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NMSK 2 - upper limb > wrist and hand soft tissue injuries > Flashcards

wrist and hand soft tissue injuries Flashcards

1
Q

what is the MOI of a wrist sprain?

A

-falls on flexed or extended wrist or contusions
-overload injury seen in gymnasts/ weight lifters

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2
Q

what structures of the wrist could be included in wrist sprains?

A

-collateral ligaments
-scapholunate ligament - grade I, II or III
- may also have tears of the triangular fibrocartilage complex on ulnar side (TFCC)

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3
Q

What are the symptoms of wrist sprains?

A

-pain
-swelling
-weakness in the wrist
-popping or slipping inside the wrist
-symptoms can get worse with activity, such as gripping, squeezing and lifting

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4
Q

what are the physical signs of a wrist sprain?

A

-tenderness over specific wrist ligaments
-swelling
-loss of ROM
-weakness
-certain positive special tests

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5
Q

what is the TFCC?

A

-lies between the ulna and carpus
-major stabiliser of the wrist
-common side of ulnar wrist pain
-injured with ulnar deviation with compression eg gymnastics, diving etc

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6
Q

what are the signs and symptoms of a TFCC tear?

A

-pain on ulnar side of wrist - associated with pronation and ulnar deviation mvt
-tender on ulnar aspect on palpation
-pain on resisted extension & ulnar deviation
-reduced & painful grip strength
-press test is positive

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7
Q

what does the conservative management of a TFCC tear involve?

A

-relative rest
-protecting brace /splint
-strengthening - isometric and grip strength
-ROM / manual therapy - but with caution if unstable

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8
Q

what does the surgical management of a TFCC tear involve?

A

-excision of torn cartilage under arthroscopy
-ulnar shortening - if it longer than radius and can impinge on radius

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9
Q

what can happen to the wrist after a grade 3 ligament sprain?

A

carpal instability

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10
Q

what carpal bone is the key bone for carpal stability?

A

-the scaphoid

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11
Q

what is the most common carpal bone instability?

A

scaphoid-lunate instability

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12
Q

what are the signs & symptoms of carpal instability?

A

-pain
-decrease in ROM
-clicking sensation
-increase in mobility on accessory motion testing
-tenderness on palpation
-decrease in grip strength

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13
Q

how is carpal instability managed?

A

-if sprain only, with no dislocation then managed as a usual ligament sprain
-if minor subluxation- may reduce spontaneously, otherwise reduced in surgery

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14
Q

what is the role of the physiotherapist in wrist ligament sprains /. carpal instability ?

A

-activity modification
-splinting (OT)
-pain management - NSAIDS, meds
-strengthening exercise
-proprioception exercises

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15
Q

what are examples of good strengthening exercises for wrist instability ?

A

-flexor carpi radialis, extensor apri radialis etc
-avoid exercising extensor and flexor carpi ulnaris
-isometric in acute stage
-progression to concentric and eccentric through range

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16
Q

why is it not recommended to exercise the ECU and FCU?

A

as it can increase the scaphoid lunate distance

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17
Q

what is skiers / gamekeepers thumb?

A

-rupture of the ulnar collateral ligament of the thumb

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18
Q

what is the MOI of skiers thumb?

A

fall on the outstretched thumb

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19
Q

what are the symptoms of skiers thumb?

A

-pain & swelling at the base of the thumb
-pain using the thumb for pinching and gripping, opening jars, cars and door handles

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20
Q

what are the physical signs of skiers thumb?

A

-tenderness along the UCL
-instability & discomfort with stress testing of the ligament thumb in extension
-x rays to out rule avulsion fracture

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21
Q

how is skiers thumb managed conservatively?

A

-casting/ splinting the wrist and thumb for several weeks

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22
Q

what does the surgical treatment of skiers thumb involve?

A

-repair of the torn ligament with reattachment to the bone
-period of immobilisation

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23
Q

what is De Quervain’s tenosynovitis?

A

-inflammation of the APL and EPB tendons as they pass through their synovial sheath at the level of the radial styloid

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24
Q

what kind of injury is De Quervains Tenosynovitis?

A

overuse injury - ulnar deviation, thumb abduction

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25
Q

what kind of sports do we see De Quervains tenosynovitis in?

A

-rowers
-ten pin bowlers

26
Q

what are the signs and symptoms of De Quervains tenosynovitis?

A

-pain along the APL and EPB tendons
-tenderness on palpation
-crepitus - cracking noises etc
-thickening along the tendon
-difficulty gripping
-resisted thumb extension & abduction reproduced pain
-pain on stretching

27
Q

what is Finkelstein’s test?

A

test involves ulnar deviation of the wrist with the thumb adducted in the palm

28
Q

what does a positive Finkelstein’s test?

A

-pain over radial styloid

29
Q

what does the management of De Quiervains tenosynovitis?

A

-relative rest / activity modfication
-POLICE
-ROM / strength
-resting splint
-steroid injection
-electro modalities for healing eg lasers

30
Q

what is intersection syndrome?

A

bursitis where APL and EBP tendons cross over the ECR tendons

31
Q

what are the signs & symptoms of intersection syndrome?

A

-tenderness dorsally on the radial side of the wrist
-selling and creptis (proximal to site of De Quervains)

32
Q

what does the management of intersection syndrome involve?

A

-similar to DE Q - activity modification, POLICE etc
-surgery is rare

33
Q

what is carpal tunnel syndrome?

A

-compression of the medial nerve as it passes through the carpal tunnel

34
Q

what are the causes of carpal tunnel syndrome?

A

-inflammation and swelling within the carpal tunnel or reduction of the size of the tunnel
-trauma eg fractured distal radius
-repetitive strain keyboard use
-repeated gripping

35
Q

what conditions is carpal tunnel syndrome associated with?

A

-pregnancy
-obesity
-RA
-diabetes

36
Q

what are the symptoms of carpal tunnel syndrome?

A

-aching, burning sensation with P&N’s in median nerve distribution
-symptoms can cause person to wake at night
-loss of sensitivity if hand
-clumsiness

37
Q

what is important to rule out with carpal tunnel syndrome?

A

-cervical spine referral
-thoracic outlet syndrome - brachial plexus

38
Q

what would a neurological exam demonstrate with a patient suffering from carpal tunnel syndrome?

A

-loss of sensation
-may or may not have reduced strength in median nerve distribution

39
Q

how is carpal tunnel syndrome managed?

A

-reduce swelling and pressure on the nerve
-if overuse, address eg ergonomics - keyboard position etc
-restore ROM if reduced
-night / resting splint
-manual therapy - median nerve mobilisation
-NSAIDS / corticosteroid injection
-acupunture

39
Q

what are examples of special tests for carpal tunnel syndrome?

A

-phalen’s test
-tinel’s test
-neural tissue provocation test of median nerve

40
Q

what is ulnar nerve entrapment?

A

-when the ulnar nerve is compressed as it crosses the wrist at the tunnel of guyon

41
Q

what can cause ulnar nerve entrapment?

A

-trauma - fracture at wrist
-FCU tendinitis at pisiform
-cyclists
-using crutches or walking sticks
-may occur with cubital tunnel syndrome

42
Q

what are the signs and symptoms of ulnar nerve entrapment?

A

-may not complain of pain
-p&n’s over the ring and little fingers
-loss of sensation at the tip of the little finger
-management is similar to carpal tunnel syndrome

43
Q

what is duputyren’s contracture?

A

-thickening and contracture of the palmar fascia

44
Q

what is the aetiology of duputyren’s contracture?

A

-unknown
-middle aged men - common
-progressive and recurring

45
Q

what does the management of Duputyren’s contracture involve?

A

-corticosteroid injection - some benefit
-splinting, stretching , ultrasound etc

46
Q

what are ganglion cysts?

A

swelling on ganglion

47
Q

where can ganglion cysts be seen?

A

-FCR tendon sheath
-digital extensors
-roof of the first dorsal compartment

48
Q

what does the treatment of ganglion cysts involve?

A

-rest
-splinting
-surgical excision if unsuccessful

49
Q

what is mallet finger?

A

-avulsion of extensor mechanism (tendon)

50
Q

what is the MOI of mallet finger?

A

-can occur with basketball, cricket and baseball

51
Q

what does Mallet finger result in?

A
  • flexion deformity of DIP
52
Q

how is a mallet finger managed?

A

-splinting for 6-8 weeks with mallet splint

53
Q

what is trigger finger?

A

-tenosynovitis of the flexor policies longus or other deep flexor tendon
-overuse injury

54
Q

what kinds of people is trigger finger common in?

A

-musicians
-gardeners
-construction workers
-activities involving repetitive gripping

55
Q

what are the symptoms of trigger finger?

A

-pain in finger
-sensation of catching or triggering of the involved digit
-the finger may actually lock in flexion or extension
-symptoms are usually worse in the morning and improve during the day

56
Q

what are the signs of trigger finger?

A

-tenderness along the flexor tendon sheath, especially at the A1 pulley in the palm
-nodule may be felt moving under the pulley with finger mvt
-locking or catching is classic

57
Q

what does the management of trigger finger involve?

A

-NSAIDS
-corticosteroid injections
-physio intervention is not useful

58
Q

what functions does FDP have?

A

-flex the wrist
flex the MCP
-flex PIP
-flex DIP

59
Q

what does the MOI of a rupture of the FDP involve?

A

-forceful hyperextension of DIP joint with FDP in maximal contraction
-eg sudden jerk of rope, such as starting a lawnmower or retraining an animal on lead

60
Q
A

NMSK 2 - upper limb (16 decks)

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