Flashcards in 02 Wrist/Hand 2 Deck (50):
1
flexor tendon lacerations
usually due to trauma
2
zones of the hand
where you can have tendon injury
3
Which zone is the worst for tendon injury?
zone 3
4
flexor tendon injury
- affected finger is unable to flex
- rests in extension
5
flexor tendon repair
example protocol
- early protected PROM
- early post-op progression to "careful ROM"
- place and hold exercises in shortened position
- splinting techniques
- tendon glide assessment
- joint mobs
- progress to resistive exercises
6
flexor tendon repair
What is used for early protected PROM?
dorsal blocking splint
7
flexor tendon repair
What is used to progress to careful ROM?
specific dynamic splint
8
flexor tendon repair
What are place and hold exercises?
- submax isometrics
- put them in a position and have them hold it there
- progress from short-length to mid-length to full-length positions
9
flexor tendon repair
what are the splinting techniques? How long are they worn?
- blocking or dynamic splints
- worn 4-6 weeks
10
flexor tendon rehab recap
phase I
time frame
what's done
- day 5 to 3 weeks
- PROM, AAROM, AROM
11
flexor tendon rehab recap
phase II
time frame
what's done
- week 4-6
- splints removed
12
flexor tendon rehab recap
phase III
time frame
what's done
week 6-12
- week 7: light resistive exercises
- week 8: PROM bilateral comparison WNL
- week 10: begin light ADLs
- week 12: all ADLs and start resistive exercises
- week 14-16: begin heavy and sustained lifting exercise and tight gripping activities
13
flexor tendon repair
Why use a dorsal blocking splint?
don't want any movement outside what you get in therapy
14
differential fisting types
- open hand
- MCP flexion
- straight fist
- hook fist
- composite fist
15
thumb UCL injury
- gamekeeper's (skier's) thumb
16
common issues with gamekeeper's thumb
- bruising
- swelling
- loose end of torn ligament may form a bump you can feel
- difficult to grip
17
thumb UCL repair
multiple anchors and k-wires
18
thumb UCL repair
When can k-wires be removed?
once it's stable
19
thumb UCL repair
rehab
- light AROM
- stretching
- resistive exercise
20
ganglion cysts
- caused by leakage of fluid from the joint into surrounding tissue
- commonly seen at ECRB
21
ganglion cysts
removal
- needle inserted to remove fluid (if you don't change the cause of fluid leakage, it'll just come back)
- surgical removal
- bible bumps home test
22
scaphoid fracture
s/s
- swelling and tenderness in the area are typical
- pain, ttp, bruising in anatomical snuffbox
23
retrograde blood supply
scaphoid tuberosity gets the most blood supply because of how the radial artery wraps around
24
scaphoid fracture treatment times
tuberosity fractures
4-6 weeks
25
scaphoid fracture treatment times
waist fractures
10-12 weeks
26
scaphoid fracture treatment times
proximal pole fractures
12-20 weeks
27
scaphoid fracture treatment times
"normal"
considered up to 4 months
28
hamate fractures
- locations
- MOI
- hook or body
- specifically applying pressure in the direction of the hook, esp holding a club or bat
29
most commonly dislocated bone in the wrist
lunate
30
lunate dislocation
MOI
- downward force in wrist extension
- lunate pressed toward the palm until it dislocates
31
lunate dislocation
secondary concern of lunate dislocation
- capitate drops into place vacated by the lunate
- positive Murphy sign
32
lunate dislocation
reduction
- can spontaneously reduce
- not as tight as before
33
metacarpal fractures
visible signs
volar
- rotated index finger
- bruising under the metacarpal
dorsal
- maybe less prominent knuckle
- breakpoint lump
34
metacarpal fractures
Why would the finger be rotated?
not as much stability on the metacarpal as normal
35
metacarpal fractures
treatment
- will be immobilized for a long time
- don't want to send to therapy until all healing has occurred
36
boxer's fracture
- end of 5th metacarpal takes force of impact
- breaks at its neck
- angulates toward the palm
- creates dorsal bump
37
boxer's fracture
trx
ulnar gutter splint
- protects only the ulnar aspect of the hand
38
Bennett's fracture
- intra-articular fx at base of 1st metacarpal
- extends into CMC
- almost always produces subluxation at CMC
39
Bennett's fracture
cause
axial directed force
- punching something really hard
- bike fall (thumb extended when you fall)
40
Bennett's fracture affects what tendon?
APL
41
Bennett's fracture
surgical stabilization
stabilized with Kirschner pin placed between thumb and index metacarpals
42
Bennett's fracture
post-op
- pt immobilized
- once all healing has occurred, sent to therapy to regain strength and mobility
43
commonly get joint sprains and dislocations at ____
PIP
44
commonly get joint fx and dislocations at _____
DIP
45
common site for finger OA
thumb
46
characteristics of finger OA
- destruction of cartilage
- inflamed joint capsule and synovium
47
boutonniere deformity
tear in central slip of extensor mechanism
- PIP in flexion
- DIP in hyperextension
48
swan neck deformity
tear in flexor tendon
- PIP in hyperextension
- DIP in flexion
49
Ehler's-Danlos
- genetic condition
- severe laxity in the joints » dislocation (due to hypermobility, not tears)
50