Pathophysiology of the Hand and Wrist

Question 1

the intrinsic extensors at the hand/wrist primarily extend at what joint?

Answer 1

MCP

Question 2

trigger fingers tend to occur at what pulley?

Answer 2

A1 pulleys

Question 3

what is a Boutonniere’s deformity?

Answer 3

central slip dysfxn at the middle phalanx

triangular ligament attenuation

volar migration of the lateral bands

Question 4

Boutonniere’s deformity is ____ of the MCP, ____ of the PIP, and ____ of the DIP

Answer 4

extension, flexion, extension

Question 5

what are some interventions for Boutoniere’s deformity?

Answer 5

surgical repair

splinting to keep the PIP in a more extended position

Question 6

t/f: Boutonniere’s deformity causes friction over the radial styloid

Answer 6

true

Question 7

what is the etiology of a Swan neck deformity?

Answer 7

disruption of the volar pulley at the PIP

flexor tendon rupture at the PIP and extensor tendon at the DIP

Question 8

Swan neck deformity is ____ of the PIP and ____ of the DIP

Answer 8

extension, flexion

Question 9

t/f:there are deficits in active PIP flexion with a Swan neck deformity

Answer 9

true

Question 10

what are some interventions for Swan neck deformity?

Answer 10

surgical repair

splinting to facilitate PIP flexion

Question 11

what is the etiology of DeQuervain’s tenosynovitis?

Answer 11

tenosynovitis of the APL and EPB due to CTD (cumulative trauma disorder ie overuse)

Question 12

what are the s/s of DeQuervain’s tenosynovitis?

Answer 12

pain at the base of the thumb

pain at the radial styloid

Question 13

what are some interventions for DeQuervain’s tenosynovitis?

Answer 13

reduce edema

splinting

NSAIDs

stretch/ROM

surgical release

Question 14

t/f: DeQuervain’s tenosynovitis causes friction over the radial styloid

Answer 14

true

Question 15

t/f: resistance will usually cause pain in DeQuervain’s tenosynovitis

Answer 15

true

Question 16

if there is a (-) Finkelstein test and pain in the snuff box, what may be going on?

Answer 16

fx

Question 17

if DeQuervain’s tenosynovitis is chronic is it easier or harder to treat?

Answer 17

harder to treat

Question 18

t/f: steroid injection are a common treatment for DeQuervain’s tenosynovitis

Answer 18

false, steroid injection may cause breakdown of the tendons, putting them at risk for rupture

Question 19

what is the test most commonly used for DeQuervain’s tenosynovitis?

Answer 19

Finkelstein test

Question 20

how many tendons cross the wrist?

Answer 20

12

Question 21

where does the FCR insert?

Answer 21

on the 2nd and 3rd metacarpals

Question 22

where does the FDS insert?

Answer 22

on the base of the middle phalanx

Question 23

where does the FDP insert?

Answer 23

on the base of the distal phalanx

Question 24

what motion does the FDS produce?

Answer 24

PIP flexion

Question 25

t/f: the FDP is 50% stronger than the FDS

Answer 25

true

Question 26

what are the 2 bundles of the FDP?

Answer 26

one bundle from the radius to the index finger another bundle from the ulna to the long, ring, and pinky fingers

Question 27

what is the Quadriga effect?

Answer 27

the distal tendon of 1 finger limits the active motion of other tendons bc of their shared muscles belly

Question 28

t/f: the excursion of combined tendons is equal to the shortest tendon's excursion

Answer 28

true

Question 29

how long does it take to regain tensile strength of tendons?

Answer 29

12 weeks to a year

Question 30

adhesions tend to form where?

Answer 30

in zones 1 and 2 (distal hand in the fingers)

Question 31

t/f: PROM helps eliminate adhesions

Answer 31

false, ACTIVE flexion is required to move the tendons through the proximal pulley (A1 pulleys)

Question 32

what are the primary intervention strategies for management of flexor tendon ruptures and repairs?

Answer 32

edema control scar management passive finger flexion active finger extension

Question 33

t/f: full IP extension must be attained immediately post-op flexor tendon repair/rupture but extension at the MCP, PIP, and DIP places adverse stretch

Answer 33

true

Question 34

t/f: passive finger extension is avoided in early stages of flexor tendon ruptures/repairs bc of tension it puts on the tendons

Answer 34

true

Question 35

what does a dorsal blocking splint for post flexor tendon repair?

Answer 35

allows MCP flexion w/full IP extension

Question 36

t/f: full wrist and finger extension is not allowed until later stages of flexor tendon repair/rupture

Answer 36

true

Question 37

active finger flexion is started at ___ weeks post flexor tendon repair if 40-50 deg difference bw PROM and AROM

Answer 37

4

Question 38

t/f: the MCP may be splinted in slight flexion (15-20 deg) to maintain the length of the collateral ligs

Answer 38

true

Question 39

what is a trigger finger?

Answer 39

thickening of the flexor tendon sheath or tendon typically at the A1 pulleys causing "snapping" as the nodule pulls through the pulley

Question 40

what is the MOI of trigger finger?

Answer 40

insidious or due to repetitive gripping of sharp edges

Question 41

t/f: there is a palpable nodule on the flexor tendon with a trigger finger

Answer 41

true

Question 42

what are the intervention strategies for trigger finger?

Answer 42

rest hand-based splint with MCP jt at 0 deg that allows full PIP motion injections surgery followed by progression to light strengthening

Question 43

t/f: there is strong evidence for modalities to treat trigger finger

Answer 43

false, there is weak evidence

Question 44

what structures run through the carpal tunnel?

Answer 44

median nerve a 9 tendons

Question 45

what tendons run through the carpal tunnel?

Answer 45

FPL 4 FDS tendons 4 FDP tendons

Question 46

why is the median nerve at risk in the CT?

Answer 46

bc it is the weakest structure, so it tends to get compressed

Question 47

what are the tests for CTS (carpal tunnel syndrome)?

Answer 47

Tinel Phalen/reverse CT compression

Question 48

how can we manage CTS?

Answer 48

activity modification wrist mobs tendon glides neuromobilization (median nerve glides) splinting to hold the hand in just a couple deg of ext (15-20) bike fitting modalities surgery

Question 49

what activity modification can be given for CTS?

Answer 49

neutral wrist in typing on the computer

Question 50

where is the Tunnel of Guyon?

Answer 50

on the ulnar side of the wrist

Question 51

what nerve is effected in the tunnel of Guyon?

Answer 51

the ulnar nerve

Question 52

what are the tests for TFCC pathology?

Answer 52

TFCC load test TFCC stress test gripping rotatory impaction test (GRIT)

Question 53

with a (+) GRIT, would pronation or supination be stronger?

Answer 53

supination would be stronger for a (+) GRIT

Question 54

what are ways to manage TFCC syndrome?

Answer 54

reduce pain and swelling restore movt RESTORE/REHAB STRENGTH AND FXN surgical repair/debridement

Question 55

what is the MOI of TFCC syndrome?

Answer 55

axial loading with compression through the wrist forceful twist

Question 56

t/f: TFCC syndrome involves wearing of the central portion

Answer 56

true

Question 57

t/f: TFCC syndrome is often a chronic condition

Answer 57

true

Question 58

disc perforations are present in what % of those over 50 with TFCC syndrome?

Answer 58

50-60%

Question 59

a colles fx is ___ angulation

Answer 59

dorsal

Question 60

collies fx is usually due to what MOI?

Answer 60

FOOSH injury

Question 61

t/f: a colles fx leads to ROM limitations that we may or may not be able to fully regain

Answer 61

true

Question 62

what are the tests we learned for jt and bone conditions of the wrist and hand?

Answer 62

Watson scaphoid instability test axial loading test

Question 63

other than scaphoid fx, what else could the axial loading test tell us about?

Answer 63

CMC or MCP arthritis

Question 64

is game keeper's thumb chronic or acute?

Answer 64

chronic

Question 65

is skiers thumb chronic or acute?

Answer 65

acute

Question 66

how is gamer keeper's thumb/skier's thumb managed?

Answer 66

thumb spica splint modalities to control pain and inflammation ROM to tolerance eventually strengthening

Question 67

what is a game keeper's thumb/skier's thumb?

Answer 67

tear of the UCL of the 1st MCP

Question 68

what is a Boxer's fx?

Answer 68

fx of the 5th metacarpal

Question 69

what is the test for lunate dislocation?

Answer 69

Murphy's sign