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TRI 3 - MSK 2 > Wrist and hand > Flashcards

Wrist and hand Flashcards

(67 cards)

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1
Q

What is positive and negative ulnar variance

A

Positive - Ulna further than the radius

Negative - Ulna shorter than the radius

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2
Q

What is used to diagnose ulnar variance

A

X-ray

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3
Q

What population may develop ulnar variance and why

A

Child gymnasts

Due to chronic compressive loads closing distal radial physes

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4
Q

What does the ulna move distal naturally

A

Normal gripping and pronation

More positive with age

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5
Q

What are some injuries associated with ulnar variance

A

Lunotriquetral ligament tears
Scapulolunate instability
Ulnar impaction syndrome
TFCC tears

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6
Q

Describe negative ulnar variance

A

Increases risk for Kienbock’s disease

Osteochondrosis of the lunate

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7
Q

Describe the MOI for TFCC pathology

A

Fall on supinated outstretched wrist

Chronic repetitive rotational loading

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8
Q

What activities may aggravate TFCC pathology

A

Tennis
Golf
Occupational tasks

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9
Q

What is the clinical presentation of TFCC pathology

A

Medial wrist pain distal to ulna in dorsal anatomic depression
- increased with end-range PRO and SUP, forceful gripping
Painful click with wrist motions

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10
Q

Describe the eligibility for TFCC repair

A

The center is avascular and not amenable for repair

The outside is vascular and repairable

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11
Q

What special tests and imaging is used to determine TFCC pathology

A

TFCC stress test
TFCC compression test
MRI

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12
Q

Describe TFCC bracing for mild and unstable cases

A 
Mild - splint for ulnocarpal support
Unstable 
 - Long arm cast
 - elbow in 90
 - wrist in UD and EXT

While immobilized educate to avoid ulnar deviation or extension and radial deviation

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13
Q

After the cast is removed what is the progression of strengthening exercises for TFCC pathology

A

FLEX, EXT
PRO, SUP
UD, RD
2 weeks after cast is removed strengthen hand a wrist, avoid torsion loads

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14
Q

Describe ulnocarpal impingement syndrome

A

Cystic and erosive changes on the ulnar head and lunate
Caused by positive ulnar variance
Diagnosed with radiographs

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15
Q

Describe the presentation of DRUJ instabilities

A

AROM / PROM C - pain with pronation and supination
PROM A - pain with dorsal and volar glides
+DRUJ instability test

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16
Q

Describe DRUJ management

A 
Minimize mal alignment
External stabilization
 - taping, bracing
Internal stabilization
 - Therex for: Strengthening, proprioception, stabilization
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17
Q

Describe Static intercarpal instability

A

Involves a tear of a ligament or fracture

More severe

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18
Q

Describe dynamic Intercarpal instabilities

A

Occur when the wrist is stressed

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19
Q

What is the difference between dissociative and non-dissociative instabilities

A

diss - between carpal bones in the same row

non diss - carpal bones in different row

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20
Q

How do you manage intercarpal instabilities

A

Cast immobilization

Surgery for chronic cases

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21
Q

What is the most common tumor of the hand

A

Ganglia

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22
Q

Describe what a ganglia is and how it develops

A

Thin walled cysts containing hyaluronic acid
Spontaneously over joint capsule or sheath
Anterior and posterior wrist and fingers

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23
Q

Describe the clinical presentation of ganglia

A

May not cause pain
As they grow they may ache with flexion and extension
May compress median and ulnar nerve

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24
Q

Describe the physical properties of a ganglion

A

Smooth
Round
Multilobulated
Tender under pressure

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25
Describe the management strategy for ganglion
Symptom relief - splint immobilization, may shrunk ganglion Needle aspiration Surgical removal if necessary
26
What is the rehab protocol for ganglia at 2 weeks
Remove short term splint AROM and AAROM wrist flexion and extension Splint between exercise and at night
27
What is the rehab protocol for ganglia at 2-4 weeks
Resisted ROM and strengthening | Stop splinting at 4 weeks
28
What is the rehab protocol for ganglia at 4-6 weeks
Allow normal activities to patient tolerance
29
What is the rehab protocol for ganglia at 6 weeks
Allow full activity
30
What are some activities associated with UCL sprain
"Game keeping" Breakdancing Skiing
31
Briefly describe UCL sprains
Injuries to the MCP joint | Most common ligament injury of the hand
32
What is the MOI for UCL sprains
Forceful abduction and hyperextension
33
What is the clinical presentation of UCL sprain
Pain, swelling, tenderness on ulnar side of MCP Weak pinch Instability
34
What classifies a UCL sprain for surgical intervention
Grade 1-2 sprain extension greater than 35-40 degrees compared to the other side
35
How do you manage a grade 1-2 UCL sprain
6 weeks of immobilization followed by 2 weeks as necessary AROM of flexion and extension to begin at 3 weeks Strengthening to begin at 8 weeks
36
What type of stress is to be avoided in the first 2-6 weeks of UCL management
abduction stress of the MCP
37
What nerves are of concern during UCL sprain management
Superficial radial | Ulnar digital
38
What is the medical management of a grade 3 UCL sprain
Thumb spica splint for 3-5 weeks, not worn during flexion and extension exercises All other guidelines the same as 1-2 grade sprains
39
Describe the arthrokinematics of thumb flexion and extension
Cave - metacarpal Vex - trapezium Flexion - ulnar glide Extension - Radial glide
40
Describe the arthrokinematics of thumb adduction and abduction
Cave - Trapezium Vex - Metacarpal Abduction - Dorsal glide Adduction - Palmar glide
41
Describe briefly mallet finger
Traumatic disruption of terminal tendon Very common extensor tendon rupture Baseball catcher, football receivers
42
Describe the MOI for mallet finger
Longitudinal force to the tip of the finger producing sudden flexion of finger resulting in tendon rupture or fracture
43
Describe the clinical presentation of mallet finger
Flexion deformity at the DIP | Can be extended passively but not actively
44
What is the primary goal when treating mallet finger
maximize functional range of motion
45
How do you manage a mallet finger with no fracture
8 week immobilization in slight hyperextension
46
How do you manage mallet finger with a fracture
6 week immobilization in neutral extension Exercise uninvolved side Maintain extension force at DIP
47
How do you progress mallet finger management
``` AROM in 20-35 degrees after active extension is achieved Splint between exercises Progressive exercise at week 8 No more splinting at week 9 Unrestricted use at week 12 ```
48
Describe the longitudinal arch of the hand
Wrist to fingertips | Grasping
49
Describe the proximal transverse row
Distal carpal row | stable gripping base
50
Describe the distal transverse arch
Metacarpal shafts to heads | Allows hand to adapt to different shapes
51
Describe this test
Watson / scaphoid shift test Tests for dynamic stability of the wrist - scapholunate ligament + if clunk or pain in posterior wrist (not very effective)
52
Describe this test
Carpal compression test Pressure over median nerve at carpal tunnel for 30 seconds + reproduces symptoms that subside in minutes after pressure is removed indicates carpal tunnel syndrome Flex wrist to 60 to make more sensitive
53
Describe the UMT palmar glide
Assesses TFCC + is pain Indicates TFCC pathology
54
Describe Weber's two pint discrimination
Finds threshold of discrimination | Less than 6mm is normal
55
Describe the Digital blood flow test
Capillary refill test | Longer than 3 seconds indicates arterial insufficiency
56
Describe this test
TFCC stress test/ compression test + is pain Indicates TFCC pathology
57
Describe the DRUJ instability test
Tests for DRUJ instability | Pain
58
What is the pattern of loss in continuity
sensory more vulnerable than motor | Large touch cells more affected than thin pain cells
59
Describe Vasomotor assessment
Blood vessels | Allen's vascular test
60
Describe Sudomotor assessment
Sweating response
61
Describe Pilomotor assessment
Goose flesh response
62
Describe Trophic assessment
Atrophy of tissue from skin to bone
63
Describe a threshold test
Measure Intensity of the stimulus for depolarization
64
Describe a functional test
How long to place items in a bin
65
Describe objective tests
How quickly a nerve depolarizes
66
Describe a Provocative test
Stressing a tissue for a response
67
What are the two phases of sensory reeducation
Sensory preparation | Sensory reeducation

TRI 3 - MSK 2 (7 decks)

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