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UE Extremity part 1 > UE - Elbow, wrist & hand > Flashcards

UE - Elbow, wrist & hand Flashcards

1
Q

THE ELBOW & FOREARM

Three Articulations:

A

Three Articulations:
1. HU (humeroulnar) jt
2. HR (humeroradial) jt
3.PRU (proximal radioulnar) jt

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2
Q

Trochlea (Metro)

Laterality?

Trochlea + Ulna =

A

Medial aspect
- Trochlea + Ulna =
Ulnohumeral jt

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3
Q

Capitulum

Capitulum + Radial fovea =

A

Lateral aspect
- Capitulum + Radial fovea =
Radiohumeral jt

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4
Q

A child you are working with caught a fall during a sport event which resulted her to have a valgus injury on the elbow. Assuming a bony lesion, you know that immobilization will be necessary for her to prevent the avascular necrosis of which bone?

A. Olecranon process
B. Capitulum
C. Trochlea
D. Ulnar head

A

B. Capitulum

Capitulum avascular necrosis = Panners

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5
Q

Capitulum Avascular Necrosis

A

Panner’s Dse

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6
Q

CARRYING ANGLE

Normal Value?
Landmarks?

Male value?
Female value?

Cubitus Valgus:
Cubitus Varus:
Gunstock Deformity:

A
  1. Long axis of humerus
  2. Long axis of ulna c elbow
    straight and supinated

Normal Value? 5-15

M: 5-10 degrees
F: 10-15 degrees

Cubitus Valgus: >15 degrees
Cubitus Varus: <5 degrees
Gunstock Deformity: -15 degrees

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7
Q

HUMERO-ULNAR JOINT
Aka: Trochlear jt

Type of joint:
Articulation:

A

Type of joint: Hinged
Articulation: Trochlea + Ulna

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8
Q

Humeroulnar Joint

OPEN-PACKED POSITION:
CLOSE-PACKED POSITION:
CAPSULAR PATTERN:

A

OPEN-PACKED POSITION: 70 flexion, 10 supination

CLOSE-PACKED POSITION: Full ext c Full supination

CAPSULAR PATTERN: Flex, Ext

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9
Q

Humeroulnar Joint

PJM?

A

❑ Stabilize humerus c gait belt @ 45
degrees
❑ Provide distal glide in a scoop
motion (J scoop)
❑ To ↑ flexion

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10
Q

HUMERO-RADIAL JOINT

Articulation:
Permits:

A

Articulation: Capitulum + Radial fovea
Permits: radius to rotate to any
degrees to allow FA S/P

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11
Q

HUMERO-RADIAL JOINT

OPEN-PACKED POSITION:
CLOSE-PACKED POSITION:
CAPSULAR PATTERN:

A

OPEN-PACKED POSITION: Full ext c Full supination

CLOSE-PACKED POSITION: 90 flexion, 5 supination

CAPSULAR PATTERN: Flex, Ext, Supination, Pronation

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12
Q

HUMERO-RADIAL JOINT PJM purpose

A

❑ To ↑ HR jt mobility
❑ To manipulate a pushed elbow

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13
Q

Proximal Radioulnar Joint

OPEN-PACKED POSITION:
CLOSE-PACKED POSITION:
CAPSULAR PATTERN:

A

OPEN-PACKED POSITION: 70 flexion, 35 supination

CLOSE-PACKED POSITION: 5 supination

CAPSULAR PATTERN: Supination=Pronation

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14
Q

LIGAMENTS OF THE ELBOW

1.
2.
3.
4
5.

A

Interosseous Membrane
Oblique Cord
Annular Ligament
Medial Collateral Ligament
Lateral Collateral Ligament

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15
Q

Interosseous Membrane

Aka:
Function:
Tensed when FA is in?

Prevents displacement of radius during?

A

Aka: Middle Radioulnar jt
Function: Helps distribute forces throughout the FA
Tensed when FA is in midposition

*Prevents displacement of radius during PUSHING

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16
Q

Oblique Cord

Prevents displacement of radius during?

A

From ulna to radial tuberosity

Prevents displacement of radius during PULLING

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17
Q

Annular Ligament

Affected in:

Nursemaid’s elbow is what?

A

Encircles the radius but it is freely
attached

Affected in: Pulled elbow/
Nursemaid’s elbow
- Head of radius is subluxed
inferiorly to the annular ligament

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18
Q

Medial Collateral Ligament

Aka:

MCL + FCU =

Has three (3) Bands:

A

Aka: Ulnar Collateral Ligament
Major restraint to Valgus stress from 20-120
deg of flex
Primary stabilizer of the elbow jt
MCL + FCU = cubital tunnel

Has three (3) Bands:
Anterior Band – limits ext
Posterior Band – limits flex
Transverse Part

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19
Q

Lateral Collateral Ligament

Aka:

Primary restraint to ____________

Resist:

MC unstable =

A

Aka: Radial Collateral Ligament
Primary restraint to Posterolateral instability
Resist: Varus stress
MC unstable = Posterolateral elbow dislocation

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20
Q

VALGUS and VARUS
STRESS TEST

A

❑ Passive
❑ Elbow @ 20-30 deg flex
❑ Palpate medial/lateral elbow
❑ Provide Valgus/Varus force at the FA
❑ Check for Abn movement

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21
Q

Moving Valgus
Stress Test

A

❑ 1st = Sh abd 90 c full elbow flex
❑ 2nd = ext elbow while maintaining
valgus stress
❑ (+) pain @ 120-70 degrees
❑ Indic: partial tear of MCL

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22
Q

BURSA AT THEELBOW

A
  • lubrication, nourishment, ↓ friction during jt motions
  1. Olecranon bursa
    Main bursa of the elbow complex.
    Lies posteriorly between the skin and the olecranon process.
  2. Deep intratendinous bursa and deep subtendinous bursa
    Between the triceps tendon and olecranon
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23
Q

Olecranon bursitis

Aka: Dart thrower’s, Miner’s, Draftman’s,
Student’s Elbow

MC

Tx:

A

MC injured bursa in the elbow
Goose egg appearance

Tx: RICE, US, ES
If conservative mgt fails: Aspiration (drain fluid)

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24
Q

Triangle sign of the elbow

3 Landmarks:

N:

(+):

A

3 Landmarks:
1. Lateral epicondyle
2. Medial epicondyle
3. Olecranon process

N: Ext = 3 landmarks are aligned
90 Flex = Isosceles/Scalene
triangle

(+): one side is longer
Indic: swelling, Fx, dislocation

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25
Major elbow flexor Nerve? Brachialis Biceps Brachii Brachioradialis Major elbow extensors? Triceps Brachii Anconeus
Major elbow flexor Nerve - Musculocutaneous nerve Brachioradialis - Msc + Radial nn Major elbow extensors - Radial nn
26
Biceps brachii MMT? Strongest: Substitutes:
MMT:Elbow flex while FA supinated Strongest: FA supinator (**trivia) Substitutes: for Abd when the Sh is in ER to compensate for supra and delts weakness Heuter’s Sign: Ask px to flex elbow c FA pronated & PT resistance (brachialis) N: FA supinated (strong biceps help brachialis) = (+) Heuter sign If no FA supination = distal biceps rupture
27
Heuter’s Sign:
Heuter’s Sign: Ask px to flex elbow c FA pronated & PT resistance (brachialis) N: FA supinated (strong biceps help brachialis) = (+) Heuter sign If no FA supination = distal biceps rupture
28
Ludington’s Test Procedure (+): Indic
❑ Alternate contxn of biceps ❑ (+): no palpable contxn ❑ Indic: Long head biceps tendon rupture
29
Brachialis Nn: MMT:
Workhorse: Active in all elbow motions Nn: Musculocutaneous nn MMT:FA pronated Largest cross section in UE MC affected in: Myositis Ossificans (Calcium deposits in ms belly)
30
Brachioradialis MMT? Cheiralgia Paresthetica (Aka: Wartenburg Dse)
MMT: FA in neutral Cheiralgia Paresthetica (Aka: Wartenburg Dse) * Affectation of Superficial Radial nn under the Brachiorads * Pure sensory affectation @ dorsal wrist, dorsal thumb, dorsal 1st webspace
31
If Musculocutaneous nn is severed, which ms substitute for elbow flex? If Biceps, Brachialis, & Brachiorads are all affected?
substitute for elbow flex? - If Biceps, Brachialis, & Brachiorads are all affected?
32
HIS/LOP heuter ludington
Heuter - insertion problem ludington - origin problem
33
Crutch Walking ms
1. Lats Dorsi – most impt 2. Triceps 3. Lower Trapz
34
Initiates elbow extension
Anconeus
35
Works as an: elbow flexor when the FA is pronated
Pronator Teres
36
Terrible Triad of the Elbow (Dislocation)
1. Radial head Fx 2. Coronoid process Fx 3. Rupture of collateral ligaments
37
Mobile wad: ms active during gripping, hammering & sawing “Wadialis” Triad
“Wadialis” Triad 1. ECRL 2. ECRB 3. Brachiowadialis
38
Cubital Fossa Contents: BOUNDARIES: Lateral: Medial: Floor: Superior: Roof:
be right there always my PT Brachiorads, Radial nn, Tendon of biceps, Artery (Brachial), Median nn, Pronator Teres BOUNDARIES: Lateral: BR Medial: PT Floor: L: M: Superior: imaginary line bet the epicondyles Roof: skin, fascia, bicipital aponeurosis
39
Your patient, who is a carpenter, is having difficulty loosening a screw using his left hand. Upon evaluation, you determine that the patient requires joint mobilization on the DRU joint. Which glide would you use? A. Dorsal glide B. Volar glide C. Medial glide D. Lateral glide
A. Dorsal glide
40
Wrist and Hand Complex Functional position of the wrist
Functional position of the wrist - greatest power of grip - 20-35 deg of ext and 10-15 deg of UD
41
DISTAL RADIOULNAR JOINT Type of joint: OPEN-PACKED POSITION: CLOSE-PACKED POSITION: CAPSULAR PATTERN: mobilization:
Type of joint: Pivot OPEN-PACKED POSITION: 10 supination CLOSE-PACKED POSITION: 5 supination CAPSULAR PATTERN: Full ROM, pain on extreme rotation mobilization: DRU pron: ant glide PRU pron: post glide
42
Main stabilizer of the DRU jt
TRIANGULAR FIBROCARTILAGE COMPLEX
43
TRIANGULAR FIBROCARTILAGE COMPLEX Function
Functions: 1. Assist in binding the distal radius to the ulnar styloid process 2. ↑ joint congruency 3. Cushions against compressive forces
44
MC Fx carpal bone (MOI: FOOSH)
Scaphoid
45
Scaphoid Neck = avascular (poor healing –> necrosis)
Preiser’s Dse
46
MC dislocated carpal bone – “Dislonate”
Lunate (aka: semilunar bone)
47
Lunate AVN: Body = Distal lunate =
Body = Kienbock’s Dse Distal lunate = Burns Dse
48
(+) Murphy’s sign
Lunate (aka: semilunar bone)
49
- Sesamoid bone - Formed under the FCU tendon - ↑ the leverage during flex/ext - Only attached to the triquetrum - Only visible at the palmar – Xray
Pisiform
50
- Largest carpal bone - Articulate c all the carpals except pisiform
Capitate (Os Magnum)
51
(-) Murphy Sign
Lunate Dislocation
52
- Connected to pisiform thru Pisohamate ligament - Forming the Tunnel of Guyon - Passageway for ulnar nn & artery
Hamate
53
RADIOCARPAL JOINT Articulation between the radius and the proximal row of carpals (scaphoid, lunate, triquetrum) Aka: Type of joint: OPP: CPP: CP: MOBILIZATION
Aka: Wrist joint Type of joint: Ellipsoidal OPP: Neutral c slight UD CPP: Ext CP: F=E MOBILIZATION inc flexion =dorsal glide inc extension= volar glide inc ulnar deviation= lateral/radial glide inc radial deviation= ulnar/medial glide
54
MIDCARPAL JOINT OPP: CPP: CP:
OPP: Neutral/slight flex c UD CPP: Full ext CP: equal in all direction
55
INTERCARPAL JOINTS Type of joint: Watson Test?
Type of joint: Plane ❑ 1st = Full UD + slight ext ❑ 2nd = apply pressure on scaphoid (palmar aspect) + counterforce at dorsal FA ❑ 3rd = RD + Flex ❑ (+) pain = scaphoid Fx ❑ (+) pain, post sublux of scaphoid & thunk upon removal of pressure = scaphoid instability
56
CARPOMETACARPAL CM of thumb: CM of four fingers: MOBILIZATION of 1st CMC:
CM of thumb: Saddle CM of four fingers: Plane 1st CMC:Very mobile : MC site of OA of the hand 2nd and 3rd: stable 4th and5th: mobile : adjusts to shape of what we grasp MOBILIZATIONof 1st CMC: abd/add - opposite-dorsal glide flex/extend - ulnar glide
57
CMC THUMB OPP: CPP: CP:
OPP: midway bet flex/ext & abd/add CPP: full opposition Cap: Abd, Ext
58
CMC FINGERS OPP: CPP: CP:
OPP: midway bet flex/ext CPP: full flex Cap: Equal limitations in all direction
59
MCP Joint (Thumb) OPP: CPP: CP:
Type of joint: Condyloid OPP: slight flex CPP: full opposition Capsular Pattern: Flex, Ext
60
Aka: Gamekeeper’s Thumb MOI: Fall in abducted thumb Rupture of: UCL/MCL
Skier’s Thumb
61
Skier’s Thumb N Valgus: <30-35: >30-35:
N Valgus: 15 deg <30-35: partial tear of MCL >30-35: complete tear
62
Skier’s Thumb MOI: Rupture of:
MOI: Fall in abducted thumb Rupture of: UCL/MCL
63
Cascade Sign
❑ Flex MCP and PIP jt ❑ N: converge to scaphoid ❑ If not: trauma/Fx to digits c altered alignments
64
Thickening of the palmar fascia
Dupuytren’s Contracture
65
Dupuytren’s Contracture ❑ MC: ❑ DM px:
❑ MC: 4th & 5th digits ❑ DM px: 3rd & 4th digits
66
Serves to prevent the tendons from "bow-stringing" when the tendons turn a corner at the wrist. Secures the tendons in place
Extensor Retinaculum
67
Spans the area between the scaphoid tubercle & pisiform proximally, and the hook of hamate & tubercle of trapezium distally Transforms the carpal arch into a tunnel, through which pass the median nerve and some of the tendons of the hand.
Flexor Retinaculum
68
Structures that pass superficial to the flexor retinaculum
Flexor carpi ulnaris tendon Ulnar nerve Ulnar artery Palmar cutaneous branch of the ulnar nerve Palmaris longus tendon (if present) Palmar cutaneous branch of the median nerve
69
Structures that pass beneath the flexor retinaculum
Flexor digitorum superficialis (4) Flexor digitorum profundus tendons (4) Flexor pollicis longus Median nerve
70
Carpal Tunnel CTS Dx Special tests (4)
* Serves as a conduit for the median nn & 9 flexor tendons * CTS Dx = EMG NCV * Special tests * Phalen’s * Tinel’s * Flick * Carpal Compression
71
Tunnel of Guyon Location? Artery and nerve that passes? If compressed: Innervated Muscles:
A depression superficial to the flexor retinaculum. Located between the hook of the hamate and the pisiform bones. Ulnar artery and ulnar nerve pass through the canal. If compressed: altered sensation at the little finger & medial half of the ring finger Innervated Muscles: AFO AIM afo digiti minimi adductor pollicis interossei (pad dab) medial half of lumbricals
72
Froment’s Paper Sign
❑ N: Thumb add – intact Add Pollicis ❑ (+): flexion of thumb IP = (+) Froment’s ❑ (+): Hyperext of MCP = (+) Jeanne’s weak adductor pollicis
73
Pinch Grip Test Aka: Okay sign/Kiloh Nevin Syndrome Negative test = Positive test = Indicates:
Negative test = Tip to Tip Positive test = Pulp to pulp Indicates: entrapment of AIN between the heads of pronator muscle
74
ANATOMIC SNUFFBOX Lateral: Medial: Floor: - (+) = ___________ Fx
Lateral:AbPoLo, ExPoBre Medial: ExPoLo Floor: Scaphoid - (+) tenderness on floor = Scaphoid Fx
75
TENODESIS EFFECT ❑ Active wrist ext → passive finger flex ❑ d/t passive insufficiency of ____________ causing shortening of ______tendons ❑ Px c SCI _____ to facilitate grasping ❑ C/I stretching of ___________
❑ Active wrist ext → passive finger flex ❑ d/t passive insufficiency of finger flexors causing shortening of FDP tendons ❑ Px c SCI C6 to facilitate grasping ❑ C/I stretching of long finger flexors
76
Intrinsic muscles: Thenar vs Hypothenar muscles: Lumbricals vs Interossei
Thenar - Abd pollicis -FPB - OP - ADD POLLICIS Hypothenar: AFO ABD DM FDMB ODM Lumbricals -Quick closure of hands Interossei - guttering/wasting
77
EXTENSOR HOOD EDC Lumbricals & Interossei 1 Central & 2 Lateral Bands
EDC - inserts on proximal phalanx EDC Lumbricals & Interossei 1 Central & 2 Lateral Bands
78
Interplay of Intrinsics + EDC if only EDC? if only Intrinsic? If all active? how to stretch intrinsic?
if only EDC - MCP ext IP's flex = Intrinsic minus (claw hand) if only Intrinsic - MCP flex, IP's ext = Intrinsic plus If all active - MCP PIP DIP ext how to stretch intrinsic? - Intrinsic minus
79
Extensor Hood Rupture Test ❑ Aka: ❑ Procedure ❑ (+): ❑ Indic
❑ Aka: Elson Test ❑ Flex PIP 90 at edge of table ❑ Actively ext PIP while palpating middle phalanx ❑ (+): weak PIP ext c hypertext at DIP jt ❑ Indic: Torn central slip
80
Flexor Pulleys A1 – A2 – A3 – A4 – A5 –
A1 – MCP jt **Trigger finger = 3rd & 4th fingers A2 – shaft of proximal phalanx A3 – PIP jt A4 – Shaft of mid phalanx A5 – DIP jt
81
Flexor tendon zones I. II. III. IV. V.
I. DIP joint II. NO MANSLAND – No blood supply = poor healing III. Metacarpals IV. CARPALTUNNEL V. Distal Forearm
82
Extensor tendon zones I. II. III. IV. V. VI. VII.
I. DIP Joint II.Middle Phalanx III- PIP Joint IV- Proximal Phalanx V- MCPJoint VI.Dorsum of the Hand VII. Dorsal Wrist
83
Terminal Slip? Central Slip? Swan neck deformity?
Terminal Slip - Mallet Finger (DIP flex) Central Slip - Boutonniere deformity EFE - MCP ext, PIP flex and DIP ext. Swan neck deformity- FEF - MCP flex, PIP hyperext and DIP flex. - contracture of the instrinsic or volar plate rupture -RA; Trauma
84
Precision Grip: ______ nn Power Grip: ______ nn
Precision Grip: Median nn Power Grip: Ulnar nn

UE Extremity part 1 (6 decks)

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