Wrist and Hand Flashcards
(67 cards)
1
Q
What is carpal Tunnel
A
- compression of the median n at the carpal tunnel of the wrist due to inflammation of the flexor tendons and/or median n
2
Q
causes of carpal tunnel
A
- known causes: trauma, pregnancy, repetitive wrist motions or gripping, diabetes, RA
- unknown causes: collagen disease, heredity
- tightening of transverse carpal ligament
3
Q
what must you rule out in carpal tunnel syndrome
A
- c spine dysfunction, TOS, peripheral nerve entrapment
4
Q
common clinical findings of carpal tunnel syndrome
A
- pain or numbness on radial side of palm
- sensory changes aggravated by prolonged hand use
- worse at night due to positioning or activity during day
- decreased prehension/clumsiness of hands
- inability to perform sustained Or repetitive wrist or finger motion
- long term compression causes atrophy and weakness of thenar mm and lat two lumbricals
5
Q
CTS CPG outcome measures
A
- Boston Carpal Tunnel Questionnaire Symptom Severity Scale (II)
- Purdue Pegboard or Dellon-modified Moberg Pick Up Test (III)
6
Q
CTS CPG Physical Impairments Measures
A
- SHOULD NOT USE LAERAL PINCH STRENGTH AS AN OUTCOME MEASURE (I)
- don’t use grip strength (II)
7
Q
CTS CPG Diagnosis/Classification
A
- use Semmes Weinstein Monofilament testing (I) –> assess middle finger with 2.83 or 3.22 monofilament as threshold normal for light touch and static 2PD (use any radial finger with 3.22 in suspected moderate to severe)
- Katz hand diagram, Phalens, Tinels, carpal compression test (II)
- combination of two: age >45, shaking hands relieves symptoms, sensory loss in thumb, wrist ratio index > 0.67, CTQ-SSS score >1.9
8
Q
CTS CPG Interventions- Assistive Technology
A
- educate pts on effect of mouse use (III)
- recommend keyboards with reduced strike force (III)
9
Q
CTS CPG Orthoses
A
- neutral wrist orthoses worm at night (II)
- daytime use when night time isnt effective (III)
- recommend for pregnant women (III)
10
Q
CTS CPG Biophysical Agents
A
- heat, shortwave diathermy, IFC (III)
- phonophoresis (III)
- do not use low level user therapy to iontophoresis or recommend magnets (III)
- do not use thermal ultrasound (III)
11
Q
CTS CPG manual therapy
A
- c spine and UE (III)
- contradictory evidence on neurodynamics (IV)
12
Q
CTS CPG orthotic/stretching program
A
- may use combined orthotic/stretching program in individuals with mild to mod without thenar atrophy and normal 2PD (III)
13
Q
Pt education for CTS
A
- keep wrist in neutral
- avoid forceful prehension
- protect areas with decreased sensitivity
14
Q
improving muscle performance in CTS
A
- start with multi-angle isometrics
- progress to endurance/strengthening
- speed coordination, manual dexterity with symptoms not longer provoked
15
Q
Ulnar nerve compression in the wrist
A
- compression within Guyon’s canal
- parasthesias of ulnar 1 1/2 digits
- weakness in ulnar innervated muscles of hand
- degree of sensory/motor loss depend on n derange
16
Q
What is DeQuervain’s Tenosynovitis
A
- inflammation/ degeneration of synovial lining of common sheath of APL and EPB in first dorsal compartment
17
Q
Etiology of DeQuervain’s Tenosynovitis
A
- often insidious
- direct trauma
- repetitive irritation
- swelling from pregnancy
18
Q
presenting symptoms of DeQuervain’s Tenosynovitis
A
- tenderness of radial styloid/anatomical snuffbox
- pain with active thumb movements and resisted thumb ext and abd
- swelling
- decreased grip and ping strength
- +Finkelstein’s
19
Q
diagnostic test for DeQuervain’s Tenosynovitis
A
- MRI but usually not necessary to make diagnosis
20
Q
DeQuervain’s Tenosynovitis treatment
A
- conservative treatment
- rest –> AROM –> gentle resistive motions
- tendon gliding techniques
21
Q
What is Colles fracture
A
- fracture of distal radius with dorsal displacement of fragments
- most common wrist fracture
“dinner fork displacement”
22
Q
Etiology of Colles fracture
A
- primary affects older adults
- F>M
- typically due to FOOSH
- lunate acts as wedge
- distal radius is sheered
- fragment displaces radially and posteriorly
23
Q
Immobilization of Colles fracture
A
typically for 5-8 weeks
24
Q
complications of Colles fracture
A
- median n compression
- loss of motion
- decreased grip strength
- CRPS
- CTS
25
Treatment considerations of Colles fracture
- ROM goals (full ROM may not be appropriate due to malalignment)
- joint mobs, ROM, strengthening, functional activities
- check vascular supply
26
What is Smith Fracture
- distal radius fracture with volar displacement of fragments
27
what deformity is associated with Smith Fracture
- "garden spade" deformity
28
Scaphoid/Lunate fracture etiology
- 20-30 yo; M>F
- FOOSH
- strong radius, so fall tends to fracture scaphoid or dislocate lunate in palmar direction
- poor blood supply to scaphoid --> delayed healing
29
complications of Scaphoid/Lunate fracture
-avascular necrosis of proximal fragment of scaphoid
- immobilized for 4-8 weeks
30
Scaphoid/Lunate fracture presenting symptoms
- pain/localized tenderness swelling in anatomical snuffbox
- long compression of thumb painful
- possible loss of thumb function
- muscle spasms with PROM
- palpation changes for lunate dislocation
31
Scaphoid/Lunate fracture treatment
- treat swelling caressively
- A/PROM after immobilization
- watch X rays for healing
- stretch right after they come out of cast
32
What is Swan Neck Deformity
- construction of intrinsic hand mm
- common with RA or after trauma
- PIP hyperextension and DIP Flexion
33
What is Boutonniere Deformity
- rupture/ avulsion of central tendinous slip of the extensor hood
- common in RA
- MCP and DIP ext
- PIP flex
34
What are claw fingers
- paralysis of ulnar nerve
- loss of intrinsic mm action --> "intrinsic minimus"
- MCP hyperextension
- PIP and DIP flexion
- arch disappears
35
ape hand deformity
- wasting of thenar eminence due to median/ulnar nn palsy
- Pt unable to flex or oppose thumb
- thumb falls in line with fingers due to pull of ext mm
-
36
Mallet finger
- rupture/avulsion of ED tendon at insertion on distal phalanx
- DIP rests in flexion
- occurs from trauma forcing DIP into flexed positing
37
Trigger finger
- "sticking" of tendon with finger flexion
- thickening of flexor tendon sheath
- usually 2-3rd fingers
- worse in AM
- pt flexes finger which "gets caught" in flexion and lets go with snap
- Rx: surgical release, tendon gliding
38
Dupuytren's Contracture
- contracture of palmar fascia
- usually seen in 3-4th digits
- M>F
- 40-70yo
- increased incidence in people with gout, epilepsy, alcoholism
- painless, sometimes surgically released
39
what is Jersey Finger
- flexor digitorum profundus tendon rupture/avulsion
- typically ring finger
40
MOI jersey finger
- forced hyperextension of DIP with max finger flexion contraction
- may rupture from insertion, avulse from bone, or rupture at musculotendinous junction
41
key finding of Jersey finger
inability to produce isolated flexion of DIP
42
treatment of jersey finger
immediate referral to hand surgeon
43
What is Gamekeepers thumb
- sprain/rupture of UCL of MCP joint of 1st digit
- caused by abduction stress to thumb while MCP is ext
- AKA Skiiers thumb
44
what does gamekeepers thumb result in
medial instability
- typically immobilized
45
What is boxers fracture
fracture of neck of 5th MC
46
treatment boxers fracture
casted for 2-4 weeks
47
fingers flex/ext convex/concave rule
concave on convex
48
MCP abduction/adduction convex/concave rule
concave on convex
49
wrist convex/concave rule
capitate, scaphoid, lunate triquetrum: convex on concave
triquetrum: concave on convex
50
wrist flexion normal ROM
80-90 degrees
51
wrist extension normal ROM
70-90 degrees
52
MCP normal flexion
85-90 degrees
53
MCP normal extension
30-45 degrees
54
PIP normal flexion
100-115 degrees
0 degrees extension
55
DIP normal flexion
80-90 degrees
56
DIP normal extension
30-45 degrees
57
1st CMC normal flexion
45-50 degrees
58
1st CMC normal abduction
60-70 degrees
59
1st CMC normal adduction
30 degrees
60
1st MCP normal flexion
50-55 degrees
0 degrees extension
61
1st IP normal flexion
85-90 degrees
0-5 degrees extension
62
radio/ulnocarpal OPP
neutral with slight ulnar deviation
63
radio/ulnocarpal CPP
full extension with radial deviation
64
mid carpal joint OPP/CPP
OPP: neutral or slight flexion with ulnar deviation
CPP: extension with ulnar deviation
65
carpometacarpal joint OPP/CPP
OPP: midway between abduction-adduction and flexion-extension
CPP: full opposition and full flexion
66
MCP OPP/CPP
OPP: slight flexion
CPP: full opposition; full flexion
67
IP joint OPP/CPP
OPP: slight flexion
CPP: full extension
