Exam 3 Upper Extremity, Elbow Wrist And Hand

Front 1

get and understanding of and always consider the anatomy that is more ... in order to treat the distal areas

Back 1

proximal

Front 2

axillary artery turns into ... artery and divides into ... artery (feeds deep palmer arch) and ... artery (feeds superficial palmar arch)
-

Back 2

brachial
radial
ulnar

Front 3

-posterior cord gives ... nerve
-medial and lateral give ... nerve
-medial cord gives ... nerve

Back 3

radial
median
ulnar

Front 4

the elbow joint: ulnohumeral
-angle of ... determines the carrying angle.
-any shift of ulna will significantly impact elbow function

Back 4

trochlea

Front 5

what is this?
-ulna abduction
-increased carrying angle

Back 5

cubitus valgus

Front 6

what is this?
-ulna adduction
-decreased carrying angle

Back 6

cubitus varus

Front 7

with abducted ulna, wrist/hand is (abducted or adducted)

and vice versa

Back 7

adducted

Front 8

radioulnar joint:
-head of radius rotates around the ulna allowing for pronation and supination.
-... is important for stabilizing proximal radioulnar joint and stabilizing radius on humerus

Back 8

annular ligament

Front 9

radial head "moves" ... in extension, and ... with flexion of the elbow

Back 9

anteriorly
posteriorly

Front 10

reciprocal motion of radius:
-radial head moves ... with pronation
-radial head moves ... with supination

Back 10

posteriorly
anteriorly

Front 11

pronation/supination involves what 2 joints?

Back 11

superior radio-ulnar joint
inferior radio-ulnar joint

Front 12

Traumatic mechanisms for somatic dysfunction:
-if you fall on a pronated arm, you jam the ... radial head (... distal end)
-if you fall on a supinated arm, you jam the ... radial head (... distal end)

Back 12

posterior (anterior distal end)
anterior (posterior distal end)

Front 13

what is this?
-radial head dislocation
-age 1-4yo typically
-axial traction injury or fall
-radial head slips under annular ligament
-child refuses to use arm
-neurovascularly intact
-anxiety > pain

Back 13

nursemaid's elbow

Front 14

treatment for nursemaid's elbow:
-hold in pronation or supination with extension, then ... and ... forearm

Back 14

supinate
flex

Front 15

interosseous membrane anatomy:
-anterior fibers run obliquely ... and ...
-posterior fibers run ... and ...
-fibers bind ... and ... together
-gives stability to ... radius

Back 15

distally and medially
proximally and laterally
radius and ulna
distal

Front 16

interosseous membrane forces:
-force is shifted from one bone to the other so that ... bones are impacted
-injury to one bone will involved the other in some way

Back 16

both

Front 17

interosseous membrane motion:
-... motion
-allows the 2 bones to move respectively to each other

Back 17

parallelogram

Front 18

what kind of fracture is this?
-radial shaft fracture with associated dislocation of distal radioulnar joint
-dislocation is at wrist

Back 18

Galeazzi fracture

Front 19

what kind of fracture is this?
-ulnar fracture with dislocation of proximal radioulnar joint
-dislocation is at elbow (radius)

Back 19

Monteggia fracture

Front 20

what is the pneumonic to remember the above 2 fractures?

Back 20

MUGR
Monteggia - fractured Ulna
Galeazzi - fractured Radius

Front 21

which median nerve syndrome is this?
-pain in hand
-compression of median nerve

Back 21

carpal tunnel syndrome

Front 22

which syndrome?
-pain on volar surface of forearm after prolonged pronation
-median nerve is compressed between pronator teres heads

Back 22

pronator syndrome

Front 23

which syndrome?
-branch given off in pronator teres mm.
-weakness of index finger flexion

Back 23

anterior interosseous N palsy

Front 24

radial nerve: C5-T1
-continuation of the ... cord of brachial plexus
-innervates ... then travels along ... of humerus
-... of hand
-sensation to ... surface of hand

Back 24

posterior
triceps, spiral groove
extensors
dorsal

Front 25

radial nerve:
-dives into ... muscle through fascia before supplying wrist/finger extensors
-compression common at ... edge of the above muscle
-posterior interosseous nerve (deep branch of radial nerve) enters extensor compartment
-deficit depends on area injured
-can have muscular weakness without sensory loss due to the superficial and deep branches of the radial nerve

Back 25

supinator
proximal

Front 26

ulnar nerve - cubital tunnel syndrome:
-numbness and pain to ... (medial or lateral) hand
-may progress to ...
-causes: frequent bending of elbow, constant direct pressure on elbow, direct blow to cubital tunnel, compression by muscle spasm

Back 26

medial
claw hand

Front 27

lateral epicondylitis "tennis elbow" effects the ... group

Back 27

extensor

Front 28

medial epicondylitis "golfer's elbow" effects ... group

Back 28

flexor

Front 29

what is this?
-inflammation of bursa overlying olecranon process.
-caused by cumulative trauma, or isolated contusion
-may be nontender chronic edema
-may be infectious or associated with systemic inflammatory process: rheumatoid arthritis, gout

Back 29

olecranon bursitis

Front 30

elbow somatic dysfunction will limit ... motion

-increased carrying angle (abducted ulna) will limit wrist ...
-and vice versa

Back 30

wrist

abduction

Front 31

treatment for hand pain is to address bony and ligamentous integrity and ... alignment
-consider extrinsic causes: neck/shoulder/elbow/wrist

Back 31

fascial

Front 32

these can lead to referred pain to ...
-elbow ligamentous injury
-ligamentous instability at cervical spine
-trigger points from forearm muscles
-visceral pain from cardiac ischemia

Back 32

hand

Front 33

when you press on a point, and it has radiating pain and generally does not go away easily, it is called a ...

Back 33

trigger point

Front 34

carpel tunnel syndrome:
-symptoms begin with paresthesia or pain
-can progress to weakness and muscle atrophy
-may be associated with metabolic disorders: hypothyroidism
-most cases are idiopathic
-... damage will occur with long standing stress to area
-women are 3 times more likely to suffer from this than men

Back 34

nerve

Front 35

what are these?
-OMT
-NSAIDS
-steroid injections
-splinting wrist
-surgery to open flexor retinaculum
-must consider fascial restriction (treat fibers of flexor retinaculum also)

Back 35

treatments for Carpel tunnel syndrome

Front 36

tests for carpel tunnel Sd:
-...: positive test if results in numbness over median n. distribution
-...(Tapp directly over median nerve

Back 36

Phalen's maneuver
Tinel sign

Front 37

what is this?
-pain, tenderness, edema over lateral wrist, difficulty gripping
-idiopathic, possibly "overuse injury", OMM can help to relieve
-tendons of abductor pollicis longus and extensor pollicis brevis mm.
-chronic degenerative or inflammatory process involving synovial sheath

Back 37

De Quervain's Tenosynovitis

Front 38

to test for Tenosynovitis, you use what test and what do you do?

Back 38

Finkelstein test
wrap thumb in other 4 fingers, extend arm, and adduct wrist

Front 39

Ligaments of fingers:
-... or ... may be treated with OMT

Back 39

dislocation
subluxation

Front 40

boutonniere deformity:
-extension at ...
-flexion at ...

Back 40

DIP
PIP

Front 41

swan neck deformity:
-flexion at ...
-extension at ...

Back 41

DIP
PIP

Front 42

what is this?
-median/ulnar nn. damage
-weakness of intrinsic mm of hand
-extrinsic mm (long extensor mm and long flexor mm) still active
-MCP extension
-PIP/DIP flexion

Back 42

claw hand

Front 43

what is this?
-flexion contracture involving palmar fascia
-gradual thikening of fibrous layer under skin
-can be hereditary
-also associated with smoking/EtOH abuse, DM, thyroid ds

Back 43

Dupuytren's Contracture

Front 44

what is this?
-radial neuropathy caused by chronic lead poisoning is associated with other physical findings
-caused by compression, ischemia, arm fracture
-proximity to humerus wrapping around bone at spiral groove
-4th most common mononeuropathy

Back 44

wrist drop

Front 45

if you have an increased carrying angle, you have ulna ... with ... glide and compression on the ... side

wrist/hand will be ... and restricted to ...

Back 45

abduction
medial
lateral

adducted
abduction

Front 46

if you have decreased carrying angle, you will have ulnar ... with ... glide

distal ulna moves ...

Back 46

adduction
lateral
medially