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msk > wrist/hand > Flashcards

wrist/hand Flashcards

1
Q

ext retinaculum hood mechanism?

A

?

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2
Q

volar plate prevents…

A

hyperext

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3
Q

hand accounts for % of upper limb function

A

90

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4
Q

thumb is involved in % of hand function

A

40-50

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5
Q

functional ROM of wrist

A

10 ext

30-35 degrees flex

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6
Q

functional position

A 
20 wrist ext
10 ulnar dev
45 MCP flex
30 PIP flex
slight DIP flex
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7
Q

distal RU joint

A

TFCC (triangular fibrocartilage complex: includes disc and ligaments) helps stabilize

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8
Q

distal RU positions

A

open-10 sup
closed- 5 sup
capsular pattern- pronation=supination, pain at extremes of pro/sup

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9
Q

TFCC

A

triangular fibrocartilage complex (includes disc and ligaments) helps stabilize
fibrocartilage disc between distal ulna and carpals in medial wrist
dorsal and volar radio-ulnar lig
ulnar-carpal lig
enhance joint congruity and cushion against compressive forces (transmits about 20% load from hand to forearm)
ECU attaches to TFCC
can get torn
popping and clicking

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10
Q

radiocarpal joint

A

distal end of the radius, scaphoid, lunate and the TFCC
open- 10 wrist flex and slight ulnar dev
closed- full ext with radial dev
capsular pattern- equal limitation all directions

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11
Q

midcarpal joint

A

proximal-scaphoid, lunate, triquetrum
distal- trapezium, trapezoid, capitate, hamate
open- neutral or slight flex with ulnar dev
closed-ext with ulnar dev
capsular pattern- equal limitations in all directions

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12
Q

first CMC joint

A

articulation between 1st metacarpal and trapezium
saddle/sellar joint
open- mid abd/add/flex/ext
closed-full opposition
capsular-abd most limited, followed by extension

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13
Q

CMC 2-5

A

open- neutral position of wrist
closed- not described
capsular pattern- equal limitation in all directions

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14
Q

MCP 1st digit

A

open- slight flex
closed- maximal opposition
capsular pattern- greater limitation in flex than ext

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15
Q

MCP, PIP, DIP, 2-5

A 
MCP
open- slight flex
closed- full ext
capsular pattern- equal restriction in all directions
PIP
open- slight flex
closed-full ext
capsular pattern- greater limitation in flex than ext
DIP
open- slight flex
closed-full ext
capsular pattern- greater limitation in flex than ext
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16
Q

extensor retinaculum

A

prevents tendons from bowstringing

forms 6 compartments

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17
Q

extensor hood

A

complex tendon covering post aspect of the digits
combination of ED,EI,EDM
distal portion of hood receives tendons of lumbricles and interossei over prox phalanx
between MCP and PIP, complete tendon splits into 3 parts: central slip and 2 lateral bands
arrangement creates cable system for ext MCP and IP joints

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18
Q

oblique retinacular ligament (ORL)

A

runs from solar side proximal to PIP - dorsal terminal extensor tendon
links DIP and PIP movement
can measure length: measure DIP flex with PIP ext and measures DIP flex with PIP flex
contracture ORL- increased DIP flex with PIP flexed
unchanged- joint capsule contracture

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19
Q

flexor retinaculum

A

flexor retinaculum- between pisaform, hamate, scaphoid, and trapezium
serves as attachment site for thinner and hypothenar muscles
maintains transverse carpal arch
acts as restraints against bowstringing of flexor tendons
protects median N

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20
Q

flexor pulleys

A

annular and cruciate connective tissues restrain flexor tendonos to metacarpals and phalanges, contribute to tunnels through which the tendons travel

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21
Q

volar plate

A

very thick fibrocartilage band which joins 2 bones in the finger, reinforces joint capsule

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22
Q

9 structures that go through carpal tunnel

A

4 FDP, 4 FDS, median N, FPL

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23
Q

carpal bones

A

numerous ligaments
pisaform has 2 attachments- FCU is the only extrinsic forearm muscle to insert on carpal bone and abductor digit minim also inserts

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24
Q

tenodesis

A

passive hand grip and release mechanism, effected by wrist flexion or extension
moving the wrist in ext will cause the fingers to curl or grip
moving the wrist in flex will cause fingers to straighten or release

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25
Q

tunnels

A

carpal- median N and 9 flexor tendons
tunnel of guyon- located between hook of hamate and pisiform
passageway for ulnar N and artery into the hand

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26
Q

arches

A

proximal transverse- carpal bones, rigid, immobile
distal transverse- heads of metacarpals, mobile
longitudinal- flex, mobile

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27
Q

RA pathology

A

systemic disease
use adaptive equipment
heat/parafin
AROM
cycles of stretching, healing and scarring that occurs as a result of inflammatory process
causes significant damage to soft tissues and periarticular structures
can lead to pain, stiffness, joint damage, instability, deformity (swan or buttonier)

28
Q

ulnar drift

A

result of interaction of forces and damage to collateral log and ext mechanisms
pulls the finger into ulnar deviation, pronation, ant subluxation
up to 45 deg of lat deviation can occur at the MCP joint

29
Q

boutonniere deformity

A

deformity of ext of MCP and DIP and flex of PIP
occurs when common ext tendon that inserts on base of middle phalanx is damaged
damage to central slip insertion requires extra effort to extend joint, causing hypertext at DIP
lateral bands drift forward past axis of rotation of pip and act as flexors while hyperextending DIP
caused by division, rupture, avulsion, or closed trauma to common ext tendon; RA
2nd most common closed tendon injury in sports
if more than 30 degree ext lag is present at PIP, boutonniere lesion should be suspected
immobilize PUP FULL EXT with MCP and DIP for 6-8 weeks

30
Q

swan neck deformity

A

flex of DIP and hypertext of the PIP
destruction and oblique retinacular ligament of the extensor mechanism leads to posterior displacement of the lateral bands resulting in hypertext of PIP
pull on FDP tendon causes flexion of DIP
intervention-silver ring slip for neutral PIP

31
Q

TFCC lesion

A

disruption of articular disc
occur following fall on supinated outstretched wrist or chronic repetitive rotational loading (golfing)
medial wrist pain distal to ulna, increased with end-range forearm pronation/supination and forced gripping
painful click during wrist motions
tenderness localized to distal to ulnar head
pain with ulnar (compression) and radial deviation (stretch)
joint distraction, wrist strengthening, avoid pronation/supination
long arm cast or splint 6 weeks
surgical

32
Q

OA

A

primary-commonly involved 1st CMC joint or scapotrapezioid joint
secondary- attributed to old trauma or infection
1st CMC
womens > men
45 yo
joint pain at base of thumb which increases with use, restricted ROM in capsular pattern, joint crepitus
joint compression/rotation reproduces pain

33
Q

heberdans nodes

A

DIP jt

caused by formation of osteophytes of articular cartilage in response to repeated trauma at the joint

34
Q

Z deformity of thumb

A

flexed MCP and hyperext IP

may be due to arthritis or hereditary

35
Q

dupuytren contracture

A

active cellular process in the fascia of the hand, characterized by nodules in palmar and digital fascia
pathologic changes in fascia result in tendon-like cords
contractors form mally at MCP and PIP, little finger involved in 70% of patients, usually bilateral
caucasian men later in life
alcoholic, diabetes, epileptic, tobacco, hereditary
inability to straighten fingers, primarly 4th and 5th

36
Q

UCL sprain

A

gamekeepers thumb or skiers thumb
injury to MCP of thumb
most common ligament injury of hand
pain or tenderness on ulnar aspect of the MCP joint
direct force causing hypertext and abduction MCP joint or repeated trauma
may need splinting

37
Q

ganglia

A

thin walled cysts containing hyaluronic acid that develop spontaneously over a joint capsule or tendon sheath
can occur overnight
pain with flex, limited ext
backside of wrist

38
Q

tendonitis

A

common cause of overuse

APL and EPB often involved

39
Q

tenosynovitis

A

inflammation of tendon sheath

frequently seen in inflammatory rheumatic disease, DM, hypothyroid conditions

40
Q

DeQuervain disease

A

progressive tendinitis or tendonsynovitis involving tendon sheaths of first post compartment of wrist (APL and EPB) resulting in sickening of the extensor retinaculum, stenosing of the fiber-osseus canal and eventual entrapment and compression of tendons
gradual and insidious onset, can be associated with DM and hypothyroid
creak in wrist
sever pain with ulnar deviation and thumb flex/adduction
localized swelling and tenderness in region radial styloid process
loss of abduction of CMC joint
texting can cause
more localized

41
Q

trigger finger

A

painful snapping or triggering of the fingers due to disproportion between the flexor tendon and its tendon sheath
more common in thumb, ring, and middle finger
more common in pots with DM, young children, menopausal women, RA
limited finger motion especially PIP
crepitus or moving nodular mass near A1 pulley with finger movement
swelling
splint MCP joint
excise pulley surgery
can happen in kids also

42
Q

tendon gliding exertion

A

straight hand
hook hand-greatest excursion between FDP and FDS
full fist- full excursion FDP
flat fist- full exertion FDS

43
Q

mallet finger deformity

A

traumatic disruption of the terminal tendon from DIP
loss of active ext of the DIP, can be ext passively
flex deformity of the DIP
can turn int swan neck deformity if not treated
splint in DIP ext

44
Q

carpel tunnel syndrome

A

ischemic compression of median nerve at the wrist
increase in synovial fluid pressure
intermittent pain and paresthesia in median nerve distribution of hand
worse at night
pregnancy, short/stiff finger flexors
can be bilateral
decreased grip strength

45
Q

claw hand

A

median N

46
Q

ape hand

A

median N

47
Q

radial N entrapment

A

weak wrist and finger ext
wrist drop
weak hand grip

48
Q

wartenberg syndrome

A

compression of the super sensory radian N
pain and parenthesis numbness on radial aspects of hand and wrist (ECRL and brachioradialis) all sensory but some motor somewhere else

49
Q

ulnar N entrapment

A

tunnel of guyon (pisiform and hamate)

50
Q

claw hand of ulnar N

A

bishops hand

can’t ext bc of lumbricles

51
Q

nerve regeneration

A 
1 inch a month (1mm/day)
order:
pain/temp
30 cps vibration
moving touch
constant touch
256 cps vibration
52
Q

chronic regional pain syndrome

A 
RSD
persisting pain
edema
stiffness
skin temp changes, sweating
hyperalgia
mirror therapy
53
Q

colles fracture

A

distal radius fracture
complete fracture with POST displacement
FOOSH

54
Q

smith fracture

A

complete fracture of distal radius with ANT displacement

fall on back on a FLEXED HAND

55
Q

boxers fracture

A

transverse fractures of the 5th metacarpal
MOST COMMON type of metacarpal fracture
usually ulnar gutter splint

56
Q

scaphoid fracture

A

most commonly fractured carpal bone (waist of scaphoid)
FOOSH with fist pronated
post radial side wrist pain
tender anatomical snuff box
pain with axial thumb compression
***treat all wrist pain with swelling and pain in snuffbox as fx until proven otherwise
want to diagnose early bc poor blood supply
CT or bone scan

57
Q

kienbock disease

A

lunate injury
aseptic necrosis or osteonecrosis of lunate
pain over lunate, FOOSH, decreased grip strength

58
Q

lunate dislocation

A

volar displacement
FOOSH or hit by outside force, pain over lunate, deformity, inability to move wrist, median neuropathy
avoid extension until healed

59
Q

raynauds phenomenon

A

vasospasm of distal vessels of hand and toes
decreased circulation of distal UE
diffuse pain in hand
pale fingers
cold may trigger
+ Allen
blanching of fingers followed by reddening

60
Q

Volkmans ischemic contracture

A

hook like contracture of flexor muscles due to meurovascular trauma, fracture

61
Q

hook grip

A

median and ulnar

62
Q

power grip

A

median and ulnar

63
Q

lateral pinch

A

ulnar

64
Q

precision pinch

A

median N

65
Q

cylindrical grip

A

median, ulnar, radial

msk (13 decks)

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