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KNPE 331 > Week 12: Elbow, Wrist and Hand > Flashcards

Week 12: Elbow, Wrist and Hand Flashcards

1
Q

Elbow Joint (3 Joints)

A
  1. Ulnohumeral joint
  2. Radiohumeral joint
  3. Proximal Radioulnar joint

*hinge joint

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2
Q

Elbow Ligaments (2)

A
  1. Ulnar (Medial) Collateral Ligament (UCL)
  2. Radial (Lateral) Collateral Ligament (RCL)
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3
Q

Ligaments of the Wrist and Hand (3)

A
  1. Collateral Ligaments of wrist & fingers
    -Ulnar (Medial) Collateral Lig.
    -Radial (Lateral) Collateral Lig.
  2. Intercarpal Ligaments (dorsal, palmar)
  3. Triangular Fibrocartilage Complex (TFCC)
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4
Q

Triangular Fibrocartilage Complex (TFCC) aka Triangular Disc:

A

-Complex made up of load-bearing triangular fibrocartilage articular disc & ligaments on medial aspect of wrist
-Disperses axial load from carpals→ulna
-Thickened by the ulnar collateral ligament (UCL) medially
-TFCC is a major stabilizer of:
○ Ulnocarpal joint
○ Distal radioulnar joint
-Facilitates articulations at the wrist joint

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5
Q

Nerves at Elbow and Wrist (2 Main)

A

Note location of:
1. Ulnar nerve both at elbow & wrist
2. Median nerve under flexor retinaculum

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6
Q

Elbow Flexor Muscles (3)

A
  1. Biceps brachii (long head and short head)
  2. Brachialis
  3. Brachioradialis
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7
Q

Elbow Extensor Muscles (2)

A
  1. Triceps brachii (long head, medial and lateral head)
  2. Anconeus
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8
Q

Muscles of the Forearm, Wrist and Hand (Common Origins)

A
  1. Medial epicondyle= Common flexor tendon origin
  2. Lateral epicondyle= Common extensor tendon origin
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9
Q

Carpal Tunnel (4 Components)

A
  1. Flexor tendons
  2. Carpal bones
  3. Median nerve
  4. Transverse carpal ligament
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10
Q

Elbow ROM (2)

A
  1. Flexion/extension
  2. Pronation/supination
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11
Q

Wrist ROM (2)

A
  1. Flexion/extension
  2. Radial deviation/ulnar deviation
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12
Q

Digits ROM (3)

A
  1. Flexion/extension
  2. Abduction/adduction
  3. 1st-5th opposition/reposition
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13
Q

Lateral Epicondylitis a.k.a Tennis Elbow

A

-MOI: overuse of forearm extensors
-Common in tennis, squash, badminton
-Most common extensors affected:
○ Extensor Carpi Radialis Longus
○ Extensor Carpi Radialis Brevis
-S&S: TOP common extensor origin (lateral epicondyle), pain & weakness with wrist extension
-Acute management: stretch wrist extensors – in elbow extension & flexion; PIER (if “itis”), tennis elbow brace?
○Recall the “R” in PIER means rest – in some cases this means altered activity
-Eccentric strengthening program for forearm extensors

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14
Q

Medial Epicondylitis a.k.a Golfer’s Elbow

A

-MOI: overuse of wrist flexors
-Common in golfers & pitchers
-Most common flexors affected:
○ Flexor Carpi Radialis (FCR)
○ Pronator Teres (PT)
-S&S: TOP common flexor origin (medial epicondyle), pain & weakness with wrist flexion
-Acute care: stretch forearm flexors, PIER

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15
Q

Ruptured Biceps

A

-MOI: sudden lengthening of contracting muscle (eccentric) – e.g./ sudden load when lifting, or catching a heavy load
-Distal biceps tendon most common
-S&S: “Popeye muscle”/muscle balled up, bruising, pain near insertion of biceps into radial tuberosity, pain & weakness with elbow flexion & supination (complete ruptures might be painless)
-Acute management: PIER, pressure pad to approximate any remaining fibers, shorten biceps in sling to remove tension
-Surgical repair within first couple weeks for active people

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16
Q

DeQuervain’s Syndrome Tenosynovitis

A

-MOI: overuse of thumb due to gripping/wringing
-Inflammation of the tendons & sheath around the thumb tendons (Extensor Pollicis Brevis, Abductor Pollicis Longus)
-S&S: pain over tendons of thumb, weakness with thumb abduction or extension, pain with gripping
-Common in golf
-Special test: Finkelstein Test
-Acute management: PIER, thumb spica brace
-If left untreated, can progress to thickening/scarring & reduced ROM

17
Q

Elbow Hyperextension Injuries

A

-MOI: FOOSH – landing on an extended elbow – sometimes with added external force
-S&S: anterior elbow pain & swelling from ligament/capsule sprain and/or muscle strain, posterior elbow pain from osteochondral lesion (olecranon in olecranon fossa of ulnohumeral joint)
-Need to rule out olecranon fracture – may see a deformity
-Acute Management: PIER, shorten injured tissues (elbow flexion) → sling
-Tape job for elbow hyperextension is very effective
-What do we need to consider when rehabbing that joint?

18
Q

Ulnar Collateral Ligament Sprains of the Elbow

A

-MOI: FOOSH, overuse by repeat valgus force on the elbow
-S&S: pain & laxity (instability) in medial elbow joint
-Can include ulnar nerve symptoms
-Common in pitchers due to repeat high velocity force
-Tommy John surgery reconstructs UCL using a graft tendon -palmaris longus, semitendinosus, or gracilis
-Incidence of this injury/reconstruction is increasing

19
Q

Collateral Ligament Sprains of the Wrist

A

-MOI: FOOSH, forced forearm rotation
○ Ulnar Collateral Ligament: valgus force
○ Radial Collateral Ligament: varus force
-S&S: pain, swelling & instability on medial (UCL) or lateral (RCL) aspect wrist
-Special Tests
○ UCL(MCL): Valgus Stress Test
○ RCL(LCL): Varus Stress Test
-Acute management: PIER → wrist wrap!
-Wrist tape job for RTP

20
Q

Ulnar Collateral Ligament (UCL) Sprain of the Thumb a.k.a Skier’s Thumb or Gamekeeper’s Thumb

A

-MOI: traumatic or overuse hyperabduction of the thumb (1st metacarpophalangeal joint)
○ Traumatic = Skier’s thumb – thumb gets caught, FOOSH, catching ball
○ Overuse = Gamekeeper’s thumb – repeat gripping/twisting
-Can also result in avulsion fracture
-S&S: pain, swelling & instability at 1st MCP joint
-Surgery is recommended for instability to stabilize joint & prevents osteoarthritis longer term
-Acute management: PIER, possible x-ray to rule out avulsion
-Brace for healing
-Thumb tape job/brace for RTP

21
Q

Thumb Tape Jobs Considerations

A

-Which ROM do you want to limit?
○ Hyperextension?
○ Abduction?
-Changes your pre/post special test
○ ROM you want to limit
○ 1st MCP instability glide into ext’n vs. valgus stress
-Starting position
○ What is required for sport?
-Ribbons & hoods – limit both ranges!
○ Be mindful of ribbon direction

22
Q

Triangular Fibrocartilage Complex (TFCC) Tear

A

-MOI:
○ Acute: FOOSH, forced forearm rotation
○ Overuse: repetitive wrist motions (wrench, hammer, lifting)
-S&S: medial wrist pain, pain with ulnar deviation & loading through wrist, popping/clicking, wrist weakness
-Special Test: TFCC compression test (passive ulnar deviation with axial compression – loads through the disc)
-Acute management: PIER, brace as it heals
-Anti-inflammatory injections if needed, surgery for persistent instability

23
Q

Elbow Dislocations

A

-Elbow joint bony structure provides a lot of stability – but enough force can cause dislocations
-MOI: FOOSH
-S&S: deformity, pain++, holding elbow, tingling/numbness?, shock
-Acute care: stabilize, splint, monitor/treat for shock, ER/EMS
-Reduction under sedation

24
Q

Elbow Fractures and Surgical Approaches

A

-MOI: direct trauma/fall
-S&S: pain++, unable or unwilling to move elbow
-Acute care: splint, monitor for shock, ER for x-rays/surgical referral
-ORIF = Open Reduction Internal Fixation

25
Q

Colles’ Fracture Distal Radius Fracture

A

-MOI: FOOSH
-Distal radius gets displaced posteriorly
-S&S: “dinner fork deformity”, pain++, numbness?
-Deformity is obvious, so no need for testing
-Acute management: splint, monitor for shock, emerge for x-rays, surgery if unable to align

26
Q

Scaphoid Fractures

A

-MOI: FOOSH
-S&S: TOP of anatomical snuffbox
-Scaphoid has poor blood supply = decreased ability to heal
-Important to identify early & immobilize – cast or brace

27
Q

Metacarpal (MC) and Finger Fractures

A

-MOI: axial compression (jammed) finger, direct trauma, being stepped on
-S&S: localized pain, swelling, unable to grip
-Acute care: Fingers: buddy tape to stabilize Hand (MC) – SAM Splint
-Can get avulsion fractures – tendon pulls off piece of bone
-Immobilization or surgical repair

28
Q

Cyclist Palsy

A

*nerve condition
-MOI: compression from handlebars
-S&S: tingling/numbness/nerve pain, decreased muscle strength of 5th digit, hand cramping
-Common in new cyclists, distance cyclists
-Prevention: avoid hyperextension of wrist on handlebars, proper bike fit
-Acute care: PIER, splint
-May require NSAIDs

29
Q

Carpal Tunnel Syndrome

A

*nerve condition
-MOI: overuse of wrist flexor tendons causing pressure on median nerve within carpal tunnel
-S&S: burning/tingling/numbness in anterior wrist & hand (along median nerve distribution – digits 1-3 and ½ of 4), decreased grip strength
-Acute care: bracing, PIER, anti-inflammatory treatment, proper ergonomic set up (prevention too!)
-Steroid injection?
-Surgery to open up tunnel if conservative treatment unsuccessful

KNPE 331 (12 decks)

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