Elbow, Wrist, Hand

Question 1

what is the common extensor tendon

Answer 1

extensor muscles all attach here

Question 2

what is the carrying angle

Answer 2

• where joint is created by the humerus axis and forearm axis during full extension in anatomical positiion
• commonly a valgus angle
• allows arm to swing without contracting the hip

Question 3

Average valgus carrying angle or adults

Answer 3

Females –> 20 degrees
Males –> 15 degrees

• may contribute to UCL laxity

Question 4

Common elbow fractures

Answer 4

• olecranon
• Radial head or neck
• distal humerus

Question 5

MOI elbow fractures

Answer 5

• FOOSH to “break your fall”
• Hyperextension
• Direct impact, contact, trauma, direct fall on elbow

Question 6

S&S elbow fractures

Answer 6

• swelling near back of elbow
• stiffness of elbow
• bruising around elbow/arm
• numbness or weakness in hand or fingers
• tenderness to touch
• pain with rotation of forearm

Question 7

surgical vs. non-surgical elbow fractures

Answer 7

Surgical –> distal humerus, radial head
non-surgical –> Radial neck, olecranon

Question 8

Risks with fracture

Answer 8

distal humerus - sharp fragments causing damage, leave athletes in comfortable position during transport

Radial head –> interarticular fracture - bone head splits can cause osteo issues, pin usually put in

Question 9

S&S of elbow sprains and ligament tears

Answer 9

• localized pain
• point tenderness
• instability with stress test

Question 10

MOI of elbow sprains and ligament tears

Answer 10

• fall on extended hand (hyperextension injury)
• valgus or varus force
• most common –> repetitive forces irritate and tear ligaments, mostly UCL (tommy john surgery)
  -ulnar nerve may be affected
• not urgent, no ER needed

Question 11

Management of sprains and ligament tears

Answer 11

• ice
• rest
• active therapy/treatment

Question 12

UCL injury

Answer 12

Chronic micro-tearing to UCL leading to rupture (3 degree)

Question 13

Surgery required for UCL injury? give details

Answer 13

• surgery needed –> Tommy John, introduced by Dr. Frank Jobe
• graft from palmaris longus on same side as injury
• 1 year revcovery
• Graft is stronger than OG ligament

Question 14

MOI olecranon bursitis

Answer 14

• fall on a flexed elbow
• constant leaning on elbow
• repetitive compression, friction

Question 15

S&S olecranon bursitis

Answer 15

• tender, swollen, relatively painless
• may rupture
• 50% sudden onset, 50% gradual onset of a couple weeks
• limited flexion - tension increased over bursa

Question 16

Management olecranon bursitis

Answer 16

• ice
  -meds
  -donut pad
• possible doctor aspiration and/or cortisone
• surgical removal

Question 17

Tendonitis - lateral epicondylitis, anatomy and common names

Answer 17

• extensor muscle strain at lateral epicondyle region
• common extensor tendon –> extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris
• tennis elbow (outside)
• golfers elbow (inside)

Question 18

MOI Tendonitis - lateral epicondylitis

Answer 18

• overuse of forearm extensor muscles –> overload of wrist extensor muscles, eccentric muscle weakness
• tennis elbow –> overuse of gripping and wrist movements (combo)

Question 19

S&S Tendonitis - lateral epicondylitis

Answer 19

• long term symptoms, chronic
• pain with shaking hands, turn door handle, squeeze, grip
• strap/brace gives false insertion to reduce tension

Question 20

Tendonitis - medial epicondylitis anatomy

Answer 20

common flexor tendon –> pronator teres, FCR, palmaris longus, FDS, FCU

Question 21

MOI medial epicondylitis

Answer 21

• repeated valgus stress to elbow joint –> medial tension
• commonly overuse of forearm flexors –> repetitive loading of flexor forearm tendons
• AKA “little league elbow” or “golfer’s elbow”

Question 22

S&S medial epicondylitis

Answer 22

• long term, chronic
• swelling, local tenderness
• pain at site and may radiate distally
• pain increases with activity, resistance or valgus stress

Question 23

Radius fractures

Answer 23

Colle’s - radius bends backward
Smith - distal radius with some dislocation

Question 24

Ulnar fractures

Answer 24

Ulnar styloid - usually give medial stability, pinned to fix

nightstick - direct impact, heals well

Question 25

S&S Carpal bone fractures (scaphoid)

Answer 25

- history of FOOSH - point tenderness in anatomical 'snuff box' - pain with upward pressure or compression along long axis - increased pain with wrist extension and radial deviation

Question 26

management Carpal bone fractures (scaphoid)

Answer 26

- standard acute --> splint - physician referral, bone scan or CT scan

Question 27

concern with Carpal bone fractures (scaphoid)

Answer 27

- non-union - bone necrosis (death) - needs surgery

Question 28

wrist sprain anatomy

Answer 28

- 8 carpal bones --> complex arrangement (2 rows of 4) - ~20 ligaments stabilize and support wrist

Question 29

MOI wrist sprain

Answer 29

- FOOSH - 'jammed' wrist, hyperflexion, hyperextension, radial/ulnar deviation

Question 30

S&S wrist sprain

Answer 30

- minimal swelling, possible bruising - painful and limited ROM - grip weakness - possible sense of popping, grinding

Question 31

Management wrist sprain

Answer 31

- Ruling out fracture (doc referral, imaging) - RICE - OTS brace - taping - active therapy

Question 32

types of hand fractures

Answer 32

Bennett's fracture: - articular fracture --> proximal end of metacarpal 1 Boxer's fracture: - neck of 4 or 5 (weakest) metacarpal

Question 33

MOI bennett's hand fracture

Answer 33

- axial compression, - 'Jam' thumb - immediate ER referral --> cast, surgery

Question 34

MOI boxer's hand fracture

Answer 34

- throw punch - direct impact - immediate ER referral --> cast, surgery

Question 35

Anatomy of finger dislocations

Answer 35

- might involve collateral ligaments and volar plate

Question 36

types of finger dislocations

Answer 36

- metacarpophalangeal (MCP) --> rare, easy to recognize, hyperextension or shear - Proximal interphalangeal (PIP) --> most common, hyper extension and axial loading (ball hitting the finger) - Distal interphalangeal (DIP) --> usually occur dorsally, reduced on its own

Question 37

S&S finger dislocations

Answer 37

- tight - local swelling - pain - restricted range

Question 38

management finger dislocations

Answer 38

- immobilization (finger splint, tongue depressor) - ice bath, hot wax bath - physician referral (imaging to rule out intra-articular fracture)

Question 39

Thumb sprains and anatomy

Answer 39

- skier's or gamekeeper's thumb - Tear of ligaments at MP joint

Question 40

mechanism and management of thumb sprain

Answer 40

- MP joint in extension and forceful abduction - Doc referral --> imaging

Question 41

mechanism and management of finger sprains (PIP joint)

Answer 41

- excessive valgus and varus --> collateral ligament sprains - powertape, "buddy" taping, ice bath/massage

Question 42

tendon rupture? what to do if they happen

Answer 42

- Jersey finger and mallet finger - Let the AT know - 9 days to get surgery after injury (if not tendon shrinks, tightens or recoils)

Question 43

Jersey finger anatomy, mechanism, and management

Answer 43

- rupture of FDP from distal phalanx - rapid, forced extension (from active flexion) --> grabbing a jersey - can't flex finger all the way -surgery referral

Question 44

Mallet finger anatomy, mechanism, and management

Answer 44

- Rupture of extensor tendon from distal phalanx - can't straighten finger - might cause avulsion - forceful flexion of distal phalanx - surgery and possible plastic surgeon assessment

Question 45

Carpal tunnel MOI

Answer 45

- Direct trauma - Repetitive overuse (bad keyboard position) - prolonged compression or sustained wrist flexion

Question 46

carpal tunnel S&S

Answer 46

- pain at night --> relived when shaking hands - pain, tenderness, tingling, burning on palm side of thumb, index and middle fingertip - symptoms worsen if wrist is fully flexed or extended or with gripping

Question 47

carpal tunnel managment

Answer 47

- conservatively (brace?) - surgery if symptoms persist