. Superficial = middle phalanx
What areas do you palpate in the elbow exam?
Lateral epicondyle (orange), radial head (blue), olecranon (finger), lateral triangular space (green), medial epicondyle and biceps tendon.
What do you test for in elbow ROM?
Elbow flexion/extension/pronation/supination
What do you test for in the elbow strength exam?
Elbow flexion/extension/pronation/supination and test radial and ulnar pulses
What special test can you do for lateral epicondylitis?
Resisted long finger extension. Rest the patient’s arm with the elbow almost fully extended. Have them extend their fingers, press on the middle finger and resist your force. Test is positive it there is pain in the lateral epicondyle.
What are some key things you look for during inspection of the hand and wrist?
Thenar atrophy, Heberdon’s nodes, Bouchard’s nodes and other deformities.
What structures do you palpate in the wrist and hand exam?
Distal radius styloid and head, distal ulna styloid and head, anatomic snuffbox and scaphoid tubercle (circle).
What ROM tests do you do in the wrist and hand exam?
Wrist: Flexion, Extension and Ulnar/Radial Deviation. Fingers MCP/DIP/PIP flexion and extension. Also test for rotational abnormality of the fingers.
What strength exams do you do for the wrist and hand examinations?
Wrist flexion/extension, Grip strength, Thumb abduction, Flexor profundis (DIP in left image), Flexor superficialis (PIP in right image), Extensor (DIP and PIP) and finger ab/adduction.
What would you suspect if a patient had weakness with this motor test?
This is testing thumb abduction. Weakness would indicate carpal tunnel syndrome.
What is the signature test for carpal tunnel syndrome?
Phalen maneuver. Have them hold it for 30 seconds. If they get numbness or tingling in the hands the test is positive.
What test can you do on any superficial nerve of the hand and wrist?
Tinel’s Median Nerve test. You lightly tap on the nerve and parasthesia in nerve distribution is a positive Tinnel’s sign. It can also be done on the ulnar nerve at the elbow or wrist.
What test indicates DeQuervain’s Tenosynovitis?
Finkelstein’s test. The patient makes a fist with the thumb inside the fingers. Push the fist into ulnar deviation. Pain at the dorsoradial aspect of the wrist is a positive test.
What are the bones of the hand?
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Why can’t this patient make the OK sign circular?
They have a radial nerve injury evidenced by weakness of the adductor pollicus longus.
What are the significant tendons of the hand? Bones?
EPL, EPB, Extensor Digitorum, FCR and FCU tendons. Scaphoid, Radial styloid, Ulnar styloid and Hamate bones.
