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Elbow, wrist and hand disorders
In the hand and elbow the diagnosis is made almost entirely by examination: where the tenderness is, which resisted movement hurts and which fingers are numb — this separates tendinopathy, nerve compression and a joint problem.
Why it matters in the exam
The exam describes a mechanic with lateral elbow pain, a massage therapist with radial wrist pain, a woman woken at night by numbness in fingers 1–3, and a person whose finger locks. It asks about the diagnosis, the diagnostic test and the first treatment.
In children "nursemaid's elbow" returns: a toddler who will not move the arm after being pulled — reduction is simple and no X-ray is needed.
Most of these problems are linked to repetitive strain at work or at home, so part of the treatment is changing the movement and not only a drug or an injection.
In questions about a fall on an outstretched hand remember the scaphoid fracture: tenderness in the anatomical snuffbox requires immobilisation and a repeat X-ray even when the first X-ray is normal. An incidental soft lump on the back of the wrist is usually a ganglion cyst, which sometimes resolves by itself.
Key points
- Fingers 1–3 at night — carpal tunnel; finger 5 — the ulnar nerve.
- Finkelstein — De Quervain's; treatment: splint and injection.
- Tennis elbow usually resolves within about a year; less load and exercises.
- Trigger finger — steroid injection, common in diabetes.
- Toddler after a pull — reduction by pronation, no X-ray.
Summary table
| Condition | Site and test | Risk group | Treatment |
|---|---|---|---|
| Lateral epicondylitis (tennis elbow) | Tenderness at the lateral epicondyle, pain on resisted wrist extension | Repetitive manual work | Reduce load, exercises, brace; usually resolves within about a year |
| Carpal tunnel syndrome | Numbness in fingers 1–3 and half of 4, mainly at night; Phalen, Tinel | Pregnancy, hypothyroidism, diabetes, obesity | Night splint, steroid injection; surgery for weakness or thenar atrophy |
| De Quervain's tenosynovitis | Radial wrist pain; Finkelstein test | New mothers, repetitive thumb use | Thumb splint and steroid injection |
| Trigger finger | Clicking and locking of the finger in flexion | Diabetes | Steroid injection into the tendon sheath; surgery if it recurs |
| Ulnar nerve compression at the elbow | Numbness in finger 5 and half of 4, weakness of the small hand muscles | Leaning on the elbow | Avoid pressure, night splint; surgery for weakness |
| Nursemaid's elbow (radial head subluxation) | Child aged 1–4 after a pull, arm held by the side and pronated | — | Reduction by hyperpronation; no X-ray in a typical case |
Free exam questions
לכל המטופלים הבאים תוצאה של T Score -1.3 בצפיפות עצם עדכנית. מי מהם זקוק להדמיית עמוד שדרה לאיתור שברים אוסטאופורוטיים אתסמיניים? (the question as examined, in Hebrew)
- א. גבר עם אובדן גובה של 5 ס"מ
- ב. גבר בן 75 הסובל מיתר לחץ דם
- ג. אישה בת 60 הסובלת מתסמונת התעלה הקרפלית
- ד. אישה שטופלה בפרדניזון (Prednisone) עקב Bell's Palsy לפני שנה
בן 7 .מגיע למלר"ד לאחר שנפל מאופניים ונחבל במרפק יד שמאל מצורף צילום במנח AP ?. כיצד תנהל את המקרה (the question as examined, in Hebrew)
- א. חבישה מרופדת, שחרור לביתו להפעלה מוקדמת
- ב. גבס מלא, שחרור לביתו להמשך טיפול שמרני
- ג. סד גבס, אשפוז לניתוח CRIF .תחת שיקוף
- ד. סד גבס, אשפוז לניתוח ORIF
In the full version for subscribers
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Sources
- Goroll AH, Mulley AG. Primary Care Medicine, 8th edition (2020) — Evaluation of elbow, wrist and hand problems
- American Academy of Orthopaedic Surgeons, 2016 (updated 2024) — Clinical practice guideline on the management of carpal tunnel syndrome
- Coombes BK et al., JAMA, 2013 — Effect of corticosteroid injection, physiotherapy, or both on lateral epicondylalgia
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.