Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Ortho/Rheumatology > Wrist and Elbow Injuries > Flashcards

Wrist and Elbow Injuries Flashcards

1
Q

What is another name for Lateral Epicondylitis and what is it?

A

“Tennis Elbow”

It is Tendinitis/Tendinosis of the extensor wad of the elbow - MC to the ECRB (Extensor Carpi Radialis Brevis).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Who gets Tennis Elbow?

A

30-50 y/o; M=F - laborers w/frequent heavy lifting/gripping/grasping, tennis players.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Clinical Presentation of Tennis Elbow?

A
  • Pain w/gripping/grasping.
  • Focal lateral elbow pain; may radiate into proximal forearm and described as dull/achy/toothache type pain; may feel like dropping an object they are holding.
  • Aggravated w/activity.
  • Alleviate w/Rest/Ice/NSAIDs.
  • Insidious onset.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

PE of Tennis Elbow?

A
  • No abnormality on inspection.
  • Mild - Severe TTP to lateral epicondyle.
  • Pain reproduced w/resisted wrist extension.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Cozen’s Test?

A

Test for Tennis Elbow - pain that is reproduced w/resisted wrist extension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Diagnostics for Tennis Elbow?

A
  • X-ray = likely normal; may see changes such as cystic or enthesopathic.
  • U/S = can eval integrity of the tendon, low cost, noninvasive.
  • MRI = surgical planning; not required for Dx.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Treatment for Tennis Elbow?

A
  • Treatment is listed from least invasive to most invasive:
  • Rest, activity modification, bracing, compression sleeves.
  • NSAIDs.
  • PT (strengthening, massage, taping, dry needling).
  • CS Injections.
  • PRP (platelet rich plasma).
  • Surgery, which is reserved for pt’s who have exhausted the above options; have severe tendon degradation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is Olecranon Bursitis? What are the causes?

A

Inflammation of the bursa of the elbow.
-Bursa is the thin-fluid filled sac acting as a cushion b/t bony prominences and soft tissue structures.

Causes:

  • Trauma (acute injury to the elbow).
  • Repetitive microtrauma.
  • Infection = injury to tip of elbow breaking skin and inoculating the bursa w/bacteria.
  • Rheumatoid, Gout.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Clinical Presentation of Olecranon Bursitis?

A
  • Likely an inciting even or pertinent medical condition.
  • Focal swelling about posterior elbow; unilateral.
  • Aggravated w/direct pressure, elbow flexion.
  • Alleviated w/compression, activity modification, aspiration.
  • May or not be painful - infx/gout are usually painful.
  • Infection (erythematous, warm to touch, +/- wound, +/-purulence.
  • Gout/Pseudogout; tophi may be present.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Diagnostic tests for Olecranon Bursitis?

A
  • X-ray = eval for any bony trauma, retained FB.
  • Fluid analysis = cell count/sed rate, ESR/CRP, gram stain, crystals, culture.
  • MRI/US = less common; better to eval assoc. injuries, abscess, osteomyelitis, tumor, etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Treatment for Olecranon Bursitis?

A
  • Rest, activity modification, reassurance.
  • NSAIDs, compression sleeve, elbow pad - the mainstay for acute trauma and chronic bursitis.
  • Aspiration, +/- CS injection (can be diagnostic and therapeutic).
  • Surgery - reserved for chronic noninfectious bursitis and infectious bursitis (septic pt’s).
  • *Trial of Abx in healthy pt’s w/infectious olecranon bursitis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Distal Biceps Rupture and who gets it?

A

A rupture of the insertion of the biceps from the radial tuberosity.

  • *Accounts for 10% of bicep ruptures (rare compared to proximal long head biceps rupture).
  • Men&raquo_space; Women (93%) in 40-60 y/o.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical Presentation of Distal Biceps Rupture?

A
  • Acute injury - typically eccentric injury (flexed elbow forced into extension); can occur lifting a heavy object.
  • Focal anterior elbow pain - may have felt a “pop.”
  • Aggravated w/motion.
  • Alleviated = may be none; Rest/Immobilization.
  • Pain described as sharp/stabbing/throbbing pain.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

PE of Distal Biceps Rupture?

A

Inspection:
-Reverse Popeye Sign (tendon retraction), ECCHYMOSIS at ant. elbow/AC space.

Palpation:

  • Complete rupture will have a palpable defect.
  • Weakness w/supination, some loss of elbow flexion strength.
  • (+) Hook Test.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the Hook Test?

A

Used to identify a distal biceps rupture.

*Pt. flexes elbow to 90 degrees, full supination, examiner is able to place their finger 1 cm beneath the tendon.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Will a pt with a distal biceps rupture be able to flex their elbow?

A

Yes - the problem is with supination.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Diagnostic tests to order for a distal biceps rupture?

A 
X-ray = may have an avulsion from the radius.
U/S = identify ruptured tendon.
MRI = non-contrast; operative planning - GOLD Standard.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Treatment for a distal biceps rupture?

A

Non-Operative mgmt:

  • reserved for partial tears, pt’s who are low demand.
  • PT, bracing, analgesia (NSAIDs).

Surgery:

  • pt’s who are high functioning and active that will benefit from operative intervention.
  • will require PT post-op to regain ROM, strength.
  • surgery should occur w/in a few days to weeks from injury.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is an Ulnar Collateral Ligament tear (UCLT)? Who gets it?

A

It is a rupture of the ulnar collateral ligament of the medial elbow from acute trauma (dislocation) or repetitive microtrauma.

Overhead athletes placing excessive valgus stress on the elbow (baseball, javelin thrower); high-velocity trauma (dislocation - wrestler, MVC, fall from height).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Clinical presentation of an Ulnar Collateral Ligament Tear?

A
  • Usually an acute injury - elbow dislocation, one pitch “felt a pop,” may have anteceded elbow pain.
  • Focal medial elbow pain; no radiation.
  • Aggravated w/motion.
  • Alleviated by mostly rest/immobilization.
  • Pain described as sharp/stabbing/throbbing pain and may describe a feeling of “tightness” in the elbow, which is due to hemarthrosis.
21
Q

PE of an Ulnar Collateral Ligament Tear?

A
  • may have an abnormality to inspection.
  • +/- swelling, ecchymosis.
  • Tenderness at medial epicondyle of humerus.
  • Laxity to valgus stress:
  • -flex elbow to 30 degrees, apply valgus stress to elbow and will have soft endpoint w/complete tear.
22
Q

Diagnostic tests to order for UCLT?

A
  • Xray - may have bony avulsion, but uncommon.

* MRI - GOLD standard; operative planning. w/an arthrogram - will allow for eval of partial vs full thickness tear.

23
Q

Treatment of UCLT?

A

Non-operative:

  • Rest, PT, activity modification.
  • Often 1st line therapy for most pt’s.

Surgery:

  • “Tommy John” surgery; UCL reconstruction.
  • Reserved for high level athletes; those who want to continue high level overhead sports.
  • Lengthy recovery, extensive PT.
24
Q

What is Radial Nerve Palsy? Who gets it?

A

It is an injury to the radial nerve in the upper arm (radial nerve courses through the spiral groove of the humerus); it results in inability to extend the wrist, digits and 1st dorsal web space numbness.

Often associated w/humerus fractures; nerve injury may occur at time of Fx, during reduction or operative intervention.

25
Q

Clinical presentation of radial nerve palsy?

A

“Wrist Drop” is clinical; it is an inability to extend the wrist, digits and thumb.

  • Inability to independently extend index finger.
  • Numbness - 1st dorsal web space, dorsal aspect of the radial 3.5 digits.
26
Q

Diagnostic tests for radial nerve palsy?

A

EMG/Nerve conduction study:

  • it will help follow nerve recovery.
  • order 3-4 months post injury.
  • follow pt for PE in clinic every few weeks (wrist extension returns 1st and index finger extension last.

X-ray will not tell you anything about a nerve injury.

27
Q

Treatment for radial nerve palsy?

A

Non-operative:

  • “Watch and Wait” Dx.
  • PT for passive stretching.
  • Wrist cock-up splint.
  • NMES/TENS for muscle re-education.

Surgery:
-primary radial nerve repair; often does not yield return to function.

28
Q

What is Cubital Tunnel Syndrome? Who gets it?

A

Nerve compression at the elbow.

Overuse, prolonged elbow extension, unstable ulnar nerve (“snapping”); no diff in M/F, age.

29
Q

Clinical Presentation of Cubital Tunnel Syndrome?

A
  • Numbness/tingling/burning on ulnar side of 4th digit, 5th digit - worse w/elbow flexion.
  • Decreased grip strength and pinch.
  • Claw hand.
  • (+) Tinels at the elbow.
  • (+) Froments sign.
  • +/- subluxation of ulnar nerve.
30
Q

What is Fromet’s Sign?

A

Place a piece of paper b/t the thumb and index finger, bilaterally; ask the pt to prevent you from pulling the paper from their grip. If one of the thumbs compensates for the decreased pinch strength due to weakness of thumb adduction = +Fromets Sign.

31
Q

Diagnostics for Cubital Tunnel Syndrome?

A
  • X-ray - eval bony abnormality; will likely be normal.
  • U/S - eval for space occupying lesion; likely normal.
  • EMG/Nerve conduction study:
  • Mainstay but not required for Dx.
  • Can help eval severity of nerve damage.
  • Can help eval “double crush” – nerve entrapment elsewhere.
32
Q

Treatment for Cubital Tunnel Syndrome?

A

1: NSAIDs, nighttime extension splinting to allow nerve to heal.

  • PT.
  • Surgery – cubital tunnel release, possible ulnar nerve transposition for those w/subluxing ulnar nerve.
33
Q

Carpel Tunnel Syndrome and who gets it?

A

MC compressive neuropathy - compression of the median nerve at the wrist.

F>M; assoc. w/DM, pregnancy, hypothyroidism, RA, Amyloidosis, +many others.

34
Q

Clinical presentation of Carpel Tunnel Syndrome?

A
  • Numbness/tingling/burning in thumb, index, middle, radial fingers.
  • Pain/numbness/tingling worse at night - “wake and shake.”
  • Clumsiness, drops things, difficulty w/fine motor activity.
  • Chronic carpal tunnel – Thenar atrophy.
35
Q

Phalen’s test and Tinel’s sign for Carpel Tunnel Syndrome?

A

Phalen’s test - reverse prayer; reproduces pain when median nerve compressed.

Tinel’s Sign - tapping at wrist reproduces pain.

36
Q

Diagnostics for Carpel Tunnel Syndrome?

A

X-ray = eval bony abnormality; likely normal.
U/S = eval for space occupying lesion; likely normal.
EMG/Nerve conduction study:
-help eval severity of nerve damage.
-diff. b/t DN and carpal tunnel.
-eval “double crush” – nerve entrapment elsewhere.
-not required for Dx.

37
Q

What “double crush” mean?

A

a nerve entrapment elsewhere.

38
Q

Treatment for carpal tunnel?

A

NSAIDs, nighttime wrist bracing, activity modification.
**CS Injections - can be diagnostic and therapeutic.
Surgery - carpal tunnel release.

39
Q

What is Kienbock’s Disease? Who gets it?

A

AVN of the lunate; it is not much of a disease as a sequala of trauma.

Males 20-40 w/Hx of wrist trauma.

40
Q

Why are we so concerned about such a small bone (lunate) involved with Kienbock’s Disease?

A

The lunate provides a significant amount of stability and ROM to the wrist.

41
Q

Clinical presentation of Kienbock’s Disease?

A
  • Hx of remote wrist trauma; does not have to be acute.
  • Dorsal wrist pain worse w/wrist ROM, weight-bearing throughout wrist (pushing out of chair, pushups, picking up something heavy).
  • Wrist stiffness/decreased ROM compared to other side.
  • May be incidental finding/pt may be asymptomatic at time of Dx.
42
Q

Diagnostics for Kienbock’s Disease?

A
  • X-ray = can be normal early; will show bony resorption in later stages.
  • MRI = ideal for early disease (x-ray normal).
  • CT = ideal in later disease, once lunate has collapsed (CT better bony detail).
43
Q

Treatment for Kienbock’s Disease?

A
  • NSAIDs/observation in early disease.
  • Wrist bracing.
  • activity modification.
  • Surgery:
  • most surgical options lead to decrease in ROM, function/strength but improved pain.
44
Q

What is a Ganglion cyst?

A

A synovial cyst caused by trauma, synovial herniation.

anyone can get it; slight prevalence in women 20-40 y/o.

45
Q

What is the most common hand mass?

A

Ganglion Cyst. Dorsal side&raquo_space; Volar side.

46
Q

Clinical presentation of a ganglion cyst?

A
  • Hx of trauma; may be insidious onset.
  • usually painless.
  • may cause decrease in ROM, depending on size of the mass.
  • mas may fluctuate in size.
47
Q

Diagnostics for a ganglion cyst?

A
  • X-ray = usually unremarkable, can eval for abnormality in the setting of ganglion w/trauma.
  • U/S = used for aspiration; can eval mass contents.
  • Transillumination = should illuminate; solid masses no.
48
Q

Treatment of a ganglion cyst?

A
  • Reassurance - benign; no treatment required.
  • Aspiration - high recurrence rates.
  • Surgery:
  • excision of mass, closure of joint capsule where stalk of the cyst originates.
  • recurrence lower at 3-10%.

Ortho/Rheumatology (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions