Chapter 19 Wrist and Hand Conditions Flashcards
(38 cards)
What are wrist sprains and what are the S/S?
Axial loading on the proximal palm during a fall on an outstretched hand
Most common ligamentous instability – scaphoid and lunate
Gymnasts – high incidence of dorsal wrist pain when excessive forces are exerted on the wrist, producing combine hyperextension, ulnar deviation and intercarpal supination
S/S - point tenderness on dorsum of radiocarpal joint, POP distal radius, scaphoid, lunate, pain with active/passive extension
What is Gamekeeper’s thumb and what are the S/S?
Ulnar collateral ligaments sprain of the first MC joint
MOI – MP joint is near full extension and thumb is forcefully abducted away from hand
S/S – palmar aspect of the joint is painful, swollen, visible bruising, increased pain and weakness with opposition or pinching
Total rupture – valgus stress test greater than 15 degrees laxity
What is interphalangeal collateral ligament sprains and what are the S/S?
Excessive varus/valgus stress and hyperextension can damage the collateral ligaments of the fingers
Ligament failure occurs at its attachment to the proximal phalanx or in mid-portion
S/S – stiffness, pain and limited ROM, valgus/varus test positive
What is distal radioulnar joint injury?
Isolated injury or in conjunction with a radius fracture
MOI – hyperextension of the wrist
Ulnar dorsal dislocation – hyperpronation
Ulnar volar dislocation – hypersupination
Damage to TFCC possible
What is triangular fibrocartilage complex tear?
Five structures: the articular disk, which an elongated triangular structure is resting between the ulna/radius and lunate and triquetrum, deep and superficial layers of the subcruentum ligament, two disk-carpal ligaments
MOI – FOOSH, swinging bat/racquet, violently twisting their wrist
S/S – pain on ulnar side of wrist, increase pain with ulnar deviation
Management – takes up to 12 weeks to full repair
What are perilunate and lunate dislocations?
Shape of lunate and position between large capitate and lower end of radius, prone to dislocation
Perilunate dislocation – force impacts the carpals, distal row is displaced away from the lunate resulting in lunate resting dorsally
Lunate dislocation – dorsal ligaments rupture, relocation of the carpals and rotating the lunate, lunate rests in volar position
Repeated trauma – vascular compromise Kienbock disease
What is jersey finger?
Individual grips an opponent’s jersey with the opponent simultaneously twists and turns to get away
Jerking motion finger extends rapidly rupture of flexor digitorum Profundus from its attachment on distal phalanx
Ring finger most common
S/S – one finger in complete extension and the rest in slight flexion (10 degrees)
What is mallet finger?
Occurs when an object hits the end of the finger while the extensor tensor tendon is taut
Forceful flexion can avulse the lateral bands of the extensor mechanism from their distal attachment, or the tendon may remain attached to an avulsed piece of bone or fracture fragment
S/S – unable to extend the DIP joint
What is boutonnière deformity?
Caused by blunt trauma to the dorsal aspect of the PIP joint or by rapid, forceful flexion of the joint against resistance
Central slip of the extensor tendon ruptures at the middle phalanx, leaving no active extensor mechanism intact over the PIP joint
Pseudo-boutonnière deformity – injury to volar plate flexion deformity but central slip of the extensor tendon is not involved
S/S – hyperextension at the MP joint, flexion at the PIP joint, hyperextension at DIP joint
What is tendinitis?
overuse leading to derangement of both the mechanical and physiological components of the normal tendon
What is tenosynovitis?
tendon sheath is inflamed as a result of trauma, overuse or infection
What is trigger finger?
Multiple, severe traumas to the palmar aspect of the hand or in individuals who perform repeated movement and clenching of the fingers
Middle or ring finger
Repeated trauma and inflammation lead to a thickening of the tendon sheath as it passes over the proximal phalanx
Finger becomes locked in flexion when the nodule becomes too thick, or the sheath too constricted
What is De Quervain tenosynovitis?
Individuals who use a forceful grasp, combined with repetitive use of the thumb and ulnar deviation
Friction among the tendons, stenosing sheath and bony process
Abductor pollicis longus and extensor pollicis brevis
S/S – pain over radial styloid process that increases with thumb and wrist motion
What is intersection syndrome?
Tendinitis or friction tendinitis in the first and second dorsal compartments
Stenosing tenosynovitis of the sheath of the second compartment at the area where it traverses the muscle bellies of the first compartment
What is dupuytren contracture?
Nodules develop in the palmar aponeurosis – unknown reasons
Nodules limit finger extension causing a flexion deformity
S/S – fixed flexion deformity visible
What are ganglion cysts?
Benign tumour masses typically seen on the dorsal aspect of the wrist
Cyst – jellylike, colorless fluid or mucin and is freely mobile and palpable
What is subungal hematoma?
Direct trauma to the nail bed can result in blood forming under the fingernail
S/S – increase pressure under the nail bed due to hemorrhage throbbing pain
What is paronychia?
Infection along the nail fold, seen with hangnail whose hands are frequently immersed in water
S/S – nail fold becomes red, swollen, painful, produces purulent drainage
What is anterior interosseous nerve syndrome?
Occurs after a set of strenuous or repetitive elbow motion exercise
Compression of the nerve by fibrous bands from the deep head of the pronator teres or flexor digitorum superficialis
No sensory changes occur
Acute – individual suddenly loses use of the flexor pollicis longus and index finger profundus tendons
Slow – gradual weakness of muscles, especially during heavy activity
Median nerve
What is carpal tunnel syndrome?
Floor – volar wrist capsule
Roof – transverse retinacular ligament
Tunnel – median nerve, finger flexors, flexor pollicis longus irritation of synovial sheath covering tendons can produce swelling or edema that puts pressure on the median nerve
Movement of tendons and nerves during prolonged repetitive hand movements, direct trauma, anatomical anomalies
S/S – pain that awakens individual at night, NTB felt in finger tips, grip and pinch strength limited
What is ulnar tunnel syndrome?
Compression of ulnar nerve – occurs as the nerve enters the ulnar tunnel or deep branch curves around hook of hamate
Seen in people who experience repetitive compressive trauma to the palmar aspect of the hand
S/S – numbness in ulnar nerve distribution (little finger, unable to grasp paper between thumb and index finger)
What is cyclist’s palsy?
Occurs when a bike leans on the handlebars for an extended period of time
S/S – swelling in the hypothenar eminence, symptoms disappear rapidly after ride
Management – Padding on handlebars, wearing gloves
What is bowler’s thumb?
Compression of the ulnar digital sensory nerve in the medial aspect of the thumb in the webspace while gripping the ball
S/S – NTB on the medial aspect of the thumb, no true motor involvement but grip strength may be decreased secondary to pain
What is distal posterior interosseous nerve syndrome?
Compression of the distal posterior interosseous nerve as it passes dorsally over the distal radius
S/S – deep, dull ache produced with forceful wrist extension
