Wrist and Hand- thru Dupuytrens Flashcards by Jessica Chambers

Most ADLs require ______ & _______________.

Extension and ulnar deviation

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What amount of extension is required for drinking activities?

6-24˚

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What amount of extension is required for using a phone?

40˚ extension

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What amount of ROM is necessary for turning a doorknob?

40˚ extension, 40˚ flexion, 30˚ ulnar deviation

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What is the ideal functional ROM?

30-50˚ flexion
60˚ extension
20˚ radial deviation
40˚ ulnar deviation

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What is the functional position of the hand the optimal position for?

Strength and precision

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What is the position of the wrist in the functional position of the hand?

Slightly hyperextended

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What is the position of the 2nd - 5th fingers in the functional position of the hand?

Slightly flexed

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What is the position of the thumb in the functional position of the hand?

In opposition

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What us the etiology of De Quervain’s Tenosynovitis?

Repetitive thumb use with ulnar deviation and gripping

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What is De Quervain’s Tenosynovitis?

Tendinopathy of snuff box tendons

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What is De Quervain’s related directly to?

Personal device use

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What is inflamed and likely thickened with De Quervain’s?

The extensor policis brevis and abductor policis longus tendons and sheath causing pain just proximal to the anatomical snuff box

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What happens at the thumb with De Quervains?

Decreased grip and pinch strength

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What are S&S of De Quervain’s?

Tendinopathy
Special tests positive - Finkelstein’s

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What is the PT rx for De Quervain’s?

POLICED
Reduce typing and dictate
Tendinopathy MET
Tendon Glides
Thumb Splint

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What is the MD RX?

anti-inflammatory Injections

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Injections for De Quervain’s are __ % successful but may require….

75% successful; may require two injections

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What is the issue with injections for De Quervains?

Doesn’t address problem

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What is the extensor expansion ligament?

Also known as the extensor hood- a small triangular-shaped aponeurosis of connective tissue

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What is the shape of the extensor expansion ligament?

Wider at base, narrow distally

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Where is the extensor expansion ligament?

Dorsum and side of the proximal phalanx of the fingers, inserts distally at base of distal phalanx

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What does the extensor expansion ligament allow?

Fine motor movements

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What does the extensor expansion ligament over the MCP joint do?

Study These Flashcards

Hood over the MCP joint and holds extensor tendons in midline and close to bone

Where does the extensor expansion ligament attach when over the MCP joint?

Middle and/or distal phalanx -attachment site for many muscles

What is the etiology for mallet finger?

Trauma or disease (possibly RA)

What is Mallet finger?

Tendon rupture or avulsion fracture of the extensor hood mechanism at DIP

What does Mallet finger result in if untreated?

DIP Joint flexion and possible contracture if untreated

What is the etiology for boutonniere deformity?

Trauma or disease

What is a Boutonniere deformity?

Rupture or stretch of extensor tendon at PIP

What does a Boutonniere deformity result in if untreated?

PIP flexion with DIP extension and possible contracture if untreated

What is the etiology of a swan neck deformity?

Trauma or disease

What is a swan neck deformity?

Rupture of volar plate at PIP

What does a swan neck deformity result in if untreated?

Hyper extension at PIP Flexion at DIP and possible contracture if untreated

What is the general Rx for tendon deformities?

Splinting Address consequences of immobilization - Tendon integrity / proliferation and mobility

What does a wrist sprain involve?

Flexor retinaculum and associated ligaments

What causes a wrist sprain?

Primarily hyperextension mechanism with FOOSH

What is the flexor retinaculum?

Fibrous band on volar wrist

Where does the flexor retinaculum attach?

From pisiform and hamate to scaphoid and trapezium

What is the function of the flexor retinaculum??

Holds flexor tendons, supports carpal arch as most activities performed with wrist extended, limits hyperextension

What do the collateral ligaments support at the wrist?

Radiocarpal, Ulnotriquetral, MCP, and IP joints medially and laterally

What do medial collateral ligaments limit?

Valgus stresses

What are medial collateral ligaments also known as in the hand?

Ulnar collateral ligaments

What do lateral collateral ligaments limit?

Varus stresses

What is another name for lateral collateral ligaments in the wrist?

Radial collateral ligaments

What is a skier's / gamekeeper's thumb?

Excessive valgus stress with hyperextension and abduction during a FOOSH

What does the skier's / gamekeeper's thumb involve?

Ulnar collateral ligament at 1st MCP joint

What are S&S of sprains?

- trauma, immediate onset - inflammation, TTP right on it - Swelling - Painful AROM/PROM with lengthening ligament - Weak and painful with resisted tests - pain with distraction, impulse if acute, compression relieving - weakness of affected muscle

What is the PT Rx for sprains?

- Stabilization and tissue integrity - immobilize for brief period - POLICED - bracing / taping PRN

What are the sets and reps for sprains?

Start 1-2 sets of 10-15 reps with light resistance, increase as tissues can handle, we want to get to a heavy load

Where is the triangular fibrocartilage complex?

Articular disc -Located distal to ulna - attached to triquetrium and lunate

What is the function of fibrocartilage?

Manage compression

What is the triangular fibrocartilage complex inflamed or damaged by?

- FOOSH sprains/fractures - Repetitive ulnar deviation (such as hammering) - Prolonged Ulnar deviation (such as cycling)

What are S&S for articular disc?

- Pain with compression - AROM - ulnar deviation and radial deviation painful, extension possibly painful and provoking - Resisted tests not unique - hyper mobility = abnormal end feels

What is the etiology of dupuytren's contracture?

A disease process that affects collagen formation of palmar fascia or aponeurosis

What is the palmar facia?

Thick, triangular shaped fascia, superficial in palm of the hand, covers tendons of extrinsic muscles, provides protection, distal attachment of palmaris longus

What are S&S of Dupuytren's Contracture?

- flexion contractures of MCPs and IPs * limited ROM and accessory motion into extension particularly * elastic and firm end feels - more often involved 4th and 5th digits - usually have non painful modules found with palpation

What is the PT rx for Dupuytren's contracture?

MT - emphasizing mobility - improved ROM and function with 8 weeks of 2 mins each of multi-planar TFM and maximal finger extension stretch MET - for tissue elasticity and mobility * Splinting and bracing to assist mobility

What does splinting and bracing do for Dupuytren's contracture?

Assists mobility and prevents from getting worse

Wrist and Hand- thru Dupuytrens Flashcards

(59 cards)