Elbow-Wrist-Hand

Question 1

Olecranon Bursitis symptoms

Answer 1

Pain on posterior elbow, possibly tender. Painful activities include weightbearing on arm

Question 2

What is olecranon bursitis?

Answer 2

Two-thirds of cases are nonseptic (ie, without infection) and usually occur when trauma or repeated small injuries lead to bleeding into the bursa or release of inflammatory mediators. This condition can be caused by acute injuries (trauma) during sports activities because they can include any action that involves direct trauma to the posterior elbow. For example falling onto a hard floor et cet.

Question 3

What is posterior impingment

Answer 3

Present in younger athletes who are subjected to high valgus stress at the eblow while in hyperextension or repeated forceful extension where elecranontip is jammed into fossa at back of the elbow. Common in these sports: Baseball, Softball, Tennis, Other overhead racket sports

Question 4

Posterior impingement symptoms

Answer 4

Posterior elbow pain, pain with palpation and pain in extension

Question 5

Elbow OA

Answer 5

Pain anterior/posterior, no pain with palpation, normal elbow range. Maybe morning stiffness

Question 6

loose body (in the elbow joint) symptoms

Answer 6

Pain with ROM, catching, locking. Pain in the joint capsule and pain with palpation and loading

Question 7

What is Pronator Syndrome

Answer 7

caused by compression of median nerve, usually by swollen/inflamed structures in the elbows

Question 8

Pronator syndrome symptoms

Answer 8

Pain anterior and pain on palpation of pronator teres. Painful activities include wrist flexion and pronation. May have tingling, myotomal weakness

Question 9

Biceps Tendinopathy (distal)

Answer 9

Pain anterior, pain with palpation and lifting or twisting motions

Question 10

Medial epicondylitis symptoms

Answer 10

Pain over medial epicondyle that worsens with squeezing activities and repetitive pronation.

Question 11

Valgus extension Overload symptoms

Answer 11

Pain in posteriomedial elbow, painful activities include elbow extension, wrist pronation, overhead throwing, and deceleration phase of pitch

Question 12

UCL tear symptoms

Answer 12

Tenderness along UCL origin, painful activities include anything causing valgus

Question 13

Posteriorlateral Rotatry Instability symptoms

Answer 13

FOOSH mechanism causing subluxation(pain, instability, apprehension, weakness, clunk pop), pain on lateral elbow. Also includes catching, clicking, locking

Question 14

Posterior interosseous Nerve impairment symptoms

Answer 14

takes years to present sympotoms Dorsal Arm Pain with resisted extension/gripping, Wrist extensor weakness (paresis)

Question 15

Cubitial tunnel syndrome symptoms

Answer 15

insidious onset of paresthesia, pain, numbness in ulnar nerve distribution, Hand pain, pain in the elbow when it is bent

Question 16

Anterior Interosseous Nerve Impairment symptoms

Answer 16

Poorly localized pain in forearm and cubital fossa is main complaint. Difficulty bringing distal phalanx of thumb and index finger together (traumatic or spontaneous). Painful activities include forming a fist, buttoning shirt.

Question 17

What does extensive damage to the median nerve result in?

Answer 17

Blind Hand

The term ‘Blind Hand’ refers to the inability to use the hand effectively due to median nerve injury.

Question 18

What is a consequence of extensive damage to the ulnar nerve?

Answer 18

Loss of power grip

The loss of power grip affects the hand’s ability to grasp and hold objects securely.

Question 19

What is Zone 2 referred to due to its challenges?

Answer 19

No man’s land

This zone is known for the difficulty of healing and a higher risk of rupture and adhesion formation.

Question 20

What injuries are associated with Zone 2?

Answer 20

Injury to FDP and FDS

Zone 2 injuries may also involve the pulleys.

Question 21

Which specific tendons may be injured in Zone 2 for the thumb?

Answer 21

FPL and intrinsic FPB

FPL stands for Flexor Pollicis Longus, and FPB stands for Flexor Pollicis Brevis.

Question 22

What may happen if hand tendon glides are too easy?

Answer 22

It may slow down the healing process

Question 23

What may occur if there is difficulty gliding with hand tendons?

Answer 23

It may advance more quickly

Question 24

What are the common causes of olecranon fractures in young individuals?

Answer 24

High energy injuries leading to comminuted fractures

Young individuals typically sustain these injuries from sports or accidents.

Question 25

What test can be used to assess the ability to extend the elbow after an olecranon fracture?

Answer 25

Elbow extension test ## Footnote Patients with olecranon fractures often struggle to fully extend their elbow.

Question 26

What is a Die-Punch fracture?

Answer 26

Depressed fracture of the lunate fossa of the articular surface of the distal radius ## Footnote This type of fracture often occurs due to axial loading of the wrist.

Question 27

Define Barton’s Fracture.

Answer 27

Fracture-dislocation of radiocarpal joint with intra-articular fx involving the volar or dorsal lip ## Footnote It can be classified as volar Barton or dorsal Barton fx.

Question 28

What is Chauffer's fracture commonly associated with?

Answer 28

Radial Styloid ## Footnote This fracture is typically caused by a fall onto an outstretched hand.

Question 29

Describe a Colle’s Fracture.

Answer 29

Low energy, dorsally displaced, extra-articular fx ## Footnote It is often referred to as a 'dinner fork' deformity due to its characteristic appearance.

Question 30

What characterizes a Smiths Fracture?

Answer 30

Low energy, volarly displaced, extra-articular fx; Spade like ## Footnote This fracture is often the result of a fall onto the back of the hand.

Question 31

What does the Radial Nerve control in Kumar's Sign screening test?

Answer 31

Extend wrist ## Footnote The Radial Nerve is responsible for wrist extension.

Question 32

What action is tested for the Ulnar Nerve in Kumar's Sign?

Answer 32

ABD the middle, ring and little finger (dorsal interossei) ## Footnote ABD refers to abduction of the fingers.

Question 33

What is the function of the Median Nerve in Kumar's Sign?

Answer 33

Oppose the thumb and 1st finger (FPL & FDP of 1st finger) ## Footnote FPL stands for Flexor Pollicis Longus and FDP stands for Flexor Digitorum Profundus.

Question 34

What is the significance of the Hook Test?

Answer 34

It should be able to grasp the distal biceps tendon easily ## Footnote A positive Hook Test indicates intact biceps continuity.

Question 35

What are the three bundles of the UCL?

Answer 35

* anterior bundle (ABUCL) * oblique bundle (OBUCL) * posterior bundle (PBUCL) ## Footnote The UCL is crucial for elbow stability, particularly against valgus stress.

Question 36

What is the role of the anterior bundle of the UCL?

Answer 36

Key valgus stabilizer ## Footnote The anterior bundle is specifically important in resisting valgus forces.

Question 37

What is the position for the Valgus Stress Test?

Answer 37

Position in > 20 degrees of flexion ## Footnote This position is critical for accurately assessing the integrity of the UCL during the test.

Question 38

Valgus Extension Overload Test

Answer 38

Begin Test in 30 degrees of Elbow Extension Apply REPETITIVE Valgus force to distal humerus while moving into end-range extension Repeat this multiple times POS is pain similar to that of throwing or at the posteromedial tip of the olecranon process

Question 39

Humeroulnar joint open and close packed position

Answer 39

Open packed: 70 flex, 10 SN Close packed: Full ext, full SN

Question 40

Radiohumeral joint open and close packed position

Answer 40

Open Packed: Full ext, full SN Close packed: 90 flex, 5 SN

Question 41

Proximal radioulnar joint open and close packed position

Answer 41

Open packed: 70 flex, 35 SN Close packed: 5 SN

Question 42

Distal radioulnar joint open and close packed position

Answer 42

Open packed: 10 SN Close packed: 5 SN

Question 43

Lateral Epicondyalgia CPR for use of MWM

Answer 43

2/3 Variables = +LR 3.2 3/3 Variables = +LR infinity < age 49 years Pain free grip strength (PFGS) of affected side > 112 Newtons (about 25 lbs) PFGS unaffected side of < 336 Newtons (75 lbs)

Question 44

TFCC symptoms and tests

Answer 44

Presents like: Ulnar sided wrist pain – possible fall or degenerative changes Pain with turning a key or door knob POS Testing: Pain with Ulnar Deviation (compression) or Radial deviation (distraction) Fovea Sign – palpation pain soft spot between the ulnar styloid and flexor carpi ulnaris tendon, between the volar surface of the ulnar head and the pisiform

Question 45

Skier’s Thumb or Gamekeepers Thumb

Answer 45

Acute Presents Like POS pain, bruising, edema & pain w/ palpation. POS Valgus stress test, and pinch weakness Chronic: Gamekeepers – stretching of the UCL & thumb instability

Question 46

What is a Stener Lesion?

Answer 46

Part of skier's thumb or gamekeepers thumb injury, Part of UCL gets caught outside of ADD

Question 47

Prontator Compression test

Answer 47

Compress the Pronator Teres for 30 Seconds POS test is indicated by reproduction of paresthesia in the lateral 3-1⁄2 digits in 30 seconds or less, while the uninvolved limb remains asymptomatic

Question 48

Therapeutic Dry Needling Contraindications

Answer 48

Phobia to needles (Trypanophobia) Bleeding disorders & Difficulty Clotting; consider medications anticoagulants and long term aspirin or NSAID use Allergy to Medals in the Needle (e.g. Nickle or chromium) Local or Systemic infection Blood borne pathogens Vascular or Lymphatic disease or skin conditions at the DN site Pregnancy Cosmetic implants again relative to the implant site e.g. breast, calf, pectoral, deltoid, biceps, buttock…