Hand/UE Disorders & Injuries Flashcards Preview

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

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


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


Skiers Thumb/Gamekeepers thumb

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


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


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


CRPS symptoms

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


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


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


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


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.


Complete vs Incomplete Fracture

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


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.


Transverse Fracture

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


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


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


Impacted, Compressed or Longitudinal Fracture

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


Avulsion Fracture

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


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


Carpal Fx

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



Classified by location; common complication is rotational deformities.


Boxers Fx

Fx of 5th MC; req ulnar gutter splint


Prox Phalanx Fx

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


Distal Phalanx Fx

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


Humerus Fx of greater tuberosity could

Affect rotator cuff


Humerus Fx of radial shaft could

Injure radial nerve - wrist drop


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


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


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


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


de Quervains

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


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


Lateral Epi or Tennis Elbow

Overuse of wrist extensors esp ECRB - degen of tendon origin


Medial Epi or Golfers Elbow

Overuse of wrist flexors - degen of tendon origin


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


Trigger Finger

Tenosynovitis of finger flexors - most commonly A1 pulley


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