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wrist/hand Flashcards

(65 cards)

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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
tunnels
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
26
arches
proximal transverse- carpal bones, rigid, immobile distal transverse- heads of metacarpals, mobile longitudinal- flex, mobile
27
RA pathology
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
ulnar drift
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
boutonniere deformity
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
swan neck deformity
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
TFCC lesion
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
OA
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
heberdans nodes
DIP jt | caused by formation of osteophytes of articular cartilage in response to repeated trauma at the joint
34
Z deformity of thumb
flexed MCP and hyperext IP | may be due to arthritis or hereditary
35
dupuytren contracture
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
UCL sprain
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
ganglia
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
tendonitis
common cause of overuse | APL and EPB often involved
39
tenosynovitis
inflammation of tendon sheath | frequently seen in inflammatory rheumatic disease, DM, hypothyroid conditions
40
DeQuervain disease
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
trigger finger
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
tendon gliding exertion
straight hand hook hand-greatest excursion between FDP and FDS full fist- full excursion FDP flat fist- full exertion FDS
43
mallet finger deformity
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
carpel tunnel syndrome
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
claw hand
median N
46
ape hand
median N
47
radial N entrapment
weak wrist and finger ext wrist drop weak hand grip
48
wartenberg syndrome
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
ulnar N entrapment
tunnel of guyon (pisiform and hamate)
50
claw hand of ulnar N
bishops hand | can't ext bc of lumbricles
51
nerve regeneration
``` 1 inch a month (1mm/day) order: pain/temp 30 cps vibration moving touch constant touch 256 cps vibration ```
52
chronic regional pain syndrome
``` RSD persisting pain edema stiffness skin temp changes, sweating hyperalgia mirror therapy ```
53
colles fracture
distal radius fracture complete fracture with POST displacement FOOSH
54
smith fracture
complete fracture of distal radius with ANT displacement | fall on back on a FLEXED HAND
55
boxers fracture
transverse fractures of the 5th metacarpal MOST COMMON type of metacarpal fracture usually ulnar gutter splint
56
scaphoid fracture
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
kienbock disease
lunate injury aseptic necrosis or osteonecrosis of lunate pain over lunate, FOOSH, decreased grip strength
58
lunate dislocation
volar displacement FOOSH or hit by outside force, pain over lunate, deformity, inability to move wrist, median neuropathy avoid extension until healed
59
raynauds phenomenon
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
Volkmans ischemic contracture
hook like contracture of flexor muscles due to meurovascular trauma, fracture
61
hook grip
median and ulnar
62
power grip
median and ulnar
63
lateral pinch
ulnar
64
precision pinch
median N
65
cylindrical grip
median, ulnar, radial

MSK (13 decks)

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