Wrist and Hand Flashcards
(158 cards)
1
Q
5 areas from subjective history that are super important for wrist and hand:
A
Occupation
Sensory changes
Functional changes
Age
MOI
2
Q
Three red flags to consider with wrist and hand:
A
Sudden swelling - infection
Pain not responsive to movement
Excessive pain worsened with treatment
3
Q
4 areas that refer pain to the wrist and hand
A
cervical spine
upper thoracic spine
shoulder
elbow
4
Q
What is the most common cause of hand pain?
A
Carpal tunnel syndrome
5
Q
With carpal tunnel syndrome, which nerve is compressed?
A
median nerve
6
Q
How is early carpal tunnel syndrome classified?
A
S/S present for less than a year
S/S intermittent and mild
Axons not damaged
Negative Tinel
7
Q
How is intermediate carpal tunnel syndrome classified?
A
Varying intensity of s/s
No atrophy present
Axons injured
Weakness and positive Tinel
8
Q
How is advanced carpal tunnel syndrome classified?
A
Intensifying s/s
Thenar muscle atrophy
weakness with pinch and grip
constant numbness
9
Q
The most bothersome S/Sx with __________ is pain, N/T or loss of sensation
A
carpal tunnel syndrome
10
Q
What are some important Pt history flags for carpal tunnel syndrome (6):
A
Over 45 yrs
N/T or loss of sensation
Dropping objects
Shaking hands improve S/Sx
S/Sx exacerbated by gripping tasks
S/S at night
11
Q
6 predisposing factors for carpal tunnel syndrome:
A
Diabetes
Increased BMI
OA, RA
Pregnancy
Thyroid disorders
Excessive alcohol use
12
Q
What fracture can lead to carpal tunnel syndrome?
A
Colles’ fracture
13
Q
With carpal tunnel syndrome is numbness and tingling worse during the day or at night?
A
at night
14
Q
To manage carpal tunnel syndrome, should a splint be used during the day or at night?
A
At night
15
Q
What is the gold standard for CTS prediction?
A
EMG
tells you about the integrity of the nerve and muscle.
16
Q
5 CPR items give you ___% certainty of CPS
A
90%
17
Q
4 CPR items give you ___% certainty of CTS
A
70%
18
Q
CPR list for Carpal tunnel syndrome (5):
A
Shake hand for symptom relief?
Reduced median sensory field of digit 1
Age >45 yrs
Symptom severity scale score >1.9
Wrist-ratio index >.70
19
Q
Instrinsic minus hand involves which two nerves?
A
Median and ulnar
20
Q
Management of intrinsic minus hand:
A
Tendon transplants
21
Q
S/S of Intrinsic minus hand (3):
A
MCP hyperextension, DIP and PIP flexion
Loss of arches
Atrophy of intrinsics
22
Q
Drop wrist deformity is caused by what nerve?
A
Radial nerve palsy
23
Q
S/S of drop wrist deformity (1):
A
Paralysis of wrist and finger extensors (inability to extend).
24
Q
Management of drop wrist deformity:
A
Repair/decompress radial nerve if able
Splinting in functional position
25
Pronator Teres syndrome involves the compression of what nerve?
Median nerveA
26
Anterior interosseus nerve syndrome is a ________ nerve pathology without _______ deficit.
Median; sensory
27
Posterior interosseus nerve syndrome involves which nerve?
radial nerve
28
Which carpal is involved in about 10% of wrist injuries?
The Lunate
29
Avascular necrosis of the lunate is called _______ disease.
Kienbock's
30
Two things that can lead to Kienbock's disease
Trauma or repetitive stress
Short ulna (excessive radial/lunate pressure)
31
S/S of Kienbock's disease (4):
Aching, stiffness with wrist flexion
Tender over lunate
Decreased grip strength
Degeneration on radiograph
32
What patient population is most prone to Kienbock's disease?
Young men, 18-40 y.o.
33
PT management of Kienbock's disease (3):
Pain control
Maintain ROM of uninvolved joints
Progressive ROM, strengthening
34
Identify the stage of Kienbock's disease:
Aching, stiffness
Ischemia of lunate
No radiographic changes
Stage I
35
Identify the stage of Kienbock's disease:
Density changes: trabecular necrosis. Reactive cortical bone growth (Sclerosis)
Stage II
36
Identify the stage of Kienbock's disease:
Collapse of lunate: Pathologic fracture (not due to outside mechanism). Deformity.
Stage III
37
Identify the stage of Kienbock's disease:
Pancarpal arthrosis - ALL carpals involved. Degenerative changes and instability at wrist.
Stage III A and B
38
Two types of management for Kienbock's disease:
Conservative or surgical
39
Describe the conservative approach to Kienbock's disease:
Immobilization for 1-3 months to decrease stress on the lunate.
40
Colles' fracture is most likely to be seen in which patient population?
Elderly women
41
Two causes of Colles' fracture:
Falls (FOOSH)
OA
42
What is the ratio of colles' fracture seen in women as compared to men?
6:1 women > men
43
Describe what happens in a colles' fracture:
Dorsal displacement of distal fragment (named for where the fragment goes)
Silver fork deformity
44
What may also occur with a Colles' fracture (5)?
Fracture of ulnar styloid
Shattering of distal radius
Injury to radiocarpal or distal radioulnar jt
TFCC tear
Scapholunate dissociation
45
S/S of Colles fractures (3):
Silver fork deformity
Pain with ALL wrist and hand movements
Local tenderness
46
Management of Colles fracture (4):
Closed reduction and immobilization
ORIF and external fixation if unstable or complex
Maintain ROM and strength of uninvolved joints
Progressive ROM and strengthening
47
What is a common complication seen in elderly women due to Colles fracture?
Adhesive capsulitis
48
Four additional complications associated with Colles fracture:
Adhesive capsulitis
CRPS
Malunion
Rupture of EPL tendon
49
A reverse Colles' fracture is termed ___________ fracture.
Smith's fracture
50
MOI for Smith's fracture:
Fall onto flexed wrist
51
The management for a Smith's fracture is the same as what?
Colles' fracture
52
Radial styloid fracture is also called a __________ fracture.
Chauffeur's fracture
53
What occurs in a radial styloid fracture?
Radial styloid is displaced laterally
54
MOI for Smith's fracture
FOOSH with forced radial deviation
55
Management for Smith's fracture:
Closed reduction, immobilization in UD. Fixation with K wires if necessary.
Progressive ROM and strengthening
56
What is the most common carpal fracture?
Scaphoid
57
MOI for a scaphoid fracture:
Fall onto fully extended wrist
58
S/S of scaphoid fracture (3):
Pain with extension, flexion and radial dev.
Weak/pain grip, pain with compression
Tender anatomical snuffbox (CLASSIC SIGN)
59
Management of a scaphoid fracture (3):
Immobilization, including thumb
Possible ORIF
Progressive ROM and strengthening
60
Possible complications of a scaphoid fracture (3):
Delayed union
non-union
Avascular necrosis
61
What location of a scaphoid fracture lead to avascular necrosis?
fractures in proximal 1/3
62
What occurs with a Boxer's fracture?
Transverse fracture of the neck of MC 2-5
63
Which metacarpal is most commonly involved in a Boxer's fracture?
5th
64
MOI of a Boxer's fracture:
Compressive force through metacarpals
65
S/S of a Boxer's fracture (3):
Flattening of knuckle
pain
swelling
66
Management of a Boxer's fracture (3):
Reduction
Immobilization
K-wire if unstable
67
What occurs during a Bennet's fracture?
Oblique fracture of base of 1st MC
68
Bennet's fracture is NEVER/ALWAYS a complex fracture
Always!!! as it extends into the joint
69
MOI for Bennet's fracture:
Punching
Martial arts
70
S/S of Bennet's fracture (2):
Edema
Short-appearing thumb
71
Management of Bennet's fracture (2):
ORIF, immobilization
Progressive ROM and strengthening
72
Transverse fractures are common in which phalanges?
Proximal and middle
73
In which phalanx is a phalangeal fracture considered complex?
Distal phalanx
74
MOI for proximal and middle phalangeal fractures:
Bending, jamming
75
MOI for distal phalangeal fractures:
Crushing
76
Management for phalangeal fractures (undisplaced vs displaced):
Undisplaced: Splint, buddy taping
Displaced: Closed reduction, immobilization
Progressive ROM and strengthening
77
What often occurs with a phalangeal fracture?
dislocation
78
MOI for a phalangeal dislocation:
Forced bending usually with twisting or compression
79
S/S of a phalangeal dislocation:
Deformity
pain
swelling
80
Management of a phalangeal dislocation:
Closed reduction
Splinting
81
What is the location of fracture in a night stick fracture?
Mid-portion of the ulna
82
Describe a greenstick fracture:
Incomplete fracture of young bones due to flexibility.
83
A greenstick fracture is common in what body part?
Forearm
84
If a patient cannot fully, actively extend their elbow, what should be recommended?
Go in for imaging if acute trauma to elbow.
85
With carpal instability, the focus is mainly on which two carpals?
Scaphoid and Lunate
86
Two causes of carpal instability:
Fracture/Trauma
RA
87
S/S of carpal instability (4):
Wrist pain, stiffness
Tenderness over lunate/scaphoid
clicking, snapping
weakened grip
88
What is the most common carpal instability?
Scapholunate dissociation
89
A gap between the scaphoid and lunate greater than 3 mm is considered what?
Scapholunate dissociation
90
Clinical presentation of Scapholunate dissociation:
Increased PA and AP movement between the two bones.
91
What is the result of scapholunate dissociation?
Lateral carpal instability
92
Describe ulnar translocation of the carpals
Proximal row of carpals migrate toward the ulna (hand deviates to radial side).
93
Ulnar translocation of the carpals occurs with which pathology?
RA
94
Ulnar dislocation of the carpals leads to PROXIMAL/DISTAL carpal instability.
Proximal
95
Define arthrodesis:
Fusion of bones
96
An arthrodesis provides wrist _________ at the cost of ________.
stability; mobility
97
Describe a ganglion Cyst
Cystic degeneration of capsule, tendon sheath, or bursa. Leaves distended sac filled with viscous fluid.
98
What patient population are associated with ganglion cysts?
Young adults
99
S/S of a ganglion cyst:
Painless soft lump usually on dorsal wrist
100
Management of a ganglion cyst
None
Can aspirate/excise, but recurrence is common.
101
Describe Dupuytren's contracture
Hypertrophy and contracture of palmar fascia (flexion contracture).
102
Dupuyren's contracture usually involves these fingers:
4th or 5th fingers
103
Dupuyten's contracture is often BILATERAL/UNILATERAL.
Bilateral
104
What happens at the PIP and MIP with Dupuytren's contracture?
they are pulled into flexion
105
T/F Dupuyten's contracture may be genetic
True!!
106
Management of Dupuytren's contracture:
Can slow progression but not stop it
Stretching, friction massage
Surgical excision of thickened fascia
107
Arterial or venous insufficiency: Decreased or absent pulse.
Arterial
108
Arterial or venous insufficiency: Pale with elevation, increased redness with dependency.
Arterial
109
Arterial or venous insufficiency: Cool to touch
Arterial
110
Arterial or venous insufficiency: Shiny, thin, pale, thick nails, hair loss.
Arterial
111
Arterial or venous insufficiency: Increased pain with elevation, decreased pain with dependence, paresthesia
Arterial
112
Arterial or venous insufficiency: WNL pulses
Venous
113
Arterial or venous insufficiency: Pink progressing to cyanotic and brown at ankles.
Venous
114
Arterial or venous insufficiency: Warm temp
Venous
115
Arterial or venous insufficiency: Edema
Venous
116
Arterial or venous insufficiency: Discolored, scaly, ulcers, varicosities.
Venous
117
Arterial or venous insufficiency: Increased pain with dependence, decreased with elevation
Venous
118
Important cardiopulmonary observations when examining wrist and hand
Edema
Clubbing
Skin color
Nail beds
119
Neurologic observations to check for during the systems review:
Hand deformity
Atrophy
Trophic changes
Tremor
120
White discolorations observed on the nails are termed what?
Leukonychia
121
When the nails have an indented shape, like a spoon, they are termed what?
Kilonychia
122
CRPS stands for what?
Complex regional pain syndrome
123
RSD stands for what?
Reflex sympathetic dystrophy
124
6 specific diagnoses to rule out when assessing wrist and hand:
CRPS/RSD
RA
Gout
Septic bursitis
MI/Angina (can refer to UE)
Cervicogenic pain (radiculopathy)
125
Pathology characterized primarily by increased sensitivity.
RSD/CRPS
126
How do you treat CRPS/RSD?
Focus on desensitization of the area. Need to retrain the brain.
127
Ulnar drift is an indication of what pathology?
RA
128
Peak incidence of RA is __-__ years old.
30-50
129
Which gender is RA more likely in?
Women (3:1)
130
Which gender is OA more likely in?
Equal
131
Does OA or RA also include systemic symptoms (fever, fatigue)
RA
132
What causes gout?
The buildup of uric acid in the joints
133
List postoperative management of CTS (6):
Immobilization
Edema control
Scar tissue mobilization
Nerve gliding
Progressive ROM and strengthening
Work simulation
134
How does anterior interosseus syndrome differ from CTS, Pronator Teres syndrome, and cervical radiculopathy?
Sensation is normal; unable to make the "ok" sign
135
How is pronator teres syndrome different from CTS, Pronator Teres syndrome, and cervical radiculopathy?
Forearm pain is increased with pronation
136
Functions of the TFCC (5):
Dissipates compressive loads with ulnar WB
Connects ulna with radius
protects head of ulna
assists forearm pronation
stabilizes distal radioulnar joint
137
TFCC is usually caused by MICRO/MACRO trauma.
Macro; almost always FOOSH
138
Management of DeQuervain's disease
NSAIDS, immobilization, iontophoresis, modification of activity, progressive exercise, surgical splitting of sheath.
139
S/S of tenosynovitis (3):
Marked edema
Increased temperature
PAin
140
What is the most common form of carpal instability?
Scapholunate dissociation
141
Ulnar translocation of carpals is common in what pathology?
RA (as distal radius erodes)
142
Define arthrodesis:
Fusion of bones
143
Two causes of swan neck deformity:
Contracture of intrinsic muscles
Tearing of volar plate
144
S/S of swan neck deformity (2):
Flexion of MCP and DIP
Hyperextension of PIP
145
How do you manage swan neck deformity?
Stretching
146
Cause of Boutonniere deformity:
Rupture of extensor hood
147
Describe Boutonniere deformity:
Extension of MCP and DIP
Flexion of PIP
148
What causes mallet finger?
Rupture avulsion of extensor hood
149
S/S of mallet finger (1):
Inability to extend distal phalanx
150
Management of mallet finger:
Acute = splint
Chronic = none, not functionally limiting
151
Trigger finger/thumb is associated with what pathologies (3)?
RA, DM, Gout
152
What happens in trigger finger?
Stenosing - nodule or swelling in tendon prevents gliding through sheath.
153
S/S of trigger finger (1):
Discomfort at base of digit
locking of finger/thumb
154
Management for trigger finger:
NSAIDS, Injection, splint, surgical splitting of sheath.
155
What occurs with a skier's/gamekeeper's thumb?
Rupture of 1st MCP ulnar collateral
156
MOI for skier's/gamekeeper's thumb:
Repeated twisting
Falling with thumb hooked in ski pole strap
157
S/S of skier's thumb (incomplete vs complete):
Complete tear: unstable pinch
Incomplete tear: Positive valgus stress test
158
Management of Skier's thumb (complete vs incomplete):
Complete: surgical repair, immob.
Incomplete: Immob. but freq. gentle ROM
Gradual return to activity
