Upper Extremity

Question 1

Lateral epicondylitis (Tennis Elbow) usually occurs in…

Answer 1

patients 35 years or older and between the ages of 30-50.

Question 2

Populations affected by radial head dislocation and have trouble moving in to supination

Answer 2

Children- usually occurs when the parent gives the child a strong tug “come along” and dislocates the head of the radius.

Question 3

Osteoarthritis changes in the hand are more likely to occur over what age?

Answer 3

40.

Question 4

FOOSH can lead to…

Answer 4

carpal bone fracture or dislocation, often lunate dislocation, pain with PROM wrist flexion

Question 5

Pain in the tip of the olecranon can indicate…

Answer 5

bursitis

Question 6

Pain in the anatomical snuffbox can indicate…

Answer 6

a scaphoid injury

Question 7

Carrying angle in males

Answer 7

5-10 degrees

Question 8

Carrying angle in females

Answer 8

10-15 degrees

Question 9

Cubital Vagus

Answer 9

> 15 degrees

Question 10

Cubital Varus

Answer 10

<5-10 degrees

Question 11

Where and what is the triangular space?

Answer 11

between the tip of the olecranon, the radial head and the lateral epicondyle, it is a common area of swelling with joint injury

Question 12

Osteoarthritis

Answer 12

Herberden’s nodes: DIP joints

Bouchard’s nodes: PIP

Question 13

Rheumatoid Arthritis

Answer 13

Ulnar drift at the MCP joint

Question 14

ROM: elbow flexion

Answer 14

140-150

Question 15

ROM: elbow extension

Answer 15

0- (-) 10

Question 16

ROM: elbow supination

Answer 16

90

Question 17

ROM: elbow pronation

Answer 17

80-90

Question 18

ROM: wrist flexion

Answer 18

80-90

Question 19

ROM: wrist extension

Answer 19

70-90

Question 20

ROM: Ulnar deviation

Answer 20

30-45

Question 21

ROM: Radial deviation

Answer 21

15

Question 22

Tip when assessing wrist ROM

Answer 22

compare both sides at the same time

Question 23

What is Lateral epicondylitis?

Answer 23

This condition may be secondary to failure of the musculotendinous attachment with resultant buildup of fibrous tissue (fibroplasia). The symptoms and chronicity of epicondylitis may be related to a poor repair process.

Question 24

Commonly seen in males 4-5x more than women and in patients between the ages of 30-50 y/o. The dominant arm is most likely to be affected. Onset is usually insidious (no specific mechanism of injury), but a RSI. Pain is usually located over the epicondyle where the lateral extensor attaches. This area will be point tender and lifting even light objects or opening doors. Pain can be sharp stabbing, and/or dull and achy which can radiate proximally or distally. Western tx: cortisone injections.

Answer 24

Lateral Epicondylitis (Tennis Elblow)

Question 25

If Lateral Epicondylitis is bilateral check..

Answer 25

lower cervical segments which foramina test (C6,C7) *Remember to also treat the Extensor group!

Question 26

Tests to use when checking for lateral epicondylitis

Answer 26

Cozen's Test Mill's Test Extensor Digitorum

Question 27

TCM diagnosis of lateral epicondylitis

Answer 27

LV Blood deficiency, LV Qi stagnation, Local stagnation of Qi and Blood at the epicondyle

Question 28

TX : lateral epicondylitis

Answer 28

Build LV Blood, Smooth LV Qi, Move local stagnation of Q/B, relax the sinews

Question 29

Point prescription for lateral epicondylitis

Answer 29

Ling Ku, TW 5 Zone, LI10, Ext. Dig. and ECRB IZ, osteoacupuncture at the epicondyle, tuina, kinesiotaping

Question 30

Pain on the medial aspect of the elbow, similar presentation as lateral epicondyle, check biceps, medial head of trice, and pronator trees trigger points. This condition responds much slower to treatment than lateral epicondylitis as the muscles that attach to the medial epicondyle have tendinosus sheaths are are more tubular compared to the extensor groups fan like attachment.

Answer 30

Medial epicondylitis (Golfer's Elbow)

Question 31

Flexor vs. Extensor tendons

Answer 31

flexor tendons are rounded and have synovial sheaths and have longer excursions than extensor tendons, for this reason they take longer to heal than extensor tendons which are flat.

Question 32

Most common muscles affected in medial epicondylitis

Answer 32

pronator teres, flexor carpi radialis

Question 33

Test for medial epicondylitis

Answer 33

Medial epicondylar stretching

Question 34

DX of medial epicondylitis

Answer 34

LV Blood deficiency, LV Qi stagnation, Local stagnation of QI and Blood at the epicondyle

Question 35

Tx for medial epicondylitis

Answer 35

Build LV blood, smooth LV Qi, move local stagnation or Qi and Blood, relax the sinews

Question 36

Pain near radial styloid process of wrist (LI5) occurs with movement of thumb and wrist, including PROM. Worse with PROM thumb abduction and extension, forming a fist, grasping or gripping things or turning the wrist. Pain can present with or without movement as electric stabbing pain. Difficult to differentiate between this and osteoarthritis of the CMC joint

Answer 36

Tenosynovitis (De Quervain's Disease)

Question 37

De Quervain's Disease means...

Answer 37

A chronic inflammation of the tendon sheath of the extensor pollicis brevis and abductor pollicis longs, this is a RSI

Question 38

Test to use when diagnosing De Quervain's disease

Answer 38

Finkelstein

Question 39

TCM Diagnosis of Finklestein

Answer 39

Wind Cold invasion, Blood stagnation and painful Bi

Question 40

TX of De Quervain's disease

Answer 40

Ah Shi: needle along the EPB and EPL (not into) LU7,8.(, LI4, LI5, LI6, SI11,

Question 41

What is carpal tunnel syndrome?

Answer 41

most common for of chronic wrist injury. the symptoms of carpal tunnel are related to compression of the median nerve, which travels through the carpal tunnel. ANything that causes compression, swelling, thickening or irritation of the synovial membranes around the tendons in the carpal tunnel can result in pressure on the median nerve.

Question 42

Numbnesss or paraesthesia felt at the palmar aspect of the lateral 3 1/2 fingers. worse with use, wakes them at night, shaking hands remove sensation, pain can extend into the forearm and the palm but also up into the arm and the shoulder. Wasting of the then muscle is possible. RSI can cause this, also dampness during pregnancy

Answer 42

Carpal Tunnel Syndrome

Question 43

Tests for Carpal tunnel

Answer 43

Phalen's (a negative test does not rule out condition) Carpal compression test Pronator teres syndrome

Question 44

TCM DX of carpal tunnel

Answer 44

Qi/Blood stagnation of the PC and LU meridians

Question 45

TX of carpal tunnel

Answer 45

remove stagnation from the meridians Ah Shi near end of tunnel, PC7 in direction of hand Palmaris Longus IZ SP9, LI11, ST36 (reduce water retention during pregnancy) huato's c6-c11 (prego)