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Diff Dx > Elbow/Forearm 1 > Flashcards

Elbow/Forearm 1 Flashcards

1
Q

What kind of stress of the elbow predominates with athletes?

A

valgus stress

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2
Q

overuse of the elbow (pronation/supination)

A

muscle strain, trigger points, or peripheral nerve entrapment

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3
Q

overuse of the elbow (cocking or medial stretch)

A

consider medial collateral ligament sprain, flexor muscle strain, ulnar nerve stretch irritation

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4
Q

when do you refer out for an elbow problem?

A

fracture/dislocation
infection, unresolving butsitis, gout
inflammatory joint disease
soft tissue and articular disorders if unresponsive

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5
Q

if there is a history of hyperextension due to FOOSH injury or a direct blow to antecubital fossa, what should you always consider?

A

supracondylar fracture in child

radial head fracture in adult

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6
Q

if there is a sudden valgus force of the elbow, what do you consider?

A

potential avulsion of the medial epicondyle
medial collateral ligament sprain
capitulum fracture

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7
Q

direct fall onto the tip of the elbow with elbow flexed may result in?

A

olecranon fracture or olecranon bursitis

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8
Q

nursemaid’s elbow

A

sudden traction on the forearm of a young child that can result in radial head entrapment

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9
Q

medial epicondylitis

A

repetitve flexion and medial elbow pain

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10
Q

lateral epicondylitis

A

repetitive extension associated with lateral elbow pain

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11
Q

weakenss at the elbow without associated pain is a possibility of?

A

biceps tendon rupture

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12
Q

instability is a consequency of?

A

past fracture, dislocation or sudden valgus force

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13
Q

restricted passive flexion or extension coupled with trauma is suggestive of?

A

joint effusion or fracture

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14
Q

nontraumatic restriction to passive extension suggest what?

A

tight biceps or anterior capsule, history of overuse is usual

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15
Q

nontraumatic restriction to passive flexion suggests?

A

tight triceps or posterior capsule adhesion

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16
Q

locking/creptius in young patients

A

suggestive of osteochrondritis desiccans

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17
Q

locking/crepitus in older patients

A

degenerative changes

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18
Q

swelling at the elbow is suggestive of?

A

gouty tophi
rheumatoid nodules/arthritis
olecranon bursitis

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19
Q

Mill’s test

A

passive wrist flexion with elbow extended

for lateral epicondylitis

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20
Q

reverse Mill’s

A

passive wrist extension with elbow extended

medial epicondylitis

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21
Q

Cozen’s test

A

resisted wrist extension (with elbow flexed and extended)

increases lateral epicondylitis pain

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22
Q

tinel’s test

A

ulnar nerve irritation

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23
Q

lateral epicondylitis

A

lateral pain on resisted wrist extension &/or passive flexion of wrist with elbow extended/forearm pronated &/or resisted finger extension

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24
Q

medial epicondylitis

A

medial pain on resisted wrist flexion with elbow extended &/or passive wrist extension with the elbow extended/fore arm supinated &/or reissted finger flexion

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25
Q

lateral elbow pain worsened by? What is the name for this?

A

resisted wrist extension and gripping

tennis elbow

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26
Q

motions that cause tennis elbow

A 
repetitive motion (computer keyboardists, carpenters, golfers, meat cutters, etc)
cause forceful wrist extension, radial deviation and supination
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27
Q

what muscles are mainly involved in tennis elbow?

A

extenor carpi radialis brevis*
extensor digitorum communis
extensor carpi radialis longus

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28
Q

how will someone with lateral elbow pain present?

A

cozen’s, mill’s will be positive
pain on resisted wrist extension or 3rd finger extension with extended elbow causes pain
lifting a chair with pronated hand
pain, often sharp, in the lateral elbow occurs upon extension of the wrist or supination of the forearm
may cause inability to lift or hold objects

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29
Q

medial epicondylitis has pain following what?

A

repetitive activity

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30
Q

inciting activity for medial epicondylitis?

A

wrist flexion and pronation

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31
Q

what are the other names for medial epicondylitis?

A

golfer’s elbow

little leaguer’s elbow

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32
Q

what muscle tendons are involved in meidal epicondylitis?

A

wrist flexors

pronators

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33
Q

what motion reproduces pain for medial epicondylitis?

A

resisted wrist flexion

pronation and grasping

34
Q

what test exacerbates medial epicondylitis?

A

mill’s

35
Q

monteggia fracture

A

ulnar shaft fracture with associated proxial dislocated radius

36
Q

galeazzi fx

A

fracture distal radius and dislocated distal radial ulnar articulation

37
Q

greenstick/torus

A

incomplete fracture

38
Q

colles fx

A

distal radial fracture with dorsal and radial angulation

39
Q

smith’s fx

A

distal radial fracture with volar/palmar angulation

40
Q

how do wrist complaints usually occur?

A

direct trauma, falls, over use, arthritic conditions

41
Q

when do we send someone out for a wrist complaint?

A 
fracture
dislocation
disassociation
AVN
soft tissue/articular disorders that don't resolve in 2-3 months
42
Q

most common carpal fracutred

A

scaphoid fracture at the waist

43
Q

how is the scaphoid usually fractured?

A

FOOSH injury

44
Q

what is teh most common site for an occult fracture?

A

scaphoid

45
Q

where is the pain in a scaphoid fracutre?

A

in the anatomic snuffbox after a FOOSH injury

46
Q

AVN of the lunate

A

Kienbock’s disease

47
Q

history and clinical presentation of kienbock’s

A

stiff and painful wrist
often no history of trauma
repetitive minor truama is supected as a commin initiator

48
Q

how might someone acquire a scapholunate disassociation?

A

radial or dorsal wrist pain following FOOSH

49
Q

what is the sign associated with scapholunate disassociation?

A

terry thomas sign

or david etterman’s sign

50
Q

signet ring sign

A

rotatory subluxation of the scaphoid with scapholunate instability

51
Q

dequervain’s tenosynovitis

A

presents as radial wrist pain
forceful gripping with ulnar deviation or repetitive use of the thum
stenosis tenosynovitits of abductor ppollicis longus and extensor pollicis brevis resulting from chronic microtrauma

52
Q

what test is positie with dequervain’s tenosynovitis

A

resisted thumb extension with wrist in radial deiation

finkelstein’s

53
Q

patient presents with forearm pain with hand and wrist numbness/tingling and weakness. what should you look for?

A

dequarvain tenosynovitis

54
Q

if median nerve is involved, what should you look for?

A

CTS, pronator syndrome

55
Q

if ulnar nerve is inolved, what should you look for?

A

cubital tunnel syndrome, tunnel of guyon

56
Q

if radial nerve is involved, what should you look for?

A

radial tunnel syndrome

57
Q

what is the most common nerve entrapment syndrome?

A

carpal tunnel

58
Q

what will patient complain of if they have carpal tunnel?

A

numbness/tingling in palmar surface of thumb and radial 2 1/2 fingers

59
Q

when would someone have median nerve involvement?

A

direct external pressure on the tunnel or history of prolonged full flexion or extension

60
Q

most common cause of “nonspecific flexor tenosynovitis”

A

repetitive motion*

swelling in carpal tunnel

61
Q

compression of the median nerve can be compressed by?

A

wrist flexor retinaculum

62
Q

what test should you do for wrist complaints?

A 
tinel sign
phalan's test
reversed phalan's
pressure provocative test
electrodiagnostic studies
flick sign****
63
Q

what might someone with pronator syndrome complain of?

A

volar forearm pain, usually no history of trauma

64
Q

what history might someone with pronator syndrome have?

A

repetitive pronation and wrist flexion such as incurred by carpenters, assembly-line workers and weightlifters

65
Q

how do you provoke the pain of someone with pronator syndrome

A

resisted pronoation with elbow extended and wrist flexed (from hypertrophy)
resisted middle finger flexion (compression at flrxor digitorum superficialis

66
Q

where can the median nerve be compromised?

A

at the wrist, or at the level of the pronator teres

67
Q

most common entrapment sites for median nerve

A

between two heads of pronator teres and arch of flexor digitorum superficialis

68
Q

ulnar nerve/cubital tunnel syndrome

A

complaint of medial forearm pain and paresthesia into the ring and little finger
throwing history

69
Q

where does the ulnar nerve usually get compressed/stretched?

A

elbow(cubital tunnel or ulnar groove)

70
Q

how are symptoms reproduced with cubital tunnel syndrome

A

passive or reissted elbow flexion with the elbow in a maximally flexed pposition

71
Q

tunnel of guyon

A

complaint of numbness/tingling or pain in the 4th or 5th digits

72
Q

what is the tunnel of guyon?

A

osseofibrous tunnel formed by a groove between the pisiform and hook of the hamate

73
Q

handlebar palsy

A

chronic compression at the tunnel of guyon

74
Q

provocative tests for tunnel of guyon?

A

tinel’s or presser at the pisiform hamate area

75
Q

radial tunnel syndrome

A

complaint of dull aching pain over the lateral forearm
compression of the radial nerve
tenderness is distal to the lateral epicondyle
provocative measures are based on the site of entrapment

76
Q

finger and thumb complaints are usually due to?

A

trauma

77
Q

what are non traumatic conditions that cause finger and thumb complaints?

A

arthridities, CT disease, vascular problems (raynaud’s, relfex sympathetic dystrophy)

78
Q

hand fracture examples

A 
mallet finger
metacarpal fracutre
volar plate fracture
gamekeeper's thumb
bennett's fracture
rolanto's
79
Q

baseball/mallet finger

A

avulsion of the extensor tendon at its insertion on the dorsal surface of the base of the distal phalynx
results from a blow to the end of the finger causing a hyperflexion to a forcibly extended finger
may have partial or complete tendon tear or bony avulsion

80
Q

bennett’s fracutre

A

oblique intra-articular fx at the base of the thumb with radial deviation fo the distal fragment

81
Q

rolando’s fracutre

A

intraarticular comminuted fracture at the base of the 1st metacarpal with radial displacement

Diff Dx (17 decks)

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