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PT OCS Exam > Elbow/Wrist/Hand > Flashcards

Elbow/Wrist/Hand Flashcards

(54 cards)

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1
Q

Dorsal wrist Compartments

A

1) EPB AbPL
2) ECRB/ECRL
3) EPL
4) EDC/EDI
5) EDM
6) ECU

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2
Q

DeQuervain’s Tenosinovitis

A

*Most Common
Dx: (+ pain) Finkelstein *test Bilat.

Effects the 1st dorsal compartment (EPB/AbPL)

Tx: Rest with thumb spica to allow IP to move, steroids can also be effective if rest doesn’t help

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3
Q

Intersection Syndrome

*Also called texter’s or gamekeeper’s thumb

A

Effects 1st and 2nd dorsal compartments (AbPL/EPB and ECRB/ECRL)

Dx: Pain with wrist extension and thumb circumduction
TTx: Rest, Splint, NSAIDS

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4
Q

ECU subluxation

A

Consider in DDx of ulnar side wrist pain

Caused by traumatic UD and wrist flexion rupturing tendon sheath

Dx: ECU tendon subluxes with UD while in full supination
Tx: Cast in Pronation/Ext for 6 weeks

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5
Q

ECU tendonitis

A

2nd most common, occurs in racquet sports from overuse and trauma
*Associated with injury to TFCC
Tx:Rest, splint, NSAIDs, injections

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6
Q

MCP UCL rupture

A

Loss of Thumb pinch grip

MOI: “Skier’s thumb” rupture or “Gamekeeper’s thumb” laxity (microtrauma)

Dx: Valgus stress test (+ if >15 deg of uninvolved or >35 deg)

XR if Stener lesion suspected (non-healing avulsion fx)

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7
Q

Volar Plate Avulsion

A

MOI:Common in ball sports

Keep’s finger from hyperextension (normal flexion ROM approx. 110 deg @ PIP)

XR if swelling/pain in palmar PIP

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8
Q

FDB Avulsion “Jersey Finger”

A

4th finger is most common

MOI: Forced extension while trying to flex at DIP

Unable to make a fully closed fist due to lost DIP flx

Tx: Surgery referral

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9
Q

Bennett Fx

A

1st MCP fx (Most Common MC Fx)

MOI: Fall on Flexed Thumb

Avulsion Fx medially by APL tendon

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10
Q

Scaphoid Fx

A

TTP anatomical snuff box
(+) Watson’s test (Axial Thumb Load)
If Radial wrist pain with extension suspect fracture and may require CT scan to confirm

MOI is fall backward on to hand

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11
Q

Hook of Hamate Fx

A

MOI: Shearing from 4/5 flexor tendons
Dx: Made by CT/Bone Scan
Might present with ulnar neuropathy (Close to Guyon’s tunnel)

Tx:Surgical excision is most effective

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12
Q

Criteria to Dx a wrist Fx

A

Pain with gripping
Pain with supination
Pain with A/PROM wrist extension
Local tenderness/edema

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13
Q

Pisiform Fx

A

MOI: Direct blow or Racquet sport
Tx: Surgical Excision

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14
Q

Lunate Fx

A

*Rare, Kienbock’s disease (Lunate AVN)

Dec. Grip strength
Dx: MRI
Microtrauma

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15
Q

Distal Radius Fx (3 types)

A 
Colles' Fx (Dorsal displacement)
Smith Fx (Volar displacement)
Barton Fx (Intra-articular fx, dorsal or volar dislocation)

Most common Fx seen in ED
Very Common and present with “dinner fork” deformity
*Important to examine the Median N.
Tx: Closed Reduction with splint followed by cast

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16
Q

Wrist Ligament injuries

A

Scapholunate (Most Common), MOI: FOOSH on pronated hand (wrist ext/UD), Dx: Stress view XR (Fist)

Lunotriquetral, MOI: FOOSH with wrist in ext/RD

Midcarpal instability (often Bilat.)
Dx: XR, Tx: Splint immobilization

Carpal Dislocation, MOI: Collision sports and usually affects the scapholunate joint. Tx: Surgery

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17
Q

DRUJ injuries

A

Involved the TFCC which is main stabilizer (especially when wrist is in pronation)
MOI: FOOSH or tensile overuse (traction force)

Dx: Piano Key sign, Press Test (Use hands to stand up), hypermobility at DRUJ

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18
Q

Boxer’s Fx

A

MOI: Fracture of MC shaft/head from direct trauma
Tx: Splinting

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19
Q

Mallet Finger

A

Distal extensor tendon avulsion
MOI: rapid forced flexion of finger (ball hits finger tip)
Tx: Splint in full extension

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20
Q

CPR for Hand OA (4+/5)

A

Hand pain, ache, stiffness

Hard tissue enlargement of 2 or more joints (CMC, 2nd/3rd PIP/DIP)

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21
Q

Swan-neck deformity

A

DIP flexed and PIP hyperextends
will require surgery

Association with RA

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22
Q

Boutonniere deformity

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A

DIP hyperextended
PIP flexed
Responds well to splinting and exercise

23
Q

Trigger Finger

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A

Usually involves the A1 pulley

24
Q

Pronator Teres Syndrome

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A

Volar forearm pain
Sensory neuropathy of thumb and 2,3, 1/2 of 4th finger on palmar surface
Weak thumb, index and middle fingers
(-) compression at pronator border

PT is spared

25
Carpal Tunnel Syndrome
Entrapment of Median N. in the flexor retinaculum Presents with numbness and paraesthesia in finger tips of median nerve distribution, nocturnal paraesthesia MOI: repetitive wrist flexion (i.e. typing, forceful gripping) Thenar Atrophy *R/O peripheral neuropathy in alcoholics, renal disease and DM
26
Cubital Tunnel Syndrome
Entrapment of Ulnar N. at cubital tunnel or arcade of struthers Froment's sign (+) unable to maintain key grip due to weakness of the AddPB and FPB, uses FPL instead (AIN innervation) (+) Wartenberg's sign (unable to adduct pinky) (+) Ulnar Nerve compression test (+) Elbow flexion test (AROM held for 60 sec) excellent test to R/I, moderate to R/O
27
Nerve Injuries
Neuropraxia (compression or strain injury which heals between a few days and a few months, great prognosis) Axonotmesis (crush or traction injury which takes longer to heal, 1mm per day or 1" per month) Neurotmesis (nerve transection, poor healing and requires surgery) *Ventral Root is motor, Dorsal Root is sensory
28
Ulnar Nerve Palsy (C8-T1)
Entrapped at Pec. Minor, Cubital Tunnel or Guyon's tunnel | Hypothenar atrophy
29
Volkmann's Ischemia
``` Compartment syndrome characterized by: Palor Pulselessness Paresthesia Pain Pain with passive stretch ```
30
Radial Nerve Palsy (C5-C8)
Drop Arm caused by compression of the Radial Nerve MOI: Honeymooner's palsy, Saturday Night Palsy, fracture through the radial groove Proximal injury: Crutch Palsy, Humeral shaft fracture Distal injuries at arcade of frohse will effect the PIN (no sensory involvement)
31
Musculocutaneous Nerve (C5-C7)
Biceps, Brachialis, Coracobrachialis Ant.Lat. arm cutaneous sensation
32
Dupuytren Disease
Fibrosis of the palmar aponeurosis | Presents as flexion contractures of the MP and PIP joints
33
DRUJ Fx
``` Essex-Lopresti Fx (Radial head Dx, DRUJ dislocation) Galeazzi Fx (Distal 1/3 radius, DRUJ dislocation) ```
34
AIN syndrome (FDP, FDL, PQ)
Inability to make the "OK sign", weak FPL and FDP (lateral 2) ***NO sensory loss***
35
PIN syndrome
Lateral forearm/elbow pain Wrist extension with radial deviation (ECU weakness) Weakness of the finger extensors Thumb extension elicits pain at lateral epicondyle ***NO sensory loss***
36
CRPS
``` Hyperaesthesia Sudomotor changes Allodynia Inc. temperature Redness ```
37
Guyon's tunnel
Entrapment sites proximal (sensory and motor), distal to ulnar tunnel (sensory), between ADM and FDM (motor only)
38
Wartenberg Syndrome
Causes pain and paraesthesia along the lateral dorsum of the hand usually from tight casting
39
Claw deformities
``` Median Nerve (Ape Hand: unable to make a oppose thumb, or flex 2nd/3rd fingers due to loss of DFP and lumbricals) Ulnar Nerve (unable to extend the 4th/5th digits due to loss of IO) ```
40
UCL injury
Moving valgus test 70-120 deg (excellent to R/O) Valgus stress test at 25 deg TTP at ant. UCL
41
Lateral epicepicondylitis
ECRB test Dec. grip strength (wrist extension required for strong gripping) TTP anterior epicondyle Tx: responds well to dorsal to volar HVLA at the wrist Always R/O C2-C7 involvement MWM also effective Counter-force brace good for pain-free grip P.T. > injection early on due to tendency to return to activity too soon after injection due to immediate relief
42
Radial Tunnel Syndrome
Painless weakness through the EPL, EDM, supinator
43
Normal grip strength
76 lbs. +/- 13 lbs. for setting goals (1N = .22 lbs)
44
Medial Epicondylalgia
Weak flexors and pronators but grip strength not usually affected
45
CPR for CTS (4+/5)
Age > 45 Shaking hands relieves symptoms Wrist Ratio index > .67 (wrist width A/P divided by M/L) Reduced median sensory field 1st digit (thumb sensation vs. thenar eminence) Symptom severity scale >1.9
46
Tendon glides
5 steps into making a fist: | Straight, hook, fist, tabletop, straight fist
47
Nerve glides
6 steps into opening the hand followed by the thumb
48
Wartenberg's sign
Inability to Abduct 5th digit after finger have been passively spread (IO weakness)
49
Martin-Gruber Anastomosis
Ulnar nerve to median nerve allows for funky patterns of regeneration as well as altered symptom distribution
50
Axillary Nerve Palsy
Deltoid weakness and Teres Minor weakness caused by dislocation or surgical neck fracture
51
LTN Palsy
Backpacker's palsy, scapular winging due to SA weakness
52
CNXI Palsy
Shoulder Sag due to trap weakness
53
Carpal Bones (Radial to Ulnar)
*Some Lovers Try Positions That They Can't Handle Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate
54
Lig. of Struther's syndrome
PT Syndrome + PT Involvement (sensory and motor)

PT OCS Exam (8 decks)

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