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MSK Final - ELBOW/ WRIST & HAND/ TMD > Wrist and Hand- thru Dupuytrens > Flashcards

Wrist and Hand- thru Dupuytrens Flashcards

1
Q

Most ADLs require ______ & _______________.

A

Extension and ulnar deviation

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2
Q

What amount of extension is required for drinking activities?

A

6-24˚

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3
Q

What amount of extension is required for using a phone?

A

40˚ extension

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4
Q

What amount of ROM is necessary for turning a doorknob?

A

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

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5
Q

What is the ideal functional ROM?

A

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

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6
Q

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

A

Strength and precision

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7
Q

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

A

Slightly hyperextended

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8
Q

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

A

Slightly flexed

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9
Q

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

A

In opposition

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10
Q

What us the etiology of De Quervain’s Tenosynovitis?

A

Repetitive thumb use with ulnar deviation and gripping

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11
Q

What is De Quervain’s Tenosynovitis?

A

Tendinopathy of snuff box tendons

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12
Q

What is De Quervain’s related directly to?

A

Personal device use

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13
Q

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

A

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

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14
Q

What happens at the thumb with De Quervains?

A

Decreased grip and pinch strength

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15
Q

What are S&S of De Quervain’s?

A

Tendinopathy
Special tests positive - Finkelstein’s

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16
Q

What is the PT rx for De Quervain’s?

A

POLICED
Reduce typing and dictate
Tendinopathy MET
Tendon Glides
Thumb Splint

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17
Q

What is the MD RX?

A

anti-inflammatory Injections

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18
Q

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

A

75% successful; may require two injections

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19
Q

What is the issue with injections for De Quervains?

A

Doesn’t address problem

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20
Q

What is the extensor expansion ligament?

A

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

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21
Q

What is the shape of the extensor expansion ligament?

A

Wider at base, narrow distally

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22
Q

Where is the extensor expansion ligament?

A

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

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23
Q

What does the extensor expansion ligament allow?

A

Fine motor movements

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24
Q

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

A

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

25
Q

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

A

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

26
Q

What is the etiology for mallet finger?

A

Trauma or disease (possibly RA)

27
Q

What is Mallet finger?

A

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

28
Q

What does Mallet finger result in if untreated?

A

DIP Joint flexion and possible contracture if untreated

29
Q

What is the etiology for boutonniere deformity?

A

Trauma or disease

30
Q

What is a Boutonniere deformity?

A

Rupture or stretch of extensor tendon at PIP

31
Q

What does a Boutonniere deformity result in if untreated?

A

PIP flexion with DIP extension and possible contracture if untreated

32
Q

What is the etiology of a swan neck deformity?

A

Trauma or disease

33
Q

What is a swan neck deformity?

A

Rupture of volar plate at PIP

34
Q

What does a swan neck deformity result in if untreated?

A

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

35
Q

What is the general Rx for tendon deformities?

A

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

36
Q

What does a wrist sprain involve?

A

Flexor retinaculum and associated ligaments

37
Q

What causes a wrist sprain?

A

Primarily hyperextension mechanism with FOOSH

38
Q

What is the flexor retinaculum?

A

Fibrous band on volar wrist

39
Q

Where does the flexor retinaculum attach?

A

From pisiform and hamate to scaphoid and trapezium

40
Q

What is the function of the flexor retinaculum??

A

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

41
Q

What do the collateral ligaments support at the wrist?

A

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

42
Q

What do medial collateral ligaments limit?

A

Valgus stresses

43
Q

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

A

Ulnar collateral ligaments

44
Q

What do lateral collateral ligaments limit?

A

Varus stresses

45
Q

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

A

Radial collateral ligaments

46
Q

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

A

Excessive valgus stress with hyperextension and abduction during a FOOSH

47
Q

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

A

Ulnar collateral ligament at 1st MCP joint

48
Q

What are S&S of sprains?

A
  • 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
49
Q

What is the PT Rx for sprains?

A
  • Stabilization and tissue integrity
  • immobilize for brief period
  • POLICED
  • bracing / taping PRN
50
Q

What are the sets and reps for sprains?

A

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

51
Q

Where is the triangular fibrocartilage complex?

A

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

52
Q

What is the function of fibrocartilage?

A

Manage compression

53
Q

What is the triangular fibrocartilage complex inflamed or damaged by?

A
  • FOOSH sprains/fractures
  • Repetitive ulnar deviation (such as hammering)
  • Prolonged Ulnar deviation (such as cycling)
54
Q

What are S&S for articular disc?

A
  • Pain with compression
  • AROM - ulnar deviation and radial deviation painful, extension possibly painful and provoking
  • Resisted tests not unique
  • hyper mobility = abnormal end feels
55
Q

What is the etiology of dupuytren’s contracture?

A

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

56
Q

What is the palmar facia?

A

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

57
Q

What are S&S of Dupuytren’s Contracture?

A
  • 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
58
Q

What is the PT rx for Dupuytren’s contracture?

A

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

59
Q

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

A

Assists mobility and prevents from getting worse

MSK Final - ELBOW/ WRIST & HAND/ TMD (6 decks)

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