wrist and hand worksheet

Question 1

Know as the dinner fork, radial fracture) – fall on the palm of an outstretched hand. (Distal frag is displaced in the dorsal direction, within 2.5 cm of the wrist)

Answer 1

Colles fracture

Question 2

(reverse Colles) – fall on the dorsum of the hand. (Radial frag displaced in the palmar direction)

Answer 2

-Smith’s fracture

Question 3

What is the MOI of scaphoid fractures?

Answer 3

The result of a minor fall on the palm with the wrist hyperextended and radially deviated.

Question 4

What type of strengthening exercises should be implemented when appropriate with a patient that has experienced a scaphoid fracture?

Answer 4

Putty
sustained grip activities
gradual closed-chain activities
progressed to tolerance.

Question 5

What interventions can assist the patient if they are having difficulty regaining motion?

Answer 5

Static progressive splinting
dynamic splinting
jt mobilization can help restore full range.

Question 6

What structures are affected with a boxer’s fracture?

Answer 6

4th and 5th metatarsals

Question 7

What is the position of immobilization?

Answer 7

The wrist in slight ext and MP jt flexed for 3-4 wks

Question 8

What structures are affected with a Bennett fracture?

Answer 8

The palmar base of the proximal first metacarpal

Question 9

What types of interventions can be implemented once the bennett fracture is stable?

Answer 9

• Resistance exercises
• pinch
• grip
• WBing on the palm with the thumb ABD can be progressed.

Question 10

What is skier’s thumb?

Answer 10

• An acute sprain of the ulnar collateral ligament of the thumb.
• Sudden valgus stress and hyperextension of the thumb, resulting in either partial ligament tear or a complete rupture.

Question 11

You are treating a patient recovering from skier’s thumb and the patient asks when you think that they can return to unrestricted use of the affected hand. What is the best answer?

30 days
3 months
6 months
1 year
Never

Answer 11

3 months

Question 12

What structures does De Quervain disease affect?

Answer 12

• The abductor pollicis longus
• extensor pollicis brevis tendons and sheaths.

Question 13

What motion may provoke painful symptoms in a de quervain patient?

Answer 13

Ulnar deviation of the wrist when the thumb is clasped in the palm.

Question 14

Note: Tendon Injuries are classified into zones. See K & C

Which zone is referred to as “no man’s land”?

Answer 14

Zone II

Question 15

What is the significance of extensor tendon injuries that makes strengthening so important?

Answer 15

An intact extensor mechanism is essential for functional grasp and release

Question 16

What structure does mallet finger affect?

Answer 16

• Closed rupture of the terminal extensor tendon in zone 1
• usually from forceful hyperflexion.

Question 17

What structures does the swan neck deformity affect?

Answer 17

• The unopposed force of the flexor digitorum profundus muscle
• positions the DIP jt in flex
• may lead to hyperextension of the PIP

Question 18

If splinting is recommended for a swan neck defromity, what joint is immobilized, what position and what is the time frame?

Answer 18

• The unopposed force of the flexor digitorum profundus muscle
• positions the DIP jt in flex
• may lead to hyperextension of the PIP

Question 19

At what point in the recovery process of a swan neck deformity can active flexion of DIP begin to be implemented?

Answer 19

6 weeks

Question 20

What education should be provided to a swan neck defromrity patient regarding contraindicated movements?

Answer 20

No using strong muscle contractions or passive flexion.

Question 21

Under normal circumstances and with patient compliances, what is the expected time frame that a swan neck deformity patient can expect to achieve full active motion?

Answer 21

Could take up to 6 months

Question 22

What is a boutonniere deformity?

Answer 22

• PIP flexion and DIP extension
• caused by rupture of the central band of the extensor hood

Question 23

What signs and symptoms would cause the PTA to alert the PT about a boutonniere deformity?

Answer 23

The goal is to approximate the ends of the tendon so they can heal together.

Alert the PT If swelling decreases and the splint or cast is loose.

Question 24

What motions are encouraged for a boutonniere deformity?

Answer 24

Active and passive DIP flexion
After 6weeks active motion of the PIP is initiated but the digit is splinted in between sessions for 2 to 4 weeks.

Question 25

Flexor tendon injuries will lead to loss of what motion?

Answer 25

Loss of active flexion

Question 26

Which zone is the most difficult to treat? What structure(s) are involved?

Answer 26

* Zone two is the most difficult. * It extends form the level of the MP joint to the insertion of the flexor diitorum superficialis just distal to the PIP loint. Injuries int his zone may involve both the FDS and the FDP tendons

Question 27

What are the 3 approaches to flexor tendon rehab?

Answer 27

1. Immobilization 2. Early passive mobilization 3. Early active mobilization

Question 28

When are strengthening exercises implemented for flexor tendon injuries?

Answer 28

it is initiated at about 8 weeks

Question 29

an abnormal thickening of the tissue just beneath the fascia. A formation of pits and firm nodules. The nodules can be composed of overactive fibroblasts producing collagen or can be from “bunching” of the skin in response to a longitudinal contraction

Answer 29

Dupuytren Disease shank 392

Question 30

What structure is affected with Carpal Tunnel Syndrome (CTS)?

Answer 30

* the median nerve is compreesed or entrapped at the wrist. * the carpal tunnel is formed by the carpal boneds and the trasvers sarpal ligament and contains the median nerve and nin flexor tendons

Question 31

What are the possible causes of CTS?

Answer 31

* Anatomic changes of arthritis * fractures * cysts * diabetes * hypothyroidism * aging * pregnancy * alcohol abuse

Question 32

What are the clinical signs of CTS?

Answer 32

* numbness of the thumb and radial digits * tingling * pain that is often worse at night * clumsiness in hand activity * weakness of grip and pinch * atrophy of the thenar muscles * swelling in the hand and forearm

Question 33

What type of education is important to provide to a CTS patient?

Answer 33

* avoid extreme flex and extension * no tight sleeves * watchbands * braclets * applying pressure over the median nerve when the pronated arm is resting against a desk

Question 34

If a patient has surgery to correct CTS, what motions must be avoided to prevent bowstringing?

Answer 34

the pt is taught to avoid simultaneously flexing the wrist and fingers

Question 35

What is CRPS?

Answer 35

Complex Regional Pain Syndrome- Is where the pain of an injury is abnormally severe and /or prolonged

Question 36

What types of interventions may be implemented with a CRPS patient?

Answer 36

Pain control may be helped by the use heat or cold modalities, contrast baths in which extremes of temperture are avoided , TENS,CPM, hydrotherapy