Elbow, Wrist, and Hand Pain/Exam

Question 1

What is the normal carrying angle of the elbow?

Answer 1

5-15 degrees

Question 2

Nuresmaid’s elbow

Answer 2

annular L. slips out of radial head and gets trapped in radiohumeral joint
Presentation: arm close to body w/ elbow slightly flexed
Management: hyperpronation

Question 3

Medial Epicondylitis

Answer 3

aka golfer’s elbow
Presentation: pain on medial side of elbow (medial epicondyle), tenderness w/ passive extension of wrist and resisted flexion of wrist
Management: modified activity, bracing, NSAIDs

Question 4

Lateral Epicondylitis

Answer 4

aka tennis elbow; due to excessive hyperextension
Presentation: pain on lateral aspect of elbow, tenderness w/ resisted wrist extension
Management: modify activity, bracing, NSAIDs

Question 5

Olecranon Bursitis

Answer 5

aka student’s elbow; inflammation of the olecranon bursa
Presentation: pain and swelling on olecranon bursa
Management: RICE, NSAIDs, aspiration of fluid present with analysis

Question 6

Cubitus Varus

Answer 6

<5 degree carrying angle (adduction of ulna)

Question 7

Cubitus Valgus

Answer 7

> 15 degree carrying angle (abduction of ulna)

Question 8

Elbow Flexion

Answer 8

140-150 - biceps brachii, brachialis, brachioradialis, choracobrachialis

Question 9

Elbow Extension

Answer 9

0 - (-5) - triceps brachii, anconeus

Question 10

Elbow Supination

Answer 10

90 - supinator, biceps brachii

Question 11

Elbow Pronation

Answer 11

90 - pronator teres, pronator quadratus

Question 12

Biceps tendon reflex

Answer 12

C5

Question 13

Brachioradialis tendon reflex

Answer 13

C6

Question 14

Triceps tendon reflex

Answer 14

C7

Question 15

Lateral arm dermatome

Answer 15

C5

Question 16

Lateral forearm and thumb dermatome

Answer 16

C6

Question 17

middle finger dermatome

Answer 17

C7

Question 18

Medial forearm and little finger

Answer 18

C8

Question 19

Medial Arm

Answer 19

T1

Question 20

Valgus Stress Test

Answer 20

arm slightly abducted and externally rotated w/ forearm supinated and flexed to 30; slight valgus stress applied to elbow

(+) = pain/tenderness w/ palpation; increased laxity
Indicates: sprained medial (ulnar) collateral L.

Question 21

Varus Stress Test

Answer 21

arm slightly abducted and internally rotated w/ elbow flexed to 15; slight varus stress applied to elbow

(+) = pain/tenderness w/ palpation; increased laxity
Indicates: sprained lateral (radial) collateral L.

Question 22

Tinel Test for Ulnar N. Entrapment

Answer 22

tap between olecranon and medial epicondyle in ulnar groove

(+) = tingling sensation down forearm within ulnar distribution (4th and 5th digits)
Indicates: ulnar N. entrapment/cubital tunnel syndrome

Question 23

Golfer’s Elbow Test

Answer 23

pt’s elbow flexed to 90 and forearm placed in supination; physician places one hand under proximal forearm to stabilize and other over pt’s wrist to resist movement; pt flexes wrist

(+) = pain/tenderness around medial epicondyle
Indication: Medial epicondylitis

Question 24

Tennis Elbow Test (Cozen’s Test)

Answer 24

pt’s elbow flexed to 90 and pronated; physician places one hand under proximal forearm to stabilize and other over pt’s hand to resist motion; pt extends wrist

(+) = pain/tenderness around lateral epicondyle
Indicates: lateral epicondylitis

Question 25

Little League Elbow

Answer 25

pain over medial epicondyle, initially after throwing medial apophysitis (childhood) Medial epicondyle avulsion fracture (adolescence) Medial collateral L tear (adulthood)

Question 26

Carpal Tunnel Syndrome

Answer 26

compression of median N. Presentation: pain and paresthesias along first 3 1/2 digits Management: mild = wrist splint at night; moderate to severe = EMG, continued splinting, steroid injections, carpal tunnel release

Question 27

De Quervain Tenosynovitis

Answer 27

recurrent inflammation of tendon and synovial sheath covering extensor pollicis brevis and abductor pollicis longus Presentation: radial wrist pain at base of thumb (with movement of thumb) Management: thumb spint, NSAIDs, glucocorticoids, surgery

Question 28

Trigger Finger

Answer 28

aka stenosing flexor tenosynovitis Presentation: pain, locking, and clicking of MCP joint Management: splinting MCP slightly flexed, NSAIDs, corticosteroid injection, surgery for severe cases

Question 29

Dupuytren's contracture

Answer 29

fibrosis of palmar fascia Presentation: thickening on palmar surface w/ or w/o pain; flexed digits w/ palpable cords Management: using gloves w/ padding on palm; steroid injections, surgery

Question 30

Scaphoid Fracture

Answer 30

Presentation: pain on radial aspect of wrist, reduced grip strength after FOOSH Management: initial XR (may not show fx), splint for 2 week and repeat XR

Question 31

Boxer's Fracture

Answer 31

fracture of metacarpal neck Presentation: pain on dorsal of hand after direct trauma Management: initial splinting, closed reduction

Question 32

Colles Fracture

Answer 32

wrist fracture after FOOSH w/ wrist extended Presentation: wrist pain w/ possible dinner fork deformity; tenderness on radial aspect of wrist Management: based on degree of fx

Question 33

Rheumatoid Arthritis

Answer 33

Presentation: morning stiffness, swelling, pain of MCP and PIP; deformity Management: NSAIDs, steroids, DMARDs, rheumatologist

Question 34

Wrist Flexion

Answer 34

80-90 - flexor carpi radialis, flexor carpi ulnaris, palmares longus

Question 35

Wrist Extension

Answer 35

70 - extensor carpi radialis longus and brevis, extensor carpi ulnaris

Question 36

Wrist Adduction (ulnar deviation)

Answer 36

30-40 - flexor carpi ulnari, extensor carpi ulnaris

Question 37

Wrist Abduction (radial deviation)

Answer 37

20-30 - flexor carpi radialis, extensor carpi radialis longus and brevis

Question 38

OK Sign

Answer 38

pt cannot make an "O" with thumb and forefinger Indicates: anterior interosseous N impingement

Question 39

Tinel's Sign

Answer 39

tap over transverse carpal L./flexor retinaculum (+) = numbness/tingling, pain radiating to thumb, index and middle finger Indicates: Carpal Tunnel Syndrome

Question 40

Phalen's Sign

Answer 40

Pt places dorsal aspects of hand together; fingers facing down (+) = any reproduction of sx Indicates: Carpal Tunnel Syndrome

Question 41

Finkelstein Test

Answer 41

its makes a fist encompassing thumb and ulnar deviate wrist (+) = increased pain in lateral wrist Indicates: DeQuervain's tenosynovitis