02 Wrist/Hand 2 Flashcards Preview

7212 Pathophysiology > 02 Wrist/Hand 2 > Flashcards

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

treatment for boutonniere and swan neck deformities

splints