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NPTE > Elbow/Wrist/Hand > Flashcards

Elbow/Wrist/Hand Flashcards

(89 cards)

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1
Q

Lateral Epicondylitis: mm involved

A

ECRB

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2
Q

Medial Epicondylitis: mm involved

A

FCR
Pronator Teres

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3
Q

Lateral Epicondylitis: key sxs

A

*P! with wrist extension.
-Agg by wrist + elbow ext (ECRB max excursion).
-Agg by radial deviation.
-Agg by finger ext.
-Grip strength decreased.
-ROM intact (but may be pain-limited).

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4
Q

Lateral Epicondylitis: MOI

A

Repeated wrist EXT

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5
Q

Medial Epicondylitis: MOI

A

Repeated wrist FLEX

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6
Q

Lateral Epicondylitis: special tests

A

P! with resisted middle finger ext.
-Cozen’s
-Mill’s
-Maudsley’s

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7
Q

Medial Epicondylitis: key sxs

A

*P! with wrist flexion.
-Agg by wrist ext + elbow ext + supination (pronator mass stretched).

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8
Q

Medial Epicondylitis: special tests

A

-P! with resisted pronation.
-P! with wrist flex.
-Reverse Cozen’s
-Reverse Mill’s

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9
Q

Cozen’s Test: procedure, purpose, (+)

A

Lateral Epicondylitis.
Forearm pronated, wrist ext, slight RD.
Resist wrist flex + UD.
(+) = P! in lateral epicondyle.

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10
Q

Reverse Cozen’s Test: procedure, purpose, (+)

A

Medial Epicondylitis.
Forearm supinated, wrist flex, slight RD.
Resist wrist ext + UD.
(+) = P! in medial epicondyle.

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11
Q

Mill’s Test: procedure, purpose, (+)

A

Lateral Epicondylitis.
PROM forearm pronation, wrist flex, elbow ext.
(+) = P! in lateral epicondyle.

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12
Q

Reverse Mill’s Test: procedure, purpose, (+)

A

Medial Epicondylitis.
PROM forearm supination, wrist ext, elbow ext.
(+) = P! in medial epicondyle.

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13
Q

Maudsley’s Test: procedure, purpose, (+)

A

Lateral Epicondylitis, Radial N involvement.
Forearm pronated.
Lift middle finger up.
Resist middle finger ext (don’t let me push down to the table).
(+) = weak, painful.

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14
Q

Olecranon Bursitis: pathophysiology & key sxs

A

“Student’ Elbow”
Inflammation of olecranon bursa.
Swelling on posterior elbow.
Posterior elbow pain & tender to pressure.
Agg by max elbow flex/ext.

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15
Q

Cubital Tunnel: nerve involved & key sxs.

A

Ulnar N compression.
-Paresthesia in digits 4+5.
-Pain in medial elbow, radiates down.
-Decreased grip strength.
-Agg by elbow flexion (most pressure in cubital tunnel).

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16
Q

Sxs of prolonged or severe Cubital Tunnel

A

Thenar atrophy.
Clawing.
Pinky abducts.

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17
Q

Cubital Tunnel Special Test

A

Tinel’s: tapping on cubital tunnel (medial epi) & along Ulnar N.
(+) pain or numbness in digits 4+5.
Most distal point where abnormal sensation is felt indicates “how far” N has regenerated.

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18
Q

Cubital Tunnel treatments

A

-Ulnar N glides.
-Stretch flexors & pronators.
-Avoid max elbow flexion.
-Orthosis with flexion block; or splint at 45 flex.

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19
Q

Pronator Syndrome: nerve involved & key sxs

A

Median N compression (at elbow or forearm).
-Pain in prox forearm.
-Agg by repetitive elbow motion & forearm pro/sup.
-Paresthesia in thenar, thumb, digits 2-4.
-Weakness of FPL & FDP & pronator teres.

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20
Q

Pronator Syndrome special test

A

P! with resisted pronation.
(+) Tinel’s at pronator teres.
(-) Tinel’s at wrist.
(-) Phalen’s.

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21
Q

How to differentiate Pronator Syndrome from Carpal Tunnel?

A

Pronator = thenar eminence tingling & paresthesia (this is not common with carpal).

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22
Q

Pronator Syndrome treatments

A

-Median N glides.
-STM to biceps, pronator teres, FDS.
-If irritable: posterior gutter orthosis (holds elbow at 90 flex).

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23
Q

Radial Tunnel: location, nerves involved, mm borders

A

-Located near radiohumeral joint.
-Radial N branches into superficial & deep.
-Deep Branch becomes PIN in the radial tunnel.
-Borders: ECRB, ECRL, supinator, brachioradialis.

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24
Q

Radial Tunnel Syndrome sxs

A

-Can occur w/ lateral epicondylitis (ECRB compressing PIN).
-Weakness in supinator & wrist/finger extensors.
-Point tenderness ~4cm distal to lateral epi.
-Agg by stretching Radial N: elbow ext, pronation, wrist flex.

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25
Radial Tunnel Syndrome special tests
-P! with resisted supination. -Rule out TOS & proximal N impingement.
26
Radial Tunnel Syndrome treatments
-Radial N glides. -Stretching supinator & ECRB. -Custom orthosis with wrist in extension.
27
Elbow fx: possible sites & initial medical interventions
-Distal Humerus: cast (2wk) then hinged brace. ORIF if bad. -Radial Head: sling (1wk) & early AROM. ORIF if bad. -Olecranon: typically requires ORIF. -Capitulum/Trochlea: custom orthosis & early AROM.
28
Potential complication of elbow fractures & key sign
Heterotopic Ossificiation Significantly impaired ROM & hard end feel.
29
What may increase risk of Heterotopic Ossification?
Aggressive ROM too early
30
UCL injury risks
-Pitching velocity & volume (overuse). -Throwing mechanics (esp curveballs). -Humeral Retrotorsion (due to GIRD).
31
UCL injury sxs & special tests
-Ulnar N paresthesia. -Pain during cocking phase. -UCL tender to palp. (+) Tinel's (+) Valgus Stress
32
Valgus Stress Test procedure & purpose
UCL stability. -Elbow in slight flex. -Stabilize above elbow. -Valgus force (pull outward) below elbow. (+) excess motion & P!
33
Varus Stress Test procedure & purpose
RCL stability. -Elbow in slight flex. -Stabilize above elbow. -Varus force (push inward) below elbow. (+) excess motion & P!
34
Moving Valgus Stress Test procedure & purpose
UCL stability (functional). -Sh abd 90, elbow max flex. -PROM elbow ext + apply valgus force (quick movement). (+) P! typically at greater elbow flex.
35
Modified Milking Maneuver procedure & purpose
UCL stability (functional). -Elbow at 90, forearm supinated (thumbs up). -Pull by thumb into shoulder ER while stabilizing elbow. (+) reproduces symptoms.
36
Distal Biceps Tendon Rupture: MOI & presentation
-MOI: violent pull into ext while biceps active. -Pop at moment of rupture. -Middle aged men. -Reverse Popeye deformity. -Weakness of elbow flex + sup. (+) Hook Test
37
Hook Test procedure & (+)
-Sh abd 90, elbow 90. -Supinate against resistance (not a break test). -Hook finger to palpate for distal biceps tendon. (+) = tendon cannot be felt.
38
Distal Biceps Tendon Rupture treatments
Initial strengthening of triceps & shoulder. Strengthen biceps later once ROM restored.
39
Elbow capsular tightness pathophysiology & interventions
-Stiffness can happen quickly after immob, fx, surgery, etc. -Serial casts or splinting (using creep). Example: JAS splint = cranks into ext until stretch felt, hold there, crank more once it's relaxed, continue.
40
Myositis Ossificans: definition & common locations
-Same as HO, but specifically bone growing into mm. -UE flexors & LE extensors.
41
Myositis Ossificans: sxs
-Significant ROM decrease (often ext more affected than flex). -Lymphedema. -Weakness. -Compression of neurovascular; paresthesia.
42
Myositis Ossificans: treatment & prevention
-Avoid aggressive stretching/ROM after period of immobilization or trauma. -Immob for a few days. -Cryotherapy, RICE.
42
Distal Radius Fractures: types, MOIs, & deformities
Colle's: radius goes dorsal. -MOI = FOOSH -Dinner Fork deformity. Smith's: radius goes volar. -MOI = fall on back of hand. -Garden Spade deformity.
43
Common causes of ulnar wrist pain
-TFCC ligament or disc tear. -Degenerative (RA). -ECU instability. -FCU/FCR tendonitis. -Ulnar Tunnel Syndrome: Ulnar N compression at Guyon's Canal.
44
Ulnar N Compression (wrist) special test & treatment
(+) Tinel's at Guyon's Canal. Orthosis to maintain neutral wrist position.
45
Scaphoid Fx: MOI & possible complication
-FOOSH + radial deviation. -Avascular Necrosis (very likely if proximal part)
46
Lunate Fx: MOI & possible complication
-FOOSH -Avascular Necrosis
47
Hamate Fx: MOI & presentation
-Force thru base of palm during forceful grip (racket sports, golf). -Ulnar neuropathy. -Flexor tendon rupture often also occurs.
48
Carpal Fractures: which is most common?
Scaphoid most common. Hamate kinda common. Lunate rare.
49
Carpal Fractures: treatment
1. Long-term immob. 2. Once cast removed, ROM & control edema. 3. Strengthen once bone & ligament healed.
50
Carpal Malalignment common patterns
Distal (DISI) vs. Volar Intercalated Segment Instability (VISI). DISI = lunate abnormally extended. VISI = lunate abnormally flexed.
51
DISI causes...
Capitate displaces, creating gap btwn scaphoid & lunate.
52
VISI causes...
Gap btwn lunate & triquetrum
53
Scaphoid Shift Test purpose, procedure, & (+)
Integrity of scaphoid-lunate ligament & DISI. Feel Scaphoid movement during RD/UD. (+) = audible thunk when scaphoid relocates & subluxes.
54
Ballotment Test purpose, procedure, & (+)
Integrity of lunate-triquetrum ligament & VISI. Wiggle lunate & triquetrum back & forth dorsally & volarly. (+) = pain.
55
Structures within the Carpal Tunnel
Median N Flexor Retinaculum FPL FDP FDS
56
Carpal Tunnel Syndrom key symptoms
-Paresthesia along Median N distribution (volar thumb & digits 2+3). -No paresthesia in thenar eminence or palm (key sign of Pronator Syndrome). -Later stages: thenar atrophy, loss of dexterity.
57
Carpal Tunnel Syndrome risk factors
Repeated forceful gripping + wrist flex (typing, construction).
58
Carpal Tunnel Syndrome special tests
(+) Tinel's (+) Phalen's (+) Carpal Compression
59
Carpal Tunnel Syndrome treatment
Median N glides Splint to maintain neutral wrist FDS/FDP tendon glides
60
Phalen's Test procedure & (+)
Hold max wrist flex for 1min. (+) = reproduces symptoms.
61
Carpal Compression Test procedure & (+)
Apply direct pressure to Carpal Ligament for 30sec. (+) = reproduces symptoms.
62
Radial N Injury deformity
Wrist drop
63
High vs Low Radial N Injury: key symptom to differentiate
Low = no sensory loss bc PIN is motor only. High = sensory and motor loss.
64
Ulnar N Injury deformity
Claw hand
65
Thumb UCL injury MOI
Hyperext + radial deviation. May be acute rupture (Skier's Thumb) or chronic overuse (Gamekeeper's Thumb).
66
Thumb UCL Stress Test procedure & (+)
Valgus stress to MCP (push away from other fingers). When thumb ext = assessing UCL + accessory ligament. When thumb slightly flexed = assessing UCL only. (+) = excess valgus. >30deg = complete rupture. >15deg = partial tear or sprain.
67
Boutonniere Deformity: what does it look like & what causes it?
Flexed PIP Extended DIP Extensor tendon injury
68
Swan Neck Deformity: what does it look like & what causes it?
Extended PIP Flexed DIP RA & cerebral palsy
69
Mallet Finger: deformity & what causes it?
Flexed DIP DIP tendon injury
70
DeQuervain's: involved structures, MOI, key sxs
APL & EPB MOI = repeated UD + thumb abduction. P! with UD. P! with thumb flexion & adduction (stretching tendon). (+) Finklestein's Test
71
Dupuytren's Disease: deformity & pathophysiology
Digits 4+5 contracted in flex. Fibrosis of fascia.
72
Trigger Finger deformity & presentation
Flexed PIP + DIP. Not completely stuck in a contracture, but difficult & painful to extend. Popping/clicking when extending.
73
Proximal RUJ Posterior Glide: procedure & promotes what motion?
Pronation. Push posteriorly on radial head at elbow.
74
Proximal RUJ Anterior Glide: procedure & promotes what motion?
Supination. Push anteriorly on radial head at elbow.
75
Distal RUJ Posterior Glide: procedure & promotes what motion?
Supination. Supinate forearm, push down on radius at wrist.
76
Distal RUJ Anterior Glide: procedure & promotes what motion?
Pronation. Pronate forearm, push down on radius at wrist.
77
Radiocarpal Dorsal glide: procedure & promotes what motion?
Wrist extension. Move prox carpal row dorsally. Stabilize radius/ulna.
78
Radiocarpal Palmar glide: procedure & promotes what motion?
Wrist flexion. Move prox carpal row palmarly. Stabilize radius/ulna.
79
Radiocarpal Radial glide: procedure & promotes what motion?
Ulnar Deviation. Hand off edge of table, thumb up. Stabilize radius/ulna. Pull upward on prox carpal row (and slightly distally bc radial styloid in the way).
80
Radiocarpal Ulnar glide: procedure & promotes what motion?
Radial Deviation. Hand off edge of table, thumb up. Stabilize radius/ulna. Push down on prox carpal row (and slightly distally bc ulnar styloid in the way).
81
Mid-Carpal Palmar Glide: procedure & promotes what motion?
Wrist extension. Stabilize radius/ulna. Push palmarly on distal carpal row.
82
Mid-Carpal Dorsal Glide: procedure & promotes what motion?
Wrist flexion. Stabilize radius/ulna. Push dorsally on distal carpal row.
83
Thumb CMC Radial Glide: procedure & promotes what motion?
Extension. Hand positioned w/ thumb up. Stabilize radius/ulna. Glide 1st MCP towards radius.
84
Thumb CMC Ulnar Glide: procedure & promotes what motion?
Flexion. Hand positioned w/ thumb up. Stabilize radius/ulna. Glide 1st MCP towards ulna.
85
Thumb CMC Palmar Glide: procedure & promotes what motion?
Adduction. Hand positioned w/ palm down. Stabilize radius/ulna. Glide 1st MCP towards palm.
86
Thumb CMC Dorsal Glide: procedure & promotes what motion?
Abduction. Hand positioned w/ palm down. Stabilize radius/ulna. Glide 1st MCP dorsally.
87
MCP & IP Dorsal Glide: procedure & promotes what motion?
Extension. Stabilize proximal bone. Glide distal bone dorsally.
88
MCP & IP Palmar Glide: procedure & promotes what motion?
Flexion. Stabilize proximal bone. Glide distal bone palmarly.

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