Midterm written Flashcards
(36 cards)
1
Q
Describe closed pack position of the radiocarpal joint
A
Full Extension
2
Q
Describe arthrokinematics and understand joint mobilisation theory for the radiocarpal, midcarpal, distal radioulnar joints
A
- Distal Radioulnar - synovial pivot joint - Convex head of the ulna on concave ulnar notch radius - 1 degree of freedom pro/sup
- Radiocarpal - Synovial ellipsoid joint - Convex carpals on the concave radius and meniscus
3
Q
Describe function of major structural ligaments (palmar radiocarpal, dorsal radiocarpal, radial collateral ligament of wrist, ulnar collateral ligament of wrist, ulnar collateral ligament of first MCP joint)
A
- Palmar Radiocarpal - Checks extension
- Dorsal radiocarpal - checks flexion
- Radial collateral ligament of wrist - checks adduction and ulnar deviation
- Ulnar collateral of wrist - checks abduction and radial deviation
- Ulnar collateral 1st MCP - checks valgus stress (abduction of the thumb)
4
Q
Describe location and function of TFCC
A
- Triangular fibrocartilage complex.
- Location: Ulnar side of the wrist
- Function: Cushions and supports the small carpal bones in the wrist. Keeps the radius and ulna stable when hand grasps or forearm rotates
5
Q
Describe biomechanics of flexion, extension, radial deviation, and ulnar deviation
Wrist and hand
A
- Flexion/extension & radial/ulnar deviation axis is through the capitate
- Flexion - Primarily midcarpal joint
- Extension - Primarily radiocarpal joint. Slight supination with extension (screw home movement) to achieve full close pack position. Twist occurs from Scaphoid
- Ulnar Deviation - Greater range because triquetrum clears ulnar styloid process more easily than scaphoid clearing radial styloid process
6
Q
Moving from Flexion to Extension
Wrist and hand
A
- During Flexion - distal and proximal rows are in loose pack. Moving into extension, carpals glide anteriorly. At neutral, distal row stops, scaphoid does supinatory twist to lock itself and distal row into closed pack. Afterwards, movement continues at the proximal row.
- Struggle with full wrist extension, scaphoid jt play probably indicated.
7
Q
Carpal Movement during Radial/Ulnar Deviation
A
- Radial deviation - Proximal row moves into pronation, ulnar glide and flexion. Distal row moves into supination, ulnar glide, extension
- Ulnar Deviation is opposite - proximal row moves into supination, radial glide, extension. Distal row into pronation, radial glide, flexion
8
Q
Describe arches of the hand
A
Arches improve the functional ability of the hand. Three main arches are:
Longitudinal (1 per finger)
Long finger and capitate form focal point
Transverse carpal (Proximal transverse)
Distal row of carpals, more mobile than distal transverse
Transverse metacarpal (Distal transverse)
Formed by heads of metacarpals
Third metacarpal, capitate, lunate are the center point.
Flat at rest, increasing curve with fist clench or grasping objects
9
Q
Describe power grip and precision grip
A
- Power grip is forceful flexion of digits 1-5 with the thumb stabilizing. An object is in contact with the palm. This uses the ulnar side of the hand. It is an isometric contraction.
- Precision grip is more dynamic, with digits 1-3 grasping an object, such as pinching (holding a paintbrush). Precision grip uses the median side of the hand. Isotonic contraction.
10
Q
Describe or define swan neck deformity, boutonniere deformity, dupuytren’s contracture, heberden’s nodes, bouchard’s nodes, ulnar drift, Z deformity of hand, mallet finger
A
- Swan neck deformity - MCP flexion, PIP extension, DIP flexion - contracture of intrinsic mm, often with RA or trauma
- Boutonniere deformity - MCP extension, PIP flexion, DIP extension - central slip of dorsal digital hood, often with RA or trauma
- Dupuytren’s contracture - Idiopathic contracture of palmar fascia. Fixed flexion deformity usually digits 4-5
- Heberden’s nodes - DIP nodes
- Bouchard’s nodes - PIP nodes
- Ulnar Drift - Changes in MCP and pull of tendons - seen in RA
- Radial drift - Seen with OA
- Mallet Finger - Distal phalanx in flex position - rupture or avulsion
- Zig zag deformity - CMC flexed, MCP hyperextended, IP partial flexion - seen with RA
- Z deformity - MCP flexed, IP hyperextended, familial
11
Q
Describe hand positions seen following degeneration injuries to radial, ulnar, and median nerves
A
- Radial nerve lesion - wrist drop
- Ulnar nerve lesion - Bishops (benediction) digits 4-5 resting flexed (loss of lumbricals), Claw hand - same as bishops but with some abduction digits 4-5, Froment’s sign - Loss of adductor pollicis leads to recruitment of flexor pollicis longus.
- Median nerve lesion - Ape hand (wasting of thenar mm), thumb rests in line with other digits and loss of ability to oppose or flex thumb, Oath Hand - inability to make fist, as digits 1-3 cannot flex.
12
Q
Describe definition, affected tissue, signs and symptoms of carpal tunnel
A
- Compression of median nerve in carpal tunnel, hallmark sign is nocturnal numbness, pain, tingling. Also achy forearm, atrophy of thenar mm, weakness
13
Q
Describe definition, affected tissue, signs and symptoms of dupuytern’s contracture
A
- Dupuytren’s contracture - Idiopathic contracture of palmar fascia, Involves flexor palmaris longus or flexor carpi ulnaris. Shortening and fibrosis causes spontaneous contracture of palmar fascia
SNS: tender palmar fasica, wrist flexor hypertone
14
Q
Describe definition, affected tissue, signs and symptoms of gamekeeper’s thumb
A
- Gamekeeper’s thumb - Acute trauma or repetitive stress cause 1st MCP UCL sprain. Forceful abduction can cause this. Symptoms include ulnar sided MCP pain digit 1, positive UCL of thumb stress test, difficulty pinching or grasping
15
Q
Describe definition, affected tissue, signs and symptoms of FPL Tenosynovitis
A
- FPL Tenosynovitis - Inflammation of tendon FPL tendon sheath. Signs are palmar thumb pain with movement. Normally from repeated thumb use. Pain is usually with AROM and not MMT because isometric contraction does not cause tendon movement.
16
Q
Describe definition, affected tissue, signs and symptoms of 1st CMC OA
A
- 1st CMC OA - Long-term degeneration, causes pain and relative instability in 1st CMC. Pain in anatomical snuff box, worse in morning or with prolonged disuse, gripping actions usually avoided and cause pain.
17
Q
Describe definition, affected tissue, signs and symptoms of scaphoid fracture
A
- M/c fractured carpal, m/c misdiagnosed sprain, signs are wrist pain that doesn’t go away, radiographs hard to read or doesn’t show up, poor blood supply to scaphoid. Pain on the radial side, esp with RD and ext.
18
Q
Describe definition, affected tissue, signs and symptoms of lunate dislocation
A
- m/c dislocated carpal, FOOSH with wrist hyperextension, signs are swollen wrist with painful extension of digits,
19
Q
Describe definition, affected tissue, signs and symptoms of trigger finger
A
- Idiopathic Digital tenosynovitis/tenovaginitis, thickening of flexor tendon sheaths or nodules developing, causes sticking of tendon from flexion to extension. Signs are finger/thumb stiffness, audible snap, progresses to needing passive extension
20
Q
Describe definition, affected tissue, signs and symptoms of De quervain’s syndrome
A
- Tenosynovitis of abductor pollicis longus and extensor pollicis brevis. RSI from ulnar and radial deviation and forceful gripping. Pain and symptoms over the radial side of the thumb.
21
Q
Describe definition, affected tissue, signs and symptoms of TFCC injury
A
- TFCC Injury - Cause by FOOSH with hyperextension or rotation injury. Slow onset through repetitive use is also possible. One of the most common causes of ulnar sided wrist pain. Deep ulnar sided wrist pain, worse when carrying heavy objects, pain worse in end range pronation,
22
Q
Describe closed pack position and capsular pattern of restriction of GH, AC, SC joints
A
- GH closed pack: Full AB & ER Capsular Pattern: ER > AB> IR
- AC Closed pack: 90* Ab Capsular Pattern: Full elevation w/ pain
- SC Closed pack: Maximal arm elevation Capsular Pattern: Full elevation with pain
23
Q
Describe arthrokinematics and understand joint mobilisation theory for the glenohumeral joint and the sternoclavicular joint
A
- GH: Convex head of humerus on concave glenoid fossa of scapula
- SC: Convex ant/post and concave sup/inf clavicular notch of manubrium on concave ant/post and convex sup/inf sternal end of the clavicle
24
Q
Describe function of major structural ligaments (coracohumeral, transverse humeral, acromioclavicular ligs, coracoclavicular complex)
A
- Coracohumeral: Strengthens superior capsule which checks gravity
- Transverse humeral: holds long biceps tendon in groove. (rupture = unstable biceps tendon
- Acromioclavicular ligaments: Prevents AC separation
- Coracoclavicular complex: Trapezoid, which checks excessive lateral movement and conoid, which checks excessive superior movement and scapuloclavicular angle widening
25
Describe scapulohumeral rhythm
* The scapula and humerus move in a 2:1 ratio. There are 3 phases:
* 0-30* ABd Scapula does not move - “scapular setting”
* 30-90* at about 40* ABd, scapula begins to rotate
* 90-180* 2:1 ratio continues and in the final, stage the clavicle elevates and rotates posteriorly. Humerus laterally rotates
26
Describe scapula malposition and muscles responsible for malposition (see SICK scapula)
* Scapular winging (medial border moves away from thorax) Dynamic: serratus anterior injury, compromised long thoracic nerve, or possible mm imbalance/strain to rhomboids or traps. If static, could be structural deformity of scapula, clavicle, spine, ribs
* Scapular tilting is also indicative of weakness or instability
27
Describe 3 force couples of shoulder function (a pair of equal and opposite forces that act on opposite sides of an axis, creating a rotational effect (torque) without a net force)
* Delts and rotator cuff: Delts create an upward and outward force, while SITS creates a downward and inward force
* Traps and serratus anterior: 3 parts of traps and serratus help with rotation of the scapula
* Long head biceps helps depress the head of humerus with ABd in external rotation (ex. throwing football)
28
Describe passive stability of the GH joint
* GH joint provides passive stability (when the arm hangs to the side and there is little to no mm contraction). The superior joint capsule and coracohumeral ligament hold the humerus in the glenoid fossa
29
Describe active stability and compromised stability of the GH joint
* Active stability: Shoulder is raised away from side (neutral/passive), jt capsule becomes lax and rotator cuff maintains stabilization
* Two conditions compromise GH stability:
* Excessive Thoracic Kyphosis: Creates a downward rotation, causing the superior jt capsule and coracoacromial ligaments to become lax. Causes SITS to take over with active stabilization, can increase tone and lead to impingement syndrome.
* Muscle paresis: Weakness or imbalance may cause scapular mm to orient in the same rotation as thoracic kyphosis. Inferior dislocation or subluxation may occur if SITS are affected.
30
Describe 3 ways to provoke musculotendinous tissue in assessment
* Contraction against resistance (RROM/MMT contraction)
* Lengthening (AROM opposite direction)
* Palpation
31
Describe definition, affected tissue, signs and symptoms of tendonitis
* Tendonitis: Overuse injury causing inflammation to tendons involved in repetitive movements. Commonly SITS and biceps. Referral pain, sleep disturbance, swelling, redness, pain with palpation
32
Describe definition, affected tissue, signs and symptoms of bursitis
* Bursitis: Inflammation of bursa, in GH main two are:
* Subacromial (on top of supraspinatus)
* Subscapular
* Usually secondary to other conditions, overuse, excessive friction with repetitive movement, poor biomechanics, mm imbalance, postural change, trauma
33
Describe definition, affected tissue, signs and symptoms of Impingement
* Impingement: Inflammatory condition which involves coracoacromial arch and space b/w AC and GH jts. Tissue compressed is supraspinatus, long head biceps tendon, subacromial bursa. Caused by wear and tear when repeatedly pushed into a coracoacromial arch. SNS: Insidious onset pain over lateral brachial region
34
Describe definition, affected tissue, signs and symptoms of Shoulder Instability
Complete/partial dissociation of articulating surfaces of GH jt.
35
Describe definition, affected tissue, signs and symptoms of AC Separation
* Caused by direct trauma, fall landing on AC or FOOSH. Involves the Coracoclavicular ligaments (trapezoid and conoid). Three grades
* type one is minor damage,
* type two is disruption to AC joint.
* Grade 3 is rupture of AC and CCC ligaments. Medical intervention required
36
Describe definition, affected tissue, signs and symptoms of Adhesive Capsulitis
* Self limiting inflammation and fibrosis of the joint capsule. Significant pain in early stages with reduction in ROM. Caused by Arm not being used because of painful condition, disuse, fibrosis of jt capsule. Primary frozen shoulder is idiopathic.
* 3 phases
* Freezing - gradual onset lasting 3-9 months
* Frozen or stiffening - Severe pain diminishes, ADL’s affected, Disuse atrophy
* Thawing - pain continues to diminish, motion and function gradually return, but full ROM isn’t always regained
