Exam 5: Wrist and Hand Flashcards
(136 cards)
1
Q
The hand is involved in approximately 90% of upper limb function (true/false)
A
true
2
Q
Which finger is the most involved in hand function?
a. thumb
b. index finger
c. middle finger
d. little finger
A
thumb
3
Q
Which styloid is shorter?
a. radial styloid
b. ulnar styloid
A
ulnar styloid
4
Q
Which side has more deviation?
a. radial deviation
b. ulnar deviation
A
ulnar deviation
5
Q
Which ligament holds the extensor mechanism at the PIP joint?
a. Oblique retinacular ligament
b. Ulnar collateral ligament
c. Radial collateral ligament
d. Transverse retinacular ligament
A
Transverse retinacular ligament
6
Q
The volar plate attaches to the
a. Distal phalanx
b. Proximal phalanx
A
proximal phalanx
7
Q
What serves as an attachment for the thenar and hypothenar muscles?
a. Extensor hood
b. Extensor retinaculum
c. Flexor retinaculum
d. ulnar collateral ligament
A
flexor retinaculum
8
Q
The flexor retinaculum serves to protect which nerve?
a. Radial nerve
b. Median nerve
c. Ulnar nerve
d. axillary nerve
A
median nerve
9
Q
What carpal ligaments provide the majority of wrist stability?
a. Intrinsic ligaments
b. Extrinsic ligaments
c. Collateral ligaments
d. Retinacular ligaments
A
Extrinsic ligaments
10
Q
What carpal ligaments serve as a rotation restraint?
a. Intrinsic ligaments
b. Extrinsic ligaments
c. Collateral ligaments
d. Retinacular ligaments
A
Intrinsic ligaments
11
Q
The function of the extensor hood is to
a. provide stability for the lumbricals
b. serve as a protection
c. Allow the lumbricals to assist in the flexion of the MP joints
d. assist in finger and wrist extension
A
Allow the lumbricals to assist in the flexion of the MP joints
12
Q
The Transverse Carpal Ligament or flexor retinaculum functions to
a. absorb force to the palmar side of the hand
b. Help maintain the transverse carpal arch and protect the median nerve
c. protects the ulnar nerve
d. protect the palmar surface
A
Help maintain the transverse carpal arch and protect the median nerve
13
Q
The function of the triangular fibrocartilage complex (TFCC) is to
a. Improve joint congruency
b. Cushion against compressive forces
c. protect the distal radius and ulna
d. a and b
A
Improve joint congruency
Cushion against compressive forces
14
Q
A condition in which ordinarily nonpainful stimulus evokes pain
a. Allodynia
b. Hyeralgesia
c. Hyperesthesis
d. Hyperpathia
A
Allodynia
15
Q
Excessive sensitivity to pain describes
a. Allodynia
b. Hyperalgesia
c. Hyperesthesia
d. Hyperpathia
A
Hyperalgesia
16
Q
Unusual increased or altered sensitivity to sensory stimuli
a. Allodynia
b. Hyperalgesia
c. Hyperesthesia
d. Hyperpathia
A
Hyperesthesia
17
Q
Increased reaction to a stimulus, especially a repetitive stimuli
a. Allodynia
b. Hyperalgesia
c. Hyperesthesia
d. Hyperpathia
A
Hyperpathia
18
Q
At what stage of CRPS is there marked wasting of tissue and it may become irreversible?
a. Stage I
b. Stage II
c. Stage III
A
Stage III
19
Q
At what stage of CRPS does muscle wasting begin and this stage will last for 3-6 months?
a. Stage I
b. Stage II
c. Stage III
A
Stage II
20
Q
What is the function of the pulley system?
A
to prevent bowstringing
21
Q
What transmits a load from the hand and forearm?
A
Triangular Fibrocartilage Complex (TFCC)
22
Q
Which nerve radiates on the dorsal surface from the thumb to the middle of the ring finger?
a. median nerve
b. radial nerve
c. ulnar nerve
d. axillary nerve
A
radial nerve
23
Q
Which nerve radiates on the dorsal and palmar surface in the pinky and half of the ring finger?
a. radial nerve
b. median nerve
c. ulnar nerve
d. digital nerve
A
ulnar nerve
24
Q
Which nerve radiates on the palmar side from the part of the thumb to the lateral side of the ring finger?
a. radial nerve
b. ulnar nerve
c. median nerve
d. axillary nerve
A
median nerve
25
What motion is limited by the interosseous membrane and the bony impaction between the notch of the radius and the ulnar styloid process?
a. pronation
b. supination
c. flexion
d. extension
supination
26
What motion is limited by bony impaction between the radius and ulna?
a. pronation
b. supination
c. flexion
d. extension
pronation
27
What motion is limited by impact of the scaphoid onto the radial styloid and the UCL?
a. ulnar deviation
b. radial deviation
c. pronation
d. supination
radial deviation
28
The functional arches of the hand allow for the fingers/thumb to
hold objects in the hand
29
Which functions to maintain the constant relationship between the tension and joint axis to provide for max joint motion within the limits of the muscle excursion?
a. pulley system
b. extensor mechanism
c. flexor retinaculum
d. TFCC
pulley system
30
What two pulleys are critical for creating composite flexion?
a. A1 and A2
b. A2 and A3
c. A2 and A4
d. A1 and A3
A2 and A4
31
A pain syndrome triggered by a noxious event that is not limited to a single peripheral nerve
CRPS Type I: RSD
32
What clinical characteristics can be seen with CRPS?
```
pain
allodynia
hyperalgesia
hyperesthsia
hyperpathia
```
33
What SNS changes are common with CRPS?
swelling
abnormal color or temp
sweating
trophic changes
34
At what stage of CRPS is pain limited to the site of the injury?
a. stage I
b. stage II
c. stage III
stage I
35
At this stage of CRPS there is increased sensitivity of skin to touch and light pressure
a. stage I
b. stage II
c. stage III
stage I
36
Patient is experiencing muscle cramps, stiffness and limited mobility, sensitive to touch, skin is warm, red and dry. What stage of CRPS?
a. stage III
b. stage II
c. stage I
stage I
37
Patient presents with pain that is diffuse, swelling has become hard, muscle wasting is seen. What stage of CRPS?
a. stage III
b. stage II
c. stage I
stage II
38
Patient presents with marked wasting of tissue that may be irreversible. What stage of CRPS?
a. stage III
b. stage II
c. stage I
stage III
39
RSD is more (regional/focused) and Causalgia is more (regional/focused)
RSD regional
| Causalgia focused
40
This type of treatment may provide a permanent cure or partial remission and blocks the SNS
sympathetic block
41
A sympathetic block will provide
prognostic info about potential merits of other treatments
42
Sympathectomy is for (acute/chronic) patients with intractable sympathetic (intermittent/maintained) pain
and have responded _ to _
chronic intractable sympathetic maintained pain and have responded favorably to a series of blocks
43
This type of treatment for CPRS is an implantation of an electrode using low intensity impulses along the spinal cord
spinal cord stimulation
44
with CRPS patients it is important to immobilize (true/false)
false
| do NOT immobilize
45
Prognosis of CRPS is _ for stage I or intervention has begun 3-6 months after onset
good
46
Prognosis of CRPS is _ for stage II or intervention has begun 6-12 months after onset
variable
47
Prognosis of CRPS is _ for stage III or intervention has begun 1 year after onset
poor
48
Patient presents with pain over the radial styloid process with gripping activities, what is your initial hypothesis?
a. Capral Tunnel
b. DeQuervain Syndrome
c. Ulnar Nerve compression
d. Dupuytren
DeQuervain Syndrome
49
Patient reports an insidious onset of numbness and tingling in the first 3 fingers, and possible report of worse pain at night, what is your initial hypothesis?
a. Capral Tunnel
b. DeQuervain Syndrome
c. Ulnar Nerve compression
d. Dupuytren
Capral Tunnel Syndrome
50
Patient reports of paresthesias over dorsal aspect of ulnar border of hand and finger 4-5, what is your initial hypothesis?
a. Capral Tunnel
b. DeQuervain Syndrome
c. Ulnar Nerve compression at canal of Guyon
d. Dupuytren
Ulnar Nerve Compression at canal of Guyon
51
Patient reports inability to extend MCP or IP joint, what is your initial hypothesis?
a. Capral Tunnel
b. DeQuervain Syndrome
c. Ulnar Nerve compression
d. Dupuytren or trigger finger
Dupuytren or trigger finger
52
Patient reports of falling on hand with wrist hyperextended, reports of pain with loading of wrist, what is your initial hypothesis?
a. Carpal Tunnel
b. Scaphoid fracture or carpal instability
c. radial fracture
d. ulnar nerve compression
scaphoid fracture or carpal instability
53
Trigger finger is a _ of the _ tendon sheath
thickening
| flexor tendon
54
What can result in trigger finger?
repetitive trauma
55
_ on the tendon and thickening of the _ = trigger finger
nodules
| annular pulley
56
Which finger is the most common to get a trigger finger?
a. index
b. middle
c. ring
d. thumb
thumb
57
Trigger fingers are more common in males (true/false)
false
| females
58
Trigger fingers are associated with
RA
Dupuytren's
Diabetes
59
With trigger finger, the patient will have pain at the _ joint of the finger or MP of the thumb
a. DIP
b. PIP
c. CMC
d. IP
PIP
60
In trigger finger, it will lock in a _ or _ position
flexed or extended position
61
A palpable nodule is found at the _ pulley with trigger finger
A1
62
Non-operative options for trigger finger
steroid injection
return to normal activities
splinting
63
Patient with trigger finger can return to activities when?
a. 1 week
b. 10 days
c. 2 weeks
d. 3 weeks
3 weeks
64
Which of the following is described as a dorsal displacement of distal radius "dinner fork" deformity?
a. Colles fracture
b. Smith fracture
c. scaphoid fracture
d. ulna fracture
Colles fracture
65
What is the MOI for a Colles fracture?
FOOSH
66
in a Colles fracture, the wrist is _ with a _ hand
hyperextended and pronated hand
67
Which of the following describes a complete fracture of the distal radius with volar displacement of the distal fragment?
a. Colles fracture
b. Smith fracture
c. scaphoid fracture
d. ulna fracture
Smiths fracture
68
Smiths fracture is with the wrist _ during injury
flexed
69
What is the most commonly fractured bone in the wrist?
a. radius
b. scaphoid
c. phalanges
d. metacarpals
scaphoid
70
For a scaphoid fracture, it is common to immobilize in a _ cast for 6 weeks followed by 6 weeks in a _ cast
long arm thumb spica
| short arm cast
71
If there is still a non-union after a scaphoid fracture at _ weeks, will undergo ORIF
a. 6 weeks
b. 3 weeks
c. 8 weeks
d. 12 weeks
12 weeks
72
Which type of management is immobilization in a long arm thumb spica or short arm thumb spica cast with the wrist in slight extension and radial deviation?
a. waist
b. proximal pole
c. distal third
d. tuberosity
proximal pole
73
Which type of management is immobilization in a short arm thumb spica cast for 6-8 weeks?
a. waist
b. proximal pole
c. distal third
d. tuberosity
distal third
74
Which of the following types of management is immobilization in a long or short arm thumb spica for 5-6 weeks?
a. waist
b. proximal pole
c. distal third
d. tuberosity
tuberosity
75
It is more common for the elderly population to have metacarpal fractures (true/false)
false
| younger more active
76
Which of the following is described as progressive tenosynovitis which affects the tendon sheath of the 1st dorsal compartment of the wrist resulting in a thickening of the extensor retinaculum causing compression and entrapment of the associated tendons?
a. Tendonitis
b. Dequervain's
c. Trigger Finger
d. Tenosynovitis
Dequervain
77
A patient with Dequervain's Tenosynovitis will have pain where?
a. ulnar side of the wrist
b. down the center of the hand
c. radial aspect of the wrist and may radiate into the thumb or forearm
d. on the dorsal side of the hand
radial aspect of the wrist and may radiate into the thumb or forearm
78
A patient has pain with activities such as gripping, holding, and twisting, what would you assume they might be diagnosed with?
a. Trigger Finger
b. Fracture
c. Dequervain
d. Ganglion cyst
Dequervain's
79
Therapy for Dequervain's can include mobilization with _
| _ glide of carpals
movement
| radial glide of carpals
80
When can patients with Dequarvains expect to return to activities?
a. 6-8 weeks
b. 4-5 weeks
c. 4-6 weeks
d. 8-10 weeks
6-8 weeks
81
A patient presents with a swelling on the dorsal or volar surface of the wrist and has a recent history of wrist sprain, which of the following could they have?
a. Trigger Finger
b. Fracture
c. Dequervain
d. Ganglion cyst
Ganglion cyst
82
With a Ganglion cyst, a visible nodule will be on the _ surface of the wrist
dorsal or volar
83
Carpal Tunnel can be due to
```
trauma
overuse
disease (RA, DM, Gout)
pregnancy
use of crutches
chronic pressure (cyclists)
jackhammers (vibration)
```
84
Patient is experiencing pain and paresthesias in the median nerve distribution, what can they be diagnosed with?
a. Ganglion cyst
b. Dequervain
c. Carpal Tunnel
d. none of the above
Carpal Tunnel Syndrome
85
Onset of symptoms with Carpal Tunnel is insidious (true/false)
false
| gradual
86
Patient is experiencing pain in their wrist at night and it feels stiff in the morning, so they shake it to make it feel better. What is their diagnosis?
a. Ganglion cyst
b. ulnar nerve compression
c. Dupuytren
d. Capral Tunnel
Carpal Tunnel Syndrome
87
Thenar atrophy may be seen with Carpal Tunnel Syndrome (true/false)
true
88
Resistive testing to test for Carpal Tunnel will find
a. weak distally
b. weak proximally and distally
c. weak proximally and normal distally except for grip and pinch
d. strong distally and proximally
weak proximally and normal distally except for grip and pinch
89
What ULNT test will be positive for Carpal Tunnel?
a. ULNT 1
b. ULNT 2a
c. ULNT 2b
d. ULNT 3
ULNT1 or ULNT2a
90
After carpal tunnel surgery, when can tendon glides start?
a. 5 days
b. 3 days
c. 1 week
d. 2 weeks
3 days
91
When can strengthening and nerve gliding begin after carpal tunnel surgery?
a. 1 week
b. 2 weeks
c. 3 weeks
d. 4 weeks
3 weeks
92
What are the 3 types of pinch to test?
tip pinch
3-point
key pinch or lateral pinch
93
This type of test is when you grab the first metatarsal and load it down into the bone, what test is this?
a. Gamekeepers
b. Finkelsteins
c. Scaphoid compression
d. Phalens
Scaphoid compression
94
A positive Scaphoid compression test will indicate
a. tingling
b. weakness
c. sensitivity
d. pain
pain
95
Snuff box tenderness is positive if the patient experiences
reproduces symptoms
96
Gamekeepers test is used to test for
a. scaphoid fracture
b. tenosynovitis
c. instability
d. carpal tunnel
thumb instability
97
The therapist will hold the thumb into extension and apply a valgus stress to the MCP joint to stress the ulnar collateral ligament, which test is this describing?
a. Gamekeeprs
b. Finkelsteins
c. Phalens
d. Scaphoid compression
Gamekeepers
98
A positive Gamekeepers test can be indicated by
a. numbness and tingling
b. gaping of the joint and pain
c. pain
d. weakness
gaping of the joint and pain
99
The patient makes a fist with the thumb inside the fingers then ulnarly deviates, the therapist will resist. What test is this describing?
a. Gamekeeprs
b. Finkelsteins
c. Phalens
d. Scaphoid compression
Finkelsteins
100
A positive Finkelsteins test will be indicated by
a. weakness
b. pain
c. inability to flex fingers
d. tingling
pain
101
For this test the patient will bend their elbow and flex their wrists then hold it for 60 seconds, what test is this?
a. Gamekeeprs
b. Finkelsteins
c. Phalens
d. Scaphoid compression
Phalens
102
What is the most common test used for carpal tunnel?
Phalen's
103
A positive Phalens test will be indicated by
a. pain in the thumb
b. tingling
c. reproduced symptoms along median nerve distribution
d. reproduced symptoms along ulnar nerve distribution
reproduced symptoms along median nerve distribution
104
Which test is a tap of the fingers on the median distribution of the arm?
a. Finkelsteins
b. Phalens
c. Tinel test
d. Median Nerve compression
Tinel test
105
Which 3 tests are very similar and involve compressing on the median nerve?
Tinel test
Median nerve compression
Median nerve compression/pressure provocation test
106
For this test compress on the median nerve between the flexor carpi radialis and palmaris longus and hold for 15 seconds to 2 minutes
a. Tinel test
b. medial nerve compression/pressure provocation test
c. median nerve compression
d. Phalens test
medial nerve compression/pressure provocation test
107
What does a positive medial nerve compression/pressure provocation test produce?
symptoms along median nerve distribution
108
A positive two-point discrimination test will be indicated by
a. inability to feel 4 mm or more
b. inability to feel 1 mm or more
c. inability to feel 2 mm or more
d. inability to feel 6 mm or more
inability to feel 6 mm or more
109
A Semmes Weinstein test is used to test for
a. carpal tunnel syndrome
b. scaphoid fracture
c. wrist instability
d. cubital tunnel syndrome
carpal tunnel syndrome
110
A positive Semmel Weinstein test is indicated by
feeling the monofilament at 2.83 milligram
111
This test is completed by the patient raising their hands over their head and flexing their wrists for 2 minutes
a. phalens
b. hand elevation
c. Tinel test
d. Finkelsteins
Hand Elevation
112
The hand elevation test is used to test for
a. carpal tunnel syndrome
b. scaphoid fracture
c. wrist instability
d. cubital tunnel syndrome
carpal tunnel syndrome
113
the carpal compression test is pressure on the median nerve holding for _
30 seconds
114
Wrist extension test is
putting hands together in wrist extension in front of chest
115
Wainner's clinical prediction rule for CTS is 2 or more of
```
hand shaking improving symptoms
wrist ratio > 0.67
SSS score > 1.9
decrease in sensation of median nerve over thumb
age > 45
```
116
Joint mobilizations for the wrist and hand
a. not suppose to mobilize the wrist and hand
b. only 3 or 4
c. only 1 and 2
d. only 1's
only 3 and 4
117
Which soft tissue release is when you wrap your hands around their palm and with fingernails touching you push out and spread the hand
a. TCL spread
b. palmar raking
c. tendon mobilization under TCL
d. pronator teres release
TCL spread
118
Which soft tissue release is putting the fingers between theirs and pulling on the palmar fascia
a. TCL spread
b. palmar raking
c. tendon mobilization under TCL
d. pronator teres release
palmar raking
119
Which soft tissue release is putting pressure on ligament then sliding tendons underneath ligament?
a. TCL spread
b. palmar raking
c. tendon mobilization under TCL
d. pronator teres release
tendon mobilization under TCL
120
What does a pronator teres release help to improve?
median nerve pain
121
for soft tissue release, how long should it be held?
3-5 seconds
| 3-5 times
122
soft tissue release should go from (proximal to distal/distal to proximal)
distal to proximal
123
Where is the tunnel of gyon located?
superficial to the flexor retinaculum, between the hook of the hamate and the pisiform bones
124
What is the function of the tunnel of gyon?
passageway for the ulnar nerve
| artery into the hand
125
The extensor mechanism creates a cable system that extends the _ and _
MPs and IPs
126
What allows for a lumbrical grip?
extensor mechanism
127
radial deviation occurs between _ and _
proximal and distal rows
128
ulnar deviation occurs
primarily at the radiocarpal joint
129
What are the arches of the hand?
transverse
| longitudinal
130
Does the moment arm increase or decrease when bowstringing happens?
increase
131
What is the diagnostic criteria for CRPS?
initiating noxious event or cause of immobilization
pain, allodynia, hyperalgesia - disproportionate to event
edema, change in skin BF
rule out everything else
132
What can be seen with mild cases of CRPS in the first stage?
lasts a few weeks
subsides spontaneously
responds rapidly to treatment
133
What is the cornerstone of treatment for RSD?
normal use of the affected part as much as possible
134
AROM should be performed immediately after operative treatment for trigger finger (true/false)
true
135
Your patient has pain with gripping, holding, and twisting activities, there is swelling over the 1st dorsal compartment and pain with active, passive, and resistive testing. What is his diagnosis?
Dequervains
136
When can you start doing nerve glides after carpal tunnel surgery?
3 weeks
