PATHOLOGY: elbow, wrist, hand

Question 1

Fall on hyperextended or flexed elbow
Most common in kids → gunstock deformity
lose extension

Answer 1

Supracondylar fracture

Question 2

common fracture with fall onto elbow/powerful tricep contraction

maybe steroid use

Answer 2

olecranon fracture

Question 3

how do coronoid fractures happen?

Answer 3

high energy injury, moves posteriorly and coronoid snaps off

Question 4

What elbow fracture happen with a FOOSH?

Answer 4

radial head fracture (head forced into the capitulum)

Question 5

posterior or posterolateral elbow dislocation with a FOOSH + axial force

Answer 5

Humero-ulnar dislocation

Question 6

What is nursemaid’s elbow

Answer 6

radial head dislocates (slips out of annular ligament) due to distraction force

PRUJ

Question 7

with elbow dislocations, what is a common fracture (10% of cases)

Answer 7

radial head fx

Question 8

what soft tissues are usually damaged with elbow dislocations?

Answer 8

anterior/posterior capsule
anterior bundle of UCL
brachialis mm

Question 9

Patient has acute pain or “pop” with sharp pain over medial elbow
OR
progressive pain with throwing
What dx?

Answer 9

UCL sprain

Question 10

MRI of elbow: you see a t-sign
what does this mean

Answer 10

complete rupture of UCL

Question 11

Patient is a gymnast/cheerleader with lateral elbow pain, clicking.
Dx?

Answer 11

LCL/RCL sprain
axial compression + shoulder ER + elbow valgus force

Question 12

what is the most common type of recurrent instability at the elbow

Answer 12

postero-lateral rotary instability
(LCL sprain)

Question 13

Patient has:
1. “pop” with pain, swelling
2. MOI: resistance against arm 90 flexion

Answer 13

distal biceps tendon rupture

Sx right away

Question 14

Differential Dx of lateral elbow tendinopathy

Answer 14

1. radial nerve entrapment (PIN 5% of cases)
2. instability/stress at radiocapitellar joint

Question 15

Patient has:
1. lateral elbow pain
2. TTP 1 cm distal to lateral epi
3. pain with PROM wrist flexion, gripping, resisted wrist extension + finger extension

Answer 15

lateral elbow tendinopathy (ECRB/EDC)

Question 16

Patient has:
1. dull aching pain in forearm
2. weak grip
3. ulnar nerve paresthesia

Answer 16

medial elbow tendinopathy

Question 17

4th and 5th finger paresthesia
loss of grip strength
most likely Dx:

Answer 17

cubital tunnel syndrome
(2nd most common nerve entrapment)

diff dx: cervical radic, TOS

Question 18

What nerve entrapment is associated with cyclists

Answer 18

ulnar (cubital tunnel syndrome)
= sustained flexed posture

Question 19

Patient has tenderness/pain a few cm away from lateral epicondyle
weakness in fingers/extensors…

Answer 19

radial tunnel syndrome
test EI/EPL –> PIN

Question 20

Patient has pain at volar forearm, numbness in first 3 1/2 fingers induced with activity

Answer 20

pronator teres syndrome
*DDX resisted pronation

could also be:
carpal tunnel
cervical radiculopathy

Question 21

patient has:
problems with buttoning shirt/grip/making a fist
hard time with OK sign
no sensory involvement

Answer 21

AIN syndrome
FPL, PQ, FDP 2nd and 3rd

Question 22

Patient is a gymnast/cheerleader
1. TTP around olecranon tip
2. pain with forced elbow extension
3. valgus laxity

Answer 22

valgus extension overload syndrome
MOI: repeated extension

Question 23

Patient is young (7-10), has fairly sudden onset lateral elbow pain.
dull, achy, worse with motion.
no locking/catching.

Answer 23

Panner’s (osteochondrosis of humeral capitulum)

don’t need sx usually, may result in some limitation of mvmt

Question 24

Patient is 12-17 years old, thrower/gymnast with gradual lateral elbow pain
dull, achy, worse with mvmt
locking and catching COMMON

Answer 24

osteochondritis dissecans

Question 25

What will you find in your exam with OCD?

Answer 25

1. tender radio-capitellar joint 2. limited extension 5-20 degrees 3. crepitus 4. joint effusion

Question 26

Patient has superficial swelling over olecranon full ROM except extreme flexion. They took a direct blow to their elbow or repetitive trauma...

Answer 26

olecranon bursitis Diff dx: cellulitis, septic arthritis/bursitis, elbow sprain

Question 27

* Dull ache → sharp pain at medial H-U joint line * Medial elbow pain w/ valgus stress (throwing, overhead lifts, etc) * May or may not have ulnar n. paresthesias * ↓ grip strength w/ or w/o pain

Answer 27

medial elbow instability/UCL sprain

Question 28

* Dull ache → sharp pain at H-R joint line (postero-lateral typically) * Feelings of joint slipping or unstable (may have clicking) * Pain and symptoms w/ CKC UE tasks * ↓ grip strength w/ or w/o pain

Answer 28

posterolateral rotary elbow instability/RCL sprain

Question 29

most commonly affected nerve in elbow

Answer 29

ulnar nerve (cubital tunnel)

Question 30

FOOSH, pain in snuffbox but negative x ray

Answer 30

scaphoid fracture *commonly missed until they start healing

Question 31

wrist pain on ulnar side with gripping TTP over hamate pain with resisted 4th/5th finger flexion MOI: repetitive torque stress with racket sports

Answer 31

hook of hamate fracture

Question 32

FOOSH with fractured distal radius is usually

Answer 32

colles fx (wrist extension --> distal radius goes dorsally) | shortened arm

Question 33

MOI: axial loading with ulnar deviation/wrist distraction

Answer 33

TFCC tear

Question 34

Patient had a major crush trauma. Now fingers, wrist, hand are all flexing up and swollen

Answer 34

Volkmann's contracture --> ER

Question 35

forced wrist extension + radial deviation = sprain to what

Answer 35

lunotriquetral ligament

Question 36

FOOSH can sprain what?

Answer 36

radioscapholunate ligament

Question 37

If you have enlargements at 3 or more MCPs, what are you thinking

Answer 37

RA less than 3 MCP and mostly DIPs/PIPs = OA

Question 38

If you have 3 or more enlargements at the PIP/DIP (especially 2nd and 3rd finger), what are you thinking?

Answer 38

OA DIP: heberden's nodes PIP: bouchard's nodes

Question 39

swan neck: what is torn

Answer 39

volar plate MCP flexion PIP extension DIP flexion

Question 40

Ext of MCP and DIP w/ flex of PIP Rupture of central tendon of extensor hood due to RA or trauma

Answer 40

boutonniere deformity

Question 41

Thickening of flexor tendon sheath causing tendon to ‘catch’ Eventually will not extend Common w/ RA

Answer 41

trigger finger

Question 42

what hand deformities are associated with RA

Answer 42

swan neck boutonniere trigger finger ulnar drift

Question 43

1st CMC OA CPR

Answer 43

1. hand pain/stiff 2. hard tissue enlargement of 2 or more joints AND 2nd and 3rd DIPs, PIPs, 1st CMCs 3. less than 3 swollen MCP joints 4. hard tissue enlargement of more than 2 DIPs 5. deformity of 2 or more selected joints

Question 44

MOI: 1° a repetitive overuse problem but direct trauma can cause TTP over radial styloid Pain w/ active thumb abd and passive add

Answer 44

de Quervain's tenosynovitis

Question 45

most commonly DISLOCATED carpal bone

Answer 45

lunate (FOOSH) shifts dorsally, scaphoid shifts volarly = scapholunate instability

Question 46

Avulsion of distal slip of extensor tendon MOI: forced flex of DIP ↓ DIP extension, normal PIP extension

Answer 46

mallet finger

Question 47

Avulsion of FDP tendon MOI: Forced ext against active flex Typically 4th digit

Answer 47

JERSEY finger

Question 48

Ulnar deviation of digits from weakening passive structures MOI: RA

Answer 48

ulnar drift

Question 49

Wasting of thenar mm. Thumb falls in line w/ fingers Unable to oppose or flex thumb

Answer 49

ape hand due to median nerve palsy

Question 50

What is fractured with boxer's fracture

Answer 50

4th and 5th MC bone

Question 51

Palmar fascia contraction w/ finger deformity in MCP and PIP joints Most often 4th/5th digits associated with diabetes

Answer 51

dupuytren's contracture

Question 52

MOI: Forced abd w/ hyperextension of thumb

Answer 52

gamekeeper's thumb *most common hand ligament injury: UCL

Question 53

MMT extensor indicis, resist supination elbow straight, retest extensor indicis. (+) if weaker! (EI or EPL)

Answer 53

Dx for radial tunnel syndrome

Question 54

How to Dx carpal tunnel

Answer 54

tinel's phalen's sensory changes in median nerve --> activity related pain/paresthesia (80% accurate)

Question 55

5 sites of ulnar nerve compression

Answer 55

medial intermuscular membrane arcade of Struthers medial epicondyle heads of FCU between FCU and ulna/FDP