Wrist/Elbow Competency

Question 1

If you’re given the Elbow exam, what are the steps on the rubric to do?

Answer 1

1. Verbalize that you’re performing an extremity exam for the elbow
2. Inspect the elbow (carrying angle, edema, erythema)
3. Palpate 2 things regarding the elbow (olecranon process, medial or lateral epicondyle)
4. Perform AROM (flex, extension, pro, sup)
5. Strength testing (flex/Ext)
6. Biceps, Triceps, Brachioradialis reflexes
7. Sensations
8. Specialty Task

Question 2

What is the normal carrying angle for males and females?

Answer 2

males 5 degrees

females 10-15 degrees

Question 3

What are the degrees of motion for elbow flexion, extension, supination and pronation

Answer 3

130-140, 0 to -5, 90 90

Question 4

What nerve root is tested for the biceps reflex?

Answer 4

C5

Question 5

What nerve root is tested for the triceps reflex?

Answer 5

C6

Question 6

What nerve root is tested for the brachioradialis reflex

Answer 6

C7

Question 7

What are the typical sensations that we test?

Answer 7

C4 - Deltoid
C5 - Arm to forearm
C6 - Thumb Region
C7 - Middle Finger
C8 - Pinky Side
T1 - Ulnar Side

Question 8

What are you going to do during inspection of the elbow?

Answer 8

look for erythema, swelling, and then edema… press in for 5 seconds and let go and say 0 or 1… not detectable or barely detectable

Question 9

What is the Valgus Stress Test and what is it evaluating?

Answer 9

It tests the MCL

You put the arm at a 30 degree flexion, forearm is supinated.

You slightly push medially at the elbow and pull laterally at the wrist.

If there’s pain/tenderness with palpation or increased laxity, it’s an MCL sprain

Question 10

What is the Varus Stress Test and what is it evaluating?

Answer 10

The arm is slightly abducted and internally rotated. The arm is flexed about 15 degrees

You’re pulling at the elbow more laterally and giving a slight push at the wrist.

IF tenderness/pain with palpation or increased laxity at the lateral side, it’s an LCL sprain

Question 11

What angle do you put the arm for varus/valgus and why do we do this?

Answer 11

if we have it at a higher angle, it moves the shoulder.

30 degrees = valgus
15 degrees = Varus

Question 12

What is golfer’s elbow and what is it testing?

Answer 12

You flex the elbow at 90 degrees, put them in SUPINATION and they FLEX against resistance.

If you have pain at the medial epicondyle of the humerus it’s called “golfer’s elbow”, or “medial epicondylitis”

Question 13

What is Tennis elbow and what is it testing?

Answer 13

You flex the elbow at 90 degrees, put them into PRONATION and they EXTEND against resistance. If their lateral epicondyle is in pain or tender then you have “tennis elbow” or “lateral epicondylitis”

Question 14

What is the Tinel’s Test for the elbow?

Answer 14

You’re tapping between the olecranon and the medial epicondyle in the ulnar groove.

If you have tingling sensation down the forearm = positive test

indication = ulnar nerve entrapment

Question 15

If you were given the wrist exam, what are the steps you’re going to take?

Answer 15

1. Verbalize that you’re going to be performing a physical exam of the wrist and hand
2. Inspect BILATERAL hands, wrists, or fingers, palmar and dorsal aspect
3. Palpate the hands bilaterally at at least 3 areas: Carpal bones, Distal Ulna, Distal Radius, Anatomical Snuff Box
4. Palpate the Radial Artery bilaterally
5. Evaluate AROM for wrist = Flexion, Extension, Abduction, Adduction
6. Evaluate Active Range of motion for the fingers: Flexion, Extension, Abduction, Adduction
7. Evaluate AROM of thumb: Extension, Flexion, Abduction, Adduction, Opposition, Reposition
8. Evaluate Grip Strength bilaterally
9. Evaluate ROM against resistance for strength bilaterally
10. Specialty test

Question 16

What are you going to palpate for the wrist exam?

Answer 16

Distal Radius, Distal Ulna, Carpal Bones, Anatomic Snuff Box

Question 17

What is the AROM for the wrist?

Answer 17

Flexion = 80-90
Extension = 70
Abduction = 20-30
Abduction = 30-40

Question 18

What is the Finkelstein Test?

Answer 18

This is the terrible punch.

You cover your fingers over your thumb and then Adduction (ulnar deviate) and if there’s pain below the wrist you have “Dequervain’s Tenosynovitis”

Question 19

What is the Phalen’s Test?

Answer 19

Testing for carpal tunnel syndrome

You flex the wrists and press the back of the hands together and hold it for 30-60 seconds. If you get pain or numbness in the medial 3 fingers + palm = carpal tunnel syndrome

Question 20

What is the Tinel’s Wrist Test?

Answer 20

You hold the patient’s wrist in EXTENSION. Then you tap on the flexor retinaculum with the tip of a finger or the reflex hammer.

If you have numbness in the thumb, index and middle finger it’s indicative of carpal tunnel syndrome.

Question 21

What do you do for a scaphoid fracture?

Answer 21

Confirm it’s a FOOSH injury.

You put the patient in pronation and then ulnar deviate and then palpate the scaphoid tubercle in the anatomical snuff box region. This would be indicative of a feature if there was pain. if no pain, no fracture.