Orthopedic Assessment Unit 2

1. Biceps brachii

2. Cubital fossa

3. Brachioradialis

4. Pronator teres

5. Flexor carpi radialis

6. Palmaris longus

7. Flexor carpi ulnaris

8. Pronator quadratus

1. Medial epicondyle

2. Ulna

3. Ulnar collateral ligament (anterior band)

4. ulnar collateral ligament (posterior band)

5. Ulnar collateral ligament (transverse band)

1. Olecranon process

2. n/a

3. Triceps brachii

4. Anconeus

5. Ulnar nerve

6. Extensor carpi ulnaris

7. Extensor carpi radialis brevis

8. Extensor carpi radialis longus

9. Extensor digitorum

10. Extensor digiti minimi

11. Extensor pollicis brevis

12. Abductor pollicis longus

13. n/a

1. Lateral epicondyle

2. Radial head

3. Radial collateral ligament

4. Capitellum

5. Annular ligament

6. Lateral ulnar collateral ligament

Humeroulnar & radial end-feel

Flexion: soft

Extension: hard

Proximal radioulnar end-feel

Supination: firm

Pronation: hard or firm

Distal radioulnar end-feel

Supination: firm

Pronation: firm

Median nerve branch

Anterior interosseous nerve

Ulnar nerve branch

Tunnel of guyon

Arcade of struthers

Radial nerve branch

Deep branch

Superficial branch

The humeroulnar joint has _____ degrees of freedom

1

The humeroradial joint has _____ degrees of freedom

2

In 90% of dislocation cases it’s usually _____

Posterior

FOOSE MOI

Olecranon process fracture

FOOSH MOI

Coronoid process fracture

Radial head & neck fractures

FOOSE or FOOSH MOI

Distal humerus fracture

FOOSE or hyperextension MOI

Supracondylar fracture

For PROM, olecranon process fractures have pain with:

End-range extension

For PROM, radial head fractures have pain with:

Supination & pronation

Where at the elbow is the radial head most easily palpated?

Posterior

Which of the following is NOT a compartment in the forearm?

Lateral compartment

A varus stress performed on the elbow is assessing the integrity of which ligament?

RCL

What is the bundle of the UCL that is the primary restraint against a valgus force when the elbow is flexed beyond 60?

Posterior

What degrees determine what bundles during a valgus stress test?

25 anterior bundle

60 posterior bundle

During the Cozen’s test. the patient is asked to perform this action against your resistance.

Wrist extension

What are the actions of the muscles originating from the medial epicondyle?

Flexion & pronation

What are the actions of the muscles originating from the lateral epicondyle?

Extension & supination

An unresolved, chronic Valgus Extension Overload can place excessive compressive and shear forces at the lateral elbow, placing this structure at risk for OCD.

Capitellum

The normal maximum AROM for supination at the elbow is:

90

The sensitivity and specificity of the posterolateral rotatory test is improved when combined with this:

Chair/floor sign

Valgus extension overload that consists of loose bodies or osteophytes presents with the following PROM for elbow extension

Early, hard end-feel

A history of smoking has been shown to place someone at 7.5 times higher risk for this elbow pathology.

Distal biceps tendon tear

The radioulnar joints are classified as what type of joint?

Syndemotic

The posterior triangle is observed in elbow flexion and composed from these 3 landmarks.

Medial epicondyle

Lateral epicondyle

Olecranon process

What is the indentation of the lateral epicondyle that accepts the radial head during elbow flexion?

Radial fossa

What muscles should be strengthened to help stabilize an RCL sprain?

Wrist extensors

What muscles should be strengthened to help stabilize a UCL sprain?

Wrist flexors

What traumatic injuries are involved in the “Terrible Triad” of the elbow?

Humeroulnar dislocation

Fracture of radial head

Fracture of coronoid process

Humeral fractures (12%) are associated with this nerve pathology:

Radial nerve pathology

Throwers with insidious (degenerative) UCL sprains often experience pain in the following throwing phases.

Late cocking

Early acceleration

Which of the following are risk factors for medial epicondylalgia (little leaguer’s elbow)

Golfing

Young throwing athletes

An increase carrying angle at the elbow is called what?

Cubitus valgus

What bundle is the most common in a UCL sprain?

Anterior bundle

Begins as insidious UCL sprain turns to ulnar nerve paresthesia turns to limited elbow extension or osteophytes

What pathology is this?

Valgus Extension Overload

Osteochondritis dissecans of capitellum is _____ in 80% of cases

Unilateral

What are the two pathologies that have pain w/ late cocking & early acceleration in throwing?

UCL sprain

Osteochondritis dissecans of capitellum

Which muscle is commonly irritated in lateral epicondylalgia (tennis elbow)?

Extensor carpi radialis brevis

What pathology has a distal upper arm defect at 90 degrees and a popping sensation?

Distal biceps tendon tear

Full or partial tear of distal biceps tendon include these three factors:

Hypovascular zone

Avulsion of radial tuberosity

Tendon and aponeurosis degrade

What digits are effected for ulnar and median nerve pathologies?

Ulnar: 4th & 5th digits

Median: Digits 1-3

What are the compartments of the forearm?

Superficial volar compartment

Deep volar compartment

Dorsal compartment

Mobile wad

What are the six P’s of compartment syndrome

Pain

Pallor

Paralysis

Paresthesia

Poikilothermia

Pulselessness

If forearm compartment syndrome goes untreated it can result in a _____

Volkmann’s ischemic contracture

1. Thenar eminence

2. n/a

3. Hypothenar eminence

4. Metacarpals

5. n/a

6. Collateral ligaments of MCP joints

7. Phalanges

8. Collateral ligaments of IP joints

9. Thenar webspace

10. Extensor digitorum

11. Extensor indicis

12. Extensor digiti minimi

13. Extensor pollicus longus

14. Extensor pollicus brevis

1. Ulna

2. Ulnar head

3. Ulnar styloid process

4. UCL

5. Extensor carpi ulnaris

6. Lister tubercle

7. n/a

8. RCL

9. Scaphoid

10. Lunate

11. Triquetrum

12. Trapezium

13. Capitate

14. Trapezoid

15. Extensor carpi radialis brevis

16. Extensor carpi radialis longus

1. Extensor carpi ulnaris

2. Extensor digiti minimi

3. Extensor digitorum and indicis

4. Extensor pollicus longus

5. Extensor carpi radialis longus and brevis

6. Abductor pollicus longus and extensor pollicus brevis

1. Radius

2. Flexor carpi radialis

3. Palmaris longus

4. Carpal tunnel

5. Ulna

6. Flexor carpi ulnaris

7. TFCC

8. Pisiform

9. Hamate

What angulation of metacarpal fracture would require surgical reduction with internal fixation?

>35 degrees

The radial (thumb) side of the palm of the hand is called what?

Thenar eminence

Which of the following wrist ligaments resists (becomes taunt in) radial deviation?

UCL

Which wrist pathology is commonly associated with clicking on the ulnar side of the wrist?

Triangular fibrocartilage tear

What is the muscle responsible for flexing the four PIP joints, but not the DIP joints?

Flexor digitorum superficialis

What muscle is responsible for flexing just the DIP joints?

Flexor digitorum profundus

Trauma or pathology to which nerve results in a drop-wrist deformity?

Radial

Which of the following neuropathies underlies a Bishop's deformity (hand posture)?

Ulnar

Which nerve travels through the carpal tunnel in the wrist?

Median

A radius fracture that displaces anteriorly (palmar) is called what?

Smith’s fracture

Reverse Colles fracture

Colles fractures are _____ displaced and reverse colles fractures are _____ displaced.

Dorsal; palmar

What type of ulnar variance can be corrected by surgical resection of a portion of the ulna?

Positive ulnar variance

What is the most commonly fractured carpal bone in the hand?

Scaphoid

Which nerve travels through the tunnel of Guyon?

Ulnar

Which of the following is a sign of carpal tunnel syndrome?

Thenar atrophy

Which ligament forms the roof of the carpal tunnel?

Transverse carpal

A UCL sprain of the first MCP (thumb) is also known as what?

Skier’s thumb

Gamekeeper’s thumb

Which carpal bone is palpable as the floor of the anatomical snuffbox?

Scaphoid

Which of the following structures provides finger stability and smooth gliding for flexor tendons?

Volar plate

Which of the following finger deformity is due to avulsion of the extensor digitorum tendon, resulting in an inability to extend the DIP?

Mallet finger

What is a benign collection of thick fluid within a tendinous sheath or joint capsule found on the dorsal wrist called?

Ganglion cyst

Which of the following carpal bones is a sesamoid bone?

Pisiform

So long to pinky, here comes the thumb

Scaphoid, lunate, triquetrum, pisiform, hamate, capitate, trapezoid, trapezium

Felon is infection of _____ and paronychia is infection of _____

The nail and the nail bed

Which hand joint has 2 degrees of freedom?

Radiocarpal joint

Metacarpophalangeal joint

Which hand joint has 1 degree of freedom?

Interphalangeal joint

Distal radioulnar joint

Which hand joint has 1-2 degrees of freedom?

Carpometacarpal joint

Which hand joint has 0 degrees of freedom?

Intercarpal joint

The triangular fibrocartilage complex (TFCC) provides support to the _____ joint

distal radioulnar

What are the superficial volar muscles?

Palmaris longus

Flexor carpi ulnaris

Flexor carpi radialis

Flexor digitorum superficialis

What are the deep volar muscles?

Pronator quadratus

Flexor pollicis longus

Flexor digitorum profundus

Ape hand

• Median nerve

Bishop’s deformity

• Ulnar nerve

Claw hand

• Ulnar & median nerve

Dupuytren’s contracture

• Shortening of palmar fascia

Volkmann’s ischemic contracture

• Lack of blood supply