Lecture 10 - Wrist/hand

Question 1

Movements at the wrist (7)

Answer 1

Distal radioulnar
Radiocarpal
Intercarpal
Midcarpal
Carpometacarpal
Metacarpalphalangeal
Interphalangeal

Question 2

Type of joint for distal radioulnar

Answer 2

Uniaxial pivot joint

Question 3

Distal radioulnar joint - resting position/close packed position/capsular pattern

Answer 3

R.p = 10d of supination
Close p = 5d of supination
Cp = full ROM, pain at extremes of rotation

Question 4

Type of joint for radiocarpal

Answer 4

Biaxial ellipsoid joint

Question 5

Radiocarpal joint - resting position/close packed/capsular pattern

Answer 5

RP = neutral with slight ulnar deviation
Close packed = extension with radial deviation
Cap p = flexion and extension limited equally

Question 6

Carpals - truc pour se rappeler de l’ordre

Answer 6

Please Tell Little Suzie Tucker To Come Home

Question 7

What is TFCC

Answer 7

Triangular fibrocartilage complex

Question 8

MOI of TFCC

Answer 8

Compression of the ulnar side and rotation OR excessive radial deviation stretching the TFCC (ex: from swinging a hammer)

Question 9

Normal functional hand movements

Answer 9

40d flexion
40d extension
15d radial deviation
20d ulnar deviation

Question 10

4 types of sympathetic changes in nails in observation

Answer 10

• Vasomotor
• Sudomotor
• Pilomotor
• Trophic

Question 11

List the common hand/wrist deformities

Answer 11

• Benediction hand
• Drop wrist
• Beau’s line
• Mallet finger
• Bouchard’s nodes
• Heberden’s nodes
• Osteoarthritis
• Swan neck deformity
• Boutonniere deformity
• Ulnar drift
• Clubbing
• Ganglion or small cyst swelling

Question 12

What’s Benediction hand deformity?

Answer 12

Hyperextension of the metacarpophalangeal joint and flexion of the interphalangeal joints

Question 13

What is ulnar drift?

Answer 13

Results in ulnar deviation of the digits

Question 14

What is swan neck deformity?

Answer 14

Extension of the proximal interphalangeal joint

Question 15

What is mallet finger?

Answer 15

Rupture or avulsion of the extensor tendon -> flexion of the distal phalanx consistent

Question 16

What is Boutonniere deformity?

Answer 16

Extension or the metacarpophalangeal and distal interphalangeal and flexion of proximal interphalangeal joint.

Question 17

What position you put the wrist for RROM

Answer 17

Neutral at hand/wrist

Question 18

Mvts of functional wrist/hand scan (5)

Answer 18

• Standard fist
• Hook grasp fist
• Straight fist
• Pulp-to-pulp pinch
• Tip-to-tip pinch

Question 19

For wrist sagittal plane, most of the motion for extension comes from (66,5%)?

Answer 19

Radiocarpal

Question 20

How to measure the wrist in frontal plane (ulnar vs radial dev)?

Answer 20

Angle between radius and the third metacarpal

Question 21

Functional ability - ___ from index and middle

Answer 21

Power

Question 22

Functional ability - ____ from middle and little

Answer 22

Dexterity

Question 23

3 tests for precision

Answer 23

3 finger pinch
Lateral pinch
Tip pinch

Question 24

4 tests for grip (see p.514)

Answer 24

Hook
Fist
Cylindrical
Spherical

Question 25

What is the functional position of the wrist? "Position of rest"

Answer 25

Wrist extension 20-35d Ulnar deviation 10-15d

Question 26

Functional position plus (wrist immobilization)

Answer 26

- More wrist extension - More MP flexion - IP extended - Potential for contracture is kept to a minimum

Question 27

What is the ulnomeniscotriquetral dorsal glide test?

Answer 27

Dorsal glide of pisotriquetral complex -> + for TFCC looking for excessive laxity

Question 28

condition where there is a compression of the median n.

Answer 28

Carpal tunnel syndrome

Question 29

Sx of carpal tunnel syndrome

Answer 29

Inc P at night Numbness and tingling Weakness and atrophy in LOAF

Question 30

What is the LOAF muscles

Answer 30

Lumbricals Opponens pollicis ABD/Flex pollicis brevis

Question 31

What is the double crush syndrome?

Answer 31

Compression of the nerve that happens somewhere else along the root where the first compression occurs, because of compensation

Question 32

Condition where there is compression of the ulnar n.

Answer 32

Guyon's canal syndrome

Question 33

Guyon's canal syndrome - Type 1

Answer 33

Affects sensory and motor Palmar sensory loss Flex carpi uln & flex. digi spared

Question 34

Guyon's canal syndrome - type 2

Answer 34

Only motor affected Interossei and add. pollicis

Question 35

Guyon's canal syndrome - Type 3

Answer 35

Distal end of guyon's canal Purely sensory (palmar superficial sensory branches)