HANDS & UE ORTHO: general Info Flashcards
gross/cylindrical grasp
all fingers/thumb wrap around object handle
- OPPOSITION = YES
- used by small children before finger control required
- impaired in CMC OA
EX: holding onto a handle, grasping a steering wheel
power grasp
- variation of gross grasp
- used when extra force is required, thumb STABILIZES, ulnar fingers most involved
THUMB OPPOSITION = NO - greater effort to control with this grasp = greater risk for injury
EX: holding a hammer while building
hook grasp
fingers “hook” around object without thumb
- radial nerve palsy = can’t form this grasp
- OPPOSITION = NO
EX: carrying a shopping bag/briefcase
spherical grasp
thumb & fingers form “cup” shape to grasp round objects
- OPPOSITION = YES
EX: holding an apple
conoid grasp
hold a cone shaped object, with the apex of the cone at the ulnar side of the palm
- The ring and little fingers provide extra control and stability at the smaller end of the cone
- OPPOSITION = YES
EX: holding an ice cream cone
lateral pinch
- thumb pushes against the side of the index finger to secure an object
- Often used to compensate for weakness or instability of the tip and palmar pinches
- Also used to compensate for poor thumb opposition
- OPPOSITION = NO
EX: holding car keys while starting a car, gathering & sorting paperwork into piles
palmar pinch/3 jaw chuck
- thumb opposes against the tips of the index and middle fingers to secure a small object
- OPPOSITION = YES
EX: pick up, place and push small building blocks together
tip pinch
- thumb opposes the tip of a finger, usually the index finger, to secure a small object
- OPPOSITION = YES
EX: pulling a pin out of a pin cushion
tripod grasp
- variation of palmar pinch, used to hold writing and drawing tools
- shaft of the tool is held by the tips of the thumb and index finger and stabilized by the side of the middle finger near the PIP joint (3 fingers)
- OPPOSITION= YES
quadruped grasp
- Another variation of palmar pinch, used to hold writing and drawing tools
- The shaft of the tool is held by the tips of the thumb, index and middle fingers and stabilized by the side of the ring finger near the PIP joint (4 fingers)
- OPPOSITION = YES
which type of grasp is impaired in radial nerve palsy?
hook grasp
which type of grasp is impaired in CMC OA?
gross/cylindrical grasp
flexors are on what part of the hand/arm?
volar
extensors are on what part of the hand/arm?
dorsal
nerve distribution of the UE
C3-C4 = supraclavicular
C6-C8 = radial
C5-C8 & T1 = median
C8-T1 = ulnar
ulnar nerve distribution of the hand
DORSAL & VOLAR: pinky, ulnar side of ring finger
median nerve distribution of the hand
VOLAR: radial half of ring, middle, index, and ulnar side of thumb
DORSAL: index, middle, radial half of ring finger PIP, ulnar side of thumb
radial nerve distribution of the hand
VOLAR: radial side of thumb
DORSAL: index, middle, radial side of ring below PIP
pillar pain
pain on either side of the carpal tunnel (source is unknown)
Carpal tunnel syndrome
Compression of MEDIAN nerve due to inflammation & repetitive motion with poor positioning
- palmar numbness of 1st – half of 4th finger, general weakness & pain, including pain at NIGHT, NO ROM LIMITATIONS
Assess: sensation, fine motor coordination, weakness
ASSESSMENTS: Semmes Weinstein Monofilament test, Nine hole peg test, dynamometer & pinch gauge (DO NOT TAKE GONI MEASUREMENTS UNLESS SYMPTOMS HAVE BEEN PRESENTS FOR A LONG TIME & ROM IS LIMITED)
+ Tinels sign
+ Phalens sign
+ Moberg Pick Up test
Cubital tunnel syndrome
- Compression of the ulnar nerve at the elbow
- due to repetitive elbow pressure or sustained elbow bending
- Numbness and tingling along ulnar aspect of forearm/ hand, pain at elbow with extreme, weak power grip
- advanced stages = FCU, FDP atrophy to digits 4 & 5, atrophy of ulnar nerve innervated muscles of the hand
+ Tinel’s sign at elbow (pain or sensation)
+ Phalens test
+ elbow flexion test
Double crush injury
a peripheral nerve is entrapped in more than one location
- Intermittent diffuse arm pain and paresthesias with specific postures
Guyon’s Canal
inflammation/irritation due to compression of the ulnar nerve at the wrist
- Numbness and tingling in ulnar nerve distribution of hand; motor weakness of ulnar nerve innervated musculature
- due to ganglion, pressure, fascia thickening
- advanced stages = ulnar nerve innervated muscles atrophy
+ Tinel’s sign at Guyon’s canal
Pronator teres syndrome
Compression of the median nerve between the 2 heads of the pronator muscles
- cause: trauma to the forearm or repetitive overuse, especially against resistance (i.e. turning a manual screwdriver)
- Palmar numbness and numbness of digit 1 - half of 4th digit, with generalized weakness and pain, aching pain in the PROX VOLAR FA, No pain at NIGHT
+ Tinels sign at FA, no night symptoms
Radial nerve palsy
Decreased conduction of the radial nerve
- cause: compression, fractures, and laceration
- Weakness/paralysis of extensors to wrist, MCPs, thumb
- wrist drop/Saturday night palsy
- Slow nerve regeneration
Radial tunnel syndrome
Compression of the radial nerve in the proximal FA
- cause: inflammation, repetitive motion, injury to the lateral side of the elbow, tumor
- lateral FA dull ache & burning sensation
Thoracic outlet syndrome
excess pressure is placed on a neurovascular bundle passing between the anterior scalene and middle scalene muscles
- cause is repetitive motion in the upper arm and shoulder, injury, poor posture, anatomical defects, tumors, or pregnancy)
- Vascular symptoms: swelling or puffiness in the arm or hand, bluish discoloration of the hand, feeling of heaviness in the arm or hand, pulsating lump above the clavicle, deep, boring toothache-like pain in the neck and shoulder region which seems to increase at night, easily fatigued arms and hands, superficial vein distention in the hand
- Neurologic symptoms: paresthesia along the inside forearm and the palm (C8, T1 dermatome), muscle weakness and atrophy of the gripping muscles (long finger flexors) and small muscles of the hand (thenar and intrinsics), difficulty with fine motor tasks of the hand, cramps of the muscles on the inner forearm (long finger flexors), pain in the arm and hand, tingling and numbness in the neck, shoulder region, arm and hand
what are the gripping muscles called?
long finger flexors (muscles on the inner FA)
what are the small muscles of the hand called?
thenar & intrinsics
nerve laceration or lesion is due to
Laceration = partially or completely severed
Lesion = damaged by trauma or prolonged compression
how does ape hand deformity/simian hand present?
high or low median nerve injury, thenar muscles paralyzed
- Loss of thumb abduction/opposition/pinch, sensory loss in index, middle, and radial side of the ring finger; index finger MCP and PIP flexion; & decreased pronation
- not its own dx, default position of the injured hand at rest when thenar muscles have atrophied
Brachial plexus
housed in the spinal canal of the vertebral column/spine
- network of nerves that conducts signals from the spinal cord to the shoulder, arm, & hand
which vertebrae does the brachial plexus originate in?
C5-C8, T1 spinal nerves, innervate the muscles and skin of the chest, shoulder, arm and hand
brachial plexus injuries causes
- shoulder trauma, tumors, or inflammation
- Pain, including avulsion pain (a burning pain in the injured nerve area), loss of sensation distal to the brachial plexus, muscle weakness, partial or total paralysis of the affected upper extremity
Erb’s palsy
- C5-C6 injury
- arm paralyzed/hangs limp with shoulder IR due to atrophy/paralysis in the biceps, deltoid, brachialis, and brachioradialis muscles
- limits functional movement
- paralysis can resolve on its own over a period of months, require therapy, or surgery
Long thoracic nerve palsy
- causing pain and limited movement in the shoulder
- Shoulder pain, limited overhead movement, and abnormal protruding/WINGING of the scapula
median nerve laceration results in
loss of thumb opposition, weak pinch, APE HAND DEFORMITY (thenar eminence flattening)
LOW LESION: wrist = Clawing of index/mid fingers
- motor loss = MCP flexion of digits 2 & 3, opposition, abduction, thumb flexion
HIGH LESION: at/prox to elbow = Benedictine hand
- motor loss: all in low lesion + 1,2,3,flexion, unable to flex to radial aspect of wrist
median & ulnar nerve injury involves
- Can be caused by car accidents and glass injuries
- Loss of sensation to the front surface of all digits, loss or impairment of finger flexion, thumb opposition. Clawing of all digits
radial nerve laceration presents as
Can’t release objects, difficulty manipulating objects
ulnar nerve injury presents as
ulnar claw deformity and numbness of the ulnar side of the hand and the fifth and half of the fourth digits, with generalized weakness of the ulnar side of the hand and pain
- MCP hyperextends
- Trouble cutting with small knife
- Trouble with power grip and lateral pinch
when does tenosynovitis occur?
when the tendon and its sheath become inflamed
when does tendonitis occur?
when the tendon becomes inflamed due to repetitive use of a muscle
DeQuervain’s tenosynovitis
cause is cumulative microtrauma, repetitive motion- inflammation of the thumb muscle/tendon unit
- involves abductor pollicis longus (APL), extensor pollicis brevis (EPB) —> (1st dorsal compartment)
- Pain & swelling over radial styloid, limited motion in APL & EPB & tendons in the first dorsal compartment of the wrist
+ Finklesteins test
lateral epicondylitis
tennis elbow
- inflammation of the tendons of the wrist extensors at the insertion points on and around the lateral epicondyle, caused by repetitive motion
Pain, inflammation, limited movement of the wrist extensors, especially ECRB
medial epicondylitis
golfer’s elbow
- inflammation of wrist flexors (flexor pronator, FCR, FCU) at the insertion points around the medial epicondyle, caused by repetitive motion
Pain, inflammation, limited movement of the wrist flexors.
rotator cuff tendonitis
inflammation of rotator cuff, caused by repetitive motion, chronic joint inflammation
- impingement at coracoacromial arch (acromian, coracoacromial ligament, coracoid process)
- Pain, swelling, limited movement of the tendons of the shoulder
trigger finger
tenosynovitis of the finger flexors. Caused by cumulative trauma
- Most commonly occurs in the A1 pulley, edema in the tendon and synovium of the digit results in lack of smooth flexion or extension of the finger
wrist tendonitis
inflammation of the tendons of the wrist
- Pain, inflammation, limited movement in the wrist
avulsion injuries/avulsion fracture
A small piece of bone that is attached to a tendon breaks away from the main bone. Mallet finger is an example of an avulsion fracture
extensor tendon injury
EDC or EIP injury, requires surgery
flexor tendon injury
A deep cut on the palm side of the fingers, hand, wrist, or forearm (laceration), can’t bend the fingers or thumb
mallet finger
avulsion of the terminal tendon
cumulative trauma disorder
Trauma to soft tissue caused by repeated force (deQuervains, lateral/medial epicondylitis, trigger finger)
- muscle fatigue, pain, chronic inflammation, sensory impairment, decreased ability to work
due to repetitive strain/overuse, musculoskeletal disorders OR acute trauma, pregnancy, diabetes, arthritis, wrist size/shape
Example: playing piano 10 hours a day.
MCP flexion limitation
Difficulty flexing the MCP’s due to ligament tightness
- MCPs = condyloid joints (reception of rounded heads of the MC bones into shallow cavities on the proximal ends of digit 1 (exception of the thumb = hinge thumb)
PIP flexion contracture
Shortening and tightening of the tendons and ligaments surrounding the PIP joint due to injury
Skier’s Thumb/Gamekeepers Thumb
Rupture of the ulnar collateral ligament of the MCP joint of the thumb. (i.e., skiing with the thumb held in a ski pole)
Boutonniere deformity
PIP joint flexed, and the DIP joint hyperextended
swan neck deformity
injury to the MCP, PIP, or DIP joints characterized by PIP hyperextension and DIP flexion
ulnar drift
Hand deformity in which the swelling of the metacarpophalangeal joints (the big knuckles at the base of the fingers) causes the fingers to become displaced, tending towards the little finger. The hand including the fingers move towards the ulna. Ulnar deviation is a disorder in which flexion by ulnar nerve innervated muscles is intact while flexion on the median nerve side is not.
bennetts fx
Fracture of the first metacarpal base
boxer’s/proximal fracture
A boxer’s fracture is the result of a clenched fist hitting an object with enough force to break the metacarpophalangeal neck, most commonly seen in the fourth and fifth digits.