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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
Q

Major elbow flexor Nerve?
Brachialis
Biceps Brachii
Brachioradialis

Major elbow extensors?
Triceps Brachii
Anconeus

A

Major elbow flexor Nerve - Musculocutaneous nerve

Brachioradialis - Msc + Radial nn

Major elbow extensors - Radial nn

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26
Q

Biceps brachii

MMT?
Strongest:
Substitutes:

A

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

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27
Q

Heuter’s Sign:

A

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

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28
Q

Ludington’s Test

Procedure
(+):
Indic

A

❑ Alternate contxn of biceps
❑ (+): no palpable contxn
❑ Indic: Long head biceps
tendon rupture

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29
Q

Brachialis

Nn:

MMT:

A

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)

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30
Q

Brachioradialis

MMT?

Cheiralgia Paresthetica (Aka: Wartenburg Dse)

A

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

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31
Q

If Musculocutaneous nn is severed, which ms
substitute for elbow flex?
If Biceps, Brachialis, & Brachiorads are all
affected?

A

substitute for elbow flex? -

If Biceps, Brachialis, & Brachiorads are all
affected?

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32
Q

HIS/LOP

heuter
ludington

A

Heuter - insertion problem
ludington - origin problem

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33
Q

Crutch Walking ms

A
  1. Lats Dorsi – most impt
  2. Triceps
  3. Lower Trapz
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34
Q

Initiates elbow extension

A

Anconeus

35
Q

Works as an: elbow flexor when
the FA is pronated

A

Pronator Teres

36
Q

Terrible Triad of the Elbow (Dislocation)

A
  1. Radial head Fx
  2. Coronoid process Fx
  3. Rupture of collateral
    ligaments
37
Q

Mobile wad: ms active during
gripping, hammering & sawing
“Wadialis” Triad

A

“Wadialis” Triad
1. ECRL
2. ECRB
3. Brachiowadialis

38
Q

Cubital Fossa
Contents:

BOUNDARIES:
Lateral: Medial:

Floor:
Superior:
Roof:

A

be right there always my PT

<lateral>

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
</lateral>

39
Q

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

A. Dorsal glide

40
Q

Wrist and Hand Complex
Functional position of the wrist

A

Functional position of the wrist
- greatest power of grip
- 20-35 deg of ext and 10-15 deg of UD

41
Q

DISTAL RADIOULNAR JOINT

Type of joint:
OPEN-PACKED POSITION:
CLOSE-PACKED POSITION:
CAPSULAR PATTERN:

mobilization:

A

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
Q

Main stabilizer of the DRU jt

A

TRIANGULAR FIBROCARTILAGE
COMPLEX

43
Q

TRIANGULAR FIBROCARTILAGE
COMPLEX Function

A

Functions:
1. Assist in binding the distal radius to
the ulnar styloid process
2. ↑ joint congruency
3. Cushions against compressive
forces

44
Q

MC Fx carpal bone (MOI: FOOSH)

A

Scaphoid

45
Q

Scaphoid Neck = avascular (poor healing –>
necrosis)

A

Preiser’s Dse

46
Q

MC dislocated carpal bone – “Dislonate”

A

Lunate (aka: semilunar bone)

47
Q

Lunate AVN:

Body =
Distal lunate =

A

Body = Kienbock’s Dse
Distal lunate = Burns Dse

48
Q

(+) Murphy’s sign

A

Lunate (aka: semilunar bone)

49
Q
  • Sesamoid bone
  • Formed under the FCU tendon
  • ↑ the leverage during flex/ext
  • Only attached to the triquetrum
  • Only visible at the palmar – Xray
A

Pisiform

50
Q
  • Largest carpal bone
  • Articulate c all the carpals except pisiform
A

Capitate (Os Magnum)

51
Q

(-) Murphy Sign

A

Lunate Dislocation

52
Q
  • Connected to pisiform thru Pisohamate
    ligament
  • Forming the Tunnel of Guyon
  • Passageway for ulnar nn & artery
A

Hamate

53
Q

RADIOCARPAL JOINT

Articulation between the radius and the proximal row of carpals
(scaphoid, lunate, triquetrum)

Aka:
Type of joint:
OPP:
CPP:
CP:

MOBILIZATION

A

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
Q

MIDCARPAL JOINT

OPP:
CPP:
CP:

A

OPP: Neutral/slight flex c UD
CPP: Full ext
CP: equal in all direction

55
Q

INTERCARPAL JOINTS

Type of joint:

Watson Test?

A

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
Q

CARPOMETACARPAL

CM of thumb:
CM of four fingers:

MOBILIZATION of 1st CMC:

A

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
Q

CMC THUMB

OPP:
CPP:
CP:

A

OPP: midway bet flex/ext & abd/add
CPP: full opposition
Cap: Abd, Ext

58
Q

CMC FINGERS

OPP:
CPP:
CP:

A

OPP: midway bet flex/ext
CPP: full flex
Cap: Equal limitations in all direction

59
Q

MCP Joint (Thumb)

OPP:
CPP:
CP:

A

Type of joint: Condyloid

OPP: slight flex
CPP: full opposition
Capsular Pattern: Flex, Ext

60
Q

Aka: Gamekeeper’s Thumb
MOI: Fall in abducted thumb
Rupture of: UCL/MCL

A

Skier’s Thumb

61
Q

Skier’s Thumb
N Valgus:
<30-35:
>30-35:

A

N Valgus: 15 deg
<30-35: partial tear of MCL
>30-35: complete tear

62
Q

Skier’s Thumb
MOI:
Rupture of:

A

MOI: Fall in abducted thumb
Rupture of: UCL/MCL

63
Q

Cascade Sign

A

❑ Flex MCP and PIP jt
❑ N: converge to scaphoid
❑ If not: trauma/Fx to digits c
altered alignments

64
Q

Thickening of the palmar
fascia

A

Dupuytren’s
Contracture

65
Q

Dupuytren’s
Contracture

❑ MC:
❑ DM px:

A

❑ MC: 4th & 5th digits
❑ DM px: 3rd & 4th digits

66
Q

Serves to prevent the tendons from
“bow-stringing” when the tendons
turn a corner at the wrist.

Secures the tendons in place

A

Extensor Retinaculum

67
Q

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.

A

Flexor Retinaculum

68
Q

Structures that pass superficial to
the flexor retinaculum

A

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
Q

Structures that pass beneath
the flexor retinaculum

A

Flexor digitorum superficialis (4)
Flexor digitorum profundus tendons (4)
Flexor pollicis longus
Median nerve

70
Q

Carpal Tunnel

CTS Dx
Special tests (4)

A
  • 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
Q

Tunnel of Guyon

Location?
Artery and nerve that passes?

If compressed:

Innervated Muscles:

A

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
Q

Froment’s Paper Sign

A

❑ N: Thumb add – intact Add Pollicis
❑ (+): flexion of thumb IP = (+) Froment’s
❑ (+): Hyperext of MCP = (+) Jeanne’s

weak adductor pollicis

73
Q

Pinch Grip Test
Aka: Okay sign/Kiloh Nevin Syndrome

Negative test =
Positive test =

Indicates:

A

Negative test = Tip to Tip
Positive test = Pulp to pulp
Indicates: entrapment of AIN between the
heads of pronator muscle

74
Q

ANATOMIC SNUFFBOX

Lateral:
Medial:
Floor:
- (+)
= ___________ Fx

A

Lateral:AbPoLo, ExPoBre
Medial: ExPoLo
Floor: Scaphoid
- (+) tenderness on floor
= Scaphoid Fx

75
Q

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 ___________

A

❑ 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
Q

Intrinsic muscles:

Thenar vs
Hypothenar muscles:

Lumbricals vs
Interossei

A

Thenar
- Abd pollicis
-FPB
- OP
- ADD POLLICIS

Hypothenar: AFO
ABD DM
FDMB
ODM

Lumbricals
-Quick closure of hands

Interossei
- guttering/wasting

77
Q

EXTENSOR HOOD

EDC
Lumbricals & Interossei
1 Central & 2 Lateral Bands

A

EDC - inserts on proximal phalanx

EDC
Lumbricals & Interossei
1 Central & 2 Lateral Bands

78
Q

Interplay of Intrinsics + EDC

if only EDC?

if only Intrinsic?

If all active?

how to stretch intrinsic?

A

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
Q

Extensor Hood Rupture Test

❑ Aka:
❑ Procedure
❑ (+):
❑ Indic

A

❑ 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
Q

Flexor Pulleys

A1 –
A2 –
A3 –
A4 –
A5 –

A

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
Q

Flexor tendon zones

I.
II.
III.
IV.
V.

A

I. DIP joint
II. NO MANSLAND – No blood supply =
poor healing
III. Metacarpals
IV. CARPALTUNNEL
V. Distal Forearm

82
Q

Extensor tendon zones

I.
II.
III.
IV.
V.
VI.
VII.

A

I. DIP Joint
II.Middle Phalanx
III- PIP Joint
IV- Proximal Phalanx
V- MCPJoint
VI.Dorsum of the
Hand
VII. Dorsal Wrist

83
Q

Terminal Slip?

Central Slip?

Swan neck deformity?

A

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
Q

Precision Grip: ______ nn
Power Grip: ______ nn

A

Precision Grip: Median nn
Power Grip: Ulnar nn

UE Extremity part 1 (6 decks)

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