Wrist/Elbow Competency Flashcards
(21 cards)
If you’re given the Elbow exam, what are the steps on the rubric to do?
- Verbalize that you’re performing an extremity exam for the elbow
- Inspect the elbow (carrying angle, edema, erythema)
- Palpate 2 things regarding the elbow (olecranon process, medial or lateral epicondyle)
- Perform AROM (flex, extension, pro, sup)
- Strength testing (flex/Ext)
- Biceps, Triceps, Brachioradialis reflexes
- Sensations
- Specialty Task
What is the normal carrying angle for males and females?
males 5 degrees
females 10-15 degrees
What are the degrees of motion for elbow flexion, extension, supination and pronation
130-140, 0 to -5, 90 90
What nerve root is tested for the biceps reflex?
C5
What nerve root is tested for the triceps reflex?
C6
What nerve root is tested for the brachioradialis reflex
C7
What are the typical sensations that we test?
C4 - Deltoid C5 - Arm to forearm C6 - Thumb Region C7 - Middle Finger C8 - Pinky Side T1 - Ulnar Side
What are you going to do during inspection of the elbow?
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
What is the Valgus Stress Test and what is it evaluating?
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
What is the Varus Stress Test and what is it evaluating?
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
What angle do you put the arm for varus/valgus and why do we do this?
if we have it at a higher angle, it moves the shoulder.
30 degrees = valgus
15 degrees = Varus
What is golfer’s elbow and what is it testing?
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”
What is Tennis elbow and what is it testing?
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”
What is the Tinel’s Test for the elbow?
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
If you were given the wrist exam, what are the steps you’re going to take?
- Verbalize that you’re going to be performing a physical exam of the wrist and hand
- Inspect BILATERAL hands, wrists, or fingers, palmar and dorsal aspect
- Palpate the hands bilaterally at at least 3 areas: Carpal bones, Distal Ulna, Distal Radius, Anatomical Snuff Box
- Palpate the Radial Artery bilaterally
- Evaluate AROM for wrist = Flexion, Extension, Abduction, Adduction
- Evaluate Active Range of motion for the fingers: Flexion, Extension, Abduction, Adduction
- Evaluate AROM of thumb: Extension, Flexion, Abduction, Adduction, Opposition, Reposition
- Evaluate Grip Strength bilaterally
- Evaluate ROM against resistance for strength bilaterally
- Specialty test
What are you going to palpate for the wrist exam?
Distal Radius, Distal Ulna, Carpal Bones, Anatomic Snuff Box
What is the AROM for the wrist?
Flexion = 80-90 Extension = 70 Abduction = 20-30 Abduction = 30-40
What is the Finkelstein Test?
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”
What is the Phalen’s Test?
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
What is the Tinel’s Wrist Test?
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.
What do you do for a scaphoid fracture?
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.
