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DPT 516 > Quiz #8 > Flashcards

Quiz #8 Flashcards

1
Q

loss of sensation on volar and dorsal medial hand

A

cubital tunnel

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2
Q

intact sensation of the dorsal medial hand

A

guyon’s canal

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3
Q

weakness of medial hand with strong FDS FDP and weak lumbricals (intrinsics)

A

tunnel of guyon

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4
Q

weakness of the medial hand with intrinsic loss and FDP FDS loss

A

cubital tunnel

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5
Q

what fractures are notoriously difficult to get back full ROM?

A

intraarticular fractures

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6
Q

how are intraarticular fractures rehabed?

A

low load, long time

soft tissue work

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7
Q

where is the ulnar nerve often compressed?

A

behind the medial epicondyle

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8
Q

how do we test for ulnar nerve damage?

A

Fromen’s sign

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9
Q

what is the functional loss with a median nerve injury?

A

loss of pronation, wrist flexion, radial deviation, thumb flexion/abduction/opposition, and gripping

ape hand deformity

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10
Q

what is the functional loss with an ulnar nerve injury?

A

loss of wrist flexion, ulnar deviation, 5th digit PIP flexion, finger abduction/adduction,

benediction hand deformity (loss of extension of DIP and PIP of 4th and 5th digits)

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11
Q

what is the functional loss with a radial nerve injury?

A

loss of supination, wrist extension, gripping, wrist stabilization, finger extension, and thumb abduction

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12
Q

what is being described?: entrapment of the ulnar nerve at the medial intermuscular septum which slopes from a thick wide base at the medial epicondyle to a thin edge on the humeral shaft

A

cubital tunnel syndrome

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13
Q

what causes cubital tunnel syndrome?

A

superfical traction from flexion and entrapment from the anconeus

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14
Q

what signs are associated with cubital tunnel syndrome?

A

pain and paresthesia of digits 4-5 in the ulnar nerve distribution on the dorsal and volar aspect of the forearm and hand

inability to adduct/abduct finger

loss of grip

worsens throughout the day

atrophy of intrinsics, FDP and FDS

(+) Tinnel sign

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15
Q

what is an ulnar nerve transposition?

A

removing the medial muscles, taking the nerve and moving it in front then reattaching the muscle

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16
Q

what is an insitu ulnar nerve transposition?

A

debridement to loosen the nerve IN PLACE

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17
Q

what is pronator teres syndrome?

A

median nerve entrapment at the ligament of suthers causing pain at the wrist, medial forearm, and with increased extension and pronation

paresthesias in digits 2-3 and possibly the thumb

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18
Q

which occurs more carpal tunnel syndrome or pronator teres syndrome?

A

carpal tunnel syndrome

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19
Q

what are the sites for entrapment with pronator teres syndrome

A

biceps aponeurosis, pronator teres, FDS

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20
Q

how can pronator teres symptoms be replicated?

A

with direct pressure over pronators (4cm distal to cubital crease), resisted pronation(PT), supination, long finger flexors(FDS), elbow and wrist flexion

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21
Q

what is one differentiating factor b/w pronator teres syndrome and carpal tunnel syndrome?

A

carpal tunnel has nocturnal symptoms, while pronator teres may not

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22
Q

how can pronator teres syndrome be tested?

A

handshake with resisted pronation, extend elbow passively (+=reproduction of pain)

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23
Q

what makes up the carpel tunnel?

A

pisiformis, triquetrum, lunate, scaphoid, and trapezium

transverse carpal ligament

9 tendons

median nerve

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24
Q

what ligament surrounds the TFCC?

A

radioulnar lig

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25
Q

what does the radioulnar lig do around the TFCC?

A

increases the depth of the jt so the wrist becomes a smooth continuous jt

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26
Q

what is negative ulnar variance?

A

shorter ulna

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27
Q

what is positive ulnar variance?

A

longer ulna

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28
Q

what is the motion at the 1st CMC?

A

15 deg flex

70-80 deg ext

70 deg abd

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29
Q

what is the motion at the 1st MCP jt?

A

75 deg flex

10-15 deg ext

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30
Q

what is the motion at the 2nd-5th MCP jts?

A

90-110 deg flexion

30-50 deg ext

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31
Q

what is the motion at the PIP jts?

A

70-110 deg flex

9-20 deg ext

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32
Q

what is the motion at the DIP jts?

A

80-90 deg flex

15-20 ext

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33
Q

t/f: the intrinsics balance flex/ext

A

true

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34
Q

what is the only extensor of the MCP?

A

extensor digitorum communis

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35
Q

the lateral bands of what muscle wraps around the volar plate of the MCPs?

A

extensor digitorum

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36
Q

what muscle continues to form the extensor hood over the proximal phalanx

A

EDC

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37
Q

what is the central slip?

A

extension of the EDC that attaches to the middle phalynx that extends the PIP

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38
Q

t/f: the actions of the extensors in the hand are really bc of the tension increated by the lumbricals

A

true

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39
Q

what is the transverse retinacular ligament?

A

the ligament extending from the PIP volar plate that encircles the PIP and prevents the lateral bands from migrating/bowstringing dorsally

creates extension force at PIP

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40
Q

what does laxity of the transverse retinacular lig result in?

A

swan-neck deformity!!!

hyperextension of PIP, flexion of DIP

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41
Q

what is a swan neck deformity?

A

PIP hyperextension

DIP flexion

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42
Q

what is the oblique retinacular lig (ORL)?

A

originates on PIP volar plate and runs obliquely to the terminal extensor tendon

PIP extension

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43
Q

what are the wrist flexors?

A

flexor carpi radialis

flexor pollicus longus

flexor digitorum superficialis

flexor digitorum profundus

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44
Q

what are the intrinsics of the hands?

A

lumbricals and interossei

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45
Q

what is the role of the intrinsics of the hand?

A

to balance flexor and extensor activities

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46
Q

do the interinsics of the hand flex or extend the IPs?

A

extend

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47
Q

do the intrinsics of the hand flex or extend the MCPs?

A

flex

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48
Q

what is the primary action of the lumbricals?

A

IPJ extension via the proximal pull on the dorsal hood

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49
Q

t/f: as the lumbricals contract, they pull the flexor tendon distally, lessening the force of the FDP contraction

A

true

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50
Q

what is the role of the palmar/volar interossei?

A

allow MP flexion, IP extension

assists the lumbricals

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51
Q

what is a Boutoneire’s deformity?

A

PIP flex, DIP hyperext

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52
Q

what is Mallet finger injury?

A

injury to the extensor hood causes DIP flexion

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53
Q

what are Bouchard’s/Heberden’s nodes?

A

Bouchards-PIP
Heberdens-DIP

hyperplasia of the IPS

arthritic change

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54
Q

what is ulnar drift?

A

pull of the fingers in the ulnar direction

common in RA

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55
Q

what is an “ape hand” injury

A

median nerve injury proximal to the wrist

inability to abd, flex, or oppose the thumn so it is in the same plane at the other digits

may see atrophy of the thenar eminence

normal PROM

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56
Q

what is the opening hand of benediction?

A

MCP ext, no IP ext

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57
Q

what is the closing hand of benediction?

A

digits 2 and 3 can’t flex

likely to see MCP flexion still at digits 2 and 3

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58
Q

what are the characteristics of an ulnar nerve injury?

A

deficit of the 4th and 5th digits

prominent at rest and when extending fingers inability to abd/add digits 2-5

atrophy of the dorsal interossei

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59
Q

what are the characteristics of a median nerve injury?

A

deficit of digits 2-3

prominent when making a fist

difficulty opposing the thumb

atrophy of thenar eminence

60
Q

what is the claw hand/intrinsic minus position?

A

MCP extension with IP flex

ulnar and median nerve atrophy of intrinsics

predominence of extensor digitorum bc flexion is taken

61
Q

what is carpal tunnel syndrome?

A

compression of median nerve at the carpal tunnel

usually idiopathic but can be related to overuse

62
Q

what are the causes of acute carpal tunnel syndrome?

A

trauma, infection, hemmorhage, high-pressure injection, acute thrombosis, and burns

63
Q

what is the average age of people with carpal tunnel syndrome?

A

40-60 y/o

64
Q

are men or women affected by carpal tunnel syndrome more?

A

women

65
Q

what are the manifestations of carpal tunnel syndrome?

A

numbness/tingling of digits 1-4

weak thumb abduction

dropping objects

worsens at night

atrophy of thenar eminence

66
Q

what is the Phalan test?

A

press the backs of the hands together to get max wrist flexion to see if they feel anything

67
Q

what is the Tinnel sign?

A

tapping a superficial nerve to see if it creates pain

68
Q

what is Guyon’s canal syndrome?

A

compression of the ulnar nerve at Guyon’s canal in the ulnar wrist

69
Q

what are the causes of Guyon’s canal syndrome?

A

overuse

direct pressure on handlebar, barbell, construction equipment

excessive gripping, twisting, or repeated wrist and hand motions

70
Q

what are the manifestations of Guyon’s canal syndrome?

A

numbness/tingling of digits 4-5

hyperthenar and interossei atrophy

intact dorsal sensation

71
Q

what is the treatment for guyon’s canal or carpal tunnel syndrome?

A

ADL mods

wrist mobs

tendon glides

nerve glides (neuromobilization)

splinting

bike fit

modalities

surgery to curt the lig and create more space

72
Q

how do we perform ulnar nerve glides?

A

flex the elbow and wrist

73
Q

how do we perform median nerve glides?

A

extend the elbow and wrist

74
Q

how do we perform radial nerve glides?

A

extend the elbow and flex the wrist

75
Q

what is DeQuervain’s tenosynovitis?

A

overuse of the abductor pollicus longus (APL) and extensor pollicus brevis

tension under the extensor retinaculum

76
Q

how is DeQuervain’s tenosynovitis diagnosed?

A

pain with thumb extension

tender and swelling over the tendons at the radial styloid process

crepitus with motion

(+) Finkelstein’s sign

77
Q

what is a positive Finkelstein’s sign?

A

tuck the thumb in and make a fist then ulnar deviate

pain=(+)

78
Q

in the initial phase, what is the treatment of DeQuervain’s tenosynovitis?

A

modalities for pain and inflammation reduction

NSAIDs

ADL modification

splinting (spica)

surgical release

79
Q

as pain subsides, what is the treatment of DeQuervain’s tenosynovitis?

A

AROM

gentle stretching

painfree resistive motion progression

80
Q

what is Colles fx?

A

distal radial fx w/dorsal angulation

dinner fork deformity

most common fx among women up to age 75

81
Q

how is a Colles fx treated?

A

casting, surgery (ext fix, int fix, pinning, bone substitutes)

pain and edema management, ROM, manual therapy, and strengthening

82
Q

what is a TFCC injury?

A

due to axial load and compression through the wrist wearing at the central portion of the TFCC

tears of peripheral portion of the disc

disc perforation in 50-60% of cases

83
Q

what is the cause of type 1 TFCC injuries?

A

acute trauma, tear in lig or fovea

84
Q

what is the cause of type 2 TFCC injuries?

A

degenerative/repetative injury

85
Q

how is a TFCC injury diagnosed?

A

TFCC load test where the wrist is ulnar deviated with long axis compression

MRI

Hx

86
Q

how are TFCC injuries treated?

A

conservative measures (pain management, movement restoration, strengthening, fxn)

surgery

87
Q

what is a trigger finger?

A

thickening of the flexor tendon sheath or tendon causes teh finger to lock then snap or trigger with flex/ext as the nodule pulls through the pulley

nodule often palpable on flexor tendon

88
Q

what causes trigger finger?

A

insidious or due to repetitive gripping of sharp edges

89
Q

how is trigger finger treated?

A

rest

hand-based splint that blocks MCP motion, but allows IP motion

modalities (not well supported by evidence)

injections

surgery

90
Q

what is a Boxer’s fx?

A

fx of the 5th metacarpal

can see a depression of the 5th metacarpal

91
Q

how is a Boxer’s fx treated?

A

immobilization or surgery

92
Q

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

A

game keeper’s-chronic
skier’s-acute

tear of the 1st MCP

can cause avulsion fx

93
Q

how is game keeper’s/skier’s thumb treated?

A

hand-based splint (stop MCP motion, allow IP motion)

modalities

ROM to tolerance

eventual strengthening

94
Q

what is a ganglion cyst?

A

ganglia arise from a jt capsule/tendon sheath causing possible pain or tenderness

pressure form cyst on a nerve can cause focal neurologic symptoms

95
Q

what are the 2 general groups of forces acting on the hips?

A

GRF (ground rxn forces)

HAT (head, arms, trunk)

96
Q

what are the 3 bones of the pelvis?

A

illium, ischium, pubis

97
Q

what connects the inferior part of the acetabulum?

A

the transverse acetabular lig

98
Q

what is the role of the labrum at the hip?

A

deepen the acetabulum

99
Q

what is the center edge angle?

A

help deepen the fossa

normal: 22-42 deg

amount of overhang the labrum has

determines the angle of femoral head coverage

100
Q

what is the acetabular anteversion angle?

A

men-18.5 deg; women-21.5 deg

the extent to which the acetabulum contains the anterior aspect of the femoral head

larger angle=risk for dislocation

101
Q

what is the angle of inclination?

A

the angle made b/w the femoral neck and shaft

influence leg length

normal: 125 deg (larger in children, smaller in older adults)

102
Q

what is coxa vara?

A

angle of inclination <125 deg

appearance of shorter leg ipsilaterally

more prominent GT

femurs appear more abducted –> genu valgus

increased glut med moment arm–>more compression of the hip

contralateral genu recurvatum

contralateral knee/hip flexion

ipsilateral pelvis rotates ant; contralateral pelvis rotate post

103
Q

what is coxa valga?

A

angle of inclination >125 deg

larger appearing leg

may see genu varus

smaller glut med moment arm–>less compression of the hip–>risk for dislocation

ankle dorsiflexion to drop the knee angle

foot pronation to shorten the leg

genu valgum ispilaterally

ipsi pelvis rotates post, contra pelvis rotates ant

104
Q

LBP is possible if the leg length discrepancy is greater than __mm

A

5

105
Q

clinically significant leg length discrepancy is greater than ___mm

A

20

106
Q

how do you measure true leg length?

A

measure from the ASIS to the distal med malleolus

107
Q

how do you measure apparent leg length?

A

measure from the AIIS to the distal med malleolus

108
Q

what is the angle of torsion?

A

the angle of anteversion of the femur

normal=15-25 deg of anteversion

109
Q

what is retroversion?

A

<15 deg anteversion

110
Q

what is anteversion?

A

> 25 deg anteversion

111
Q

is there IR or ER with retroversion?

A

ER

112
Q

is there IR or ER with anteversion?

A

IR

113
Q

what is the Craig test?

A

lie pt in prone, move the leg in and out and feel when the pelvis gets to it most lateral portion and observe how much the leg goes out

in a lot=retroversion
out a lot=anteversion

used to get insights on anteversion and retroversion

114
Q

what provides stability of the hip?

A

capsuloligamentous complex (CLC)

115
Q

what is the illiofemoral lig (Y lig of Bigelow)?

A

lig from AIIS and ant acetabulum to intertrochanteric line

can hang on the y lig with weak hip flexors

116
Q

what is the pubofemoral lig?

A

ant pubic ramus to intertrochanteric line

117
Q

what is the ischiofemoral lig?

A

post acetabulum rim to femoral neck

limits ext, IR, add from flexed position

118
Q

what is the ligamentum teres?

A

ligament from the acetabulum notch to fovea capitis

interarticular but extrasynovial

carries blood supply

119
Q

other than the ligamentum teres, what else supplies blood to the hip?

A

circumflex and retinacular arteries around the head and neck of the femur

120
Q

what fx usually disrupts blood flow to the hip?

A

femoral neck fx

121
Q

why would a femoral fx disrupting blood supply be dangerous?

A

it could lead to avascular necrosis

122
Q

a transphyseal fx has a ___ % AVN risk

A

90-100%

123
Q

a transcervical fx has a ___% AVN risk

A

50%

124
Q

a cervico-trochanteric (or basicervical) fx has a ___% AVN risk

A

25%

125
Q

an intertrochanteric fx has a ___% AVN risk

A

10%

126
Q

what is osteoarthritis?

A

focal loss of articular cartilage w/subchondral bone sclerosis, loss of jt space, and osteophytes (spurring)

127
Q

what are predisposing factors for OA?

A

obesity

family history

hypermobility

previous injury

128
Q

what are the s/s of OA?

A

stiffness following inactivity (AM) - often the first symptom

pain unrelated to imaging present in buttock, groin, thigh, and knee

pain after exercise may persist

loss of motion in a capsular pattern (IR>ext>abd)

capsular end feel

lat hip pain is not usually a primary sign

129
Q

what does radiographic imaging of OA show?

A

jt space<2.5 mm

osteophyte formation

subchondral bone sclerosis and cysts

lack sensitivity

130
Q

what is the sequelae of OA?

A

supporting capsule and ligaments are slacken

alterations in proprioceptive input

altered muscle length-tension relationships

compensation from adjacent regions (lumbar, knee, ankle, foot)

muscles can’t generate as much force

131
Q

what is the intervention for OA?

A

education and ADL modification

regular controlled loading w/periods fo rest

ROM and prolonged stretching (FABER)

132
Q

why is ROM helpful with OA?

A

it increases the ability of the jt to move and allows other portions of the jt to absorb forces

133
Q

why is manual therapy helpful for OA?

A

it reduces pain w/low grade and high grade for improving mobility

134
Q

what is femoral grind (scour) test?

A

axial compression down the femur and moving it around to see where there is pain

135
Q

what is the FABER test?

A

put the pt in FABER and add force to the jt

test for OA or SI compression

136
Q

what are the THA options for OA?

A

open vs mini

cemented vs noncemented

posterior vs anterior approach

hemiarthroplasty

hip resurfacing

arthroscopic debridement

137
Q

are more THAs cemented or noncemented?

A

cemented

138
Q

which THA approach preserves the glut and vastus lateralis?

A

posterolateral approach

139
Q

which THA approach has less hip precautions, longer open time, and heterotopiuc bone formation ?

A

anterolateral approach

140
Q

what are the hip precautions with the posterior hip approach?

A

no flexion beyond 90 deg, no add, no IR

141
Q

what are the hip precautions with the anterior hip approach?

A

ER

142
Q

what is the average lifespan of a hip replacement?

A

10-15/15-20 years

143
Q

with a hemiarthroplasty, what is replaced?

A

just the femoral side

144
Q

with a total hip replacement, what is replaced?

A

the femoral and acetabular sides

145
Q

with hip resurfacing what is replaced?

A

just the femoral head

146
Q

what is arthroscopic debridement?

A

cleaning up the joint space

DPT 516 (14 decks)

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