Hand/UE Disorders & Injuries Flashcards Preview

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Flashcards in Hand/UE Disorders & Injuries Deck (36):
1

Dupuytrens Disease

Disease of fascia of palm/digits where fascia becomes thick/contracted - develops cords/bands that extend into digits: Results in flex deformities of involved digits
*Surgical release required

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Tx for Dupuytrens Disease

Wound care - dressing changes; Edema control - elevation; Extension splint - initially at all times; A/PROM and progress to strengthening; Scar mngt; Purposeful grip/release task

3

Skiers Thumb/Gamekeepers thumb

Rupture of ulnar collateral lig of MCP joint of thumb - most common is fall w ski pole in hand

4

TS for Skiers Thumb/Gamekeepers thumb

Thumb splint 4-6mo, AROM/Pinch strengthening for 6mo, Focus on ADL that req opposition/pinch strength, post-op tx: thumb splint for 6wx then AROM. PROM can begin at 8wk, strengthening at 10

5

Complex Regional Pain Syndrome (CRPS) {2 types}

Type I: formerly known as reflex sympathetic dystrophy (RSD); Type II: formerly known as causalgia
Vasomotor dysfx as a result of an abnormal reflex; Can be localized or spread

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CRPS symptoms

Severe pain, edema, discoloration, osteoporosis, sudomotor changes, temp changes, trophic changes and vasomotor instability

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Tx for CRPS

Modalities to decrease pain, edema mngt, AROM, ADL to encourage pain-free use, stress loading (wt bear/joint distraction activities like scrubbing/carrying), splinting to prevent contractures/enable ability, encourage self mngt, interventions to avoid/caution: PROM. pass stretch, joint mob, dynamic splinting/casting

8

Intraarticular vs Extraarticular fracture

Intra-articular fractures involve a joint space and are significantly more serious because they are associated with a much greater incidence of long-term complications; Extraarticulars do not extend into the joint

9

Closed vs Open fracture

An open fracture is an injury that not only damages the bone but will break the skin; Closed does not break skin

10

Dorsal vs Volar Displacement Fracture

A Colles' fx: of the distal radius in the forearm w dorsal (posterior) and radial displacement - Sometimes referred to as a "dinner fork" or "bayonet"; Smiths fx: of the distal radius w volar displacement
A fracture with an offset of 2mm+ in any plane or 2mmm offset involving the articular surface is considered displaced.

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Complete vs Incomplete Fracture

A complete fracture means that the fracture line goes completely across the bone — through the cortex

12

Simple vs Comminuted Fracture

A simple fracture is one where there are only 2 major bone fragments and one fracture line. A comminuted fracture is one where there are multiple bone fragments and multiple fracture lines.

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Transverse Fracture

Fracture line is perpendicular to the long axis of the bone, caused by force in the direction of the fracture

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Spiral Fracture

Fracture line is twisted and the fracture line is a twisting fracture caused by a twisting injury such as a break in your leg that happens when your foot is planted but your leg keeps turning

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Oblique/Diagonal Fracture

Fracture line is on the diagonal and usually caused by force applied in the same direction as the long axis of the bone

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Impacted, Compressed or Longitudinal Fracture

Fracture line and force is in the same direction as the long axis of the bone

17

Avulsion Fracture

Bone fracture which occurs when a fragment of bone tears away from the main bone mass as a result of physical trauma.

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Types of Fx

Closed reduction: stabilization through short/long arm cast, splint, sling or fracture brace; ORIF: nails, screws, plates, wires; External Fixation; Arthodesis: fusion; Arthroplasty: joint replacement

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Carpal Fx

Most common scaphoid fx (60%) - prox scaphoid has poor blood supply and may become necrotic

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MC Fx

Classified by location; common complication is rotational deformities.

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Boxers Fx

Fx of 5th MC; req ulnar gutter splint

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Prox Phalanx Fx

Most common w thumb/index; common complication is loss of PIP A/PROM

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Distal Phalanx Fx

Most common finger fx; May result in mallet finger which involves the terminal extensor tendon which straightens DIP

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Humerus Fx of greater tuberosity could

Affect rotator cuff

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Humerus Fx of radial shaft could

Injure radial nerve - wrist drop

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Eval for Fx

Hx: w mechanism of injury/fx mngt; Results of special tests; Edema; Pain; AROM - not PROM until ordered by physician (ex humerus fx which usually begin with PROM); Sensation; Occ/roles/ADL/Activities

27

Tx for Fx - Immobilization Phase

Stabilization and healing goals - AROM of joints above/below stabilized part; Edema control: retrograde, elevation, compression garmets; Light ADL/role activities w no resistance - AT

28

Tx for Fx - Mobilization Phase

Edema control: elevation, retrograde, contrast baths, compression garmets; AROM: process to PROM when approved (4-8wks) - ex humerus fx; Light occ-based acts; Pain mngt: positioning & PAMs; Strengthening: isometrics to begin when approved

29

Cumulative Trauma Disorders (CTD) or Repetitive Strain Injuries (RSI) - Risk Factors

Overuse and/or MSD; repetition, static position, awkward postures, forceful exertion & vibration; Acute trauma, preg, DB, arthritis, wrist shape/size

30

de Quervains

Stenosing tenosynovitis of the abductor pollicus longus and extensor pollicus brevis, pain & swelling over radial styloid & positive finkelstiens - thumb in palm

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Tx for de Quervains

Conservative tx: thumb spica splint w IP joint free, activity/work mod, ice massage over radial wrist, gentle AROM of wrist/thumb to prevent stiffness; Post-Op tx: thumb spica splint & gentle AROM 0-2wks, strengthening, ADL/Role activities 2-6wks; Unrestricted activity at 6wk

32

Lateral Epi or Tennis Elbow

Overuse of wrist extensors esp ECRB - degen of tendon origin

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Medial Epi or Golfers Elbow

Overuse of wrist flexors - degen of tendon origin

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Conservative tx for Lateral/Medial Epi

Elbow strap/wrist splint, ice/deep friction massage, stretching; act/work mod, as pain decreases add strengthening - progress to isotonic/eccentric

35

Trigger Finger

Tenosynovitis of finger flexors - most commonly A1 pulley

36

Conservative tx for Trigger Finger

Hand based trigger finger splint w MCP extended and IP free; Scar massage; Edema Control; Tendon gliding; Activity/Work mod - avoid rep gripping and tool w handles too far appart