Wrist and Hand

Question 1

wrist & hand

Which muscles does the ulnar nerve innervate?

Answer 1

• FCU
• 1/2 FDP
• innervates 15/20 muscles:
  
  • 4 DABS
  • 4 PADS
  • 3 hypothenars
  • APB
  • Lumbricles 3-5

Question 2

wrist & hand

Compression of the ulnar nerve at the wrist affects the innervation of

Answer 2

most intrinsic hand muscles. When the patient attempts to form a fist, it results in a deformity known as a “claw hand”—the metacarpophalangeal joints are hyperextended due to the loss of the interossei muscles, and the interphalangeal joints are flexed.

Question 3

wrist & hand

The median nerve is most sensitive to the increased pressure, and signs of carpal tunnel syndrome reflect the nerve’s distribution. These include:

Answer 3

tingling or numbness on the palmar surface of the lateral three and a half digits and weakness and eventual atrophy of the thenar muscles. The palmar cutaneous branch of the median nerve arises proximal to the canal and passes over the flexor retinaculum, so sensation of the palm remains intact.

Question 4

wrist & hand

when an object hits the distal phalanx of the finger or thumb, and the force of the blow tears the contracted extensor tendon. In some cases, a small piece of bone is pulled away along with the tendon.

Tx?

Answer 4

Mallet finger AKA baseball finger

Tx: splint 8 weeks or ORIF

Question 5

wrist & hand

finger gets caught in jersey trying to make a tackle rupturing the flexor digitorium profundus:

Tx?

Answer 5

Jersey Finger

Tx: surgery

Question 6

wrist & hand

Triangular Fibrocartilage Complex:
What is it?
Blood supply?

Answer 6

• Like the menisici of the knee:
  
  • Good blood supply in the periphery, not blood supply in the center.

Question 7

wrist & hand

Triangular Fibrocartilage Complex:
provides cushion between wich 2 bones?
MOI?
S & S?
Special ​Test?
Tx?

Answer 7

• Cushion between ulna and triquetrum
• MOI: traumatic or degenerative
• Pain, clicking
• Press test
• Tx: conservative or
• Surgical repair if distal, removal if central

Question 8

wrist & hand

Wich is the most common entrapment neuropathy?

Answer 8

carpal tunnel syndrome

Question 9

wrist & hand

Wich is the second most common entrapment neuropathy of the UE?

Answer 9

Ulnar nerve compression in the cubital tunnel

Question 10

wrist & hand

IP collateral injury:

MOI?

Tx?

Time of recovery?

Answer 10

• MOI: abb ir add force
• Partial tear: immobilization in extension 3 weeks
• Dislocation: reduction by traction, immobilization in extension 3 weeks
• recovery takes 3 months to one year

Question 11

wrist & hand

What is the immobilization position of a IP collateral ligament partial tear?

Answer 11

in extension

Question 12

wrist & hand

inflammation of Abductor Pollicis Longus and Extensor Pollicis Brevis

What is the dorsal compartment of these muscles?

Answer 12

De Quervain Tenosynovitis

Comparment 1 (anterior border of the snuff box)

Question 13

wrist & hand

Test for De Quervain Tenosynovitis:

Answer 13

Finkelstein test

Question 14

wrist & hand

De Quervain Tenosynovitis

Answer 14

• Inflammation of APL and EPB
• Finkelstein test
• Tx: Splinting, steroid injection, surgical release, DFM, manual therapy, eccentric strengthening
• Pt education: stop doing whatever causes pain

Question 15

wrist & hand

Pt presents with pain in the first compartment of the extensor retinaculum, including the thumb and radial styloid, Aggravating factors include pinching, gripping, radial deviation of the wrist, abduction of the thumb, and resisted thumb extension.

Answer 15

de Quervain’s Tenosynovitis

Question 16

wrist & hand

What is the gold standart splinting for the tx of De Quervain Tenosynovitis?

Answer 16

Thumb spica splint

Question 17

wrist & hand

compression of brachial plexus

Answer 17

Thoracic Outlet Syndrome

Question 18

wrist & hand

Thoracic Outlet Syndrome is an entrapment disorder that occurs inside the “thoracic outlet” which is the space between

Answer 18

the clavicle and the first rib

Question 19

wrist & hand

Carpal tunnel formed by…

Answer 19

carpal bones and transverse carpal ligament,

Question 20

wrist & hand

Special tests for Thoracic outlet syndrome:

Answer 20

• Roos test: bilaterla shoulder 90 abb,, elbow flexion, open and close hands for 60 sec
• Adson test: positive when radial pulse changes when pt ipsilateral rotation and extension of the neck + extension, add, andext rotation of the arm

Question 21

wrist & hand

Carpal Tunnel Syndrome:
tests?

Answer 21

• leads to thenar atrophy and sensory loss
• +Tinnel
• +Phalens
• NT to 1-3 volar side
• Thenar weakness
• APB, FPB, opponens, lumbricles
• +compression test

Question 22

wrist & hand

Contracture of palmar fascia

Answer 22

Dupuytren’s Contracture

Question 23

wrist & hand

Dupuytren’s Contracture:

Answer 23

• Contracture of palmar fascia
• Unknown etiology
• Stretching (splint)
• Surgical removal of involved fascia

Question 24

wrist & hand

Middle and Proximal Phalanges injuries:
Tx?

Answer 24

• Undisplaced: “buddy taping”
• Displaced: closed reduction, aluminum splint or ORIF
• Displaced intra-articular: ORIF

Question 25

# wrist & hand **Boxer’s Fx:** Tx?

Answer 25

* Fx of 5th MC * MC head is depressed and posteriorly angulated * Closed reduction * Immobilization in flexion for 3 wks. * If unstable: ORIF

Question 26

# wrist & hand Bennett’s Fx

Answer 26

* Fx-dislocation of 1st CMC * Closed reduction and cast providing compression to base of MC or ORIF * Articular incongruity can lead to DJD

Question 27

# wrist & hand Pt presents c is a fracture of the base of the first metacarpal bone. Signs include pain, swelling, and ecchymosis around the base of the thumb and thenar eminence, and especially over the CMC joint of the thumb. Physical examination demonstrates instability of the CMC joint of the thumb,

Answer 27

**Bennett’s Fx**

Question 28

# wrist & hand Tear of ulnar collateral 1st MCP ligament

Answer 28

Gamekeeper’s Thumb

Question 29

# wrist & hand Gamekeeper’s Thumb test:

Answer 29

UCL stress test: * Place the patient in a seated position * Extend the patient’s thumb * Apply a valgus force to the MCP joint * **+ve test is laxity and/or pain**

Question 30

# wrist & hand CARPAL INSTABILITY

Answer 30

* Dorsal intercalated segment instability **(DISI):** * Scapholunate dissociation * Ventral intercalated segment instability **(VISI):** * Lunato-triquetrum dissociation

Question 31

Answer 31

osteoarthritis

Question 32

# wrist & hand PIP nodes:

Answer 32

Bouchard's OA

Question 33

# wrist & hand DIP nodes:

Answer 33

Herberden's OA

Question 34

# wrist & hand flexed PIP extended DIP is what type of deformity?

Answer 34

Boutonniere deformity RA

Question 35

# wrist & hand Hyperextended PIP and flexed DIP deformity:

Answer 35

Swan Neck deformity RA

Question 36

# wrist & hand OA hand deformities:

Answer 36

* Herberden’s **nodes** – DIP * Bouchard’s **nodes** – PIP

Question 37

# wrist & hand RA hand deformities:

Answer 37

* Boutonniere deformity * Swan neck deformity * Ulnar drift

Question 38

# wrist & hand WATSON’ TEST is for... Procedure?

Answer 38

**–Scaphoid instability** * Place the patient in a seated position * Grasp the scaphoid tubercle * With the other hand grasp the metacarpals * Starting in ulnar deviation and slight wrist extension, move into radially deviation and slight flexion * +ve test is the report of pain or a clunk.

Question 39

# wrist & hand Special test for OA:

Answer 39

**CMC GRIND TEST** * Patient is sitting * Examiner grabs the first digit using a pincer grip * Examiner provides a compression load to the CMC joint and then add rotation * +ve test is pain and/or crepitus

Question 40

# wrist & hand TINEL’S TEST

Answer 40

* Patient is seated while the examiner taps 5 times over the carpal tunnel with his/her finger or reflex hammer * +ve test is reproduction of symptoms in the median nerve distribution.

Question 41

# wrist & hand Phalen's test:

Answer 41

**carpal tunnel syndrome** * pt seated * +ve test is the reproduction of symptoms in the median nerve distribution

Question 42

# wrist & hand FINKELSTEIN’S TEST

Answer 42

**Dequervain’ s (Inflammation of APL and EPB)** * pt seated * fist with thumb inside fingers * active ulnar deviation of the wrist

Question 43

# wrist & hand Cubital tunnel syndrome -- also known as

Answer 43

ulnar neuropathy

Question 44

# wrist & hand Pregnant woman over 50 y/o, works in an office. Presents with sensory changes in the median nerve distribution (may or may not be accompanied by pain) and atrophy in the thenar

Answer 44

carpal tunnel syndrome