Elbow Wrist and Hand Flashcards
(18 cards)
Causes of Elbow Pain: Biceps Tendonitis
Patient age: 20-50
MOI: Repetitive hyperextension of the elbow with pronation or repetitive stressful pronation and supination
Area of symptoms:Distal part of he arm
Symptoms aggravated by: Elbow extension and shoulder extension
Observation: Unremarkable
AROM pain: Possible pain with elbow flexion
PROM pain: Pain with passive shoulder and elbow extension
Resisted pain: Pain in elbow flexion and supination
Tenderness with palpation: Distal muscle belly, musculotendinous portion of the biceps, bicipital insertion on radial tuberosity
Causes of Elbow Pain: Triceps Tendonitis
Patient age: 20-50
MOI:
• Over use of the upper are and elbow especially in activities like throwing and hammering
Area of symptoms:
• Posterior aspect of the elbow
• Symptoms aggravated by:
• Activities involving elbow extension or full elbow flexion
Observation:
• May observe swelling near the point of the elbow
AROM Pain:
• Elbow extension
• Possible pain with extreme elbos flexion
PROM Pain
• Pain with passive shoulder and elbow flexion
Resisted Pain
• Pain in elbow extension
TTP
• Posterior aspect of elbow
Causes of Elbow Pain: Lateral Epicondylitis
Patient age: 35-55
MOI:
• Gradual overuse
Area of symptoms:
• Lateral aspect of elbow
Symptoms aggravated by:
• Activities including wrist extension and grasping
Observation:
• Possible swelling over the lateral elbow
AROM Pain
• Possible pain with wrist flexion and elbow extension
PROM Pain
• Pain in passive wrist flexion with the forearm pronated and the elbow extended
Resisted Pain
• Pain on resisted wrist extension and radial deviation with the elbow extended
• Pain on finger extension
Special tests
• Cozens
• Mill’s
• Maudsley’s
TTP
• Lateral elbow over the ECRB and the ECRL
Causes of Elbow Pain: Medial Epicondylitis
Patient age: 35-55 MOI: • Gradual overuse Area of symptoms: • Anteromedial aspect of the elbow Symptoms aggravated by: • Activities involving wrist flexion Observation: • Possible swelling over the medial elbow AROM Pain • Pain on wrist extension PROM Pain • Pain on combined wrist extension and forearm supination Resisted pain • Pain on pronation with wrist flexion Special tests • Passive supination of the forearm and extension of the wrist and elbow Pain location • Anteriomedial elbow
Causes of Elbow Pain: Ulnar Nerve Compression
Patient age: 20-40 MOI: • Gradual overuse trauma Area of symptoms: • Medial elbow, forearm, and hand incuding 5th digit and half of 4th digit Symptoms aggravated by: • Activities involving elbow and wrist extension Observation: • Atrophy of hand muscles if chronic AROM pain • Inability to fully close the hand PROM pain • Full and painfree PROM Resisted pain • Weak grip Special tests • Elbow flexion test • Ulnar pressure provocation test • Tinel’s at the elbow • Wartenburg’s sign • Froment’s sign Pain location • Anteromedial elbow
Causes of Elbow Pain: Radial Nerve Compression
Patient age: varies MOI: • Gradual overuse • Trauma (humerus fx most common) Area of symptoms: • Lateral elbow Symptoms aggravated by: • Varies Observation: • Usually unremarkable AROM pain • Unremarkable PROM pain • Unremarkable Resisted pain • Pain with resisted forearm supination, resisted extension of the middle finger TTP • Max tenderness is usually over the radial tunnel if they have radial tunnel syndrome
Causes of Elbow Pain: Median Nerve Compression
Patient age: 20-40 MOI: • Gradual overuse Area of symptoms • Anterior forearm • Lateral 3.5 digits Symptoms aggravated by • Activities involving full elbow extension or pronation of the forearm Observation • Atrophy of the anterior forearm and hand muscles if chronic AROM pain • Pain on forearm pronation PROM pain • Full and pain free Resisted pain • Weakness on pronation, wrist flexion, and thumb opposition Special tests • Benediction sign • Inability to perform OK sign (AIN) • Resisted supination TTP • Over pronator teres 4 cm distal to the cubital crease with concurrent resistance against pronation, elbow flexion, and wrist flexion (pronator syndrome)
Findings in Common Elbow Conditions: Valgus Extension Overload Syndrome
Tenderness of ip of olecranon
Pain with forces passive elbow extension
increased valgus laxity (variable)
Findings in Common Elbow Conditions: UCL Strain or Tear
Medial elbow joint pain in the throwing athlete
Complete tears open on valgus stress testing with the elbow flexed at 25 degrees compared to the uninvolved side, whereas incomplete tears are TTP on the UCL but to not gap on stress testing
Findings in Common Elbow Conditions: Nursemaid’s Elbow
AKA pulled elbow syndrome
Mean age is 2-3 years
Hx is critical: reports longitudinal traction to an extended elbow resulting in a partial sslippage of the annular ligament over the head of the radius and into the radiocapitellar joint
child typically hods the harm at hte side with the hand pronated (palm down)
closed reduction with manipulation is very successful
Findings in Common Elbow Conditions: Little Leaguer’s Elbow
Covers a spectrum f pathologies about the elbow in young developing pediatric throwers
Four distinct vulnerable areas to throwing stress:
1. medial elbow tension overload
2. lateral articular surface compression overload
3, posteromedial shear forces
4. extension overload of the lateral restraints
May present as: Panner’s disease (necrosis of the capitulum), medial epicondylar fracture, medial apophysitis, medial lig rupture, posterior osteophyte formation at the tip of the olecranon
Median Nerve Entrapment Presentation
Motor Loss: Pronator T and Q, FCR, PL, FDS, FPL, FDP (Lateral), Thenar Muscles, Lateral Lumbricals
Sensory Loss: Palmar Hand, 1,2,3, Lateral 4, Posterior distal dorsal 2,3, lateral 4
Funtional Loss: Grip, Pronation, Pinch, Opposition, (APE HAND), Benediction Sign
AIN Entrapment Presentaion
Motor Loss: FPL, FDP (Lateral), Thenar Muscles, Lateral Lumbricals
Sensory Loss: NONE
Functional Loss: Pronation (90 degrees), weak opposition and thumb flexion, weak tip to tip pinch
Ulnar Nerve Entrapment Presentation
Motor Loss: FCU, FDP (Medial), PB, Hypothenar, ADD Pol, Medial Lumbricals, Interossei
Sensory Loss: Posterior and Palmar 5 and medial aspect of 4
Functional Loss: Weak wrist flexion, UD, Distal Flex 5, ABD & ADD all fingers, Ext PIP and DIP of 4 & 5 (?Benediction appearance), thumb ADD
Radial Nerve Entrapment Presentation
Motor Loss: Brachioradialis, ECRL & ECRB, EDC, EPL & EPB, APL, ECU, EI, EDM
Sensory Loss: Posterior hand (lateral 2 & 3), Posterior and lateral Thumb, Proximal , Posterior 2,3, and half of 4
Functional Loss: Supination, Wrist and finger Extension, Grasp, ABD of the Thumb (Wrist Drop)
PIN
Motor Loss: ECRL, ED, EPL & EPB, APL, ECU, EI, EDM
Sensory Loss: None
Functional Loss: Weak Wrist RD, Weak finger Extension, Weak Grasp
Lateral Epicondylitis: Etiology
Pathologic condition of common extensor muscles at their origin; ECRB primary site of injury; Shoulder/cervical injures speculated
Most Common Cause = repetitive activity
3 types:
• acute onset w. recognizable MOI/acute injury
• rupture of ECRB w. direct trauma
• chronic w. gradual onset **
Lateral Epicondylitis vs. Epiconalgia
Epicondyalgia : lack of inflammation and histological degeneration
Grip strength & isokinetic testing
Primary area of pathoanatomical change
• Lateral: ECRB>EDC
• Medial: PT> FCU
