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Elbow, Wrist, & Hand

QuestionAnswer
The Ulnar Collateral Ligament consists of what 3 bands? Anterior, posterior, and transverse
Name of the ligament that wraps around the radial head Annular Ligament
Superficial location makes it extremely susceptible to injury (acute or chronic), direct blow Etiology of Olecranon Bursitis
Pain, swelling, point tenderness, swelling spontaneous w/out usual pain and heat S & S of Olecranon Bursitis
Excessive resistive motion (FOOSH), repeated microtears that cause chronic injury, rupture of distal biceps is most common muscle rupture in UE Etiology of Muscle Strains
Active or resistive motion produces pain; point tenderness in muscle, tendon, or myotendinous junction S & S of Muscle Strains
Valgus force from rep trauma, ulnar nerve inflamm, wrist flexor tendinitis, overuse flex/pro strain, ligamentous sprains, elbow flex contractures, increased instability Etiology of UCL Injuries
Pain along medial aspect of elbow, tenderness over MCL, associated parasthesia, pain w/ valgus rest at 20°, possible end point laxity S & S of UCL Injuries
Repetitive microtrauma to insertion of extensor muscles of lateral epicondyle, tendinosis with degeneration of tendon without inflamm Etiology of Lateral Epicondylitis (Tennis Elbow)
Aching pain in region of lateral epicondyle after activity, pain worsens and weakness in wrist & hand develop, elbow decreased ROM, pain with resistive wrist ext S & S of Lateral Epicondylitis (Tennis Elbow)
Repeated forceful wrist flex & extreme valgus torque of elbow; may involve pronation teres, flex carp rad/uln, & palm long tendons; can be associated with ulnar nerve neuropathy Etiology of Medial Epicondylitis (Golfer’s Elbow)
Pain produced w/ forceful flex or ext, point tenderness, mild swelling, active wrist mvmt elicited pain (passive rarely does) S & S of Medial Epicondylitis (Golfer’s Elbow)
Impairment of blood supply to ant surface = degen of art cartilage = loose bodies, rep microtrauma in elbow rot, ext, & valgus stress = compression of radial head shearing radiocapitellar jr, young athletes throwing motion Etiology of Elbow Osteochondritis Dissecans
Osteochrondrosis of capitellum due to localized avascular necrosis Panner’s Disease (children < 10 y.o.)
Sudden pn, locking, ROM usually returns in a few days, swelling, pn at radiohumeral jt, crepitus, decreased ROM, grating with pro/sup, x-ray May show flattening of crater of capitulum with loose bodies S & S of Elbow Osteochronditis Dissecans
Rep microtrauma that occurs from throwing, may result in numerous disorders of growth in pitching elbow Etiology of Little League Elbow
Onset is slow, slight flexion contracture including tight ant jt capsule & weakness in triceps, locking or catching sensation, decreased ROM of forearm pro/sup S & S of Little League Elbow
Pronounced cubical valgus may cause deep friction problem, ulnar nerve dislocation, traction injury from valgus force, irregularities with tunnel, subluxation of ulnar nerve due to lax impingement, and progressive compression of lig of nerve Etiology of Cubital Tunnel Syndrome
Medial on which may be referred prox or dist, tenderness in cubital tunnel on palpation or hyperflexion, intermittent paresthesia in 4th & 5th fingers S & S of Cubital Tunnel Syndrome
FOOSH or sever twist while flexed, bones can be displaced bwd, fwd, or laterally, distinguishable from fx bc med & lat epicondyles are normally lined with humeral shaft Etiology of Elbow Dislocation
Swelling, severe pain, disability, complications with med/rad nerves & blood vessels, often rad head fx involved S & S of Elbow Dislocation
Fall on flexed elbow, direct blow, fx can occur in one or more bones, FOOSH = fx above or b/n humeral condyles (may result in Gunstock Deformity), direct blow to Olecranon or radial head Etiology of Elbow Fractures
May not result in visual deformity, hemorrhaging, swelling, and muscle spasm S & S of Elbow Fractures
Normal carrying angles for males & females: Male - 5-10°; female - 10-15°
Inhibited circulation to forearm, may be a loss of motor & sensory func (median nerve), irreversible damage occurs after 4-6 hrs, edema further impairs circulation propagating muscle necrosis Etiology of Volkmann’s Contracture
Pain in forearm increased with passive ext of fingers, pain followed by cessation if brachial & radial pulses, coldness I’m forearm, decreased motion S & S of Volkmann’s Contracture
Entrapment of median nerve, may become trapped due to edema or muscle hypertrophy; sensory deficits - pins & needles, numbness (digits 1-4), motor deficits - loss of flex & opposition and weakness w/ pronation, Symptoms with tight gripping & resisted pron Pronator Teres Syndrome
What nerve innervates the wrist flexors Median Nerve
What nerve innervates the wrist extensors Radial Nerve
What arteries supply the forearm Radial and Ulnar Arteries (superficial & deep palmar arches)
Ulnar side receives majority of blow due to arm blocks, acute or chronic, result of direct contact/blow; pain, swelling, hematoma Contusion of the Forearm
Forearm strain (most from severe static contraction); dull ache b/n extensors, which cross post aspect of forearm, weakness with contraction, point tenderness in interosseous membrane Forearm Splints
Occurs in lower end of rad/uln, FOOSH and rad/uln hyperextension; fwd displacement of radius causing dinner fork deformity, extensive bleeding/swelling, tendons may be torn/avulsed, may be median nerve damage (also Smith & Barton Fx) Colle’s Fracture
Developmental deformity of wrist, carpals become wedged b/n rad/uln following epiphyseal plate changes, common in females; bowing rad/uln, wrist pain & loss of forearm rot, palmar subluxation Madelung Deformity
Names the Carpal Joints Hamate (hook), pisiform, triquetral, lunate, trapezoid, trapezium, capitate, scaphoid
Most common wrist injury, abnormal forced mvmt, hyperextended wrist, violent flex/torsion, multiple may disrupt blood supply; pain, swelling, difficulty with mvmt Wrist Sprains
Violent twist or torque of wrist, often associated w/ UCL sprain; pn along ulnar side, difficulty w/ ext, possible clicking, swelling possible, athlete may not report injury immediately Triangular Fibrocartilage Complex (TFCC) Injury
Repetitive wrist accel/deccel, overuse of tendons & sheath; pn with use & passive stretching, tenderness & swelling over tendon Tenosynovitis
Primary cause - overuse of wrist, rep pulling mvmts of flex carpi radialis & ulnaris, rep pressure on palms (cycling); pn w/ use or passive stretching, isometric resistance to involved tendon causes pn, weakness, or both Tendonitis
Damage to Ulnar Nerve causes which hand deformity Benediction or Bishop’s Hand (peace sign w/ thumb)
Damage to both Ulnar & median nerves causes which hand deformity Claw Hand
Palsy of the radial nerve causes paralysis of extensor muscles resulting in which hand deformity Drop Wrist Deformity
Palsy of the median nerve causes the thumb to be pulled back in line with other fingers resulting in which hand deformity Ape Hand
Compression of median nerve due to inflammation of tendons & sheath, result of rep wrist flex or direct trauma to ant aspect of wrist; sensory and motor deficits, weakness in thumb Carpal Tunnel Syndrome
Stenosing tenosynovitis in thumb (ext poll brev & ABD poll long), constant wrist mvmt can irritate; aching pn that may radiate into hand/forearm, point tenderness & weakness during thumb ext & ABD, painful catching/snapping Dequervain’s Disease
Forceful hyperextension or FOOSH; difficulty w/ wrist & finger flex, pn, swelling, numbness/paralysis of flexor muscles due to pressure on median nerve Dislocation of Lunate Bone
Loss of blood supply to lunate resulting in osteonecrosis; pn, swelling, decreased ROM/grip strength, tenderness over bone Keinbock’s Disease
Foosh, compression b/n radius & second row of carpals, often fails to heal due to poor blood supply; swelling, severe pn in anatomical snuff box, presents like wrist sprain, pn with radial flex Scaphoid Fracture
Result of a fall or contact while holding something; wrist pn, weakness, point tenderness, pull of muscular attachment can cause nonunion Hamate Fracture
Synovial cyst, generally appears following wrist strain; appears on back of wrist, occasional pn w/ lump, pn increases with use, may feel soft, rubbery, or very hard Wrist Ganglion
Rep motion of fingers producing tenosynovitis, inflamm of tendon sheath, thickening of sheath forms a nodule that does not slide easily; resistance to re-extension, palpable snapping that is painful, palpation produces pn Trigger Finger or Thumb
Caused by blow to tip of finger avulsing extensor tendon from insertion, referred to as baseball or basketball finger; pn at DIP, x-ray shows avulsed bone on dorsal prox DP, unable to extend distal end of finger, point tenderness Extensor Avulsion (Mallet Finger)
Rupture of extensor expansion dorsal to middle phalanx, tendon slides below axis of PIP forcing DIP into ext & PIP into flex; severe pn, obvious deformity, and inability to extend DIP, swelling, point tenderness Boutonniere Deformity
Rupture of flex digitorum profundus tendon from dist phalanx, often occurs with ring finger; DIP cannot be flexed, finger remains extended, pain/point tenderness over distal phalanx Flexor Digitorum Profundus Rupture (Jersey Finger)
Nodules develop in palmar apneurosis, limiting finger ext, ultimately causes flexion deformity; often develops in 4th and 5th finger Dupuytren’s Contracture
Sprain of UCL of MCP joint of thumb, mechanism is forceful ABD of prox phalanx, occasionally combined with hyperextension; pn over UCL & weak and painful pinch Gamekeeper’s Thumb
Can include collateral lig, color plate, extensor expansion tears, occurs with axial load or valgus/varus stresses; pn, swelling, point tenderness, instability, valgus & varus tests may be positive Sprains of Interphalangeal Joints
Distal tear of volar plate may cause this (proximal tear may cause pseudoboutonniere deformity); pn & swelling w/ varying degrees of hyperextension, tenderness over volar plate of PIP, passive hyperextension Swan Neck Deformity
Direct axial/compressive force, fractures of 5th metacarpal (Boxer’s Fracture); pn, swelling, possible angular or rotational deformity Metacarpal Fracture
Occurs at Carpometacarpal joint of thumb from axial/ABD force to thumb; CMC may appear to be deformed (x-ray confirmed), patient complains of pn, swelling over base of thumb Bennett’s Fracture
Created by: natamccl