Managing patients with wrist and hand pain

What is medial epicondylagia?

-1/3 as common as lateral epicondylitis -Tendonosis of common flexor group

What is the healing rate of the distal 1/3 scaphoid?

-10% occurrence -4-8 weeks of healing

What is the healing rate of the proximal 1/3 of the scaphoid?

-20% occurrence - 12-20 weeks of healing

What is the healing rate of the waist of the scaphoid?

-70% occurrence -6-12 weeks of healing

What causes an LCL sprain of the elbow?

-A combination of axial compression, supination/ER, and a valgus force to the elbow

What causes "Pulled elbow" dislocation?

-AKA Nursemaid's elbow -Subluxation of the radial head, usually in children younger than 5, due to forceful pulling with arm in extension and pronation -Entrapped ligament can be freed by quickly supinating the forearm while the elbow is flexed

What is Axonopathy (axonotmesis)?

-Axonal damage -Slow regrowth of axons but prognosis is good since Schwann cells are intact (1mm/day or 3cm/month)

What is Severeance (neurotmesis)?

-Axonal damage and demyelination -Typically, slow with incomplete recovery, usually needs to be surgically repaired

What are the symptoms for lateral epicondylitis?

-Burning pain -Pain with resisted wrist extension, gripping -Pain with elbow extension more than elbow flexion -Loss of ROM of extension more than elbow flexion

What are Olecranon stress fractures?

-Can cause posterior elbow pain in athletes who participate in throwing sports

What is a grade 3 ligamentous sprain?

-Complete tear of the ligament -Severe impairment -Derangement < dysfunction

What is myelinopathy?

-Demyelination -Complete and rapid recovery in days (sometimes up to 3 months)

At what point during throwing is the most stress applied?

-During the late cocking and acceleration phases of pitching

What does carpi radialis longus do?

-Extends wrist and assists with elbow flexion

What is the main cause of proximal radial fractures?

-FOOSH -Need axial compression to occur

What is a Bennet's fracture?

-Fracture of the base of the first metacarpal bone which extends into the CMC joint -Most common type of fracture of the thumb

What are the red flags associated with elbow, wrist and pain

-Gout -Systemic infection -RA -Trauma

How do you treat someone with a finger fracture?

-If injury is closed, non-displaced use buddy tape -If injury is closed, angulated or displaced, stabilize, surgery

How do you treat someone with a scaphoid fracute?

-If swelling and tenderness occur, immobilize them as if they had a fracture and see if they feel better in 2-4 weeks

What is the elbow extension test?

-If you cannot extend one arm as much as your other arm after a trauma there is a chance you have an elbow fracture

What functional deficits are involved with elbow fractures?

-Inability to fully flex, extend, pronate, supinate arm in eating, reaching

What increases the likelihood for any wrist fracture?

-Increased age -Male sex -Swelling of wrist -Swelling of snuffbox -Visible deformity -Pain with radial deviation

What increases the likelihood for distal radial fractures?

-Increased age -Swelling of the wrist -Visible deformity -Distal radius tender to palpation -Pain with supination

What is Osteochondritis dissecans?

-Ischemic necrosis and partial detachment of a fragment of cartilage and underlying bone from the articular surface

How do you treat little league elbow?

-Limit the amount of pitches per game as well as innings -Throw change-ups or fast balls instead of curveballs and sliders

What are Intracondylar humeral fractures?

-Most common distal humerus fracture in adults -Caused by forces directed against the posterior aspect of a flexed elbow

What are Supracondylar humeral fractures?

-Most common in the pediatric population -Potential for vascular and nerve injuries -Often requires ORIF

What is little league elbow?

-Overuse injury in young thrower that includes osteochondrititis dissecans of the capitulum -Issue with the medial side of the elbow

What is lateral epicondylagia (Tennis elbow)?

-Overuse injury of extensor carpi radialis brevis

What are the symptoms of medial epicondylitis?

-Pain with resistance to forearm pronation and wrist flexion at the medial elbow

What decreases the likelihood of a distal radial fracture?

-Pain with ulnar deviation

When would you refer for radiographs with a scaphoid fracture?

-Pain with ulnar deviation is a positive sign -Pain with thumb-index finger pinch

What decreases the likelihood of any wrist fracture?

-Painful axial compression of the thumb

What is a grade 2 ligamentous sprain?

-Partial tearing of the ligament, may result in laxity -Moderate impairment -Derangemnt = dysfunciton

How long does a finger fracture take to heal?

-Phalanx and metacarpal: 3-5 weeks -Proximal phalangeal shaft: 5-7 weeks -Middle phalangeal shaft: 10-14 weeks

What causes "Pushed elbow" dislocation?

-Posterolateral rotatory instability (pushed elbow) is caused by a FOOSH injury. Humerus rotates internally, ulna ER, HR joint subluxes -Most common elbow dislocations -May result in 10-15 degree loss of extension, 15% loss of strength

What is a Colles wrist fracture?

-Results form landing on an extended wrist or FOOSH injury (dinner for deformity) -Hyperextension may cause avulsion of the TFCC

What is a Smith's Fracture?

-Results from landing on a flexed wrist (Garden Spade deformity) -Common complication is median nerve injury

What is the most common fracture site in the wrist?

-Scaphoid fracture

What is a grade 1 ligamentous sprain?

-Slight stretching and some damage to the fibers of the ligament -Minimal impairment -Derangement > dysfunction

How do you identify scaphoid tenderness?

-Snuff box tenderness -Pain with supination against resistance -Pain with longitudinal compression of the thumb

What is one of the most common complications following severe sprains and elbow dislocations?

-Stiffness and ligamentous instability

What causes medial epicondylagia?

-Stretch of pronator teres and FCR during the acceleration phase of throwing and swinging

What are some complications of a distal radial fracture?

-TFCC degeneration -Decreased grip strength -EPL rupture -Post traumatic reflex sympathetic dystrophy

What is the most common site of injury for lateral epicondylagia?

-Tenoperiosteal insertion at the humeral lateral epicondyle

What are general considerations for examining the elbow, wrist, and hand

-Trauma -Repetitive stress injuries -Neuropathies -OA -Systemic disease

What are Olecranon fractures?

-Usually result in decreased by functional ROM following immobilization

What causes an MCL sprain of the elbow?

-Valgus and supination/external rotation forces

What is Radial Nerve palsy?

-also known as saturady night palsy -Due to compression of the radial nerve at the spiral groove -Results in distal forearm pain, dorsum of the hand/fingers, no obvious weakness, more sensory pain rather than weakness

What are the most useful physical findings for screening for wrist fractures?

1. Localized tenderness 2. Pain with AROM 3. Pain with PROM 4. Pain on grip 5. Pain with supination

What is a Boxer's Fracture?

Fracture of the 5th metacarpal bone