Upper Evaluation - Exam 3

In order, the 1st, 2nd and 3rd metacarpals articulate with which carpals?

Answer: 1st MC with trapezium 2nd with trapezoid 3rd with capitate

An articular fracture-dislocation to the proximal end of the first metacarpal is called a(n): a. Bennet fracture b. Galeazzi Fracture c. Bowler's fracture d. Monteggia fracture

Answer: A, Bennet Fracture

After an elbow hyperextension injury, palpable anterior joint pain, particularly on the anteromedial side, is more commonly attributed to this injury: a. anterior capsulitis b. collateral ligament damage c. arterial impairment d. ulnar nerve compression

Answer: A, anterior capsulitis

Which of the following results from a repeated static contraction of the forearm muscle that correlates to medial tibial stress syndrome? a. forearm splints b. forearm fracture c. contusion d. triangular fibrocartilage injury

Answer: A, forearm splints

Most elbow dislocations result from falling on an outstretched hand and result in the ulna and radius dislocating _______ from their relationship with the humerus a. posteriorly b. laterally c. anteriorly d. medially e. all of the above are equal

Answer: A, posteriorly

A positive varus test at 15-20 degrees of elbow flexion often indicates a tear or injury to what structure? a. radial collateral ligament b. biceps brachii c. ulnar collateral ligament d. supinators

Answer: A, radial collateral ligament

A trigger finger is a condition associated with tenosynovitis of the flexor tendons resulting from repetitive trauma. It is related to what occurrence? a. stenosis b. bony deformity c. contracture d. palsy

Answer: A, stenosis

Pain and crepitus at the base of the thumb that increase when making a fist with the thumb inside and then ulnarly deviating the wrist indicates a. lunate dislocation b. De Quervain's disease c. periostitis d. trigger finger

Answer: B, De Quervain's

This injury causes a fracture of the proximal third of the ulna with dislocation of the head of the radius a. Colles b. Monteggia c. Smith d. Galeazzi

Answer: B, Monteggia

In which phase of throwing does the greatest amount of valgus occur, thus placing the most stress on the medial elbow structures? a. cocking b. acceleration c. deceleration d. follow-through

Answer: B, acceleration

The circulatory integrity of the hand is examined using which of the following tests? a. phalen b. allen c. finkelstein d. tinel

Answer: B, allen

Which of the following fingernail deformities result from a history of cardiovascular conditions? a. spooning b. clubbing c. ridging d. scaling

Answer: B, clubbing

_____ strength is often limited during carpal tunnel syndrome. a. wrist extension b. grip and pinch c. extensor pollicus longus d. radial deviation e. ulnar deviation

Answer: B, grip and pinch

If an athlete complains of burning and tingling or paresthesia to the 2nd and 3rd fingers, what structure may be injured? a. flexor digiti minimi b. median nerve c. interosseous nerve d. ulnar nerve

Answer: B, median nerve

The _____ is considered to be the most provocative special test for identifying partial tears of the ulnar collateral ligament a. varus stress test b. moving valgus c. distal biceps tendon rupture test d. active epicondylitis

Answer: B, moving valgus test

Manual muscle testing wrist extension will examine motor function for which peripheral nerve? a. median b. radial c. ulnar d. musculocutaneous

Answer: B, radial

Acute stretching or tearing of the ulnar collateral ligament in the elbow joint can occur from what mechanisms of injury? a. fall onto an adducted arm b. throwing motion c. excessive varus force d. any of the above

Answer: B, throwing motion

To properly examine for carpal tunnel syndrome, Phalen's test must be administered for at least a. 30 seconds b. 3 minutes c. 1 minute d. 5 minutes

Answer: C, 1 minute

This injury causes dorsal displacement of the radius and ulna in relation to the proximal shaft and the mechanism of injury is FOOSH with the wrist extended a. Bennett fracture b. Smith's fracture c. Colle's fracture d. Boxer's fracture e. Jersey finger

Answer: C, Colle's Fracture

A mallet finger is characterized by a. an inability to actively flex the DIP joint b. a rupture of the flexor digitorum profundus c. a hx of getting hit on the tip of the finger d. all of the above e. B and c

Answer: C, a history of getting hit on the tip of the finger

Which of the following statements about Gamekeeper's thumb is true? a. it is commonly seen in athletes participating in non-contact sports such as tennis and gold b. it is caused by forceful flexion of the thumb c. it produces local tenderness on the ulnar side of the first MCP joint d. it is also referred to as a rupture of the transverse metacarpal ligament

Answer: C, it produces local tenderness on the ulnar side of the first MCP joint

What nerve innervates the main elbow flexors? a. axillary b. median c. musculocutaneous d. radial

Answer: C, musculocutaneous

Which nerve passes between the hamate and pisiform bones? a. musculocutaneous b. radial c. ulnar d. median

Answer: C, ulnar

MMT finger abduction will examine motor function for which peripheral nerver? a. median b. radial c. ulnar d. musculocutaneous

Answer: C, ulnar nerve

In a neuro exam specifically at the elbow, what neurological levels are most appropriate? a. C5-T1 b. C5-C8 c. C5-C7 d. C6-T1

Answer: C5-T1

Of the following structures, which are involved in medial epicondylitis? 1. flexor carpi ulnaris 2. flexor carpi radialis 3. brachioradialis 4. pronator teres 5. pronator quadratus a. 1,2 b. 3,4,5 c. 1,3,5 d. 1,2,4 e. 1,2,4,5

Answer: D, 1,2,4 Flexor Carpi Ulnaris Flexor Carpi Radialis Pronator Teres

All of the following general passive stress tests can be performed to help rule out possible fractures in the hand and wrist area except for: a. longitudinal b. percussion c. transverse d. MMT e. all of the above

Answer: D, MMT

The radial border of the anatomical snuffbox is comprised of these muscles: a. extensor digitorum longus and extensor pollicus longus b. adductor pollicus longus and extensor pollicus longus c. abductor pollicus longus and extensor pollicus brevis d. extensor pollicus longus and extensor pollicus brevis

Answer: D, extensor pollicus longus and extensor pollicus brevis

Lateral epicondylitis is characterized by: a. increased pain with resisted wrist flexion and passive wrist extension b. increased pain with resisted wrist extension and passive wrist flexion c. point tenderness at the origin of the wrist extensors d. A and C e. B and C

Answer: E, B & C Increased pain with resisted wrist extension and passive wrist flexion & point tenderness at the origin of the wrist extensors

In order to determine the presence of ulnar nerve compression in the cubital tunnel, which special test would be most useful? a. elbow flexion test b. moving valgus stress test c. radioulnar joint stress test d. medial epicondylitis test

Answer: Elbow flexion test

When the proximal phalanx is overstretched or hyperextended, injury to the ____ on the palmar side of the joint should be suspected. a. volar plate b. ulnar collateral ligament c. radial collateral ligament d. profundus

Answer: a, volar plate

During passive ROM in the elbow, what type of end feel would you normally expect with extension? a. soft b. firm c. springy d. empty

Answer: b, firm

______ is the mechanism of injury that is most often associated with fractures and dislocations at the distal forearm, wrist, and hand a. direct blow b. falling on apex of elbow c. falling on dorsal surface of hand d. falling on outstretched hand

Answer: d, FOOSH

What is the preferred forearm position when testing elbow flexion? a. pronation b. neutral c. supination d. all of the above are equally important

Answer: d, all of the above are equally important

Which of the following neurovascular structures are most commonly affected in Volkmann's Ischemic contracture? a. Brachial nerve and ulnar artery b. Femoral nerve and radial artery c. radial nerve and radial artery d. median nerve and brachial artery e. none of the above

Answer: d, median nerve and brachial artery

Which of the following factors may predispose a tennis player to lateral epicondylitis? a. excessive supination while serving a ball b. applying a heat balm to the elbow before play c. drinking to much water d. faulty technique e. a or d

Answer: e, a or d excessive supination while serving a ball and faulty technique

A rupture of the flexor digitorum profundus would cause which of the following: a. boutonnier deformity b. an inability to actively flex the PIP of involved finger c. inability to actively flex the DIP of the involved finger d. jersey finger e. c and d

Answer: e, c & d inability to actively flex the DIP of the involved finger and jersey finger

The medical term for the condition in which nodules form in the palmar aponerosis, which limits finger extension and eventually causes a finger flexion deformity of the 4th and 5th digits is called ___ ____.

Dupuytren's Contracture

T/F A ganglion is a herniation of the joint capsule or the synovial sheath of a tendon; it is often thought of as a cyst structure, and occurs most frequently on the volar aspect of the wrist

False

T/F Flexion is the most important motion in evaluating elbow injuries when determining whether an athlete can return to competition

False

T/F Lateral epicondylitis results from repetitive activities that apply tension and stretch to the wrist extensors and forearm pronator muscles

False

T/F Neurovascular problems are extremely rare in association with fractures in the elbow region as a result of the anatomic arrangement of the structures in the elbow

False

T/F The definition of Panner's Disease is avascular necrosis of the trochlea

False

T/F The posterior interosseous nerve is a branch of the median nerve

False, it is a branch of the radial nerve

T/F Numbness of the dorsal web space of the hand and weakness of the wrist extensors suggest possible median nerve injury

False, it suggests a possible radial nerve injury

A smith fracture exhibits a _____ _____ deformity.

Garden Spade

The carpal bone that is most frequently fractured when an athlete strikes a stationary object with a racquet or golf club in full swing is the _____

Hamate

_____ nodes are enlargements of the DIP joints, while _____ nodes are enlargements of the PIP joints. Both types generally usually indicate no significant underlying pathology.

Herberden's Nodes and Bouchard's Nodes

In the case of an ulnar neuropathy condition, atrophy will usually be present in the _____ eminence.

Hypothenar

5 P's of Compartment Syndrome

Pain Parasthesia Pallor Pulselessness Paralysis

An infection involving the subepithelial folds of tissue surrounding the fingernail that frequently begins as a hangnail is called ____

Paryncia

The fascial tissue that surrounds the wrist and is thickened into strong fibrous bands, thus protecting the tendons in this area, is called ______.

Retinaculum

T/F Complications from an elbow dislocation may include injury to the median and radial nerve, brachial artery, and commonly myositis ossificans.

True

T/F Cubitus varus is an abnormality resulting in a carrying angle below what is considered normal

True

T/F Pronation and supination are one of the deviations from the anatomical position when determining the zero starting position for goniometry measurements of these motions

True

T/F The "swan-neck deformity", often found in rheumatoid arthritis patients, finds the fingers in a position in which the PIP joint is hyperextended and the DIP joint is flexed

True

T/F The distal end of the humerus forms two condyles: the lateral condyle is called the capitulum and the medial condyle is called the trochlea

True

T/F The extrinsic flexor muscles of the hand are more than two times stronger than the strongest extrinsic extensor muscles of the hand

True

T/F The name of the hand grip in which the fingers and thumb are used to grip a baseball or golf club against the palm is called a fisted grip

True

T/F Visually observing an elbow at a 90 degree angle of flexion, while palpating the appropriate bony structures will also show the olecranon process and both humeral epicondyles form an isosceles triangle

True

If the thrower has medial elbow pain during late cocking the _____ is probably injured. On the other hand if the thrower has medial elbow pain after releasing the ball, the ___ is most likely the injured structure.

UCL Flexor Tendon