MSK term 3 wrist tests and pathologies

Question 1

Patient Details:
* Age:
* Most common wrist injury for any age
group, particularly in elderly patients
* Gender
* In pediatric population, higher frequency
among boys than girls
* Risk taking >
* Morphology
* Pediatrics, Elderly
* Past Medical History
* Bone health (osteopenia, -porosis)

Answer 1

distal radius fracture

Question 2

Pathophysiology:
* Trauma
* FOOSH
* Colles Fracture
* Colles fracture is a complete fracture
of the distal radius with a posterior
(dorsal) displacement of the distal
fragment. Silver Fork Deformity (+)
* Smith Fracture
* Complete fracture of the distal radius
with an anterior (palmar) displacement
of the distal fragment

Answer 2

distal radius fracture

Question 3

fracture is a complete fracture
of the distal radius with a posterior
(dorsal) displacement of the distal
fragment. Silver Fork Deformity (+)

Answer 3

Colles Fracture

colles fork fracture

posterior displacement of radius

lands on palm and pushes it posteriorly

Question 4

Complete fracture of the distal radius
with an anterior (palmar) displacement
of the distal fragment

Answer 4

Smith Fracture

AUNT SMITH = anterior smith fracture

lands on dorsal aspect makes sense thats how the distal portion goes anteriorly

Question 5

• Subjective Reporting:
• FOOSH
• Immediate pain on MOI
• Felt a pop/crack
• Cannot move wrist
• Objective Findings:
• Swelling of the wrist
• Possible gross deformity
• Limited ROM
• Point tenderness over the distal radius

Answer 5

Distal Radius Fracture

Question 6

distal radius fracture can affect ulnar variance?

Answer 6

yup

Question 7

Patient Details:
* Age:
* Occurs in young and middle-aged adults 15
to 60 years of age
* Men aged 20 to 30 years are most likely to
suffer from a _________ fracture
* Gender
* Male > female
* Morphology
* Most frequently fractured carpal bone
(71% of all carpal bone fractures)
* Past Medical History
* Consider bone health
* Athletes/FOOSH

Answer 7

scaphoid fracture

Question 8

Pathophysiology:
* Direct impact fracture to the Scaphoid
bone

Answer 8

uhh scaphoid fracture

Question 9

• Subjective Reporting:
• FOOSH
• Pain at the base of the thumb
• Objective Findings:
• Point tenderness within the snuff box
• Edema
• Loss of general function
• Loss of active wrist and/or thumb mobility
• Muscle guarding with passive movement
• Pain with passive/active ROM of the wrist and thumb
• Wrist will often be held in radial deviation
• Muscle guarding with all movements
• Inability to actively perform wrist or thumb movements
  secondary to pain
• Pain with gripping activities

Answer 9

Scaphoid Fracture

Question 10

usually will catch a scaphoid fracture between 6 weeks and 6 months on imaging during that sub acute phase ?

Answer 10

yeah

Question 11

scaphoid has 3 classifications
1 distal
2 waist
3 proximal

Answer 11

true

Question 12

the ________ scaphoid fracture of the scaphoid is prob the worst since blood flow moves distally to proximally

Answer 12

yeah , the distal one is bad too but less real estate looks like, either way put a screw in it so no avascular necrosis occurs

Question 13

Patient Details:
* Age:
* 30 – 50 years old
* Gender
* Women > men
* Morphology
* Common among individuals who perform any
activity requiring repetitive hand and wrist
movement
* Past Medical History
* N/A

Answer 13

DeQuervain’s Tenosynovitis

Question 14

Pathophysiology:
* Inflammation and thickening of the abductor
pollicis longus and extensor pollicis brevis
synovial tendon sheaths and extensor retinaculum
* Entrapment tendonitis, tendon friction
* Often a direct result of repetitive stress or chronic
overuse of extensor and abductor muscles causing
excessive friction to tendon sheath
* Patients likely to develop adhesions and irritation
between tendons and their sheaths

Answer 14

DeQuervain’s Tenosynovitis

Question 15

signs and symptoms
forearm pain
* Crepitus of tendons within the extensor sheath
* Unilateral dorsal pain and swelling
* Tendon friction rub
* Upper-extremity pain
* Weak thumb abduction
* Decreased grip strength
* Wrist pain and swelling
* Decreased abduction ROM of the carpometacarpal (CMC) joint,
thumb
* Pain with thumb activity, worsens when combined with wrist radial
or ulnar deviation

Answer 15

DeQuervain’s Tenosynovitis

Question 16

functional implications
Pain with pinching, grasping, squeezing, holding heavy objects,
wringing
* Pain with movements of hand and wrist
* Loss of strength
* Tendon rupture

Answer 16

DeQuervain’s Tenosynovitis

Question 17

Diagnostic Procedures
* Resisted isometric testing
* Finkelstein’s test

Imaging
* X-ray to rule out arthritis at thumb
CMC joint

Answer 17

DeQuervain’s Tenosynovitis

Question 18

Patient Details:
* Age:
* Young adult to middle age
* Gender
* M = F – not enough data
* Morphology
* common in rowers, weightlifters,
canoeists, and wheelchair users due to
repetitive wrist flexion and extension
* Past Medical History
* Repetitive overuse injury history

Answer 18

Intersection Syndrome

Question 19

Pathophysiology:
* tenosynovitis of the ECRL and ECRB
(radial wrist extensors), where they
cross under the APL and EPB.
* Although similar to DeQuervain,
differentiation is made with the pain
distribution.
* With the ________ _________, the pain is
located in the distal forearm, 4–8 cm
proximal to Lister’s tubercle, and is
exacerbated by wrist flexion and extension,
and by resisted wrist extension.

Answer 19

Intersection Syndrome

Question 20

Subjective Reporting:
* Tenderness is found dorsally on the
radial side
* Swelling
* Crepitus
* Objective Findings:
* Decreased grip strength
* Limited range of motion due to pain

Answer 20

Intersection Syndrome

Question 21

de quervains tenosynovitis pain distribution vs intersection syndrome pain distribution

Answer 21

dequervains is more radially along thumb side
intersection syndrome is more posteriorly in line with ECRL and ECRB

Question 22

Description:
* Entrapment neuropathy of the median nerve within the
_______ _______of the wrist
Essentials of Diagnosis:
* Pain, paresthesias, and sensory loss perceived on radial
side of the palm and the palmar side of thumb, index,
middle, and radial side of the ring fingers
* Waking from pain at night is hallmark of this condition
* In advanced cases, motor dysfunction in thenar muscles
may occur, characterized by weakness, atrophy, loss of
coordination

Answer 22

carpal tunnel
this is describing carpal tunnel syndrome

Question 23

General Considerations:
* In entrapment neuropathy, nerve becomes compressed, causing ischemic damage to
the nerve
* Pathomechanics involve decreased size of the tunnel or increased volume of the
contents, causing compression on median nerve
* Often associated with repetitive motions or sustained position of the wrist and hand
* Unrelieved compression of the nerve results in neurapraxia

Answer 23

Carpal Tunnel Syndrome

Question 24

Demographics:
* Incidence: 3.5 cases per 1,000 in general population ; Prevalence: 2.1%
* Most common entrapment neuropathy
* More common in women than men (70% of cases are female); 2.5 times more
common in obese individuals
* Most common among people aged 30 to 60 years; Nearly one-half of cases will
experience bilateral symptoms

Answer 24

carpal tunnel syndrome

Question 25

# 2 entrapment #1 entrapment nerve # 2 entrapment nerve # 1 most injured nerve

Answer 25

carpal tunnel cubital tunnel radial nerve due to humerus fractures

Question 26

The ______ wrist crease marks the proximal edge of the carpal tunnel. The boundaries of the carpal tunnel are as follows: * Radial: scaphoid tubercle and trapezium. * Ulnar: pisiform and hamate. * Posterior (dorsal): the carpal bones. * Anterior (palmar): transverse carpal ligament. * Proximal: antebrachial fascia. * Distal: distal edge of the retinaculum at the CMC level, FCR, and scaphoid tubercle.

Answer 26

distal

Question 27

signs and symptoms First symptom is usually pain or paresthesias; most commonly with gradual onset * Pain complaints include numbness (most common), tingling, burning * Pain or numbness waking the patient at night is very common * Pain is experienced in distribution of the median nerve in the hand, though may radiate up to elbow, shoulder, or neck * Tenderness to percussion or pressure over the carpal tunnel * Pain may be worse with extreme wrist flexion or extension * Sensory loss may follow early symptom of pain * Motor involvement (weakness, loss of coordination, atrophy) may follow in more advanced cases

Answer 27

CTS

Question 28

functional implications * Pain with wrist movements * Difficulty with grasping and manipulation activities * Dropping items from the hand * Impaired sensation * Loss of strength in advanced cases

Answer 28

CTS

Question 29

possible contributing causes * Most often idiopathic * Genetic structural factors * Swelling of synovial tissues in rheumatoid arthritis * Swelling from conditions such as infection, congestive heart failure, pregnancy * Obesity * Systemic issues: Alcoholism, Kidney failure, Menopause * Space occupying lesions: Displaced fracture, Tumors * Structural abnormalities of carpal bones * Occupations that require repetitive motion, repetitive stress, sustained positions of wrist and hand * Direct trauma to wrist * Impaired circulation to peripheral nerves, as seen in diabetes, predisposes individuals to nerve compression symptoms

Answer 29

CTS

Question 30

Possible differential diagnosis * Cervical radiculopathy * Thoracic outlet syndrome * Pronator teres syndrome * Traumatic nerve lesion * Rheumatoid or other arthritis * Acromegaly * Hypothyroidism * Scleroderma

Answer 30

CTS

Question 31

CTS clinical prediction rule

Answer 31

Clinical Prediction Rules: * Shaking hands to relieve symptoms * Wrist ratio >.67 * Symptom Severity Scale > 1.9 * Diminished sensation in median sensory field 1 (thumb) * Age > 45 years old * Phalen’s Test * Tinel’s Test * Durkan’s Test

Question 32

wrist ratio index

Answer 32

* measured by using a pair of sliding calipers to measure the antero-posterior (AP) wrist width and the medio-lateral (ML) wrist width at the distal wrist crease. * Wrist ratio index is then calculated by dividing the AP wrist width by the ML wrist width in centimeters. * Ratios greater than .70 were found to be a predisposing factor for carpal tunnel syndrome.

Question 33

Ratios ________ than .70 were found to be a predisposing factor for carpal tunnel syndrome.

Answer 33

Ratios greater than .70 were found to be a predisposing factor for carpal tunnel syndrome.

Question 33

Patient Details: * Age: * Adults of any age, but it is more common in middle-aged individuals. * Less common in children and adolescents unless associated with trauma or congenital anomalies. * Gender * No strong gender predisposition * Morphology * People who engage in repetitive wrist and hand movements are at higher risk. * Cyclists, who often sustain pressure on the hypothenar eminence * Musicians, particularly those who play string instruments or keyboards, * Workers using vibrating tools or those whose wrists rest against hard surfaces or edges may also be more susceptible. * Past Medical History * Possible contributing factors: * Ganglion/space occupying lesion * Ulnar artery thrombosis * Ulnar-sided wrist fractures or dislocations * Repetitive trauma * Sustained pressure over Guyon’s canal such as resting hypothenar eminence on handlebars while long distance cycling. * DM2 and or RA due to inflammatory nature

Answer 33

Ulnar Neuropathy at the Wrist

Question 34

Pathophysiology: * Motor and/or sensory changes in the ulnar nerve distribution due to pressure from 3 possible ways. * Compression * Stretch * Friction * Entrapment at the wrist: * Just proximal to or within Guyon’s canal * Sensory and motor involvement between the abductor digiti minimi and flexor digiti minimi * Near hook of hamate, involves motor only * Distal end of Guyon’s canal, involves sensory only

Answer 34

Ulnar Neuropathy at the Wrist

Question 35

Motor and/or sensory changes in the ulnar nerve distribution due to pressure from 3 possible ways, what are they?

Answer 35

compression, stretch, friction compression, stretch, friction compression, stretch, friction

Question 36

entrapment at distal end of Guyons canal involves ________only

Answer 36

sensory

Question 37

entrapment near hook of hamate, involves ________ only

Answer 37

motor

Question 38

when the ulnar nerve is entrapped between abductor digiti minimi and flexor digiti minimi _______ and ______ are involved

Answer 38

sensory and motor are involved

Question 39

Subjective Reporting: * Acute or chronic paresthesia in ulnar nerve distribution. * Sensory changes * Night pain especially with elbow flexion and wrist extension * Inability to separate fingers * Hand clumsiness * Hand weakness and loss of grip power and dexterity

Answer 39

Ulnar Neuropathy at the Wrist

Question 40

* Objective Findings: * Motor and sensory changes to the ulnar nerve distribution. * Weakness with grip * Pain and discomfort with compression over Guyon’s canal

Answer 40

Ulnar Neuropathy at the Wrist

Question 41

hook of hamate fractures can mess up ulnar nerve distribution as well right ?

Answer 41

yup

Question 42

* Wartenberg sign * Froment sign * Bishops deformity * Tinel’s Test * Compression over Guyon’s canal

Answer 42

Ulnar Neuropathy at the Wrist Tests