Msk System Injuries Of The Elbow, Wrist And Hand Alasky

Front 1

Elbow, wrist, hand exam

Back 1

Think location of pain

Ant., Post., medial or lateral

ROM

Front 2

Medial Epicondylitis

(Golfer's Elbow)

Back 2

Aching pain in flexor-pronator musculature at medial epicondyle

Results from repetitive wrist flexion and forearm pronation

Tenderness just distal to medial epicondyle

Weak grip strength

Symptoms exacerbated with resisted wrist flexion and pronation

Medial epicondylitis test

Front 3

Ulnar collateral ligament injuries

Back 3

Most commonly injured ligamentous structure in the thrower's elbow

Repetitive stress on ulnar collateral ligament that results in microtears or complete rupture

Front 4

Ulnar collateral ligament injury presentation

Back 4

Swelling, pain and tenderness 2 cm distal to medial epicondyle

Pain with valgus stress testing and milking maneuver (always compare bilaterally)

Front 5

Lateral Epicondylitis

(Tennis Elbow)

Back 5

Overuse injury

Seen in racket sports, age greater than 40, dominant arm, poor technique, pain gets better with rest

Repetitive contraction of wrist extensors leads to extensor tendon degeneration

Tenderness just distal to lateral epicondyle

Pain with resisted wrist and long finger extension

Front 6

Radial tunnel Syndrome

Back 6

Deep ache distal to lateral elbow that is worse at night and after throwing and pronation-supination movements

Often confused with tennis elbow

No sensory loss

Compression occurs in radial tunnel at elbow

Pain w/resisted pronation/supination and long finger extension

Front 7

Scaphoid Fracture

Back 7

Common in many sports injuries (FOOSH injury)

Radial sided wrist pain after fall on outstretched hand

Front 8

FOOSH injury

Back 8

Fall On OutStretched Hand

Front 9

Scaphoid Fx Dx

Back 9

Palpation of anatomic snuffbox

Scaphoid compression test

Front 10

Scaphoid Fx Tx

Back 10

Short-arm thumb spica slint acutely, then short-arm thumb spica cast 6-12 wks

Front 11

Elbow, wrist, hand exam

Back 11

Think location of pain

Ant., Post., medial or lateral

ROM

Front 12

Medial Epicondylitis

(Golfer's Elbow)

Back 12

Aching pain in flexor-pronator musculature at medial epicondyle

Results from repetitive wrist flexion and forearm pronation

Tenderness just distal to medial epicondyle

Weak grip strength

Symptoms exacerbated with resisted wrist flexion and pronation

Medial epicondylitis test

Front 13

Ulnar collateral ligament injuries

Back 13

Most commonly injured ligamentous structure in the thrower's elbow

Repetitive stress on ulnar collateral ligament that results in microtears or complete rupture

Front 14

Ulnar collateral ligament injury presentation

Back 14

Swelling, pain and tenderness 2 cm distal to medial epicondyle

Pain with valgus stress testing and milking maneuver (always compare bilaterally)

Front 15

Lateral Epicondylitis

(Tennis Elbow)

Back 15

Overuse injury

Seen in racket sports, age greater than 40, dominant arm, poor technique, pain gets better with rest

Repetitive contraction of wrist extensors leads to extensor tendon degeneration

Tenderness just distal to lateral epicondyle

Pain with resisted wrist and long finger extension

Front 16

Radial tunnel Syndrome

Back 16

Deep ache distal to lateral elbow that is worse at night and after throwing and pronation-supination movements

Often confused with tennis elbow

No sensory loss

Compression occurs in radial tunnel at elbow

Pain w/resisted pronation/supination and long finger extension

Front 17

Scaphoid Fracture

Back 17

Common in many sports injuries (FOOSH injury)

Radial sided wrist pain after fall on outstretched hand

Front 18

FOOSH injury

Back 18

Fall On OutStretched Hand

Front 19

Scaphoid Fx Dx

Back 19

Palpation of anatomic snuffbox

Scaphoid compression test

Front 20

Scaphoid Fx Tx

Back 20

Short-arm thumb spica slint acutely, then short-arm thumb spica cast 6-12 wks

Front 21

Dequervain's Tenosynovitis

Back 21

Most common tendinopathy of the wrist in athletes (golf, fly-fishing, raquetball)

Caused by repetitive ulnar deviation

Front 22

Dequervain's Tenosynovitis Presentation

Back 22

Pts have pain over thumbside of wrist and can travel up forearm

Tendonitis of the extensor pollicis brevis and abductor pollicis longus

Front 23

Dequervain's Tx

Back 23

NSAIDs, Rest, PT and injections

Front 24

Triangular Fibrocartilage Complex (TFCC) Injuries

Back 24

Presents with ulnar sided wrist pain, swelling, and clicking worse with forearm pronation or supination

Injuries can be traumatic or degenerative tears

Result from fall on outstretched hand

Chronic injuries present with recurring pain from activities that require vigorous wrist motion or loading (push-ups, golf, tennis, cycling)

Front 25

Triangular Fibrocartilage Complex (TFCC) Injuries

Back 25

Tenderness over medial snuffbox (which is palmar to extensor carpi ulnaris tendon and distal to ulna)

Front 26

TFCC Tx

Back 26

Depends on stability of wrist, acute or chronic, PT, injections, surgery

Front 27

Extensor Carpi Ulnaris Tendonopathy

Back 27

2nd most common site of tenosynovitis after De Quervain's

Overuse injury from repeptitive wrist motion

Forced supination, flexion and ulnar deviation of wrist (swinging a bat)

May be result of underlying TFCC injury

Front 28

Extensor Carpi Ulnaris Tendonopathy Presentation

Back 28

Pts complain of swelling, tenderness of tendon distal to ulnar head

Symptoms reproduced w/resistance to wrist extension

Tx: rest, PT, NSAIDs, Injections

Front 29

Gamekeeper's Thumb (skiers thumb)

Back 29

Ulnar collateral lig failure

results from sudden valgus force to the thumb

Seen after fall on thumb or impact w/a ball

Present w/painful impaired grip and MCP joint swelling

Painful, swollen, ecchymotic thumb MCP joint

Front 30

Stener Lesion

Back 30

Adductor pollicis tendon interposed between torn ligament and it's insertion on phalanx, don't stress if think Stener

Tx: Sprain is thumb spica cast 4-6 wks, Stener is Sx

Front 31

Extensor hood rupture

Back 31

Forced PIP flexion against active extension and volar dislocations

Loss of full active PIP extension

Results in boutonneire deformity w/PIP flexion and DIP hyper extension

Front 32

Extensor Hood rupture Tx

Back 32

Splint in full extension PIPJ w/DIPJ allowed to flex for 6 wks

Front 33

Volar Plate Injury

Back 33

Injury secondary to hyperextension of PIP joint disrupting the volar plate (under PIP)

Swan neck

Front 34

Volar Plate Injury Tx

Back 34

Dorsal splint 20-30 degrees PIP flexion

Buddy tape 4-6 wks

Front 35

Mallet Finger

Back 35

Due to sudden forced flexion of the DIP joint during active extension

Pts have pain and swelling over dorsal aspect of joint

Avulsion of extensor tendon from its insertion on distal phalanx

Front 36

Mallet finger test

Back 36

Stabilize MCP and PIP, have Pt extend DIP

Front 37

Mallet finger tx

Back 37

Bony origin - DIP in full extension for 4 wks

Tendon origin - DIP in full extension for 6-8 wks

Protect for additional 6 wks w/dynamic tape splint during sports

Front 38

Jersey Finger

Back 38

Seen when player attempts to grab jersey for tackle

Caused by forced passive extension of DIP joint during active flexion

Front 39

Jersey Finger presentation

Back 39

Pain and ecchymosis at DIP joint or palm at level of retracted tendon

Loss of active DIP flexion is most specific finding

Isolate DIP have Pt flex it. DIP joint loss of flexion indicates tendon avulsion

Front 40

Jersey Finger Tx

Back 40

Sx referral ASAP