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NBCOT > Hand and Upper Extremity Disorders and Injuries > Flashcards

Hand and Upper Extremity Disorders and Injuries Flashcards

1
Q

Wrist Drop

A

Radial Nerve; hand is flexed at wrist, digits remain flexed

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2
Q

Carpal Tunnel Syndrome

A

Caused by repetition, awkward positions, pregnancy, lesions

Symptoms: parasthesia (tingling), hypothesia (decreased sensation), anesthesia (no tactile), eventually atrophy of thenar eminence

Positive Tinel’s Sign, Positive Phalen’s sign

Treatment:
•	Wrist splint in neutral
•	Median nerve gliding
•	Ergonomics (most common work related injury)
•	Surgical: Carpal Tunnel Release
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3
Q

Adhesive Capsulitis

A

“Frozen Shoulder”

What: Restricted ROM in one shoulder
Greatest limitation is external rotation

Why: Inflammation and immobility

How: ADL use, PROM, modalities

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4
Q

Claw Hand

A

What: MP extension with PIP and DIP flexion
unable to straighten 4th and 5th digits

Why: ulnar nerve damage, atrophy of interosseous muscles

How:
Splint with MP flexion of the 4th and 5th digits

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5
Q

Cubital Tunnel Syndrome

A

What: ulnar nerve compression at elbow

Sensory Loss: 1/2 of 4th, all of 5th, ulnar half of hand

Why: pressure at elbow, extreme elbow flexion

Symptoms:
• Numbness and tingling along ulnar aspect of forearm and hand
• Pain at elbow with extreme position of elbow flexion
• Weakness of power grip
• Positive Tinel’s sign at elbow
• Advanced stages- atrophy of FCU, FDP, ulnar nerve intrinsic muscles

How:
•	Elbow splint to prevent positions of extreme flexion
•	Elbow pad to decrease compression
•	Surgical: decompression or transposition
•	Post Op:
•	Edema
•	Scar management
•	AROM and nerve gliding
•	Strengthening
•	MCP flexion splint if clawing noted
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6
Q

Complex Regional Pain Syndrome

A

What: vasomotor dysfunction resulting from abnormal reflex

Symptoms: Pain, edema, discoloration, temperature changes

Why: Resulting from trauma or fracture

How:
modalities for pain
edema care
AROM
Stress Loading
Splinting
Avoid: 
PROM
passive stretching
joint mobilization
dynamic splinting
casting
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7
Q

DeQuervain’s Syndrome

A

What: tenosynovitis of APL and EPB

Symptoms:
pain and swelling over radial styloid
Positive Finkelstein’s test

How:
forearm based thumb spica splint leaving the IP joint free
ice massage
gentle AROM over wrist and splint

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8
Q

Dupuytren’s Disease

A

What: disease of fascia over palm and digits

Symptoms: flexion deformities

How: 
wound care
edema control
extension splint
A/PROM
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9
Q

Guyon’s Canal

A

What: ulnar nerve compression at wrist

Symptoms:
numbness and tingling in ulnar nerve distribution
motor weakness
positive tinel's sign
atrophy of ulnar musculature

Why:repetition, ganglion, fascia thickening

How:
wrist splint in neutral
surgical: decompression

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10
Q

Tinel’s Sign

A

How: tap over palmar surface of wrist at carpal tunnel

Positive finding: tingling or parasthesia along median nerve distribution = median nerve pathology at carpal tunnel

Could indicate: Carpal Tunnel Syndrome (at wrist), Cubital Tunnel Syndrome (at elbow), Guyon’s Canal

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11
Q

Finkelstein Test

A

How: bend thumb across palm of hand and bend fingers down over thumb, then bend wrist toward little finger

Positive Finding: pain on thumb side of wrist = DeQuervain’s tendosynovitis

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12
Q

Froment’s Sign

A

How: hold something between thumb and index finger using key grip pattern; clinician attempts to move object from grip

Positive finding: flexion of IP joint of thumb = paralysis of adductor pollicis muscle secondary to ulnar nerve injury

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13
Q

Phalen’s Test

A

How: push dorsal surfaces of both hands together for 30-60 seconds

Positive finding: causes tingling or other capal tunnel symptoms, indicates carpal tunnel syndrome

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14
Q

Reverse Phalen’s Test

A

How: push palms together in prayer position and hold

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15
Q

Lateral Epicondylitis

A

What: Tennis Elbow

Symptoms:
• Pain felt over lateral epicondyle and radiates down posterior surface of forearm
• Often feel pain when opening a door or lifting a glass

Why: repetitive use of wrist extensors, especially ECRB

How: 
•	Elbow strap, wrist splint
•	Ice and deep friction massage
•	Stretching
•	Add strengthening as pain decreases
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16
Q

Medial Epicondylitis

A

What: Golf Elbow

How: • Elbow strap, wrist splint
• Ice and deep friction massage
• Stretching
• Add strengthening as pain decreases

17
Q

Swan Neck Deformity

A

What: deformed position of the finger, in which the joint closest to the fingertip is permanently bent toward the palm while the nearest joint to the palm is bent away from it (DIP hyperflexion with PIP hyperextension)

Why: injury or inflammatory conditions

How:
splint with Slight PIP flexion

18
Q

Median Nerve Laceration

A

Symptoms:
Sensory Loss:
• Central palm
• Palmar surface of thumb, index, middle, radial ½ of 4th
• Dorsal surface of index, middle, radial ½ ring

Motor Loss: low lesion at wrist
•	MCP flexion of digits II & III
•	Opposition
•	Abduction
•	Flexion of thumb MCP

Motor Loss: high lesion
• Flexion of tip of index, middle, thumb
• Inability to flex radial aspect of wrist

Deformities:
• Flattening of thenar eminence (ape hand)
• Clawing of index and middle (low injury)
• Benediction sign (high injury)

Functional Loss:
• Loss of thumb opposition
• Weakness of pinch

Treatment:
• Dorsal protection splint with wrist positioned in 30° flexion (low) and elbow flexed 90° (if high)
• opponens splint, C-bar, or thumb post splint
• A/PROM
• Scar management
• Sensory reeducation

19
Q

Pronator Teres Syndrome

A

What: median nerve compression between 2 heads of pronator teres

Why: caused by repetitive pronation/supination

Symptoms: same as CTS + aching forearm pain

Interventions:
•	Elbow splint at 90° with forearm in neutral
•	Surgical: decompression
•	Post Op: 
•	AROM
•	Nerve gliding
•	Strengthening
•	Sensory reeducation
20
Q

Radial Nerve Laceration

A

Sensory Loss: high lesions at level of humerus
• Medial aspect of dorsal forearm
• Radial aspect of dorsal palm, thumb, index, middle, radial ½ of ring

Motor Loss: low lesion at level of forearm
• Loss of wrist extension due to absent or impaired innervation to ECU
• MCP extension
• Thumb extension

Motor Loss: high lesion at level of humerus
• Brachoiradialis
• Possible loss of triceps

Functional Loss:
• Inability to extend digits to release objects
• Difficulty manipulating objects

Deformities:
• Wrist drop

Interventions:
• Dynamic extension splint
• ROM
• Sensory reeducation

21
Q

Radial Nerve Palsy

A

What: radial nerve compression
Why: Caused by sleeping in position that places stress on radial nerve or by humeral shaft fracture

Symptoms:
• Weakness or paralysis of extensors to wrist, MCPs, thumb
• Wrist drop

Interventions:
• Dynamic extension splint
• Strengthening wrist and finger extensors when motor function returns

22
Q

Rotator Cuff Tendonitis

A

What: Subscapularis, Supraspinatus, Infraspinatus, Teres minor

Why: repeated overuse, weakness, ligament or capsule tightness, trauma

Interventions:
• Activity modification: avoid above shoulder level activities
• Adjust sleeping posture
• Decrease pain: positioning, modalities, rest
• Strengthening below shoulder level

23
Q

Shoulder Dislocation

A

What: most common is anterior shoulder

Why: trauma or overuse

Intervention:
ROM
Reduce Pain
Strengthen Cuff

24
Q

Skier’s Thumb

A

What: rupture of ulnar collateral ligament of MCP joint of thumb

Intervention:
• Thumb splint 4-6 weeks
• AROM and pinch strengthening
• ADL requiring opposition

25
Q

Tenosynovitis

A

inflammation of tendon and synovial sheath

o Digit swells and movement becomes painful
o Infection usually confined to one digit

26
Q

Trigger Finger

A

tenosynovitis of finger flexors (most common is A1 pulley)

Why: Caused by repetition and use of tools placed too far apart

Interventions:
•	Hand based trigger finger splint
•	Scar massage
•	Edema control
•	Tendon gliding
•	Avoiding repetitive activities
27
Q

Ulnar Nerve Laceration

A

Sensory Loss:
• Ulnar aspects of palmar and dorsal surfaces
• Ulnar ½ of ring and little fingers on palmar and dorsal

Motor Loss (low lesion):
•	Adduction and abduction of MCP
•	MCP flexion
•	Flexion and adduction of thumb
•	Abduction, opposition, and flexion of 5th

Motor Loss (high lesion)
• Flexion toward ulnar wrist
• Flexion of DIPs of ring and little fingers

Deformities:
• Claw hand
• Flattened metacarpal arch
• +Froment’s sign (thumb adduction while laterally pinching)

Functional Loss:
• Loss of power grip
• Decreased pinch strength

Intervention:
• Splinting: MCP flexion block splint
• Sensory reeducation

28
Q

Wrist Drop

A

What: hand is flexed at wrist and lies flaccid, digits remain in flexed position at MCP joints
o Damage to radial nerve
o No loss of sensation

29
Q

UE Fractures: Interventions

A

o Edema
o Pain
o AROM (do not assess PROM without physician orders)
o Sensation

30
Q

Phases of Treatment: Fractures

A
  • Immobilization phase: AROM of joints above and below, edema control, light ADL
  • Mobilization phase: edema control, AROM, light ADL, pain management, strengthening (isometrics)
31
Q

Colle’s Fracture

A

distal radius fracture with dorsal displacement

32
Q

Smith’s Fracture

A

distal radius fracture with volar displacement

33
Q

Carpal Fracture

A

most common is in scaphoid bone

NBCOT (6 decks)

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