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Patho > wirst and hand patho > Flashcards

wirst and hand patho Flashcards

1
Q

Pathologies of the hand and wrist (6)

A

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

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2
Q

Classification of hand and wrist disorders (4)

A

soft tissue
fracture
joint
nerve entrapment

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3
Q

CTS: entrapment neuropathy of the ____ N within carpal tunnel

A

Median

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4
Q

CTS: __ flexors puls___ N

A

9 flexors, median N

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5
Q

CTS: anything that ____ space within carpal tunnel

A

reduces

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6
Q

CTS: F >/< M? Ratio

A

F>M; 3:1

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7
Q

CTS: age?

A

45-54

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8
Q

CTS: risk factors (5)

A

F,
45-54 y/o
obesity
occupation
pregnancy

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9
Q

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

A

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

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10
Q

CTS tx (6)

A

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)

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11
Q

DQT full name

A

De Quervain’s Tenosynoitis

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12
Q

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

A

ABDuctor pollicis longus (APL)
Extensor pollicis brevis

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13
Q

DQT: tendons and sheath become ______

A

thickened

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14
Q

DQT gender ratio

A

F>M; 4:1

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15
Q

DQT risk factors (5)

A

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

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16
Q

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

A

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

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17
Q

DQT Tx (8)

A

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

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18
Q

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

A

Metacarpal and A1.
Thickening; Tightening
Nodule

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19
Q

Trigger finger:
commonly ___, ____ and ____ finger affected

A

thumb, middle, Ring
1, 3, 4th

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20
Q

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

A

F>M
gripping; compression

21
Q

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

A

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

22
Q

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

A

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

23
Q

Trigger finger decompression surgery only when ____

A

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

24
Q

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

A

MCP, DIP, PIP; smaller into bigger; HOOK

25
Q

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

A

thickening; deep connective tissue

26
Q

Dupuytren’s contracture: cause?

A

Unknown cause. Genetic w env factor

27
Q

Dupuytren’s contracture:______ but functionally disruptive

A

non-painful

28
Q

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

A

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

29
Q

Dupuytren’s contracture Presentation (2)
palpable____
_____ restriction

A

palpable nodules/cords
functional restriction

30
Q

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

A

fascietomy.
splinting.
wound; Ex.
Needle.
Collagenase

31
Q

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

A

it resolves naturally

32
Q

Distal Radius Fractures: most common types?

A

Colles, Smith’s

33
Q

Colles fracture is ?

A

FOOSH

34
Q

Smiths fracture is?

A

fall on the dorsal side of hand with a flexed wrist

35
Q

most common fracture site of hand

A

distal 3rd radius

36
Q

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

A

dinner fork
F>M
ulnar side
Ext & sup

37
Q

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

A

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

38
Q

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

A

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

38
Q

fracture: how physio regain function (7)

A

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

39
Q

OA mechanical; common sites (3)

A

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

40
Q

where is Heberden’s nodes

A

DIP

41
Q

where is Bouchard’s nodes

A

PIP

42
Q

what is STT joint

A

joint involving the scaphoid, trapezium, trapezoid

43
Q

OA risk factors (6)

A

age >40
F
family history
occupation
obesity
previous joint injury

44
Q

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

A

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

45
Q

OA management (8)

A

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

46
Q

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

A

spread load
wider kinetic chain
alternative grip
2 hands
break up

47
Q

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

A

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

Patho (3 decks)

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