MSK PT: Wrist and Hand

Question 1

Distal radioulnar joint

resting position

Answer 1

10º supination

Question 2

Distal radioulnar joint

closed pack position

Answer 2

5º supination

Question 3

Distal radioulnar joint

capsular pattern

Answer 3

full ROM with pain at end range

Question 4

describe the radiocarpal joint

Answer 4

• radius articulates with the scaphoid and lunate
• TFFC

Question 5

radiocarpal joint

what is the TFCC

Answer 5

• triangular fibrocartilage complex
• disc that extends from the ulnar side of the distal radius to the ulnar styloid process
• adds stability to the wrist

Question 6

radiocarpal joint

resting position

Answer 6

neutral + slight ulnar deviation

Question 7

radiocarpal joint

closed pack position

Answer 7

extension with radial deviation

Question 8

radiocarpal joint

capsular pattern

Answer 8

flexion and extension equally limited

Question 9

Intercarpal joints

resting position

Answer 9

neutral/slight flexion

Question 10

Intercarpal joints

closed pack position

Answer 10

extension

Question 11

Intercarpal joints

capsular pattern

Answer 11

none

Question 12

midcarpal joints

resting position

Answer 12

neurtal or slight flexion w/ ulnar deviation

Question 13

midcarpal joints

closed pack position

Answer 13

extension with ulnar deviation

Question 14

midcarpal joints

capsular pattern

Answer 14

equal flexion and extension

Question 15

carpometacarpal joint

resting position

Answer 15

thumb is a saddle joint
- thumb: midway between abduction/adduction and midway between flexion and extension
- fingers: midway between flexion and extension

Question 16

carpometacarpal joint

closed pack position

Answer 16

• thumb: full opposition
• fingers: full flexion

Question 17

carpometacarpal joint

capsular pattern

Answer 17

• thumb: abduction>extension
• fingers: equal all directions

Question 18

MCP joint

resting position

Answer 18

• slight flexion

Question 19

MCP joint

close pack position

Answer 19

• thumb: full opposition
• fingers: full flexion

Question 20

MCP joint

capsular pattern

Answer 20

• flexion>extension

Question 21

IP joints of the hand

resting position

Answer 21

slight flexion

Question 22

IP joints of the hand

closed pack position

Answer 22

full extension

Question 23

IP joints of the hand

capsular pattern

Answer 23

flexion>extension

Question 24

What are things to look for when observing a patients hand

Answer 24

• fingers/contractures
• muscle wasting
• local swelling
• vasomotor/trophic changes
• hypertrophy

Question 25

# Hand deformities Ape hand

Answer 25

- median nerve - wasting of thenar eminence - thumb falls in line with other fingers

Question 26

# Hand deformities Bishops hand

Answer 26

- ulnar nerve - wasting of hypothenars - flexion of 4th and 5th fingers

Question 27

# Hand deformities boutonniere

Answer 27

- extension of MCP and distal IP - flexion of proximal IP - results from central tenious slip of extensors - common with trauma and RA patients

Question 28

# Hand deformities Claw hand

Answer 28

- MCP are hyperextensed and IP joints are flexed - combined median and ulnar nerve - intrinsic minus hand

Question 29

# Hand deformities wrist drop

Answer 29

- radial nerve - weak extensors

Question 30

# Hand deformities Dupuytren contracture

Answer 30

- progressive genetic condition - contracutre of plamar fascia - fixed flexion deofrmity

Question 31

# Hand deformities mallet finger

Answer 31

- rupture of extensor tendon - distal phalanx rests in flexion

Question 32

# Hand deformities Swan neck

Answer 32

- flexion of MCP and distal IP - extension of proximal IP - due to contracture of intrinsic muscles or tearing volar plate - common with trauma or RA

Question 33

# Hand deformities Extensor plus deformity

Answer 33

- due to adhesions/shortening of extensor tendons proxmial to MCP joints - unable to simultaneously flex MCP and proximal IP joints

Question 34

# Hand deformities myelopathy hand

Answer 34

- due to C/S pathology - unable to extend and adduct ring and little finger

Question 35

# Hand deformities polydactyly/triphalangism

Answer 35

- extra finger or toes - congential

Question 36

# Hand deformities trigger finger

Answer 36

- thickening of flexor tendon sheath - causes tendon to stick when pt attempts to flex finger

Question 37

# Hand deformities ulnar drift

Answer 37

- common in RA - due to weakening of capsuloligamentous strcutures

Question 38

# Hand deformities zigzag deformity of the thumb

Answer 38

- flexed CMC and hyperextended at MCP - assoicated with RA

Question 39

What active movements should be examined with a forearm wrist/hand injury

Answer 39

- pronation/supination - radial/ulnar deviation - wrist flexion/extension - finger flexion/extension - finger abduction/adduction - thumb flexion/extension - thumb abduction/adduction ## Footnote *pronation and supination mainly comes from the forearm but can be due to wrist movement* - must examine the effect of the injury on all other parts of the forearm, wrist, and hand

Question 40

Passive movements to examine with wrist and hand

Answer 40

- tissue stretch = pronation, supination, wrist flexion/extension, finger flexion/extension finger abduction/adduction, thumb flexion and thumb abduction - bony: radial and ulnar deviation - tissue approximation: thumb adduction

Question 41

what resisted isometrics should be done at the hand and wrist

Answer 41

- supination - pronation - radial/ulnar deviation - wrist flexion/extension - finger flexion/extension - finger abduction/adduction - thumb flexion/extension - thumb abduction/adduction - opposition

Question 42

functional assessment at the wrist

Answer 42

- wrist flexion/extension - wrist radial and ulnar deviation - make a standard fist - make a hook grasp - make a straight fist - pulp-to-pulp thumb to all fingers - tip to tip thumb to all fingers

Question 43

types of grips

Answer 43

- power grip: ulnar side gives radial side stability - hook grasp - cylinder grasp - palmar prehension - fist grasp - spherical grip - lateral/key pinch - tip pinch

Question 44

# Special test: wrist and hand for ligament and capsule/joint stability

Answer 44

- joint play - ulnomeniscotriquatral dorsal glide - watson types

Question 45

# special test: wrist and hand for tendons and muscles

Answer 45

- finkelstein

Question 46

# special test: wrist and hand neurological dysfunction

Answer 46

- carpal compression test - forments paper sign - phalens/reverse phalens - tinel - webers two point discrimination

Question 47

# special test: wrist and hand circulation

Answer 47

- allen - digital blood flow - figure 8

Question 48

# Joint play wrist

Answer 48

- long axis traction - AP glide (both rows) - side glide - side tilt

Question 49

# Joint play intermetacarpal joints

Answer 49

- AP glide

Question 50

# joint play fingers

Answer 50

- traction - AP glide - rotation - side glide