Elbow, Wrist, and Hand Flashcards
(124 cards)
1
Q
definition: Reflex neurovascular disease that is common after a Colle’s Fx occurs
A
RSD/CRPS/Shoulder-Hand Syndrome
2
Q
What is the most common syndrome after surgery and/or trauma?
A
RSD/CRPS/Shoulder-Hand Syndrome
3
Q
What are the s/s of RSD/CRPS/Shoulder-Hand Syndrome?
A
- pain or hyperesthesia at the shoulder, wrist, or hand
- limitation of shoulder ABD and ER
- limitation of Wrist EXT
- limitation of hand MCP and PIP FLX
- edema of dorsal hand and wrist
- vasomotor instability
- trophic skin changes
4
Q
(true/false) With progression of RSD/CRPS/Shoulder-Hand Syndrome over time… pain and ROM decrease.
A
true
5
Q
With progression of RSD/CRPS/Shoulder-Hand Syndrome over time… why does pain decrease, but ROM does not improve?
A
Because of the swelling/edema in the area
6
Q
What can you possibly develop with RSD/CRPS/Shoulder-Hand Syndrome?
A
CVA
MI
Cervical DJD
7
Q
(true/false) It can take up to 18-24 months to heal RSD/CRPS/Shoulder-Hand Syndrome
A
true
8
Q
definition: : compression of subclavian artery or brachial plexus due to cervical rib, tight anterior or middle scalene(s), tight pec minor or major, first rib and clavicle, trauma, (swelling guarding), postural dysfunction
A
TOS
9
Q
What muscles should you stretch when a patient has TOS?
A
pec mj/minor
scalenes
Lev scapulae
10
Q
What muscles should you strengthen when a patient has TOS?
A
scapular retractors
Upward rotators
shoulder ERs
thoracic extensors
11
Q
What is the most important part of treatment for TOS?
A
Postural training and education
12
Q
Little league tear is a ____ tear from repeated (varus/valgus) stress.
A
UCL, Valgus
13
Q
How do you confirm a little league tear?
A
Valgus stress test with full elbow EXT and 10 degrees of FLX
14
Q
What muscles can be torn due to hyperextension in a little league tear?
A
Brachialis, BB, BR
15
Q
definition: swelling or tearing of tendons in the lateral aspect of the arm (common extensor origin)
A
lateral epicondylitis (Tennis Elbow)
16
Q
What is the most common muscle to be affected by lateral epicondylitis?
A
ECRB
17
Q
What are the s/s of lateral epicondylitis?
A
- gradual increase in pain with specific motions
- severe pain
18
Q
definition: swelling or tearing of tendons in the medial aspect of the arm (Common flexor origin)
A
medial epicondylitis (Golfer’s Elbow)
19
Q
What are the s/s of medial epicondylitis?
A
Increased pain with elbow FLX, lifting with palm up, and palpation
20
Q
What are the s/s of UCL laxity?
A
pain and instability with valgus stress
21
Q
What can cause UCL laxity?
A
repetitive valgus stress or trauma
22
Q
What can cause RCL laxity?
A
elbow dislocation/subluxation
23
Q
What are the s/s of RCL laxity?
A
- recurring clicking
- locking of the elbow with EXT and SUP
- gapping with varus stress
24
Q
definition: bony deposits in muscle after trauma and bleeding
A
myositis ossificans
25
What are the common muscles in the body that experience myositis ossificans?
quadriceps and brachialis
26
definition: Fx in the distal forearm that is common post-neural damage and must be surgically released (causes elbow instability)
Volkmans ischemic contracture
27
What are the ulnar nerve roots?
C8-T1
28
What are common areas of ulnar nerve entrapment? What is the most common?
- arcade of struthers
- cubital tunnel (medial aspect of elbow)
- between the heads of FCU (most common)
29
What is the most common neural injury in the elbow?
ulnar nerve compression
30
What are the median nerve roots?
C5-T1
31
What are the common sites of entrapment of the median nerve? Which are the most common in the forrearm and wrist?
- ligament of struthers
- bicipital aponeurosis
- 2 heads of PT ( most common in forearm)
- carpal tunnel (most common in wrist)
32
What are the musculocutaneous nerve roots?
C5-C7
33
What are common sites of musculocutaneous nerve entrapment?
between biceps tendon and brachial fascia
34
What are the radial nerve roots?
C6-C8
35
What are the common radial nerve entrapment sites?
- radial groove
- radial head
- supinator
36
What nerve impingement often leads to wrist drop?
radial nerve impingement
37
Open packed position of humeroulnar joint.
70 degrees elbow EXT
10 degrees supination
38
Close packed position of humeroulnar joint.
full EXT and SUP
39
What motion(s) do medial glides of the humeroulnar joint help restore?
EXT, SUP/PRON
40
What motion(s) do lateral glides of the humeroulnar joint help restore?
FLX
41
Mobilization of the ___ joint helps assess medial and lateral gapping.
humeroulnar
42
Open packed position of the humeroradial joint.
Full EXT and SUP
43
close packed position of the humeroradial joint.
90 degrees elbow FLX
5 degrees SUP
44
Distraction of the humeroradial joint at ___ degrees increases all motion.
70
45
What motion(s) do posterior glides of the humeroradial joint help restore?
EXT
46
What motion(s) do anterior glides of the humeroradial joint help restore?
FLX
47
Open packed position of proximal radioulnar joint
70 degrees FLX
35 degrees SUP
48
Close packed position of proximal radioulnar joint.
5 degrees SUP
49
What motion(s) do anterior glides of the proximal radioulnar joint help restore?
SUP
50
What motion(s) do posterior glides of the proximal radioulnar joint help restore?
PRON
51
Open packed position of distal radioulnar joint.
10 degrees SUP
52
What motion(s) do anterior glides of the distal radioulnar joint help restore?
PRON
53
What motion(s) do posterior glides of the distal radioulnar joint help restore?
SUP
54
What joint is important to mobilize after a Colle's Fracture? What can you observe while doing this mobilization?
Distal Radioulnar joint
--> may hear a “snap or pop” when adhesions and scar tissue are broken during grade III and IV mobs so it’s important to warn pts
55
With a FOOSH, children are more likely to injure their _____.
AC joint
56
With a FOOSH, adults are more likely to have a ____ or _____ injury.
distal radius fracture (Colle's Fracture)
Radial head subluxation
57
What specific tests are used for Lateral Epicondylitis?
Cozen's
Mills
Resisted 3rd finger EXT
58
What specific tests are used for medial epicondylitis?
Passive wrist and elbow EXT while Supinating the forearm
59
What specific tests are used for ulnar nerve impingement?
ulnar nerve FLX
tinels sign
60
What specific tests are used for median nerve impingement?
PT test
61
definition: Fracture of the distal radius w/ or w/o involvement of the ulna
Colle's FRacture
62
What is the most common population ot experience a Colle's Fracture?
Female > 50 y/o
63
What are the 3 types of Colle's Fracture?
Undisplaced Fx
Displaced Fx: 1 main transverse Fx with minimal cortical comminution (heals well)
Unstable Fx: broken in 2+ pieces
64
definition: Reverse Colle's fracture
Smith Fracture
65
How does one cause a smith fracture?
Fall onto a flexed wrist
66
How does one cause a colle's fracture?
FOOSH
67
IF a patient has a smith fracture, check for ____ involvement.
ulnar bone
68
Distal Fragments of a smith fracture are displaced in a ___ direction.
anterior
69
With a Colle's Fx, the lunate acts as a wedge and shears off part of the radius in a ___ direction.
dorsal
70
(flexor/extensor) tendons taker longer to heal.
Extensor
71
With a tissue Injury, avoid passive stretching for ___-___ weeks post-op
6-8 weeks
72
When stretching tendons over the wrist, do NOT let the PIP and MCPs ______.
hyperextend
73
(true/false) With tendon repairs, you can do more damage with PROM than AROM
True
74
definition: intra-articular fx of the medial aspect of the first MC base
Bennet's Fracture
75
What normally causes a bennet's Fracture?
FOOSH and axial compression of 1st MC
76
After a Bennet's Fracture surgery, AROM of the thumb and wrist begin ___ weeks after the pins are removed.
4 weeks
77
definition: Rupture of the UCL of the MCP joint of the thumb due to valgus stress; ligament may rupture or cause avulsion fx.
Gamekeeper's/skiers thumb
78
How does one diagnose gamekeeper's/skiers thumb?
Stress test for laxity and pain
79
definition: Fx of 5th metacarpal at neck; often sustained after punching or a fight
Boxer's Fracture
80
Resistance should be avoided until week ___ of boxer's fracture rehabilitation.
6
81
definition: flexion of MCP and DIP, hyperextension of the PIP; due to contracture of the intrinsic muscles
swan neck deformity
82
What deformity of the finger is normally seen with RA?
Swan neck deformity
83
definition: extension of MCP and DIP with flexion of PIP; due to rupture of the central tendinous slip of the extensor hood
most often s/p trauma or RA
boutonniere Deformity
84
definition: DIP resting in flexed position due to rupture or avulsion of the extensor tendon where it inserts in the distal phalanx
mallet finger
85
With mallet finger, the finger can move into _____ but NOT actively.
EXT
86
definition: sticking of the tendon when the pt attempts to flex their finger; may snap, catch, click; due to thickening of the flexor tendon sheath
trigger finger
87
definition: fixed flexion deformity of the MCP and PIP, usually in the 4th or 5th finger; due to contracture of the palmar fascia
dupuytren's contracture
88
Who is most commonly affected by dupuytren's fracture?
Men, 50-70 y/o
89
What deformity looks like a pope's hand?
dupuytren's contracture
90
definition: tenosynovitis in the thumb affecting the abductor pollicis longus and extensor pollicis brevis
De Quervain's syndrome (Hoffman's Syndrome)
91
De Quervain's syndrome will show a (+) _______ test.
Finkelstein's test
92
When splinting De Quervain's syndrome, position the thumb in ___ and ___.
EXT and ABD
93
definition: avulsion fx from high eccentric load on flexor side
jersey finger
94
What does the median nerve pass through in the wrist along with the flexor tendons?
Carpal tunnel
95
What are the sensory symptoms of median nerve entrapment in the wrist?
sensory changes in radial 2/3 of palm, palmar surface of the first 3.5 digits, and dorsum of distal phalanges
96
What deformities can median nerve entrapment at the wrist cause?
Ape Hand Deformity
Hand of papal benediction
97
definition: muscle wasting in hypothenar eminence
ape hand deformity
98
Treatment for median nerve entrapment at the carpal tunnel includes splinting of the thumb in ___.
ABD
99
What are the sensory symptoms of ulnar nerve entrapment in the wrist?
sensory changes in the ulnar 1/3 of the hand, entire 5th digit, and ulnar side of the 4th digit
100
What nerve impingement at the wrist is most common in cyclists or with FOOSH injuries?
ulnar nerve
101
What nerve impingement at the wrist can be caused by compression at the cubital tunnel or Guvan's canal?
Ulnar nerve
102
What deformities can ulnar nerve entrapment at the wrist cause?
Claw hand
loss of effective grasping
103
Treatment for ulnar nerve entrapment at the wrist includes splinting of the MCPs in ____ and IPs in ____.
MCP FLX, IP EXT
104
The radial nerve enters the hand as the ___ nerve.
Superficial radial nerve (sensory)
105
What are the sensory symptoms of radial nerve entrapment in the wrist?
sensory changes over the radial 2/3 of the dorsum of the hand and thumb, the proximal phalanx of the 2nd and 3rd and half of the 4th digit
106
Treatment for radial nerve entrapment at the wrist includes splinting to maintain wrist ______.
wrist EXT
107
Anterior glide of the radiocarpal joint restores _____.
wrist EXT
108
Posterior glide of the radiocarpal joint restores _____.
wrist FLX
109
Ulnar glide of the radiocarpal joint restores _____.
radial deviation
110
radial glide of the radiocarpal joint restores _____.
ulnar deviation
111
What is the splinting position of the radiocarpal joint?
- slight wrist extension
- 70* MCP flexion
- IP in neutral or slight flexion
- thumb abducted and/or opposed
112
Ulnar glide of the thumb CMC joint helps restore ____.
FLX
113
Radial glide of the thumb CMC joint helps restore ____.
EXT
114
Posterior glide of the thumb CMC joint helps restore ____.
ABD
115
radial glide of the thumb CMC joint helps restore ____.
ADD
116
Anterior/palmar/volar glide of the 2nd-5th CMC joints helps restore ___.
FLX
117
Posterior/dorsal glide of the 2nd-5th CMC joints helps restore ______.
EXT
118
Anterior glide of MCP, PIP, and DIP joints helps restore ___.
FLX
119
Posterior glide of MCP, PIP, and DIP joints helps restore ___.
EXT
120
Radiocarpal joint movement is (convex/concave) on (convex/concave)
convex on concave
121
Thumb CMC joint movement is (convex/concave) on (convex/concave) for FLX/EXT
concave on convex
122
Thumb CMC joint movement is (convex/concave) on (convex/concave) for ABD/ADD
convex on concave
123
The 2nd-5th CMC joint movement is (convex/concave) on (convex/concave)
concave on convex
124
The MCP, PIP, and DIP joint movements are (convex/concave) on (convex/concave)
concave on convex
