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Elbow/Wrist

Orthopedic Tests

QuestionAnswer
Elbow ROM Flextion 140-150, Extension 0-10, Valgus 1-15, Pronation 85-90, Supination 85-90
Gunstock elbow Deformity of elbow, resulting from condylar fracture at elbow (forearm deviates toward midline when extended)
Carrying angle aka cubitus valgus (the expected carrying angle in adults is between 0-15deg)
Busal sac fluid filling from trauma or secondarily from RA or gout
Cozen's test Resisted, seated -resist wrist extension +pain=lateral epicondylitis (attachment of ext.carpi radialis brevis, ext. digitorum, ext. digiti minimi, ext. carpi ulnaris)
Mill's test passive, seated -pronate and flex the wrist fully and extend the elbow +pain=lateral epicondylitis (stretches muscle attachment and stress on radial nerve)
Golfer's elbow test (reverse Cozen's test) resisted, seated -resist wrist flexion +pain=medial epicondylitis (attachment of flexor carpi radialis/ulnaris)
Reverse Mill's test passive, seated -extend the wrist +pain=medial epicondylitis (stretches muscle atttachment and stresses median nerve)
Ligament instability (Medial collateral Ligament test aka valgus/abduction stress test) passive, seated -abduct forearm +pain=MCL instability/injury
Ligament instability (Lateral collateral ligament test aka varus/adduction stress test passive, seated -adduct forearm +pain=LCL instability/injury
Cubital tunnel syndrome ulnar nerve compression of elbow(numbness/tingling of ring/little finger)
Tinel's sign passive, seated -tap ulnar nerve between olecranon process and medial epicondyle +parathesia=ulnar nerve impingement
Elbow flexion test active, seated -flex the elbow +parathesia=ulnar nerve impingement
Radial head/neck fracture fall on outstretched hand, immediate pain
Wrist ROM Extension=70-90, Flexion=80-90, Abduction=15, Adduction=30-45
Radicular pain (nerve entrapment) Cubital tunnel syndrome, Ulnar tunnel syndrome (Guyon's canal), Carpal tunnel syndrome, Anterior interosseous nerve syndrome
Anterior interosseous nerve syndrome -pain in proximal forearm and weakness of FPL and FDP to the index finger (entrap by the pronator teres muscle)
Pinch grip test active, seated -pinch tips of index and thumb +pulps of index and thumb touch=injury to anterior interosseous nerve, median nerve
Ulnar Tunnel Syndrome Clawing of he ring finger and hypothenar wasting.
Carpal tunnel syndrome median nerve compression at wrist (repetitive use) F>M
Tinel's sign passive, seated -tap palmar surface of wrist +tingling at 1,2,3, lateral half of 4th fingers)=CTS
Phalen's test active seated -flex the wrists and place them together for 60secs (median n compressed by flex. ret) +tingling in the hand (1-4 fingers =CTS, anterior dislocation of lunate,arthritic changes, inflammation of flex. retinaculum, tenosynovitis of FD tendons)
Reverse Phalen's test active seated -extend wrists and place palms together (inc. pressure of carpal tunnel) +tingling in the hand (1-4 fingers =CTS, anterior dislocation of lunate,arthritic changes, inflammation of flexor retinaculum, tenosynovitis of FD tendons)
Pinch test active seated -pinch piece of paper w/ thumb, index, and niddle fingers and try to pull it away +numbness/cramping of 1-4 fingers/palm in 1 min, +inability to pinch paper=refer for MRI elctromyography
Electromyograpy Diagnose dz that damage muscle tissue, nerves or nm junctions (ie. disc herniation, ALS, myasthenia gravis)
Nerve conduction test Detect and evaluate damage to PNS to help diagnose nerve d/o (ie CTS, Guillain Barre Syndrome)
Finkelstein's test active/passive, seated -bring the thumb in palm, make fist, then ulnar deviate +pain=tenosynovitis of abductor pollicis longus and extensor pollicis brevis tendons (de Quervain's dz)
Ganglion cyst Encapsulated fluid-filled mass, (joint capsule, tendon sheath), painless
Scaphoid fracture fall onto outstretched hand, high rate of non-union, snuff box tenderness
Distal radius fracture common, osteoporotic fracture (DEXA scans esp postmenopausal women)
Colle's fracture complete transverse fracture w/in distal 2cm radius -distal fragment is displaced dorsally
Scapholunate ligament injury fall on outstretched hand “wrist sprain”, pain medial to snuffbox, diagnosed w/ supinated x-ray
Created by: phdinh33