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OCS Exam > The Elbow, Wrist, and Hand > Flashcards

The Elbow, Wrist, and Hand Flashcards

1
Q

What is the normal carrying angle of the elbow?

A

usually 6 degrees of varus in full flexion and about 10-15* of valgus in full extension (women have more valgus than men)

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2
Q

Describe the interosseous membrane.

A

Has different portions, but the largest portion is called the central band and it runs from proximal lateral to distal medial.

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3
Q

Describe the medial elbow ligamentous complex.

A

The main constraint to elbow valgus instability is the MCL. It has 3 distinct bundles: anterior bundle which is the strongest, a thin posterior bunde, and a oblique or transverse bundle. The anterior band of the anterior bundle is the primary restraint of valgus from 30-90 degrees, while the posterior band is the primary restraint from 90-120 degrees. (at full ext, the bones are the primary restraint).

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4
Q

Describe the lateral ligamentous complex.

A

consists of the radial collateral ligament (lateral epicondyle to annular ligament), the annular ligament, the accessory collateral ligament, and the lateral ulnar colateral ligament

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5
Q

Describe posterolateral rotatory instability.

A

PLRI is a common pattern caused by a fall onto an outstretched arm. The humerus rotates internally on the elbow, causing ER and valgus loading as the elbow flexes.

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6
Q

Differentiate between normal and functional elbow ROM.

A

Normal ROM is 0-150, 85 of supination, 80* of pronation. Functional ROM is 30-130* with 50* of supination and pronation.

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7
Q

What is the primary pronator?

A

Pronator quadratus, with the pronator teres activating at increasing speeds.

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8
Q

What is “little league elbow”?

A

A generic term referring to several overuse injuries, such as osteochondritis dissecans of the capitellum, medially stressed valgus. The repetitive valgus stress of throwing results in microtrauma of the medial anterior oblique ligament and compression of the radiocapitellar joint.

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9
Q

What functional tests confirm diagnosis of little league elbow and how is little league elbow treated?

A

flexing and extending the elbow with a valgus stress should elicit pain. Loss of passive elbow extension may occur and is common in pro pitchers.
rest and absolutely no throwing for up to 1 year

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10
Q

What are the recommended sequence of pitches for adolescent athletes?

A 
First pitch: fastball at 8 years
Change-up at 10 years
Curve ball at 14 years
Knuckle ball at 15 years
Slider and fork ball at 16 years
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11
Q

What is lateral epicondylitis?

A

Lateral elbow pain usually involving the ECRB tendon or the extensor digitorum tendon.

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12
Q

What is the Mills maneuver?

A

a treatment option for lateral epicondylitis, intended to pull apart two surfaces joined by a scar. Pt is supine with the wrist in full flexion and the forearm fully pronated. The elbow is suddenly moved to full extension. The site may need to be numbed with an injection first.

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13
Q

What is radial tunnel syndrome?

A

The radial tunnel is about 2 inches in length, extending from the capitellum of the humerus between the brachioradialis and brachialis distally through the supinator muscle. The radial nerve may get trapped and cause pain around the lateral epicondyle.

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14
Q

How are ulnar nerve compressions classified?

A

McGowan’s classification:
Class 1- symptoms only
Class 2: signs and symptoms including weakness
Class 3: loss of sensation, weakness, and atrophy

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15
Q

What is a Martin-Gruber anastomosis?

A

An anastomosis of the meidan nerve to the ulnar nerve in the forearm before the median nerve crosses the wrist.

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16
Q

Define radial tunnel syndrome.

A

The deep branch of the radial nerve is compressed, causing a deep aching pain in the upper dorsal forearm between the brachioradialis and ECRL/ECRB.

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17
Q

Which nerve is compressed in pronator teres syndrome?

A

median nerve

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18
Q

What is Saturday night palsy?

A

compression injury to the radial nerve between the humerus and muscle

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19
Q

Describe the anatomy of the flexor sheath.

A

The pulleys are called annular (A) and cruciate (C). They prevent the tendons from bowstringing when the fingers are flexed. There are 5 annular pulleys and 3 cruciate. A1 and A2 are the most proximal, followed by cruciate and annular ligaments in an alternating pattern. The odd numbered pulleys are located at the joints while the even numbers are over the bone (nothing is over the distal phalanx)
The most crucial puleys are the A2 and A4 pulleys (the ones located over the bone)

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20
Q

What is the normal ROM of the wrist?

A

flex: 80*
ext: 70*
RD: 20*
UD: 30*
pronation: 80*
supination: 80*

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21
Q

Describe the kinematics at the wrist.

A

THe distal row moves as a unit due to strong interosseous ligaments. The proximal row has no tendinous attachments except at the pisiform. so the distal row moves first and the proximal row follows its lead

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22
Q

Describe the normal anatomy of the distal radius.

A

It tilts in two planes. 11 degrees of volar tilt and 22 degrees of ulnar inclination.

23
Q

Describe the blood supply of the scaphoid.

A

Gets blood from the ligaments with the main supply entering near the waist and others near the distal aspect. With a fracture, the most proximal portion is at risk for AVN.

24
Q

What is the innervation of the muscles of the hand?

A

All muscles are innervated by the ulnar nerve (or one of its branches) except the Abductor pollicis brevis (Rec branch of the median nerve), the superficial head of the flexor pollicis brevis (RBMN), opponens pollicis (RBMN), and the 1st&2nd lumbricals (median nerve)

25
Q

What is the action of the interossei?

A

The dorsal interossei abduct the fingers, the palmar interossei adduct the fingers

26
Q

What is usually the most appropriate position of MCP joint splinting?

A

Some degree of flexion (not extension). In ext, collateral ligaments are shortened. It is easier to regain full flexion when MCPs are splinted in flexed positions.

27
Q

What is the best position to splint the hand after injury or surgery?

A

Wrist Ext, MCP flexed, IP joint extended

28
Q

What is a mallet finger?

A

An droop of the finger into flexion at the IP joint caused by injury to the extensor mechanism at the DIP joint. Usually caused by force applied to actively extended finger.

29
Q

What is trigger finger?

A

A finger that is locked or tries to lock in flexion. The flexor tendon can’t enter the fibro-osseous canal at the level of A1 pulley due to thickening of this pulley and reactive inflammation.

30
Q

What is Dupuytren’s contracture?

A

familial disease with formatino of new fibrous tissue in the form of nodules and cords in the fascia, leading to flex contracture. More common in Northern europeans, diabetics, smokers, alcoholics, Men outnumber women 9:1

31
Q

What is Kienbock’s disease?

A

avascular necrosis of the lunate.

32
Q

What is a ganglion cyst?

A

greek for “cystic tumor”, they are mucus-filled cyst that account for most soft tissue tumors in w/h. More common in women on the dorsal wrist. Tx with aspiration, cortisone, or surgical removal.

33
Q

Define Swan Neck deformity.

A

Posture of PIP hyperextension and DIP flexion. Usually does not respond to conservative splinting or exercises and requires surgery.

34
Q

Define boutonniere deformity.

A

“Buttonhole”. Opposite of Swan neck, the PIP is flexed and DIP is hyperextended, causing a buttonholing of the head of the proximal phalanx through ext mechanism at the PIP joint. Responds to splinting and exercise.

35
Q

What is de Quervain’s disease?

A

Inflammation of tendons and synovium of AbPL and EPB tendons in the first dorsal compartment. Diagnosed with Finkelstein’s test.

36
Q

Define focal dystonia.

A

Writers cramp (excessive agonist and antagonist muscle actiivity

37
Q

When are extensor tendon repairs weakest?

A

Between 1 and 3 weeks.

38
Q

When are flexor tendon repairs weakest?

A

Between 1 and 2 weeks.

39
Q

What are the expected outcomes after flexor tendon repair?

A

75% of preinjury function and ROM.

40
Q

What are the functions of the interossei?

A

Palmar adduct fingers to middle finger, dorsal abduct fingers from middle finger (hence the middle finger only has dorsal interrossei attachments)

41
Q

Define boxer’s fractures.

A

A fracture of the metacarpal neck of the ring and pinky fingers, usually causing dorsal angulation because of intrinsic muscles cause flexion.

42
Q

Define a baseball finger.

A

Also known as mallet finger, treated by splinting for 4-6 weeks at the DIP.

43
Q

What is jersey finger?

A

Avulsion of FDP at distal phalanx (opposite of mallet finger.

44
Q

Describe Bennett and Rolando fractures.

A

fracture of the thumb metacarpal

45
Q

Define gamekeeper’s thumb.

A

An injury to the UCL of the thumb MP joint. British gamekeepers often developed laxity here due to the way they put down wounded rabbits. Most commonly seen in skiers.

46
Q

Describe Colles’, Barton’s, and Smith’s fractures.

A

Colles: dorsal angulation, displacement, and shortening of distal radius (and wrist and hand).
Smith’s: reverse colles.
Barton’s: intraarticular shear fracture with displacement either direction.

47
Q

What is the second most common wrist fracture?

A

Scaphoid fracture (radius fractures are most common). Usually from fall on ext wrist. Pain in snuff box.

48
Q

What is Wartenberg’s disease?

A

superficial radial nerve entrapment, often confused with de Quervain’s disease. Superficial along disatal radisu between brachioradialis and ECRL with pronation and ulnar deviation. Causes pain over dorsal lateral hand. Finklestein’s may be positive. Differentiate with prolonged pronation.

49
Q

Describe clinical manifestations of compression of deep motor branch of ulnar nerve.

A

second, third, and fourth digits are unable to abduct. (5th digit is superficial ulnar)

50
Q

Describe innervation at hand.

A

Ulnar nerve innervates 14.5 muscles, median nerve innervates 4.5, radial innervates none.

51
Q

What is the significance of a positive Froment’s sign?

A

ulnar nerve lesion that makes it easy to pull a piece of paper from between the thumb and finger.

52
Q

What are classic findings of median nerve compression?

A

numbness or pain in radial three and one half digits, especially at night.

53
Q

What does AIN innervate?

A

AIN innervates FPL, Pronator quadratus, and DFP to index and long finger.

OCS Exam (15 decks)

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