MSK term 3 finger patho and tests Flashcards
(49 cards)
TFCC Sprain / Injury
Ligamentous Injury:
- UCL Sprain (Thumb)
- PIP dislocations
- Carpal instability
Boney:
- Boxer’s Fracture
- CMC Osteoarthritis
- Rheumatoid Arthritis
HAND INERT TISSUE INJURIES
Description:
* The __________ is a fibrous and cartilaginous structure that separates
the radiocarpal and inferior radioulnar joints of the wrist
* It is the major ligamentous stabilizer of the distal radioulnar joint
and the ulnar carpus.
* Provides a flexible mechanism for stable rotational movements of
the radiocarpal unit around the ulnar axis and cushions the forces
transmitted through the ulnocarpal axis.
* Functions like the meniscus in the knee.
* Prone to cartilage tears that can cause symptoms of wrist pain
and clicking or catching sensations.
* The athlete most often injures the _______ when swinging a bat or
a racquet that creates a violent twist, or torque, of the wrist.
TFCC Triangular Fibrocartilage Complex
Patient Details:
* Age:
* 30-50
* Younger individuals who are involved in
sports or activities that place significant
strain on the wrist, such as gymnastics or
racquet sports, may also be at risk.
* Older individuals may have degenerative
changes.
* Gender
* No definitive gender differences
* Morphology
* Jobs requiring repetitive wrist actions,
particularly pronation and gripping, are at
higher risk.
* Sports that involve racquets, bats, or clubs.
* Gymnasts and weightlifters due to the
significant load placed on extended wrists.
* Past Medical History
* History of repetitive wrist use or injury.
* Ulnar variance can impact the load
distribution across the _________ and may be a
risk factor for injury.
TFCC
this is describing triangular fibrocartilage complex injury
- Pathophysiology:
- Forced hyperextension of the wrist, as in falling
on an outstretched hand, that compresses the
_________ between the radioulnar joint and the
proximal row of carpal bones. - Also may be caused by violent/repetitive
twisting of the wrist.
TFCC
- Subjective Reporting:
- Pain along the ulnar side of the wrist.
- Pain with axial loading and/or twisting against resistance
- Wrist extension is difficult and painful,
especially on the ulnar side of the wrist. - May be clicking sound or a catching sensation when moving the wrist.
- Objective Findings:
- Decreased grip strength secondary to pain
- Difficulty with weight bearing through hands/wrist secondary to pain
TFCC injury
- TFCC Press Test
- Piano Key Test
- Ulnar Impaction Test (Axial Load Test)
TFCC tests
TFCC press test
How to Perform the Test:
Position: The patient sits with their arm resting on a chair or table.
Action: The patient is asked to push themselves up off the chair, using their wrists to support their weight.
Interpretation: A positive test is indicated by pain at the ulnar (pinky) side of the wrist, particularly near the pisiform bone
piano key test for TFCC
Procedure:
Position: The patient’s hand is placed in pronation (palm facing down).
Stabilization: The examiner stabilizes the radius and wrist.
Pressure Application: The examiner applies pressure to the ulnar head, pushing it down.
Observation: The examiner observes for excessive movement or pain as the ulnar head returns to its normal position after the pressure is released
ulnar impaction test (axial load test) for TFCC
no idea really
Patient Details:
* Age:
* Commonly seen in active individuals between the ages of 20 and 40 due to higher participation in athletic
activities.
* Gender
* No significant gender disposition.
* Morphology
* Athletes, particularly those involved in sports where falling or forceful abduction of the thumb is possible (like skiing, football, basketball, baseball or rugby), are at a higher risk.
* The morphology typical of individuals with these injuries often includes a laxity
* Past Medical History
* High Beighton index
Thumb UCL Sprain
Pathophysiology:
* Also known as “Skier’s Thumb”
* Gamekeeper’s Thumb,
Breakdancer’s Thumb
* Injury to the MCP joint of the thumb
* Most common ligament injury of the hand
* The injury typically occurs when a radially directed impact forces the thumb into abduction and hyperextension.
thumb UCL sprain
- Subjective Reporting:
- Pain on the medial side of the thumb as it inserts into the hand.
- Reports of hyper abduction/extension of the thumb.
- Feeling a “pop”
- Objective Findings:
- Deformity
- Swelling
- Pain
- Tenderness to palpation on the ulnar aspect of the MCP joint
- Instability and weakness during pinch
Thumb UCL Sprain
Thumb UCL Stress Test
Thumb Valgus Stress Test
* The patient is positioned in sitting.
* The clinician stabilizes the patient’s hand with one
hand and takes the patient’s thumb into extension
with the other hand.
* While maintaining the thumb into extension, the
clinician applies a valgus stress (purple arrow) to the
MCP joint of the thumb to stress the UCL.
* A positive test is present if the valgus movement is
greater than 30–35 degrees, indicating a complete tear
of the UCL and the accessory collateral ligaments.
thumb UCL sprain
- Patient Details:
- Age:
- More prevalent in adults aged 20 to 40, an age
group typically involved in more intense physical
activities or sports - Elderly who experience a FOOSH
- Gender
- Slightly higher prevalence in males, potentially
due to higher participation in contact sports - Morphology
- Gymnastics, weightlifting, or racquet sports, are
at greater risk. - Morphologically, people with looser ligaments or
generalized joint laxity may be more prone to
developing carpal instability. - Past Medical History
- High Beighton index
- Elderly
carpal instability
Pathophysiology:
* Hyperextension of the wrist during a FOOSH.
* Any injury to the intercarpal ligaments that
creates instability between two carpal bones
* Scapholunate articulation is the most common
area for carpal instability.
* The integrity of the carpal relationship depends
on the stability provided by both the
interosseous ligaments and the midcarpal
ligaments.
carpal instability
Subjective Reporting:
* Patients frequently complain that the
pain is aggravated by weight bearing on
an extended wrist.
* Physical examination is often limited,
revealing swelling and a deformity
* Objective Findings:
* Patients frequently complain that the
pain is aggravated by weight bearing on
an extended wrist.
* Physical examination is often limited,
revealing swelling and a deformity
Carpal Instability
- Watson Test (Scaphoid Shift Test)
(Please read Dutton) - Pivot Shift Test of the Midcarpal Joint
(Dutton)
Carpal Instability
Description:
* Dislocations of the phalanges have a high rate of occurrence
* The mechanism that produces a ____ dislocation is hyperextension that produces a disruption of the volar plate at the middle phalanx.
* The volar plate is a thick, fibrocartilaginous ligament that is part of the anterior joint capsule.
* It forms floor of the _____ joint and separates the joint space from the flexor tendons.
PIP
this is describing a PIP dislocation
Description:
* MOI is commonly a direct axial force or a compressive force.
* Fractures of the fifth metacarpal are associated with boxing and the
martial arts and are usually called a _______ fracture.
boxers fracture
Signs & Symptoms:
* The patient complains of pain and swelling. The injury may appear to be an angular or rotational deformity.
Management:
* Initially, POLICE and analgesics are given, followed by X-ray examinations. Deformity is reduced, followed by splinting. A splint is worn for 4 weeks, after which early ROM exercises are carried out.
boxers fracture (5th metacarpal)
after a ______ fracture, a splint is worn for __ weeks after which early _______ exercises are carried out
boxers, 4, ROM
Description:
* Most common form of Osteoarthritis (OA)
* Degenerative
* Commonly affects hand and weight-bearing joints
* Can also affect interphalangeal joints and first metatarsophalangeal joint
* Associated with increasing age, obesity, sex and race/ethnicity
* Associated with abnormal loading of the joints
* Characterized by joint pain
* Arthrosis, Osteoarthrosis, Polyarthrosis
* Degenerative joint disease
CMC Osteoarthritis
General Considerations:
* Repetitive joint use or loading
* Joint alignment
* Bone or joint morphology
* Thickening of subchondral bone plate, osteosclerosis
* Joint swelling and inflammation (in certain cases,
severe cases)
* Joint pain, Morning stiffness
* Muscle atrophy and weakness
* Bony protrusion/prominence, Joint deformity
* Grasping difficulty, Difficulty with ADLs
CMC Osteoarthritis
General Considerations:
* Repetitive joint use or loading
* Joint alignment
* Bone or joint morphology
* Thickening of subchondral bone plate, osteosclerosis
* Joint swelling and inflammation (in certain cases,
severe cases)
* Joint pain, Morning stiffness
* Muscle atrophy and weakness
* Bony protrusion/prominence, Joint deformity
* Grasping difficulty, Difficulty with ADLs
Demographics:
* Increase in age (middle to older age)
* Women are more affected than men
* African American and Caucasian
* May affect about 12% of the population (US and other
developed countries)
CMC Osteoarthritis
