Comprehensive exam in the office setting

 History  Physical Exam ◦ Look ◦ Feel ◦ Move ◦ Special tests

Direct Pain: 1. Soft tissue trauma: sharp to dull aching 2. Nerve generated: burning, lancing 3. Joint effusion: throbbing 4. Bone: dull boring pain Referred Pain: Joint above and below Radicular Pain: from c/s nerve root

 Inspection standing ◦ Full extension, carrying angle  Palpation ◦ Med epicondyle, lat epicondyle, olecranon tip and radial head, ulnar nerve, olecranon bursa  ROM (-10º to 150º flex/ext, up to 90º pronation/supination)  Special Tests

 Epicondylitis ◦ Lateral epicondylitis ◦ Medial epicondylitis  Instability ◦ UCL stress testing  Nerve compression ◦ Tinel’s sign ◦ Ulnar nerve subluxation

 Inspection ◦ Deformity, wasting, swelling  Palpation  ROM ◦ Wrist flexion: 70 degrees ◦ Wrist extension: 70 degrees ◦ Ulnar deviation: 40 degrees ◦ Radial deviation: 20 degrees ◦ Forearm supination: 80 degrees ◦ Forearm pronation: 80 degrees  Special Tests

 Tenosynovitis ◦ Flexor tests ◦ Finkelstein test  Motor function tests ◦ Pinch, key and power grip  Compression/neuropathies ◦ Tinel, Phalen, Froment sign  Stability testing ◦ Ballottement testing ◦ Watson test ◦ Shuck test ◦ UCL thumb

Finkelstein test for de Quervain’s Low specificity, moderate sensitivity

Let’s practice.