Chapter 20 The Elbow Wrist and Hand Common

Chapter 20: The Elbow, Wrist, and Hand

Common Injuries § Contusions § Olecranon bursitis § Ulnar nerve contusion § Strains and sprains § Epicondylitis § Fractures § Volkmann’s contracture § Nerve injury § Dislocations and subluxations § Tendonitis Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 2

Common Injuries (cont. ) § Nerve impingement and carpal tunnel syndrome § Ganglion cyst

Special Tests § Certain tests can be performed that aid in the evaluation of

Varus/Valgus Stress Tests § The varus test (see text Figure 208) applies forces laterally at the elbow, medially at the wrist. The valgus test (see text Figure 20 -9) is exactly the opposite. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 5

Scaphoid Fracture Test § The anatomical snuff box is where pressure is exerted over the scaphoid bone. A pain response indicates the presence of a fracture. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 6

Gamekeeper’s Thumb Test § The first metacarpal is stabilized while thumb is passively abducted. Taping can keep the thumb from moving laterally. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 7

Collateral Ligament Test § The PIP joint is gently stressed in a varus direction, then the valgus direction. Pain and/or excessive laxity indicates injury. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 8

Finkelstein’s Test § This tests for de. Quervain’s tenosynovitis. With the thumb within a fist, move the wrist into ulnar deviation. Pain on the radial side is a positive sign. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 9

Tinel’s Sign § Tap a reflex hammer on the carpal tunnel. Tingling or shooting pain in the palm, thumb, index finger, and often the long finger indicates carpal tunnel syndrome. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 10

Phalan’s Test § Hold the position (see text Figure 20 -27) figure for 60 seconds or less. Tingling or shooting pain in the palm, thumb, index, and long fingers indicates carpal tunnel syndrome. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 11

Modified Phalan’s Test § Holding the position for 60 seconds produces tingling or shooting pain in the median nerve branches of the hand with carpal tunnel syndrome. (See text Figure 20 -28. ) Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 12

Elbow/Forearm Nerve Injuries § Injury to the three nerves of the elbow and forearm

Ulnar Nerve § Weakness of wrist flexion and ulnar deviation § Flexion loss of DIP joints of the little and ring fingers § Loss of flexion and extension of fingers § Inability to abduct or adduct fingers § Inability to adduct thumb Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 14

Median Nerve § Weakness with flexion and radial deviation § Loss of pronation § Loss of thumb opposition § Loss of flexion at MCP joints Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 15

Radial Nerve § Loss of wrist extension and supination § Loss of extension at MCP joints § Inability to extend abduct the thumb § Loss of triceps reflex § Weakness of elbow flexion § Ulnar and radial deviation Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 16