Extremities Pathology Final Flashcards Preview

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Flashcards in Extremities Pathology Final Deck (53):
1

Middle Finger Test Positive Sign

pain in lateral elbow

2

Middle Finger Test

Resisted middle finger extension test
Patient is seated
The wrist is extended
The patient is asked to spread the fingers apart and hold this position
Downward pressure is placed on the middle finger while the patient resists this movement

3

Medial Epicondylitis

- chronic overuse
- Repetitive wrist flexion/forearm pronation
- Microtrauma to common flexor tendon or FCR tendon
- Pain worse on wrist flexion and pronation
- Tenderness just distal to the medial humeral epicondyle
- golfer's elbow test

4

Golfer's Elbow Test

Patient is seated
Ask the patient to extend and supinate the forearm
Ask the patient to flex the wrist and hold that position
While you push down on the wrist
+= pain in the medial epicondyle

5

Little Leaguer’s Elbow

Chronic repetitive valgus loading
Associated with throwing curve balls
Causes tension overload on the medial structures-medial anterior oblique ligament or the medial epicondyle epiphysis
Young pitchers [10-16 years]
Decreased throwing speed and accuracy
Tenderness over the medial humeral epicondyle
X-ray or MRI

6

Cubital Tunnel Syndrome

Chronic or acute
Compression of the ulnar nerve as it passes between the medial and lateral heads of Flexor Carpi Ulnaris (FCU)
Second most common entrapment neuropathy in the upper limb
Medial aspect of the hand and 4th and 5th digits
Nerve Velocity Conduction tests

7

Orthopedic Tests for Cubital Tunnel Sydrome

Wartenberg, Tinel, Froment and elbow flexion tests

8

Wartenberg Test

Patient is seated
Instruct the patient to place the tested hand flat on the table
Separate the fingers
Ask the patient to bring all the fingers together
+= failure to bring the little finger in [adduct]

9

Tinel’s Tap Test (Elbow)

Stand behind the seated patient
Passively abduct the shoulder and allow the elbow to hand down
Tap the Cubital Tunnel
+= reproduction of pain radiating along the ulnar aspect of the hand and 4th and 5th digits

10

Elbow Flexion Test

Patient is seated
Ask the patient to fully flex the elbow and hold this position for 5 minutes
+= paresthesia along the ulnar border of the hand and 4th and 5th digits

11

Ulnar Collateral Ligament Sprain

Acute or chronic
Repetitive throwing motions
Pitchers and javelin throwers
Or a fall on the outstretched arm
Tear in the Ulnar Collateral Ligament
Medial elbow pain worse with forceful abduction
Abduction stress test
MRI

12

Orthopedic Test for Ulnar Collateral Ligament Sprain

abduction stress test

13

Abduction Stress Test

The patient is seated
Ask the patient to fully extend the elbow
Stabilize the lateral aspect of the patient’s elbow with one hand
Grasp the distal forearm of the patient
Pull the distal forearm laterally
+= pain over the medial elbow

14

Olecranon Bursitis

Acute or chronic
Inflammation of the olecranon bursa which lies between the skin and the olecranon
Traumatic or prolonged pressure on the olecranon or associated with RA or gout
Swelling [size of a goose egg] and pain worse on elbow flexion
If it is red and warm, then the bursa is infected
Ultrasound

15

Triceps tendonitis

Chronic or acute
Repetitive or prolonged activity placing strain on the triceps tendon
Pushups, punching, throwing the shot put or excessive hammering
Non-traumatic
Pain at the back of the elbow
Patient supports involved arm in elbow flexion
Tenderness and perhaps swelling in the olecranon fossa
Pain worse with extension against resistance
MRI may be needed

16

Posterior Impingement Syndrome

Acute or chronic
Excessive or repetitive hyperextension often with abduction
The windup or cocked position just prior to throwing
Intra-articular lesion or reactive synovitis
OA in the older patient
Pain at the back of the elbow
Tenderness when palpating the olecranon fossa
MRI may be needed

17

Occult Elbow Fracture

Acute traumatic injury
Swollen elbow
Inability to fully extend the elbow
X-ray may appear to be normal
Posterior fat pad [90% chance of an intra-articular fracture] or an anterior sail sign [75%] may be seen on the lateral x-ray
Another view may show an intra-articular fracture

18

Bicipitoradial bursitis

Repetitive supination and pronation
More common in males
Mid-elbow pain and swelling lateral to insertion of the bicipital tendon
Limited supination and pronation
Ultrasound and MRI

19

Bicipital Tendon Tear

Acute
Trauma
Older men
Smoking and use of anabolic steroids
Sudden jerky lifting of a heavy object
Bruising in front of the elbow
Mid-arm bulge
Unable to flex the elbow or supinate the forearm against resistance
MRI

20

Pronator Syndrome

Insidious
Repetitive pronation
Median nerve entrapment
Pain worse on pronating the flexed wrist against resistance
X-ray may show a bony spur
Nerve conduction velocity studies

21

Resisted Pronation test

The patient is seated
The forearm is in supination and the elbow in extension
Stabilize the proximal forearm with one hand
Hold the distal forearm
Ask the patient to pronate the forearm while you resist this movement
+= reproduction of pain

22

Nerves that innervate the wrist joint

Anterior interosseous branch of the median nerve
Posterior interosseous branch of the radial nerve
Articular branches of the ulnar nerve

23

Ranges of Motion for Wrist

Flexion: 0-80 degrees [FCR and FCU assisted by FDS and FDP]
Extension: 0-70 degrees [ECRL, ECRB and ECU assisted by ED and EI
Radial deviation: 0-20 degrees [ECRL, ECEB and FCR]
Ulnar deviation: 0-30 degrees [FCU and ECU]
Pronation and supination are allied to the elbow joint

24

Orthopedic Tests for Carpal Tunnel Syndrome

Tinel, Phalen, Reverse Phalen and Wrist Compression

25

Carpal Tunnel Sydrome

Insidious
Repetitive flexion and extension of the wrist and/or fingers
Females > 45 years
Hypothyrodism, diabetes and pregnancy
Pain or paresthesia in the thumb, index, middle and radial aspect of the ring fingers

26

Tinel's Test

The patient is seated
The forearm is supinated
Using a reflex hammer or your finger, tap one inch distal to the distal skin crease at the wrist
+= reproduction of pain or paresthesia along the thumb, index, middle and the radial half of the ring fingers

27

Phalen Test

The patient is seated
Instruct the patient to hold both hands in the flexed position for 1 minute
+= reproduction of pain or paresthesia along the thumb, index, middle and the radial half of the ring finger

28

Reversed Phalen Test

The patient is seated
Ask the patient to hold both hands as if in prayer for 1 minute
+= reproduction of pain or paresthesia along the thumb, index, middle and the radial half of the ring fingers

29

Wrist Compression Test

aka Durkan’s test
The patient is seated
Compress with both thumbs an area 1 inch beyond the distal skin crease at the wrist for 30 seconds
+= reproduction of pain or paresthesia along the thumb, index, middle and the radial half of the ring finger within 30 seconds

30

Cheiralgia Paresthetica aka Wartenberg’s syndrome

Acute or chronic
Compression of the superficial branch of the radial nerve as it lies between the ECRL and brachioradialis tendons
More common in females
Pain or paresthesia over the dorsolateral aspect of the wrist

31

Orthopedic Test for Cheiralgia Paresthetica

Tinel's sign

32

Tinel's Sign

The patient is seated
With a reflex hammer or your finger tip, tap over the lateral aspect of the wrist
About 9 cm proximal to the radial styloid process
+= pain or paresthesia along the dorsal aspect of the thumb and index fingers

33

de Quervain’s tenosynovitis

Chronic
Inflammation of the tendon sheaths of APL and EPB caused by microtrauma
Pain over the radial styloid process and the tendons of APL and EPB
Finkelstein test may be positive

34

Orthopedic Test for de Quevain's Tenosynovitis

Finkelstein Test

35

Finkelstein Test

The patient is seated
Ask the patient to make a fist with the thumb on the palm
Ask the patient to bend the wrist towards the little finger
+= pain over the styloid process of the radius

36

Ganglion

Soft tissue swelling arising from the joint capsule of tendon sheath
May be a history of repetitive wrist activities
Dorsal wrist pain worse with passive dorsiflexion
Tense cystic swelling
MRI may be helpful

37

Guyon’s Canal Syndrome

Acute or chronic
Compression of the ulnar nerve as it passes through Guyon’s canal
Compressive injury-cyclists or associated with hamate fractures
Pain or paresthesia along the 5th and the ulnar aspect of the ring finger
Tinel’s test, Froment’s and Wartenberg’s sign
Nerve Conduction Velocity studies

38

Orthopedic Tests for Guyon's Canal Syndrome

Tinel's test, Froment's and Wartenberg's sign

39

Tinel's Test

The patient is seated
With a reflex hammer or your finger tip, tap over the pisiform bone
+= Pain or paresthesia along the little finger and the medial half of the ring finger

40

Froment’s sign

The patient is seated
The elbows are flexed
Ask the patient to grasp a piece of paper between the thumb and index fingers in both hands
Attempt to pull the paper out
+=the patient flexes the interphalangeal joint of the thumb to get a better grip on the paper

41

Intersection Syndrome

Insidious onset
Repetitive activities involving the tendons of APL and EPB crossing over the tendons of ECRL and ECRB
Weight lifters and rowers
Pain over the dorsolateral aspect of the wrist 5 cm proximal to the wrist
Pain with resisted wrist and thumb extension and abduction
Crepitus over the affected tendons
Finkelstein’s test may be positive

42

Kienbock’s disease

Insidious
Avascular necrosis of the lunate bone
Stress or compression fracture or repetitive trauma
Stiff wrist with pain over the dorsum of the wrist
Pain on passive extension of the middle finger
X-ray or MRI

43

Osteoarthritis

Primary or secondary
Wear and tear degeneration
F>M in primary
M>F in secondary
Morning stiffness < 1 hour
Bilateral
Heberden’s [DIP] and Bouchard’s [PIP] nodes

44

Psoriatic Arthritis

Autoimmune disorder
F>>M
10% of patients with psoriasis will develop pain and swelling of the small joints in the hands
Pitted nails and sausage digits

45

Rheumatoid Arthritis

Autoimmune disorder
F:M 9:1
Small joints mainly
Bilateral
Early morning stiffness > 1 hour
Rheumatoid Factor + in 70% of patients
Bouchard and Haygarth’s nodes
Bracelet and wringing tests
X-ray

46

Bracelet Test

The patient is seated
Grab the wrist of the patient with one hand
Squeeze mild lateral compression to the lower ends of the radius and ulna
+= pain on lateral compression of the wrist

47

Wringing Test

The patient is seated
Give the patient a towel
Ask the patient to wring the towel with both hands
+= pain in the elbow, wrist or hand on wringing the towel

48

Scapholunate dissociation

Acute
Falling on the thenar eminence
Tear of the scapholunate and radioscaphoid ligaments
Presents with radial or dorsal wrist pain
Watson test
X-ray-David Letterman [Terry Thomas] sign [large space between the scaphoid and lunate bones

49

Watson’s Test

The patient is seated
Stabilize the radius and ulna with one hand holding the hand in slight ulnar deviation
Grasp the scaphoid and move in anteriorly and posteriorly
+= reproduction of pain, crepitus or increased laxity

50

Triangular Fibrocartilage Complex Tear

Acute or chronic
Fall on the outstretched hand with wrist in extension and forearm pronated or
Chronic wear and tear associated with a positive ulnar variance
Pain over the ulnar aspect of the wrist
Fovea sign and the Press test
MRI of the wrist

51

Fovea sign

The patient is seated
+= Tenderness in the soft spot between the ulnar styloid and flexor carpi ulnaris tendon

52

Press Test

The patient is seated in a chair with arms
Ask the patient to place both hands on the arms of the chair and push off as to suspend the body using only the hands
+= reproduction of wrist pain while pushing up

53

Triquetrohamate Instability

Acute
Disruption of the osseous coupling between the hamate and triquetrum
Injury to the ulnar side of the hand with excessive pronation
Ligamentous tear
Active pronation with ulnar deviation causes a click and may reproduces the pain
Videofluoroscopy is diagnostic