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KNSS 220 Athletic Therapy > Elbow to Hand > Flashcards

Elbow to Hand Flashcards

1
Q

Medial epicondyle =

A

flexors

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2
Q

Lateral epicondyle =

A

extensors

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3
Q

How many ROM at PIP and DIP?

A

2

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4
Q

How many ROM at wrist?

A

6

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5
Q

How many ROM at elbow?

A

4

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6
Q

How many ROM at MCP?

A
  • 4 at fingers

- 5 at thumb

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7
Q

What is the 5th ROM for the thumb at the MCP?

A
  • Diagonal​ ​motion
  • Opposition
  • What​ ​allows​ ​you​ ​to​ ​make​ ​grips​ ​with​ ​fingertips
  • 5th​ ​ROM
  • Only​ ​done​ ​actively
  • 5​ ​ROM​ ​at​ ​MCP​ ​of​ ​thumb
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8
Q

Flexion of the fingers is…

A

bringing the fingers into the palm

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9
Q

Extension of the fingers is …

A

fingers away from the palm

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10
Q

Adduction of the fingers is…

A

bringing fingers together

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11
Q

Abduction of the fingers is…

A

spreading fingers apart

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12
Q

Muscles​ ​at​ ​front​ ​of​ ​arm​ ​in​ ​anatomical​ ​position​ ​are​…

A

flexors

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13
Q

Wrist​ ​flexors​ ​generally​ ​start​ ​at​ ​the​…

A

​medial​ ​epicondyle​ ​(common​ ​flexor​ ​origin)

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14
Q

Muscles​ ​at​ ​back​ ​of​ ​arm​ ​in​ ​anatomical​ ​position​ ​are​…

A

extensors

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15
Q

Wrist​ ​extensors​ ​generally​ ​start​ ​at​ ​the …

A

lateral​ ​epicondyle​ ​(common​ ​extensor​ ​origin)

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16
Q

Describe the base of the thumb muscles.

A
  • Make​ ​movement​ ​of​ ​thumb​ ​more​ ​controlled:​ ​thenar​ ​eminence
  • 3​ ​muscles
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17
Q

Describe the base of the pinky muscles.

A
  • Hypothenar​ ​eminance

- 3​ ​muscles

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18
Q

What are PAD muscles?

A

Muscles​ ​on​ ​palm​ ​side​ ​of​ ​hand​ ​and​ ​adduct​ ​fingers​ ​together

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19
Q

What are DAB muscles?

A

Muscles​ ​on​ ​dorsal​ ​(back)​ ​of​ ​hand​ ​abduct​ ​fingers​ ​apart

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20
Q

The brachial artery splits into what?

A
  • radial artery

- ulnar artery

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21
Q

Where does the radial nerve run?

A

posterior​ ​surface​ ​of​ ​arm:​ ​triceps,​ ​extensor​ ​etc.

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22
Q

Where does the median nerve run?

A

anterior​ ​surface​ ​of​ ​arm,​ ​down​ ​to​ ​thumb,​ ​index,​ ​and​ ​middle​ ​finger

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23
Q

Where does the ulnar nerve run?

A

medial​ ​surface​ ​of​ ​arm​ ​down​ ​to​ ​pinky​ ​and​ ​ring​ ​fingers

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24
Q

What is the special condition for the elbow and hand?

A

carrying angle

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25
Q

Describe carrying angle.

A
  • Carrying​ ​angle
  • Stand,​ ​put​ ​arms​ ​in​ ​anatomical​ ​position
  • Arm​ ​straight​ ​down​ ​=​ ​0​ ​degrees,​ ​any​ ​deviation
  • In​ ​most​ ​people​ ​:​ ​15​ ​degrees
  • Arms​ ​do​ ​not​ ​run​ ​into​ ​legs​ ​when​ ​walking
  • Carrying​ ​things​ ​won’t​ ​run​ ​into​ ​body
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26
Q

Lateral and medial epicondylitis are considered ______ injuries.

A

Overuse

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27
Q

Medial epicondyle is commonly known as …

A

golfer’s elbow

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28
Q

Lateral epicondyle is commonly known as …

A

tennis elbow

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29
Q

Why can’t we use the terms golfer’s elbow and tennis elbow?

A

they can change based on MOI

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30
Q

Wrist​ ​flexors​ ​are​ ​working​ ​too​ ​much​ ​=​

A

​inflammation​ ​at​ ​medial​ ​epicondyle

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31
Q

Wrist​ ​extensors​ ​are​ ​working​ ​too​ ​much​ ​=

A

inflammation​ ​at​ ​lateral​ ​epicondyle

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32
Q

Which epicondylitis is more common?

A

lateral

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33
Q

What are the signs and symptoms of lateral and medial epicondylitis?

A
  • Low​ ​grade​ ​chronic​ ​local​ ​inflammation
  • Movement​ ​causing​ ​the​ ​muscles​ ​to​ ​contract​ ​will​ ​be​ ​painful
  • Pain​ ​with​ ​palpating​ ​muscles:​ ​tight​ ​and​ ​sore
  • Can​ ​get​ ​irritation​ ​of​ ​ulnar​ ​nerve​ ​with​ ​medial​ ​epicondylitis
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34
Q

Continued epicondylitis can lead to …

A
  • Can​ ​gradually​ ​decrease​ ​their​ ​ROM​ ​at​ ​the​ ​elbow
  • Can​ ​make​ ​it​ ​harder​ ​to​ ​flex​ ​or​ ​extend​ ​the​ ​elbow​ ​fully
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35
Q

What are the 4 general stages of overuse injuries?

A
  • Stage​ ​1:​ ​Starts​ ​only​ ​being​ ​painful​ ​after​ ​activities
  • Stage​ ​2:​ ​Starts​ ​being​ ​painful​ ​at​ ​end​ ​of​ ​event​ ​and​ ​after
  • Stage​ ​3:​ ​Starts​ ​affecting​ ​their​ ​performance,​ ​painful​ ​during​ ​as​ ​well​ ​as​ ​after
  • Stage​ ​4:​ ​Hurts​ ​all​ ​the​ ​time
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36
Q

Give an example of correcting faulty mechanics that cause epicondylitis.

A

somebody​ ​who​ ​plays​ ​tennis​ ​and​ ​does​ ​more​ ​wrist​ ​movement​ ​than​ ​arm movement

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37
Q

How do we manage lateral or medial epicondylitis?

A
  • correct faulty mechanics
  • Calm​ ​down​ ​symptoms
  • Calm​ ​down​ ​swelling,​ ​spasm,​ ​pain
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38
Q

Describe the braces that people often wear when they have lateral or medial epicondylitis?

A
  • Straps​ ​that​ ​go​ ​around
  • Bubble​ ​that​ ​goes​ ​overtop​ ​point​ ​of​ ​pain
  • Won’t​ ​actually​ ​solve​ ​problem
  • Designed​ ​to​ ​put​ ​pressure​ ​just​ ​below​ ​where​ ​you​ ​have​ ​pain,​ ​so​ ​that​ ​the​ ​part​ ​above that​ ​is​ ​now​ ​not​ ​working
  • Solves​ ​pain​ ​issue,​ ​but​ ​not​ ​actually​ ​doing​ ​anything​ ​else
  • Can​ ​cause​ ​the​ ​next​ ​part​ ​to​ ​be​ ​tight/painful
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39
Q

What is the special test for epicondylitis?

A

stretch the muscles that would be tight

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40
Q

Describe the lateral epicondylitis test.

A
  • Extensors
  • Arm​ ​straight
  • Flex​ ​wrist
  • Hand​ ​overtop
  • Positive:​ ​pain​ ​at​ ​lateral​ ​epicondyle​ ​(not​ ​stretching)
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41
Q

Describe the medial epicondylitis test.

A
  • Flexors
  • Straight​ ​arm
  • Extend​ ​wrist​ ​and​ ​fingers
  • Hand​ ​overtop
  • Positive:​ ​pain​ ​at​ ​medial​ ​epicondyle​ ​(not​ ​stretching)
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42
Q

Why is the elbow the strongest joint in the body based on only bone structure? What does this mean for injury to it?

A
  • Fits​ ​together​ ​like​ ​a​ ​tight​ ​puzzle

- Requires​ ​the​ ​most​ ​violent​ ​force​ ​to​ ​dislocate

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43
Q

What is the MOI for elbow dislocation?

A
  • Foosh​ ​when​ ​arm​ ​is​ ​already​ ​in​ ​hyperextension

- Arm​ ​in​ ​flexion,​ ​violent​ ​twist

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44
Q

What is the most common direction to dislocate the elbow?

A
  • Most​ ​common​ ​to​ ​pop​ ​ulna​ ​out​ ​backwards

- Can​ ​go​ ​in​ ​any​ ​other​ ​direction​ ​depending​ ​on​ ​force​ ​but​ ​not​ ​that​ ​common

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45
Q

Dislocating the elbow usually comes with …

A
  • Complete​ ​rupture​ ​of​ ​all​ ​of​ ​our​ ​ligaments,​ ​most​ ​of​ ​muscles
  • Common​ ​to​ ​fracture​ ​radial​ ​head
  • Dislocation​ ​backwards​ ​means​ ​it​ ​rams​ ​into​ ​humerus
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46
Q

Do elbows sublux?

A

no, ​need​ ​to​ ​go​ ​to​ ​hospital​ ​to​ ​put​ ​back​ ​in​ ​place

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47
Q

What are the signs and symptoms of a dislocated elbow?

A
  • Lots​ ​of​ ​bruising​ ​and​ ​bleeding
  • Lots​ ​of​ ​blood​ ​flow​ ​in​ ​front​ ​of​ ​elbow
  • Lots​ ​of​ ​swelling
  • Very​ ​common​ ​to​ ​have​ ​nerve​ ​symptoms​ ​down​ ​the​ ​hand
  • Tingling
  • Numbness
  • No​ ​pulse​ ​=​ ​ambulance
  • Tingling​ ​and​ ​numbness​ ​=​ ​ambulance
  • Almost​ ​always​ ​call​ ​ambulance
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48
Q

How do we manage elbow dislocations?

A
  • Surgically​ ​repaired
  • Very​ ​lucky​ ​to​ ​get​ ​them​ ​back​ ​to​ ​80%​ ​ROM​ ​and​ ​80%​ ​strength
  • 2​ ​years​ ​recovery
  • 2​ ​seasons​ ​or​ ​career​ ​ending
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49
Q

What is the MOI for olecranon bursitis?

A
  • Hit​ ​elbows​ ​lots
  • Bursa​ ​on​ ​elbow
  • Using​ ​elbows​ ​as​ ​leverage​ ​tool​ ​at​ ​work
  • Overuse​ ​injury
  • ***Exception​ ​of​ ​1​ ​acute​ ​trauma
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50
Q

What is the exception of 1 acute trauma for olecranon bursitis?

A
  • Ex.​ ​falling​ ​on​ ​elbow​ ​in​ ​hockey​ ​with​ ​no​ ​elbow​ ​pads
  • Active​ ​acute​ ​bursitis
  • Amount​ ​of​ ​trauma​ ​can​ ​almost​ ​rupture​ ​bursa
  • Needs​ ​to​ ​be​ ​drained
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51
Q

What are the signs and symptoms of olecranon bursitis?

A
  • Inflammation​ ​at​ ​bottom​ ​of​ ​elbow
  • Causes​ ​pain
  • Every​ ​time​ ​you​ ​hit​ ​elbow​ ​=​ ​pain
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52
Q

How do we manage chronic olecranon bursitis?

A
  • Decrease​ ​swelling
  • Decrease​ ​pain
  • Current
  • Laser
  • Elbow​ ​can​ ​permanently​ ​look​ ​like​ ​that​ ​from​ ​scar​ ​tissue​ ​buildup
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53
Q

How do we manage acute olecranon bursitis?

A

Drain​ ​in​ ​arm​ ​that​ ​continues​ ​to​ ​drain​ ​fluid

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54
Q

Fractures are specific to the …

A

radius and ulna

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55
Q

Where do the radius and ulna fracture?

A
  • can do one or both

- can fracture anywhere along the bone due to the amount of trauma they see

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56
Q

Mid shaft fractures of the radius and ulna is a result of a ….

A

direct blow

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57
Q

What can FOOSH do to the radius and ulna?

A
  • can​ ​crush​ ​bones​ ​up​ ​and​ ​down

- fractures at top or bottom

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58
Q

Why are the radius and ulna often displaced when fractured?

A

Lots​ ​of​ ​muscles​ ​that​ ​can​ ​create​ ​lots​ ​of​ ​force​ ​can​ ​displace​ ​bones,​ ​pull​ ​it​ ​out​ ​of​ ​place

59
Q

What are the signs and symptoms of radius and ulna fractures?

A
  • Will​ ​always​ ​see​ ​a​ ​deformity
  • Arteries​ ​and​ ​nerves​ ​run​ ​right​ ​next​ ​to​ ​the​ ​bones,​ ​can​ ​disrupt​ ​these
  • Bleeding,​ ​lack​ ​of​ ​pulse
  • Tingling,​ ​numb
60
Q

How do we splint radius and ulna fractures?

A

in the position we find them

61
Q

How do we manage radius and ulna fractures?

A
  • X​ ​rayed​ ​multiple​ ​times​ ​to​ ​make​ ​sure​ ​everything​ ​is​ ​back​ ​in​ ​the​ ​right​ ​spot
  • Might​ ​have​ ​pins​ ​and​ ​plates​ ​if​ ​they​ ​can’t​ ​get​ ​bones​ ​to​ ​stay​ ​together
  • Likely​ ​to​ ​have​ ​temporary​ ​pins​ ​and​ ​plates,​ ​will​ ​be​ ​removed
  • Braced​ ​or​ ​casted​ ​for​ ​a​ ​period​ ​of​ ​time
  • Need​ ​to​ ​get​ ​ROM​ ​and​ ​strength​ ​back
62
Q

What are the complications that can arise from using pins and plates for radius and ulna fractures?

A
  • Pins​ ​and​ ​plates​ ​will​ ​generally​ ​restrict​ ​ROM​ ​(less​ ​active,​ ​less​ ​healing)
  • ​superficial​ ​pins​ ​and​ ​plates: can​ ​have​ ​problem​ ​with​ ​electric​ ​current​ ​on​ ​it
63
Q

What is the special test for radius and ulna fractures?

A
  • Compression

- Tuning​ ​fork

64
Q

How does the tuning fork work?

A
  • Creates​ ​vibration​ ​that​ ​travels​ ​through​ ​bone

- Helps​ ​find​ ​fractures,​ ​finds​ ​if​ ​they​ ​are​ ​healed

65
Q

What is the MOI for muscle strains and ruptures in the wrist and forearm?

A

Violent​ ​contractions​ ​or​ ​violent​ ​stretches​ ​of​ ​muscles​ ​beyond​ ​ROM

66
Q

What are the signs and symptoms of a grade 1 muscle strain in the wrist and forearm?

A
  • Mild
  • Mild​ ​symptoms
  • Stretching
67
Q

What are the signs and symptoms of a grade 2 muscle strain in the wrist and forearm?

A
  • Damage
  • Tearing
  • Loss​ ​of​ ​function​ ​(muscle​ ​contraction)
68
Q

What are the signs and symptoms of a grade 3 muscle rupture in the wrist and forearm?

A
  • Rupture
  • Very​ ​difficult​ ​to​ ​do​ ​this​ ​because​ ​there​ ​are​ ​so​ ​many​ ​muscles​ ​helping​ ​each​ ​other out
  • Generally​ ​a​ ​direct​ ​blow​ ​or​ ​avulsion​ ​fracture​ ​(fracture​ ​off​ ​tendon​ ​attachment)
69
Q

What is the special test for muscle strains and ruptures in the wrist and forearm?

A

resisted ROM

70
Q

What is resisted ROM testing?

A
  • Pain​ ​=​ ​1st​ ​degree
  • Pain​ ​+​ ​lack​ ​of​ ​strength​ ​=​ ​2nd​ ​degree
  • No​ ​strength​ ​=​ ​3rd​ ​degree
71
Q

How do you manage muscle strains and ruptures in the wrist and forearm?

A
  • Surgically​ ​repaired​ ​for​ ​ruptures
  • Work​ ​on​ ​ROM
  • Work​ ​on​ ​strength
  • Dexterity
72
Q

Describe dexterity.

A
  • Ability​ ​to​ ​do​ ​pincer​ ​or​ ​whole​ ​hand​ ​grips

- Fine​ ​tuning​ ​of​ ​movement

73
Q

Describe the ligaments of the elbow.

A
  • Annular​ ​ligament​ ​goes​ ​around​ ​the​ ​head​ ​of​ ​the​ ​radius​ ​and​ ​holds​ ​it​ ​to​ ​the​ ​ulna
  • Ulnar​ ​ligament
  • Radial​ ​ligament
74
Q

Describe the ligaments of the wrist.

A
  • Most​ ​ligaments​ ​are​ ​called​ ​where​ ​they​ ​are
  • Ulnar​ ​ligament​ ​(medial​ ​side​ ​in​ ​anatomical​ ​position)
  • Radial​ ​ligament​ ​(lateral​ ​side​ ​in​ ​anatomical​ ​position)
75
Q

Describe the ligaments of the fingers.

A
  • Ulnar​ ​collateral​ ​ligament​ ​on​ ​medial​ ​side​ ​of​ ​each​ ​finger
  • Radial​ ​collateral​ ​ligaments​ ​on​ ​each​ ​finger
  • Ligaments​ ​on​ ​front​ ​and​ ​back​ ​surfaces
  • Volar​ ​ligaments​ ​on​ ​front​ ​(palm​ ​side)
  • Dorsal​ ​ligaments​ ​on​ ​posterior​ ​side​ ​of​ ​hand
  • Can​ ​sprain​ ​any​ ​depending​ ​on​ ​MOI
76
Q

What is the MOI of elbow sprains?

A
  • ​valgus​ ​force​ ​or​ ​varus​ ​force
  • Valgus​ ​force​ ​more​ ​common
  • Only​ ​sprain​ ​in​ ​the​ ​body​ ​that​ ​is​ ​related​ ​to​ ​overuse
77
Q

What people often sprain their ulnar collateral ligament?

A
  • baseball pitchers
  • Throwing​ ​a​ ​baseball​ ​is​ ​valgus​ ​force​ ​on​ ​ulnar​ ​collateral​ ​ligament
  • Can​ ​create​ ​ulnar​ ​collateral​ ​ligament​ ​sprain​ ​from​ ​just​ ​one​ ​trauma,​ ​but​ ​most pitchers​ ​will​ ​see​ ​it​ ​from​ ​multiple​ ​traumas
78
Q

What is Tommy John surgery?

A

Replacing​ ​and​ ​reinforcing​ ​the​ ​ulnar​ ​collateral​ ​ligament

79
Q

What is the most common MOI of wrist sprains?

A

fall into hyperextension

80
Q

Describe what is sprained in the wrist when falling into hyperextension.

A
  • Will​ ​sprain​ ​any​ ​ligament​ ​on​ ​the​ ​front​ ​side
  • If​ ​they​ ​have​ ​a​ ​little​ ​bit​ ​of​ ​radial​ ​or​ ​ulnar​ ​deviation​ ​we​ ​can​ ​see​ ​collateral​ ​ligament sprains​ ​as​ ​well
81
Q

Describe finger sprains.

A
  • Some​ ​sort​ ​of​ ​force​ ​that​ ​looks​ ​like​ ​dislocation​ ​force​ ​(varus,​ ​valgus)
  • Jammed​ ​straight​ ​down​ ​will​ ​still​ ​create​ ​a​ ​sprain
  • 1st,​ ​2nd,​ ​3rd​ ​degree
82
Q

How do we manage elbow, wrist, and finger sprains?

A
  • immobilize for a longer period of time
  • difficult to put modalities on them (esp. finger)
  • tend to use laser, manual therapy
  • cross friction to break down scar tissue
  • normal rehab at elbow and wrist
83
Q

Why do we immobilize elbow, wrist, and finger sprains for a longer period of time?

A
  • to​ ​make​ ​them​ ​scar​ ​down​ ​so​ ​that​ ​they​ ​are​ ​stable​ ​in
    that​ ​joint
  • Doesn’t​ ​mean​ ​that​ ​they​ ​are​ ​restricted​ ​from​ ​play
  • Keep​ ​joint​ ​in​ ​tight​ ​position
84
Q

Why do we use laser and manual therapy for elbow, wrist, and finger sprains?

A

Want​ ​scar​ ​tissue​ ​to​ ​begin​ ​with,​ ​but​ ​want​ ​them​ ​to​ ​go​ ​down​ ​eventually

85
Q

What will too much scar tissue after elbow, wrist, and finger sprains do?

A
  • decrease​ ​ROM

- If​ ​fingers​ ​can’t​ ​come​ ​together,​ ​they​ ​are​ ​weaker

86
Q

Describe what normal rehab at elbow and wrist look like.

A
  • Make​ ​them​ ​as​ ​strong​ ​as​ ​you​ ​possibly​ ​can
  • Work​ ​on​ ​ROM
  • Make​ ​sure​ ​they​ ​have​ ​full​ ​ability​ ​to​ ​do​ ​their​ ​sport
  • Make​ ​sure​ ​they​ ​still​ ​have​ ​their​ ​dexterity
  • Make​ ​sure​ ​they​ ​still​ ​have​ ​sensation​ ​in​ ​all​ ​fingers
  • Tend​ ​to​ ​have​ ​less​ ​impact​ ​on​ ​cardio,​ ​flexibility,​ ​and​ ​proprioception
87
Q

What is the special test for elbow, wrist, and finger sprains?

A

varus and valgus stress test

88
Q

Describe varus and valgus stress tests.

A
  • Only​ ​done​ ​in​ ​full​ ​extension
  • 1st​ ​degree:​ ​just​ ​pain,​ ​no​ ​laxity
  • 2nd​ ​degree:​ ​pain​ ​and​ ​laxity
  • 3rd​ ​degree:​ ​no​ ​pain,​ ​lots​ ​of​ ​laxity
  • 3rd​ ​degree​ ​finger​ ​sprain​ ​is​ ​typically​ ​a​ ​dislocation
89
Q

Why are varus and valgus stress tests different in the wrist and fingers?

A
  • because​ ​they​ ​have​ ​that​ ​ROM

- Take​ ​them​ ​to​ ​the​ ​end​ ​of​ ​their​ ​ROM​ ​and​ ​then​ ​do​ ​the​ ​stress​ ​test

90
Q

What is the MOI of carpal tunnel syndrome?

A
  • Overuse​ ​at​ ​the​ ​wrist
  • ​repetitive​ ​movement​ ​at​ ​the​ ​wrist​ ​(generally​ ​wrist​ ​flexion)
  • Or​ ​repeated​ ​contusion​ ​trauma
91
Q

Wrist pain is usually diagnosed as …

A

carpal tunnel syndrome

92
Q

What is happening anatomically for someone with carpal tunnel syndrome?

A
  • Happens​ ​specifically​ ​at​ ​the​ ​carpal​ ​tunnel
  • At​ ​crease​ ​in​ ​wrist
  • Carpal​ ​bones
  • Sheath​ ​of​ ​muscle​ ​around
  • Bones​ ​and​ ​muscle​ ​form​ ​tunnel​ ​with​ ​nerves​ ​and​ ​vessels​ ​passing​ ​through
93
Q

Describe the inflammation that blocks the carpal tunnel.

A
  • One​ ​or​ ​more​ ​of​ ​the​ ​tendons​ ​are​ ​inflamed

- Or​ ​inflammation​ ​because​ ​of​ ​some​ ​sort​ ​of​ ​contusion

94
Q

What nerves come through the carpal tunnel?

A
  • Ulnar​ ​nerve

- median​ ​nerve​

95
Q

What are the signs and symptoms of carpal tunnel syndrome?

A
  • Pins​ ​and​ ​needles​ ​or​ ​numbness​ ​in​ ​hand​ ​from​ ​inflammation
  • Nerve​ ​symptoms​ ​can​ ​be​ ​sensory​ ​or​ ​motor​ ​(can’t​ ​move​ ​or​ ​decreased​ ​strength)
  • Pain​ ​at​ ​the​ ​tunnel
  • Generally​ ​gets​ ​to​ ​the​ ​stage​ ​where​ ​they​ ​have​ ​decreased​ ​sensation​ ​or​ ​motor​ ​function​ ​at the​ ​hand
96
Q

How do we manage carpal tunnel syndrome?

A
  • Correct​ ​faulty​ ​biomechanics
  • Decrease​ ​inflammation​ ​that​ ​is​ ​causing​ ​the​ ​symptoms
  • Current
  • Laser
  • Ultrasound
  • Usually​ ​can’t​ ​stop​ ​the​ ​inflammation/action
97
Q

Describe carpal tunnel surgery.

A
  • Designed​ ​to​ ​relieve​ ​the​ ​symptoms​ ​but​ ​not​ ​necessarily​ ​correct​ ​the​ ​problem
  • Cut​ ​retinaculum​ ​at​ ​top​ ​to​ ​relieve​ ​pressure
  • Loosen​ ​anything​ ​that​ ​is​ ​stuck​ ​together
  • Doesn’t​ ​actually​ ​solve​ ​the​ ​problem​ ​why​ ​they​ ​have​ ​it​ ​in​ ​the​ ​first​ ​place
  • Doesn’t​ ​get​ ​rid​ ​of​ ​the​ ​inflammation
  • Decrease​ ​scar​ ​tissue​ ​from​ ​where​ ​they​ ​did​ ​surgery
98
Q

What is the special test for carpal tunnel syndrome?

A

phalens test

99
Q

Describe the phalens test.

A
  • Wrists​ ​together​ ​so​ ​they​ ​flex​ ​carpal​ ​tunnel
  • Hold​ ​this​ ​position​ ​for​ ​a​ ​minute
  • Positive:​ ​Pain​ ​in​ ​the​ ​wrist
  • Positive:​ ​Sensory​ ​of​ ​motor​ ​symptoms​ ​into​ ​hands
100
Q

What is false carpal tunnel syndrome?

A
  • Pain​ ​at​ ​front​ ​of​ ​forearm​ ​and​ ​wrist
  • Can​ ​give​ ​you​ ​neurological​ ​symptoms​ ​down​ ​arm
  • Not​ ​caused​ ​by​ ​MOI​ ​directly​ ​to​ ​the​ ​wrist
  • Tightness​ ​in​ ​neck,​ ​shoulder,​ ​traps​ ​that​ ​presses​ ​on​ ​a​ ​nerve​ ​can​ ​send​ ​symptoms​ ​down arm
  • Referred​ ​pain
  • Ex.​ ​concert​ ​pianist,​ ​secretary
101
Q

What is the most common fracture in the wrist?

A
  • scaphoid fracture

- Very​ ​common​ ​in​ ​skiers​ ​and​ ​snowboarders​ ​(thumbs​ ​down​ ​first)

102
Q

Describe the location and shape of the scaphoid.

A
  • Bone​ ​in​ ​the​ ​middle​ ​of​ ​anatomical​ ​snuff​ ​box
  • Scaphoid​ ​is​ ​shaped​ ​like​ ​a​ ​bowtie
  • 2​ ​different​ ​pieces:​ ​easy​ ​to​ ​fracture​ ​down​ ​the​ ​middle
  • very difficult to see on x ray
  • less blood supply to that part of the bone (thin bone)
103
Q

What is the MOI of a scaphoid fracture?

A
  • FOOSH
  • Generally​ ​more​ ​of​ ​their​ ​weight​ ​on​ ​the​ ​front​ ​side
  • Putting​ ​pressure​ ​on​ ​the​ ​scaphoid​ ​bone
104
Q

Why is having a thin scaphoid a problem?

A
  • Decreased​ ​healing​ ​ability​ ​=​ ​necrosis​ ​(tissue​ ​break​ ​down)
  • Bone​ ​physically​ ​breaks​ ​down​ ​between​ ​2​ ​pieces​ ​of​ scaphoid​ ​=​ ​scaphoid permanently​ ​in​ ​2​ ​pieces
105
Q

What are the signs and symptoms of a scaphoid fracture?

A
  • Decreased​ ​ROM​ ​in​ ​all​ ​planes
  • Pain​ ​in​ ​snuff​ ​box​ ​with​ ​movement​ ​in​ ​thumb
  • Bruising​ ​on​ ​base​ ​of​ ​thumb​ ​(palm)
106
Q

How do we manage scaphoid fractures in a cast?

A
  • Forearm​ ​cast​ ​up​ ​to​ ​thumb
  • Cast​ ​for​ ​generally​ ​6​ ​weeks
  • No​ ​movement​ ​in​ ​thumb​ ​or​ ​only​ ​at​ ​IP​ ​joint
  • Get​ ​bones​ ​lying​ ​close​ ​as​ ​they​ ​can
  • Re​ ​x​ ​ray​ ​every​ ​couple​ ​of​ ​weeks​ ​for​ ​6​ ​weeks​ ​to​ ​make​ ​sure​ ​that​ ​healing​ ​is​ ​proper
107
Q

How do we manage scaphoid fractures once the cast is off?

A
  • Once​ ​cast​ ​is​ ​off,​ ​increase​ ​ROM,​ ​increase​ ​strength​ ​in​ ​wrist​ ​as​ ​well​ ​as​ ​both​ ​of​ ​their​ ​thumb joints
  • Do​ ​all​ ​regular​ ​modalities​ ​once​ ​out​ ​of​ ​cast
  • Generally​ ​do​ ​not​ ​ultrasound​ ​over​ ​fractures​ ​or​ ​healed​ ​fractures​ ​for​ ​at​ ​least​ ​a​ ​year
108
Q

What would having 2 separate pieces of scaphoid do?

A

could​ ​decrease​ ​some​ ​ROM​ ​but​ ​won’t​ ​affect​ ​lifestyle​ ​too
much

109
Q

What is the special test for scaphoid fractures?

A

long bone pressure

110
Q

Describe the long bone pressure test.

A
  • Bend​ ​thumb​ ​and​ ​mcp​ ​and​ ​push​ ​down

- Positive:​ ​pain​ ​where​ ​scaphoid​ ​is

111
Q

Fractures of MCP, PIP, and DIP joints =

A
  • broken

- little pieces of bone could be floating around

112
Q

Dislocation of MCP, PIP, and DIP joints =

A

separation

113
Q

_____ and ______ of MCP, PIP, and DIP joints usually come together.

A

fractures and dislocations

114
Q

______ are easier to deal with in the hand than _______.

A

dislocations, fractures

115
Q

What is the MOI of MCP, PIP, and DIP dislocations?

A
  • generally​ ​a​ ​force​ ​to​ ​any​ ​one​ ​of​ ​sides

- Biggest​ ​dislocations​ ​with​ ​varus​ ​or​ ​valgus​ ​force​ ​at​ ​one​ ​joint

116
Q

What is the MOI of MCP, PIP, and DIP fractures?

A
  • ​axial​ ​load

- Load​ ​going​ ​straight​ ​down​ ​through​ ​the​ ​bone

117
Q

What is the MOI of MCP, PIP, and DIP dislocations and fractures?

A

rotation

118
Q

Pushing on a fractured bone in the hand usually…

A

moves fracture

119
Q

How will most people try to relocate their own fingers?

A
  • One​ ​pull​ ​from​ ​the​ ​end
  • Still​ ​need​ ​to​ ​go​ ​to​ ​the​ ​hospital​ ​to​ ​make​ ​sure​ ​nothing​ ​is​ ​fractured,​ ​everything​ ​is​ ​in the​ ​right​ ​place
120
Q

How do we manage MCP, PIP and DIP dislocations?

A
  • Put​ ​bones​ ​back​ ​together,​ ​stabilize​ ​until​ ​it​ ​scars
  • not​ ​necessarily​ ​be​ ​mandatory​ ​stabilized
121
Q

How do we manage MCP, PIP and DIP fractures?

A
  • mandatory​ ​immobilization

- Usually​ ​plastic​ ​splints​ ​(used​ ​to​ ​be​ ​metal)

122
Q

Why do we use plastic splints?

A
  • Easier​ ​to​ ​not​ ​have​ ​to​ ​take​ ​off​ ​if​ ​they​ ​have​ ​to​ ​x​ ​ray​ ​again
  • Protects​ ​whole​ ​finger
123
Q

What are the rules for finger taping?

A
  • Can’t​ ​leave​ ​pinky​ ​out​ ​by​ ​itself
  • Must​ ​be​ ​taped​ ​4-5,​ ​2-3
  • Can​ ​put​ ​3-4-5​ ​if​ ​needed
  • Not​ ​allowed​ ​to​ ​tape​ ​finger​ ​by​ ​himself​ ​for​ ​6-8​ ​weeks
124
Q

How long does the MCP, PIP, and DIP joints take to heal?

A
  • Average​ ​of​ ​6​ ​weeks​ ​to​ ​heal​ ​joint
  • Can​ ​be​ ​8​ ​weeks​ ​if​ ​more​ ​complicated
  • Must​ ​tape​ ​their​ ​fingers​ ​together​ ​or​ ​wear​ ​brace​ ​for​ ​this​ ​period
  • Can​ ​take​ ​it​ ​off​ ​and​ ​work​ ​on​ ​ROM​ ​after​ ​week​ ​2-3
  • Tend​ ​to​ ​be​ ​long​ ​standing​ ​because​ ​people​ ​don’t​ ​tend​ ​to​ ​rehab​ ​or​ ​take​ ​care​ ​of​ ​them
125
Q

What ROM exercises should we do for MCP, PIP, and DIP joints?

A
  • Both​ ​flexion​ ​and​ ​extension
  • More​ ​concerned​ ​about​ ​full​ ​extension​ ​(muscles​ ​that​ ​do​ ​this​ ​are​ ​not as​ ​strong)
  • More​ ​flexion​ ​activities​ ​with​ ​hand,​ ​but​ ​have​ ​big​ ​impact​ ​on​ ​life​ ​if​ ​they can’t​ ​extend​ ​fingers
  • Use​ ​elastic​ ​band​ ​for​ ​exercises
126
Q

What is the special test for dislocations of the MCP, PIP, and DIP joints?

A

no special test

127
Q

What is the special test for fractures of the MCP, PIP, and DIP joints?

A
  • Palpating

- Tuning​ ​fork

128
Q

What happens in jersey finger?

A

strain to the flexor tendon

129
Q

What is the MOI for jersey finger?

A

finger​ ​gets​ ​caught​ ​and​ ​pulled​ ​into​ ​extension

130
Q

What are the signs and symptoms of a grade 1 jersey finger?

A
  • Mild
  • Stretch
  • Can​ ​physically​ ​move​ ​it
  • Pain​ ​in​ ​palm​ ​surface​ ​of​ ​finger​ ​that​ ​was​ ​affected
131
Q

What are the signs and symptoms of a grade 2 jersey finger?

A
  • Torn​ ​part​ ​of​ ​it

- Decreased​ ​ability​ ​to​ ​flex​ ​finger

132
Q

What are the signs and symptoms of a grade 3 jersey finger?

A
  • Rupture
  • Usually​ ​ruptures​ ​from​ ​top​ ​of​ ​proximal​ ​phalange
  • Physically​ ​can​ ​not​ ​flex​ ​finger
  • Gets​ ​surgically​ ​repaired
133
Q

How do we manage jersey finger?

A
  • 3rd​ ​degree​ ​held​ ​in​ ​a​ ​brace​ ​in​ ​almost​ ​dislocation
  • 2-3​ ​weeks​ ​then​ ​exercises​ ​ROM,​ ​but​ ​put​ ​brace​ ​back​ ​on​ ​after
134
Q

What is gamekeeper’s thumb also known as? What is happening?

A
  • skier’s thumb
  • Ex.​ ​ski​ ​poles​ ​get​ ​stuck,​ ​hands​ ​keep​ ​going​ ​forward
  • Sprain​ ​to​ ​ulnar​ ​collateral​ ​ligament​ ​of​ ​MCP​ ​of​ ​thumb
  • On​ ​web-side​ ​of​ ​thumb​ ​at​ ​MCP​ ​joint
135
Q

What is the MOI of gamekeeper’s thumb?

A

abduction​ ​of​ ​MCP​ ​at​ ​thumb

136
Q

What are the signs and symptoms of a grade 1 gamekeeper’s thumb?

A
  • Mild
  • Pain
  • Local​ ​inflammation
137
Q

What are the signs and symptoms of a grade 2 gamekeeper’s thumb?

A
  • Tearing

- Laxity

138
Q

What are the signs and symptoms of a grade 3 gamekeeper’s thumb?

A
  • Rupture

- Rare​ ​to​ ​surgically​ ​repair​ ​because​ ​web​ ​will​ ​make​ ​sure​ ​thumb​ ​doesn’t​ ​go​ ​too​ ​far

139
Q

How do we manage gamekeeper’s thumb?

A

As​ ​much​ ​strength​ ​in​ ​thenar​ ​eminence​ ​as​ ​we​ ​can​ ​so​ ​that​ ​we​ ​can​ ​make​ ​thumb​ ​movements as​ ​strong​ ​as​ ​possible

140
Q

What is the special test for gamekeeper’s thumb?

A

valgus stress test

141
Q

Describe the valgus stress test for gamekeeper’s thumb.

A
  • 1st​ ​degree:​ ​Pain
  • 2nd​ ​degree:​ ​Pain​ ​with​ ​laxity
  • 3rd​ ​degree:​ ​Only​ ​laxity
142
Q

Why do we avoid metal for splints?

A
  • On​ ​route​ ​to​ ​hospital:​ ​needs​ ​to​ ​be​ ​removed​ ​for​ ​x-rays​ ​=​ ​uncomfortable
  • Comfort:​ ​metal​ ​gets​ ​cold
  • Usually​ ​only​ ​taped​ ​or​ ​plastic
  • We​ ​can​ ​melt​ ​and​ ​mold​ ​plastic
143
Q

What are we concerned about in rehab of the hand?

A
  • grip strength

- finger dexterity

KNSS 220 Athletic Therapy (14 decks)

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