L7 Hand/Elbow Flashcards
(99 cards)
1
Q
Proximal Radial Ulnar Joint
A
Radial head rotates in radial notch of ULNA
radius rotates around the ulna to create forearm rotation
2
Q
Ligaments of Proximal radioulnar joint
A
annular ligament
interosseous membrane
3
Q
Radial Head Fx
A
can be displaced or non displaced
4
Q
Non-displaced radial fx treatment
A
edema control
pain control
early AROM of elbow and forearm
5
Q
Displaced radial head fx treatment
A
Follow MD order
edema and pain control
will need hinged elbow orthosis
can start elbow motion, but need to limit forearm motion
6
Q
Anterior Joint Capsule of Elbow
A
the anterior joint capsule is often the cause of elbow flexion contractures due to its tendency to thicken and become fibrotic
there’s a capular redundancy in flexion
7
Q
Interosseous Membrane
A
Very dense
can be a restricting structure for forearm rotation after immobilization or scarring
8
Q
IM Treatment
A
responds well to low load long duration stretch. Mobilization can be used as long as both distal and proximal joints are stable
9
Q
Treatment progression of wrist instability
A
Education
Edema Control
Pain Control
Begin with AROM
Progress AA/PROM
Isometrics
Proprioception
Functional Strengthening
10
Q
Manual Edema Mobilization
A
- Rub armpit 10 firm circles
- Rub inside of elbow 10 firm circles
- With flat hand, start on back of hand and gently draw the hand up to inside of elbow to armpit onto chest 5 times
- End with arm overhead and do 10 fists
11
Q
AROM that you should begin with hand issues
A
Fingers out straight, make hook fist, make table top, make straight fist, make full fist, repeat
12
Q
Isometrics for hands
A
Goal is to learn motor control
Wrist Extension
Wrist Flexion
Ulnar Deviation
Radial Deviation
13
Q
Triangular Fibrocartilage Complex
A
load bearing structure between lunate, triquetrum, ulnar head
stabilizes the distal radoiulnar joint
known as the meniscus of the wrist
14
Q
TFCC makeup
A
ulnocarpal ligament
articular disc
dorso and volar radioulnar ligament
ECU sub sheath
15
Q
Load across the distal radioulnar joint
A
causes stress to TFCC
normal: ulnar should be slightly shorter than the radius so that more force goes through the radius
16
Q
Causes of ulnar neutral or positive variance
A
genetics
DR fracture
DRUJ injury
17
Q
How to find DRUJ
A
find lister’s tubercle and slide ulnarly but medial to ulnar styloid
18
Q
How to find TFCC
A
pronation palpate between FCU, ulnar styloid, pisiform
19
Q
Injury Types of TFCC
A
peripheral and central
20
Q
Central TFCC Injury
A
Wear and tear or ulna hitting against carpal bones
this injury is does not destabilize the joint, associated with positive ulnar variance, has poor vascularization, cannot be repaired only debrided
21
Q
Peripheral TFCC Injury
A
FOOSH especially with rotational component
has better vasularity, destabilizes the joint, but can be surgically repaired
22
Q
S/S of TFCC
A
- pain w/palpation over ulnar fovea
- popping or clicking in forearm rotation
- decreased grip strength
- edema at ulnar fovea
- pain at ulnar side with forearm rotation
- pain with weight bearing
23
Q
Press test
A
seated pt pushes up to stand on arms of chair, positive w/pain
24
Q
Ulnar impingement sign
A
elbow on table, in UD there is clicking
25
Ulnar compression Test
load wrist in ulnar deviation, positive is clicking
26
Destabilizing TFCC injury tx
if acute, refer to hand surgeon
27
Peripheral TFCC injury tx
if it is in a vascularized area and NOT displaced, can be treated while limiting forearm/wrist motion for 6-8 weeks
28
Chronic TFCC injury tx
use immobilization with orthosis
modalities to decrease pain/inflammation
avoid weightbearing
isometrics
proprioceptive exercises
29
Structures involved in forearm rotation
PRUJ and ligaments
interosseous membrane
DRUJ and ligaments
biceps, supinator, anconeus, pronator teres, pronator quadratus
30
Regaining forearm rotation following TFCC injury
avoid carpal torque when placing load in hand
compensate with shoulder abduction
orthoses, practice swinging a hammer
31
Scaphoid Anatomy
volar tubercle is in proximal thenars, dorsal in snuff box
32
Hamate is commonly
tender with palpation
33
Intrinsic ligaments of the wrist
very important and commonly injured
scapholunate ligament
lunotriquetral ligament
34
Carpal Instability Dissociative
occurs within same carpal row
involves the scapulunate ligament and lunotriquetral ligament
35
Scapholunate ligament injury
scaphoid palmar flexes while lunate and triquetrum dorsiflex
occurs with wrist hyperextension and ulnar deviation
the scapholunate angle ends up being greater than 60°
36
Lunotriquetral ligament injury
lunate palmar flexes and scaphoid and triquetrum stay vertical
angle between lunate and scaphoid is <30°
occurs from wrist hyperextension and radial deviation
37
Radial sided wrist pain can be due to
scaphoid fracture
scapholunate ligament injury
thumb OA
thumb arthritis
dorsal ganglion
38
Scaphoid fracture
MOI: FOOSH
S/S: pain at radiodorsal, may improve with time. Pain with bearing weight, pain with palpation of snuff box
39
Tx of scaphoid fracture
refer to hand surgeon
commonly requires surgery because the scaphoid can die
40
Scapholunate Ligament Injury
Hx: FOOSH
S/S: pain at dorsoradial wrist, pain with weightbearing, decreased grip, popping or clunking
41
Watson's shift test
testing for scapholunate ligament injury
thumb holds palmar scaphoid, index finger holds radial tubercle dorsally. Wrist should be in ulnar deviation.
push the hand into radial deviation. Positive if proximal pole of ligament will jump over dorsal lip of radius with a clunk, the scaphoid is dorsiflexing.
42
Rehab of scapulolunate
dart thrower's motion
wrist proprioception
stability vs mobility
immobilization 3-8 weeks in thumb spica orthosis
AROM
weightbearing in neutral
43
LT Ligament Rehab
immobilization 3-8 weeks in wrist orthosis or cast
AROM
proprioceptive
strengthening
weight bearing in neutral
44
Dart thrower's motion
indicate fro patients who will benefit from midcarpal mobility and have instability in the proximal row
45
1st CMC Joint
saddle joint that permits a wide range of motion and is largely responsible for the characteristic dexterity of human prehension
46
What stabilizes the metacarpal trapezial joint?
ligaments
muscles
47
1st CMC OA
most common in women over 50
MOI: wear and tear from overuse, laxity, previous injury
S/S: pain at base of thumb and into thenars, weakness in grip/punch, shoulder sign, loss of web space
48
Treatment of 1st CMC OA
Orthotics (can be custom)
Joint Protection
Adaptive equipment (increase handle size, increase leverage, decrease demand)
49
Adaptations for ADLs for 1st CMC OA
can opener, gripping water bottle from bottom, peelers
50
Dynamic thumb stabilization
helps to strengthen the muscles that stabilize the base of the thumb
Performed as so:
1. Web space massage
2. APB
3. OP
4. 1st DI
5. EPB
6. Resistance for all
51
When conservative management fails for thumb OA
injection with corticosteroid
surgery
remove the trapezium
ligament reconstruction
prevent caving
arthroplasty
52
Metacarpal phalangeal joint
is a hinge joint
has collateral ligaments that are tight in flexion, loose in extension, and prevent lateral deviation
has a joint capsule that prevents hyperextension
53
MCP joint sprain
often neglected by patient, and misdiagnosed or mistreated
MOI; history of impact with fist or forced abduction
S/S: edema between MC heads, tender to palpation at collateral ligament, pain with fisting
54
Tx of MCP joint sprain
buddy tape to off load injured side
custom orthosis to block MCP flexion to allow collateral ligament to heal in shortened position and take tension off
55
MC Fractures
can occur at base, shaft, neck, or head.
ulnar usually can tolerate more foce and health with immobilization
most common is a boxers fx/5th metacarpal fx
56
Non operative Treatment of MC fx
immobilization in ulnar gutter in safe position
forearm based cast in safe position which is wrist in DF, MP in flexion, IP in extension for 4-6 weeks
57
Operative MC Fx treatment
ORIF if greater than 60°
pinning
plating usually dorsal
tendon adherence with edema, start tendon gliding
58
Safe position for immobilization of the hand
edema of the hand pools dorsally due to laxity of skin. This will pull MCPS into hyperextension, which flexes the IP joints
Safely position by controlling edema and MCP flexed at 70° and IPs extended
59
Proximal IP
hinge joints
ligaments are TIGHT in extension and LOOSE in flexion
volar plate prevents hyperextension
60
Proximal IP Sprain
MOI: lateral stress to tip of finger
S/S: redness, edema at PIP
61
Tx of proximal IP sprain
edema control
early motion with finger buddy taped to decrease stress on injured ligament
use of orthosis to limit lateral stress
62
Distal IP Joint
hinge joint
ligaments prevent lateral deviation
volar plate prevents hyperextension
63
Distal IP Joint Injury
MOI: hyperextension for dorsal injury, forced flexion for volar
typically does well with immobilization fro 4-6 weeks
(pictured is dorsal dislocation)
64
Mallet finger
MOI: axial loading of DIP jt when in extension or forceful DIP flexion that overpowers the weaker extension system
S/S: loss of DIP extension
can be tendinous or bony
65
Bony mallet finger
tendon pulls a small dorsal piece of dorsal distal phalanx with it
6 weeks of immobilization, heals faster vs tendinous
66
Tendinous mallet finger
tendon tears and bone remains intact
requires min of 8 weeks of immobilization
67
Treatment of Mallet finger
immobilization of DIP in slight HE
encourage FDS gliding
gradual mobilization
watch for burning pain
change orthosis to prevent skin breakdown
68
After immobilization
check tendon integrity
wean off immobilization gradually
no flexion
no grip strengthening
there will be an imbalance between flexor and extensor systems
69
Injuries to Radial nerve
Saturday night palsy, honeymoon palsy, crutch palsy. Humerus fx, compression between supinator, post interosseous nerve injury
70
Radial nerve injury due to humerus fx
loss of wrist and digit extension and lack of sensation
71
Arcade of Frohse
compression of radial nerve between heads of supinator
72
Post Interosseous Nerve Injury
wrist function and sensation are preserved
73
Tx for radial nerve injuries
orthotics to provide function of muscles that are impaired
PROM to prevent contracture
AROM and strengthening once return begins
74
High median nerve injury
occurs proximal to ant interosseous nerve origin
loss of sensation in lateral forearm and radial hand
loss of function of pronator, radial wrist flexors, thenar muscles, extrinsic thumb, IF/MF
75
Low median nerve
helps the function of wrist and pronator
76
Anterior interosseous nerve injury
loss of FPL and FDP to IF
77
Tx of Median Nerve injuries
orthotics to retain mobility and function
PROM to prevent contracture
AROM and strengthening once motor return occurs
78
High ulnar nerve at elbow
loss of FCU, RF/SF FDP, ulnar lumbricals, dorsal interossei
clawhand, fromet's sign, wartenburg sign
79
Lower ulnar nerve injury
loss of ulnar limbricals, dorsal interossei. Loss of sensation in ulnar RF (1/2) and SF
80
Treatment of lower ulnar injury
orthotics to replace function and prevent contracture
adaptive equipment for handwriting, fine prehension
81
deQuervain's tenosynovitis
MOI: inflammation of EPB and ABPL within tendon sheath as it passes through extensor retinaculum
disease of new mothers
82
Tests for dequervain's tenosynovitis
finkelsteins test
resisted thumb extension
83
Tx for de Quervain's Tenosynovitis
rest/immobilization in forearm based thumb spica
ice, k tape, iontophoresis
gentle low rep tendon gliding, activity modificaiton, injection, surgery
84
Boutonniere Deformity
disruption of central bands leads to volar displacement of lateral bands then the lateral bands become PIP flexors, putting more tension on the tendon, causing DIP hyperextension
85
MOI of Boutonniere Deformity
rupture of central slip
PIP joint flexion contracture often post PIP sprain
86
Elson test
examiner passively flexes the PIP joint ot 90° over edge of table and asks pt to perform extension while examiner resists
a rupture would produce no extensor force at PIP, and extension at DIP
87
Tx of Boutonniere Deformity
correct any contracture with serial casting
acute requires 6 weeks of immobilization
perform oblique retinacular stretches, helps lateral band to go dorsally
Gradual mobilization
88
Jersey Finger
avulsion of the flexor digitorium profundus tendon (FDP) from its distal insertion on the distal phalanx
89
FPL can be
weak post ORIF for distal radius fracture
90
Hook fist works
interossei
91
Tabletop hand works
lumbricals
92
Hook and full fist work
FDS and FDP
93
The pulley system of FDS/FDP prevents
bowstringing
places important role in flexion
94
Trigger Finger
inflammation of flexor tendon at the pulley results in catching or locking as the nodule enters or exits the pulley system
95
Treatment for Trigger Finger
Rest
Anti inflammatory drugs
teach PROM to prevent contracture
refer to surgeon if locking
Orthotics
96
Pulley Injury
rupture of A2 pulley, usually occurs in rock climbers
97
Treatment for Pulley injury
pulley ring
progress to H taping
surgery requires reconstruction
98
Dorsal Dermis of Hand
loose and mobile
needed to make fists
99
Volar dermis of hand
more attachement and stability
needed for secure grasp
