wirst and hand patho

Question 1

Pathologies of the hand and wrist (6)

Answer 1

De Quervain’s Tenosynovitis
Trigger fingers
Dupuytren’s contracture
OA
CTS
Fractures

Question 2

Classification of hand and wrist disorders (4)

Answer 2

soft tissue
fracture
joint
nerve entrapment

Question 3

CTS: entrapment neuropathy of the ____ N within carpal tunnel

Answer 3

Median

Question 4

CTS: __ flexors puls___ N

Answer 4

9 flexors, median N

Question 5

CTS: anything that ____ space within carpal tunnel

Answer 5

reduces

Question 6

CTS: F >/< M? Ratio

Answer 6

F>M; 3:1

Question 7

CTS: age?

Answer 7

45-54

Question 8

CTS: risk factors (5)

Answer 8

F,
45-54 y/o
obesity
occupation
pregnancy

Question 9

CTS: presentation (7)
Paraesthesia/____
_______symptoms
AGGs: ______ positions
_____ relieves
wasting of _____ muscles
+ve ____&____test
_____if diagnostic uncertainty

Answer 9

numbness
nocturnal - irritate cuz hand flexion
prolonged
shaking
thenar
phalen, Tinels
NCS = Nerve conduction study

Question 10

CTS tx (6)

Answer 10

splinting
Ex (mobilizing N and tendons, proximal mobilisation)
Ergonomics (task breaks, posture)
MT
Injection
Decompression Surgery (if any motor weakness, affecting QOL, transverse carpal ligament release)

Question 11

DQT full name

Answer 11

De Quervain’s Tenosynoitis

Question 12

DQT: Affects tendons of the ______ and ______ in the first dorsal compartment

Answer 12

ABDuctor pollicis longus (APL)
Extensor pollicis brevis

Question 13

DQT: tendons and sheath become ______

Answer 13

thickened

Question 14

DQT gender ratio

Answer 14

F>M; 4:1

Question 15

DQT risk factors (5)

Answer 15

F>M
pregnancy/post partum. Hormonal changes?
OA
May follow traumatic incident or cumulative micro-trauma
Occupation/Repetitive activity

Question 16

DQT presentation (4)
tenderness over ____ +/-___
pain on ____/____, _____, ____sign
may get _____
+ve____ Test

Answer 16

Radial styloid; Swelling
Gripping, UD, scissors (radial N), hitchhiker sign
Crepitus
Finkelsteins’ test

Question 17

DQT Tx (8)

Answer 17

Activity mod
Splinting regime - gradual return to load
Reduce inflammation (ice/NSAIDs)
Mobilization (dart throwers position)
Gradual re-loading (grip and hold>add weigth>add mvmt)
Consider higher up the chain (elbow and shoulder)
Steroid injection
Decompression surgery

Question 18

Trigger finger:
commonly at the tunnel b//w __ and ___ pulley.
____ of the tendon OR _____ of the sheath
May form a ____

Answer 18

Metacarpal and A1.
Thickening; Tightening
Nodule

Question 19

Trigger finger:
commonly ___, ____ and ____ finger affected

Answer 19

thumb, middle, Ring
1, 3, 4th

Question 20

Trigger finger risk factor:
F>/< M
Repetitive ___ or direct ____ from tool use

Answer 20

F>M
gripping; compression

Question 21

Trigger finger Presentation Grade 1: ____ and point ___
2: demonstrable ____ but ___ ROM
3: demonstrable ____ required passive ______
4: locked in a ____ position

Answer 21

Pain, point tenderness.
Catching but Full ROM.
Catching; passive extension.
Flexed position

Question 22

Trigger finger Tx (7)
_____ modification
Night extension ____; ___wks
Reduce _____ (i.e.___&___)
Tendon ____ Ex (FDS and FDP)
Gradual ____
____ Injection
____ Surgery

Answer 22

Activity
Splinting; 3-6 wks
Inflammation (ice/NSAIDs)
Tendon Gliding
Gradual reloading
Steroid
Decompression

Question 23

Trigger finger decompression surgery only when ____

Answer 23

nodule is palpable and affective ADLs and painful and struggling (grade 4)

Question 24

Trigger finger: Splint ___ and or ____, ___ joint into extension? gradual reloading; ____ mvmt into ___ mvmt? work on ____ grip?

Answer 24

MCP, DIP, PIP; smaller into bigger; HOOK

Question 25

Dupuytren's contracture: Benign ___ of the palm's deep ______ (fascia)

Answer 25

thickening; deep connective tissue

Question 26

Dupuytren's contracture: cause?

Answer 26

Unknown cause. Genetic w env factor

Question 27

Dupuytren's contracture:______ but functionally disruptive

Answer 27

non-painful

Question 28

Dupuytren's contracture risk factors: (4) Gender; Earlier onset for__ Age predominantly __ and __ digits can be ____ to other conditions (e.g. __&__)

Answer 28

M>F; 2:1 ratio. Men Prevalence increases w AGE 4th and 5th fingers 2nd; diabetes and alcoholism

Question 29

Dupuytren's contracture Presentation (2) palpable____ _____ restriction

Answer 29

palpable nodules/cords functional restriction

Question 30

Dupuytren's contracture Tx (4) ___ = gold standard ____ post surgery ___management and ____ important _____ aponeurectomy _____ injection

Answer 30

fascietomy. splinting. wound; Ex. Needle. Collagenase

Question 31

Dupuytren's contracture: Why Most ppl don’t need intervention

Answer 31

it resolves naturally

Question 32

Distal Radius Fractures: most common types?

Answer 32

Colles, Smith's

Question 33

Colles fracture is ?

Answer 33

FOOSH

Question 34

Smiths fracture is?

Answer 34

fall on the dorsal side of hand with a flexed wrist

Question 35

most common fracture site of hand

Answer 35

distal 3rd radius

Question 36

Colles fracture: classic ____ deformity F ? M Common to get ___ pain ___ & ____ usually most restricted

Answer 36

dinner fork F>M ulnar side Ext & sup

Question 37

Colles fracture complications (4) nerve. CRPS. healing? rupture?

Answer 37

Nerve injury: commonly median N (CTS) complex regional pain syndrome (risk following Hand / Foot injury) Malunion Rupture EPL - check with thumb lift

Question 38

Colles management ___ if displaced _____ cast - leave ___ free ___ wks immobilization if unable to reduce or unstable ->? physio rehab to regain ____

Answer 38

MUA = Manipulation under anaesthesia short arm cast; MCP 4-6 wks ORIF regain function

Question 38

fracture: how physio regain function (7)

Answer 38

reassurance/advise/education reduce swelling ROM re-educate sensory input strength proprioception (inc WB) Function (individualize)

Question 39

OA mechanical; common sites (3)

Answer 39

DIP Heberden's nodes PIP Bouchard's nodes Thumb bsae (1st CMC or STT)

Question 40

where is Heberden's nodes

Answer 40

DIP

Question 41

where is Bouchard's nodes

Answer 41

PIP

Question 42

what is STT joint

Answer 42

joint involving the scaphoid, trapezium, trapezoid

Question 43

OA risk factors (6)

Answer 43

age >40 F family history occupation obesity previous joint injury

Question 44

OA presentation (7) pain typically around ____ ____mins morning stiffness pain with _____ mvmt (very disabling) _____ around CMC joint _____ deformity - CMC joint collapses ____ Stiffness (loss of ____) +ve ____ test

Answer 44

base of thumb (C-sign) <30 mins gripping, twisting, lifting swelling Zig Zag; inwards opposition Grind test

Question 45

OA management (8)

Answer 45

Ex ROM strengthening/inc load tolerance proprioception MT splinting injection surgery - trapeziumectomy

Question 46

Joint protection (5) ____over several joints use _____ to help w momentum w lifting try _____ position use ____ rather than one _____ load when possible

Answer 46

spread load wider kinetic chain alternative grip 2 hands break up

Question 47

dynamometers: useful for ___ diff >?% considered clinically sig best of ?# efforts setup doesn't matter so long as it _____ ____ usually most powerful also have one for ___ grip

Answer 47

obj measurement of grip strength >10% 3 efforts remains consistent held at side in standing key/pinch grip