TEST 3: Elbow, Wrist, Hand OSCE

Question 1

carrying angle

Answer 1

• axis of humerus to the axis of the forearm
• allows forearms and hands to clear hips when swinging during walking
• on average, larger in adult women due to wider hips and narrower shoulders

Question 2

how does ulnar ABduction affect the carrying angle?

Answer 2

increases CA

Question 3

how does ulnar Adduction adduct the carrying angle?

Answer 3

decreases CA

Question 4

know the locations of the following and how you could palpate them:

Answer 4

• olecranon process
• medial epicondyle
• lateral epicondyle
• radial head
• wrist flexors and pronators
• wrist extensors and supinators

Question 5

what muscles are involved in flexion of the elbow?

Answer 5

biceps, brachialis, brachioradialis

Question 6

what muscles are involved in extension of the elbow?

Answer 6

triceps

Question 7

what muscles are involved in supination of the elbow?

Answer 7

supinator, biceps

Question 8

what muscles are involved in pronation of the elbow?

Answer 8

pronator teres, pronator quadratus

Question 9

ROM of flexion of elbow

Answer 9

140-150 deg

Question 10

ROM of extension of elbow

Answer 10

0 to -5 deg

Question 11

ROM of supination of elbow

Answer 11

90 deg

Question 12

ROM of pronation of elbow

Answer 12

90 deg

Question 13

how do we ran muscle strength?

Answer 13

• 0 to 5
• 5 being the muscle contracts normally against full resistance
• 4 being muscle strength is reduced but can still move against resistance
• 3 being muscle strength is further reduced such that the joint can be moved only against gravity, no resistance
• 2 being muscle can move only if resistance of gravity is removed
• 1 being only a trace or flicker of movement is seen or felt in the muscle, or fasciculations are observed in the muscle
• 0 being no movement is observed in the muscle

Question 14

what are the principles governing elbow joint?

Answer 14

1. SD is found in minor gliding motions of the joint, not the major motions
2. SD of the ulnohumeral joint is usually primary and SD of the radioulnar joints is usually secondary
3. impaired fcn of any joint of the arm produces compensatory changes in all other joints (can cause secondary SD)

Question 15

what motion is ulnar abduction coupled with and what do we need to do to get that motion?

Answer 15

• coupled with wrist adduction (ulnar deviation)

- valgus–push medially on lateral elbow and laterally at wrist

Question 16

what motion is ulnar adduction coupled with and what do we need to do to get that motion?

Answer 16

• coupled with wrist abduction (radial deviation)

- varus–push laterally on medial elbow and medially at wrist

Question 17

what is an ulnar ABduction SD?

Answer 17

ease of motion toward ABduction, restriction of ADduction

Question 18

what is an ulnar ADduction SD?

Answer 18

ease of motion toward ADduction, restriction of motion to ABduction

Question 19

what positions should you test ulnar abduction and adduction in?

Answer 19

both in extension and supination

Question 20

what is radial head anterior glide coupled with?

Answer 20

coupled with supination

Question 21

what is radial head posterior glide coupled with?

Answer 21

coupled with pronation

Question 22

what is an anterior radial head SD?

Answer 22

ease of motion toward anterior glide and supination

Question 23

what is an posterior radial head SD?

Answer 23

ease of motion toward posterior glide and pronation

Question 24

what should we palpate at the wrist and hand?

Answer 24

• distal radius and ulna
• radial styloid process
• anatomic “snuff box”
• carpal bones
• MCP, PIP, DIP

Question 25

ROM of flexion of the wrist

Answer 25

80-90 deg

Question 26

ROM of extension of the wrist

Answer 26

70 deg

Question 27

ROM of adduction of the wrist (ulnar deviation)

Answer 27

30-40 deg

Question 28

ROM of abduction of the wrist (radial deviation)

Answer 28

20-30 deg

Question 29

what is wrist flexion coupled with?

Answer 29

coupled dorsal/posterior carpal glide

Question 30

explain wrist flexion SD

Answer 30

``` wrist: -freedom of motion in flexion -restricted to extension carpal bones: -freedom of motion in dorsal/posterior glide -restriction to ventral/anterior glide ```

Question 31

what is wrist extension coupled with?

Answer 31

``` wrist: -freedom of motion in extension -restriction in flexion carpal bones: -freedom of motion in ventral/anterior glide -restriction of dorsal/posterior glide ```

Question 32

explain wrist ABduction and what is a wrist ABduction SD?

Answer 32

- hand deviation toward radial side in the anatomical position (supinated) - wrist ABduction SD will have greater motion to ABduction and will be restricted to ADduction

Question 33

explain wrist ADduction and what is a wrist ADduction SD?

Answer 33

- hand deviation toward the ulnar side in the anatomical position (supinated) - wrist ADduction SD will have greater motion to ADduction and will be restricted to ABduction

Question 34

explain metacarpal ABduction and what is a metacarpal ABduction SD?

Answer 34

- (index, long, ring, and little fingers) move away from the long finger longitudinal axis - SD has an ease of motion in ABduction and restricted in ADduction

Question 35

explain metacarpal ADduction and what is a metacarpal ADduction SD?

Answer 35

- digits move toward long finger longitudinal axis | - SD has an ease motion in ADduction and restricted to ABduction

Question 36

explain thumb ABduction and what is a thumb ABduction SD?

Answer 36

- moves anterior from the anatomical position | - SD has ease of motion to ABduction

Question 37

explain finger flexion SD

Answer 37

ease of motion in flexion and restriction to extension

Question 38

explain finger extension SD

Answer 38

ease of motion in extension and restriction to flexion

Question 39

how to name finger flexion and extension SD?

Answer 39

name dysfunction specific to joint in question (4th MCP, 2nd DIP, thumb MCP, thumb IP)