What - Wrist and elbow

Question 1

Look and compares the overall appearance of the elbows and wrists
1. What is the anatomical position for the arm?

Answer 1

The anatomical position of the arm is having the patient’s elbow fully extended and the forearm supinated
with palm facing forward

Question 2

What are common causes of swelling in elbow?

Answer 2

Three common causes of swelling in the elbow are rheumatoid nodules, gout and olecranon bursitis

Question 3

What structures attach to the medical epicondyle and lateral epicondyle?

Answer 3

Medical epicondyle – attachments of the flexor and pronator muscle groups
Lateral epicondyle – attachments of extensor and supinator muscle groups (ERCB, EDC, ERCL, brachioradialis,
anconeus, supinator)

Question 4

What are the common names given to tenderness at the tendinous attachment areas of the lateral and
medial epicondyles respectively?

Answer 4

Tenderness at the common flexor origin (medial epicondylar area) = Weightlifter’s elbow, Golfer’s elbow
Tenderness at the common extensor origin (lateral epicondylar area) = Tennis elbow

Question 5

What can happen if extreme valgus stress is applied to the elbow?

Answer 5

Extreme valgus stress to the elbow can damage the medical collateral ligament and cause elbow instability

Question 6

What is physically happening when performing the resisted middle finger test? Cozen test?

Answer 6

Resisted middle finger extension causes a ‘tightening or pulling’ of the extensor digitorum communis as part
of the common extensors of the wrist which attach to the common extensor origin near the lateral
epicondyle, hence, pain or reproduction of patient’s symptoms in that area means a positive for ‘lateral
epicondylitis’.
Cozen’s test stresses all of the extensor tendons, particularly ECRB, and tenderness in the CEO area is
positive for lateral epicondylitis.

Question 7

Using the VITAMIN D mnemonic, what conditions can present with a swelling/effusion in the wrist?

Answer 7

Swelling/effusions in the wrist may be due to (not an exhaustive list):
V - bruising, thrombophlebitis, lymphoedema
I - infection or inflammation of local structures
T - fracture, dislocation, subluxation, sprains, bruising
A – RA, SLE, hypothyroidism and other AIDs
M – gout, pseudogout
I – post-op joint problem
N - bony or soft tissue neoplasm, hypertrophic pulmonary osteoarthropathy
D – ? any drugs that cause wrist swelling

Question 8

What are the names of the carpal bones?

Answer 8

Carpal bones can be remembered by various mnemonics:
e.g. Sally Left The Party To Take Cathy Home
(proximal row then distal, both lateral to medial)
Scaphoid, Lunate, Triquetrium, Pisiform
Trapezium, Trapezoid, Capitate, Hamate

Question 9

Assess the range of movement and strength in the wrists
9. What muscles are responsible for wrist flexion, extension, radial deviation, and ulnar deviation?
10. What is the name of the nerve and nerve root that innervates those muscles?

Answer 9

Wrist joint
Extension - extensor carpi ulnaris, extensor carpi radialis longus & brevis muscles. All by radial nerve (root C7-8)
Flexion - flexor carpi ulnaris muscle by the ulnar nerve (root C8) and flexor carpi radialis muscle by median
nerve (root C6-7)
Radial deviation – extensor carpi radialis muscle by radial nerve (root C6-7)
Ulnar deviation – extensor carpi ulnaris muscle by radial nerve (root C6-8) and flexor carpi ulnaris muscle by
ulnar nerve (root C7-T1)

Question 10

What structure is damaged in the wrist when this test is positive?

Answer 10

Scapho-lunate instability (Watson’s test) is caused by a tear in the scapho-lunate ligament and is a common
cause of wrist instability