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MS Test 2: Upper Quarter > Wrist and Hand Complex > Flashcards

Wrist and Hand Complex Flashcards

1
Q

What bones are in the proximal bones of carpals?

A

schaphoid, lunate, triquetrum, pisiform

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2
Q

What bones are in the distal row of carpals?

A

trapezium(1st MC saddle), trapezoid, capitate, hamate

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3
Q

During supinaton and pronation how does the distal radialulnar joint move?

A

primarily radius moving over ulna

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4
Q

What comprises the Triangular Fibrocartilage complex?

A

articular disc, UCL, ECU tendon sheath, meniscus homologue, radioulnar liagments

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5
Q

What is the normal ranges for wrist flexion?

A

65-80 but 40 in functional

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6
Q

What are norms for wrist extension?

A

68-80 but 40 is functional

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7
Q

What are norms for radial deviation?

A

10-20

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8
Q

What are norms for ulnar deviation?

A

20-35

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9
Q

What are norms for thumb joint?

A

ext- 55
abduction- 50
rotation- 17

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10
Q

Why are the extrinsic flexor muscles important in hand/wrist function?

A

they act as pulley restrain function, prevent bowstrings and optimizes function

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11
Q

Where does the median nerve enter the hand?

A

crosses wrist deep to flexor retinaculum and through carpal tunnel

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12
Q

Where does ulnar nerve enter hand?

A

superficial to flexor ret. and enters ulnar tunnel between pisiform and hook of hamate

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13
Q

What are the two branches of radial nerve?

A

sensory- superficial doral

motor- posterior interosseus nerve

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14
Q

What are important questions to ask during an evaluation?

A

what is your dominant hand?
are you involved in sports?
do you do any repetitive motions
how are you doing at home?

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15
Q

What is De Quervain Tenosynovitis?

A

thickening of tendon sheaths of APL and EPB

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16
Q

What is typical mechanism of injury for DQT?

A

repetitive wrist and thumb motion like using scissors, opening jars, lifting toddlers

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17
Q

What is patient presensation for DQT?

A

pain and swelling around radial styloid process, painful thumb movement

positive finkelsteins and pain with thumb ABD and EXT

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18
Q

What are interventions for DQT?

A

dcrease pain, increase tendon excursiob, modalities, splint for rest, activity modification, progress to AROM and endurance activities

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19
Q

What is an overview of fracture management?

A

minimize duration of immobilization, consider healing times of all involved structures besides just bone

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20
Q

What are goals for fracture management?

A

maintain appropriate reduction, restore jt congruence, optimize pain free ROM and strength, work on surrounding soft tissue

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21
Q

What are two kinds of distal radius fractures?

A

colles- dorsal angulated

smith- apex volar displacement

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22
Q

In weeks 0-6/8 weeks what is interventions for distal radius fractures?

A

immediate motion of uninvolved (elbow, fingers, shoulders) joints and edema management

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23
Q

What is important to remember about weeks 6/8-12 for DRF?

A

must be presence of callus formation to begin wrist ROM, gentle jt mob, and forearm rotation if good healing is shown

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24
Q

When can strengthening begin for DRF?

A

week 12 ish

25
Q

What carpal bone is most frequently fractured in hand?

A

scaphoid

26
Q

What is rehab of scaphoid fracture?

A

carpal mobs, soft tissue mob, strengthening if good healing, focus on endurance in ROM

27
Q

What is 2nd most common bone fractured in hand?

A

triquetrum and usually from fall on ulnar side of hand and forceful wrist flexion

28
Q

What is Boxer’s fracture?

A

most common MC fracture

displaced apex dorsal fracture through 5th MC neck

29
Q

What is rehab for weeks 0-3 of Boxer’s fracture?

A

ROM to promote tendon gliding

prevent adhesions

30
Q

What is rehab for weeks 4-6 of Boxer’s fracture?

A

if adequate healing then strengthening, dexterity, and endurance

31
Q

What is a common mechanism of injury for distal radial ulnar ligaments?

A

FOOSH, forceful twisting, forced hyperpronation or supination

32
Q

What are symptoms for wrist ligament injuries?

A

ulnar sided wrist pain with forearm rotation, ulnar head prominence, instability with jt play (patient may also describe this)

33
Q

What is typical mechanism of injury with TFCC?

A

axial load to extended pronated wrist, twisting the ulnarly deviated wrist (golf swing)

34
Q

What are symptoms with TFCC injury?

A

deep ulnar sided pain typically with pronation, supination and gripping

35
Q

What are typical interventions for carpal instabilities?

A

protection, examine associated regions and stabilize with isometric and gripping

36
Q

What is the most common hand injury in sports?

A

ulnar collateral ligament in thumb caused by hyperextension with radial deviation

ex: skiers thumb (acute) or gamekeepers (chronic)

37
Q

What is important to do during thumb special tests?

A

stabilization of trapezium

38
Q

What is key principle of rehab for UCL?

A

stability over motion

39
Q

What is rehab for grade 1 or 2 UCL sprain?

A

thumb splint for 2-4 weeks
key pinch and gentle thumb strengthening for next 3-4 weeks
avoid tip pinch or grasping for 8 weeks

40
Q

What is complex regional pain syndrome?

A

a hyperactive response and is a shoulder, wrist hand syndrome

a common injury will not follow the regular course of recovery

41
Q

What is phase 1 of CRPS?

A

acute 10days -2-3 months and is reversible

sx: flushed, warm, dry, diffuse, severe pain, edema and hair growth increase

42
Q

What is phase 2 of CRPS?

A

dystrophic phase 3-6 months

vasomotor instability- cool limb, pale, severe pain, nails crack, osteoporosis

43
Q

What is phase 3 of CRPS?

A

atrophic phase- 6 months and beyond

cold end phase, less movement, slightly less pain, permanent changes

44
Q

What is important in an exam for CRPS?

A

Mcgill, VAS scale, ROM, skin temp, edema measurment, function scale

45
Q

What are interventions for CRPS?

A

tens, meds, splint, ROM in WB, adl training, psychological support

46
Q

Who should be screened for CRPS?

A

all patients recently out of cast or injured pts

prevention is best approach, normalize sympathetic response

47
Q

What is carpal tunnel syndrome?

A

most common peripheral nerve entrapment syndrome caused by sustained flexion/extension posture, external pressure on volar wrist, prolonged hand vibration

48
Q

What are sx of carpal tunnel syndrome?

A

pain, parathesia (tingling), numbness

49
Q

What are special tests for carpal tunnel?

A

phalen’s, tinel sign of median nerve, MMT of APB, APB atrophy, monofilament

50
Q

What are differential diagnosis for CTS?

A

cervical spine involvement, TOS, diabetic neuropathy, pronator teres syndrome

51
Q

What is conservative managment for CTS?

A

eliminate aggravating factors, neutral wrist position, avoid vibration, avoid forceful gripping, bracing

52
Q

What is rehab after surgical release of CTS?

A

early mobilization, refrain from gripping lifting, full activity in 4-6 weeks, strength occurs though daily use

53
Q

What factors will work against patient healing?

A

DM, poor health status, smoking, ETOH, TOS, double crush injuries, workers comp cases

54
Q

What are associated injuries with RA?

A

ulnar drift, boutonniere deformity, swan neck

55
Q

What are interventions during an acute flare of RA?

A

pain reduction, gentle ROM, dont overstress tissues

56
Q

What are interventions of RA after a flare?

A

teach joint conservation tecnniques, splints/ AD, balance mobility and strength

57
Q

Where is OA of wrist and hand most common?

A

1st CMC and scaphoid

58
Q

What are interventions for OA of wrist and hand?

A

ROM exercises, joint mobs (distraction), theraputty to focus on radial muscles, joint conservation

MS Test 2: Upper Quarter (5 decks)

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