Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK 1 > 10/11 - Wrist & Hand Complex > Flashcards

10/11 - Wrist & Hand Complex Flashcards

1
Q

what patients are more appropriate to refer out to OT

A

more significant injuries/burns that need splinting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are 3 considerations when thinking ab if pt more appropriate for you or OT

A

scope of practice
skill set
comfort level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what bones articulate w the distal radius and how

A

scaphoid and lunate
- radius is concave distally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what bones does the distal ulna articulate with and how

A

w the distal radius
- ulna is convex distally

triquetrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what bone is the most fractured carpal and why

A

scaphoid
- has a narrow central waist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what bone is the most dislocated carpal and why

A

lunate
- weak volar ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what ligament is the pisiform embedded in

A

flexor carpi ulnaris (FCU)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the proximal row of carpals (radial to ulnar side)

A

scaphoid
lunate
triquetrum
pisiform

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the smallest carpal bone

A

pisiform

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the distal row of carpals (radial to ulnar side)

A

trapezium
trapezoid
capitate
hamate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is a characteristic of the distal row of carpals

A

stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the 2 main surfaces of the trapezium for articulation

A

1st CMC joint
volar groove for FCR tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what does the trapezoid articulate with

A

2nd MC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the largest and keystone distal carpal

A

capitate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the proximal and distal articulations of the capitate

A

prox: scaphoid, lunate
distal: trapezoid, hamate, 2-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what attaches at the hook of hamate

A

flexor retinaculum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the primary motion of the distal radioulnar joint (DRUJ)

A

radius moving over ulna

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what type of joint is the distal radioulnar joint (DRUJ)

A

uniaxial pivot joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is the primary goal of the triangular fibrocartilage complex (TFCC)

A

provide stability to DRUJ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the 5 components making up the TFCC

A

articular disc
wrist UCL
ECU tendon sheath
meniscus homologue
radioulnar ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

norms for wrist flexion

A

65-90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

norms for wrist extension

A

60-70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

norms for radial deviation

A

15-20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

norms for ulnar deviation

A

30-45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are normal motions at the carpal joint (4)

A

flex
ext
radial dev
ulnar dev

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what type of joint is the 1st CMC joint

A

saddle joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are the articulations of the 1st CMC joint

A

trapezium and 1st MC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are the normal motions of the 1st CMC joint and norms

A

thumb flex (20)
ABD (50-55)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is the difference b/w extrinsic vs intrinsic ligaments of the wrist and carpals

A

extrinsic - radius/ulna to carpals or carpals to MC
intrinsic - intercarpal (one carpal to the next)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

how are MCP joints are stabilized

A

strong collateral ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what type of joints are PIP and DIP joints

A

hinge joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is the importance of the pulley system with extrinsic flexor ms

A

sheathes restrain the tendons creating a pulley effect
- prevents bowstringing of tendons w distal movements
- contributes to efficient function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is seen if the tendon sheaths for extrinsic flexors are damaged

A

pulley system damaged
- bowstringing and limits amt of flex

see limitations in AROM but not necessarily PROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what are 4 intrinsic ms of the hand

A

lumbrical
interosseous
thenar
hypothenar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what is the path of the median n.

A

crosses the wrist deep to flexor retinaculum
- thru carpal tunnel (of 9 flexor tendons)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is the path of the ulnar n.

A

superficial to flexor retinaculum

enters ulnar tunnel
- b/w pisiform & hook of hamate
- divides into superficial and deep branches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what sx make you think of a nerve distribution

A

burning
numbness
tingling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what are the two branches of the radial n.

A

sensory branch - superficial
motor - post. interosseous n.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what pathology do you usually see as a result of repetitive motion

A

dequervain’s synovitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what are 4 differential dx for proximal origin pain

A

cervical radiculopathy (C6-8)
thoracic outlet syndrome
cubital tunnel syndrome (ulnar n.)
pronator syndrome (median n.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what are the goals for general fracture management (3)

A
  1. obtain and maintain appropriate reduction (closed or ORIF)
  2. restore joint congruence
  3. optimal pain-free ROM and strength
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what are 2 important considerations w general fracture management

A

minimize duration of immobilization

consider healing times of all involved structures
- not just bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

why should pediatric fractures be treated w caution

A

growth plate involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what is the most common type of fracture seen

A

distal radius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what are the two types of distal radius fractures and their MOIs

A

colles - fall in hyper-ext & sup
smith - fall in flex & pron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

why is it appropriate to start wrist ROM @5 weeks after a distal radius fx

A

people won’t be fully heald but looking for enough callus formation for safe ROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what is an important piece in the progression of rehabing a distal radius fx

A

follow up imaging to see how and the quality of healing
- know this before moving around

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what is a consideration when first initiating forearm rotation when rehabing a distal radius fx

A

first needs to be cleared by imaging

second keep elbow at side to dec the lever arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

what is the most common type of carpal fracture

A

scaphoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

where is the scaphoid most vulnerable

A

the waist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

why is the scaphoid vulnerable at the waist

A

dec blood supply there -> harder to heal
- can move onto a nonunion and is harder to deal with

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what is an important PT implication for scaphoid fx

A

lower threshold for imaging
- even if aligned, won’t necessarily heal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what is a huge detriment to a PT intervention for a scaphoid fx

A

has to be immobilized for a long time to heal bc of poor vascularization

54
Q

what is the focus on rehab for a scaphoid fx

A

endurance and dexterity

55
Q

what is the second most common carpal fx

A

triquetrum

56
Q

what is MOI for scaphoid fx

A

fall backward onto hand; wrist hyperext

57
Q

what is MOI for triquetrum fx

A

fall w hyper-ext and ulnar dev

58
Q

what carpal bone is usually also fx if the triquetrum is fx

A

trapezium

59
Q

what injuries are trapezium fx associated with (3)

A

triquetrum fx
1st MC fx
distal radius fx

60
Q

where part of the hamate is often fx

A

hook

61
Q

what are hamate fx typically associated with

A

ulnar neuropathy

62
Q

what is the MOI for hamate fx

A

compressive force at base of palm

63
Q

what is a consideration of diagnostic tools for hamate fx

A

radiographs will often be (-)
- small bone and fx usually won’t look significant

64
Q

treatment for nondisplaced vs displaced hamate fx

A

nondisplaced = immobilization 6-8weeks
displaced = surgical fixation

65
Q

what is a Boxer’s fracture

A

displaced, apex dorsal fx at 5th MC neck

66
Q

early vs late phase of rehab for a boxer’s fx

A

early phase - ROM to promote tendon gliding
- prevent adhesions

late phase - adequate healing occurs
- strengthening, dexterity, & endurance

67
Q

stable vs unstable fx

A

stable = buddy taping
unstable = orthotic device or pin fixation

68
Q

what is a concern w a FOOSH

A

significant soft tissue trauma at the wrist

69
Q

MOI for distal radioulnar joint implication w a FOOSH (3)

A

fall on pronated & ulnarly deviated hand
forceful twisting
forced hyperpronation or forced supination

70
Q

what are sx of distal radioulnar joint implication w a FOOSH (3)

A

ulnar sided wrist pain w forearm rotation
ulnar head prominence
instability

71
Q

what injuries can the TFCC be disrupted by

A

distal radioulnar joint FOOSH
distal forearm fx

72
Q

MOI for a disrupted triangular fibrocartilage complex (2)

A

axial load to extended, pronated wrist
twisting ulnarly deviated wrist

73
Q

what motions cause ulnar sided pain w a disrupted triangular fibrocartilage complex (3)

A

pronation
supination
gripping

74
Q

what is the the MOI for a wrist dislocation

A

fall onto pronated hand
- wrist hyper ext and ulnar deviation

75
Q

what bones are impacted by a wrist dislocation

A

scaphoid
lunate
lunotriquetral (less common)

76
Q

what is the interventions for carpal instability (3)

A

protection
examine associated regions
stabilize (isometrics)

77
Q

what is the most common hand injury in sports

A

thumb dislocation
- via ulnar collateral ligament involvement

78
Q

what are we concerned about with a thumb dislocation

A

stener lesion
- avulsion that will require surgical repair

79
Q

MOI for a thumb dislocation

A

hyper ext w radial dev

80
Q

what types of thumb dislocations are there

A

acute - skier’s thumb
chronic attentuation - gamekeeper’s thumb

81
Q

what is the key principle of UCL rehab in thumb dislocations

A

stability over motion

82
Q

why is tip pinch avoided for 8 weeks with a thumb dislocation

A

tip pinch load to structures that is imposed

83
Q

grade 1 and 2 thumb dislocation rehab guidelines (3)

A

thumb spica 2-4wks
key pinch and gentle thumb strengthening for next 3-4wks
avoid tip pinch and grasping for 8 weeks

84
Q

grade 3 thumb dislocation rehab guidelines (3)

A

stener lesion so surgical management
- immobilization in thumb spica for 4-6wks
- gradual mobilization and strengthening

85
Q

CRPS 1 vs CRPS 2

A

1 - formerly known as reflex sympathetic dystrophy
2 - same sx but cause is partial or complete nerve injury

86
Q

biggest diffference b/w acute and atrophic phases of CRPS

A

acute - arguably reversible
atrophic - permanent changes within structures

87
Q

sx and timeline of acute phase of CRPS

A

10days to 2-3mo
- flushed, warm, dry
- diffuse, severe pain
- edema and hair growth inc

88
Q

sx and timeline for dystrophic phase of CRPS

A

3-6mo
vasomotor instability
- cool limb
- pale, mottled, boggy edema
- severe pain remains
- nails crack
- osteoporosis

89
Q

sx and timeline of atrophic phase of CRPS

A

6mo +
cold end phase
more of dystrophic phase
- less movement
slightly less pain
permanent changes within structures

90
Q

what are 6 things to exam for CRPS

A

pain
edema
skin temp
ROM
WB
function

91
Q

what is the importance of including WB in the interventions for someone with CRPS

A

lot of people can have apprehension w WB in closed chain (esp seen in plantar grade position)
- WB can impact pain and function
- WB help to avoid osteoporotic changes

92
Q

what is an important education point for patients with CRPS

A

avoid being static
maintain some level of activity

93
Q

what is a key approach to interventions to appropriately manage CRPS

A

interdisciplinary approach
- pain modulation w meds, psych

94
Q

who are patient at high risk for CRPS

A

all recent out of cast or injured pts a potential

95
Q

what is the best way to approach PT interventions

A

prevention
- avoid prolonged immobilization
- early movement after healing

96
Q

what are two key PT interventions for CRPS

A

work on edema reduction and early motion
normalize sympathetic response
- desensitize, different textures

97
Q

where can the ulnar nerve become entrapped

A

elbow - cubital tunnel
wrist - guyon’s tunnel

98
Q

how does ulnar nerve entrapment present

A

ulnar motor weakness
- challenges w opposition

99
Q

how can ulnar nerve sx present and change

A

they are site dependent
- prox to guyon’s canal: mixed
- within guyon’s canal: motor
- distal to guyon’s canal at hook of hamate: motor
- in palmaris brevis: superficial branch (sensory)

100
Q

what is a test for ulnar nerve entrapment

A

froment sign

101
Q

what are 3 etiologies of carpal tunnel syndrome

A

sustained flex/ext posture
external pressure on volar wrist
prolonged hand vibration

102
Q

why could direct pressure lead to carpal tunnel syndrome

A

median n. is so superficial in flexor retinaculum
- direct pressure on median n.

103
Q

sx of carpal tunnel syndrome (3)

A

pain
paresthesia
numbness

104
Q

what is the significance of weakness/atrophy in thenar musculature in CTS

A

if atrophy, happen long enough and significant enough that needs to be addressed

105
Q

why is nocturnal numbness an important question to ask about

A

does it wake you up at night?
want to understand the severity
- get a feel for the need of a potential carpal tunnel release

106
Q

what are 4 tests for CTS

A

tinels
phalens
monofilament testing
2 point discrimination

107
Q

what is the biggest differential dx to be considering w CTS

A

cervical spine involvement (specifically C6)
- often can see CTS and c spine involvement

108
Q

what are 4 differential dx for CTS

A

C-spine involvement
thoracic outlet syndrome
diabetic neuropathy
pronator teres syndrome

109
Q

what are 5 education points for pts w CTS

A

eliminate aggravating factors
neutral wrist position
avoid prolonged wrist pressure
avoid vibration
avoid forceful gripping (esp w combined wrist flex/ext)

110
Q

what are 2 conservative management interventions for CTS

A

splinting/bracing - neutral splint at night
neural mobilizations

111
Q

why use neural mobilization w CTS? what is a consideration?

A

using a nerve glide technique
- general mobility to move nerve within sheath that might have gotten bogged down

important to be gentle bc can cause irritation

112
Q

what are the most concerning signs when assessing severity of CTS and might mean surgery is the best option

A

atrophy
weakness

113
Q

why should you refrain from forceful gripping or lifting in post op management of CTS or in general

A

flexor tendons run thru that flexor retinaculum also
- the more you use those flexors, the more irritation to those tendons in the retinaculum

114
Q

what are 3 exercises to avoid in post op management of CTS and why

A

repetitive gripping/pinching
use of theraputty
use of hand grippers

contributes to inflammation in flexor sheath

115
Q

why is strengthening not an included intervention in post op management of CTS

A

strengthening occurs thru daily use

116
Q

what are 3 post op CTS interventions and general timeline

A

early mobilization (ie gentle fist)
2 weeks - scar mob after suture removal
4-6 weeks - full activity

117
Q

what is a differential dx often overlooked when treating CTS

A

cervical radiculopathy
- that is what could be causing the sx

could be concurrent w CTS but CTS may be less severe than cervical involvement
- need to address both

118
Q

why is early identification key with CTS

A

sx >1yr is a factor that is associated w poor outcomes

esp if atrophy and weakness - more severe

119
Q

what are 3 main presentations of RA at the wrist/hand complex

A

ulnar drift
boutonniere deformity
swan neck deformity

120
Q

what damage causes ulnar drift in RA

A

damage to collateral ligaments & extensor mechanism
- first at the MCP then at wrist

121
Q

what does ulnar drift in RA look like

A

ulnar deviation, pronation, palmar subluxaiton

122
Q

what damage causes boutonniere deformity in RA

A

damage to common extensor tendon of PIP

123
Q

what does a boutonniere deformity in RA look like

A

flexion of PIP, hyper ext of DIP

124
Q

what damage causes a swan neck deformity in RA

A

to oblique retinacular ligament leading to dorsal displacement of extensor mechanism

125
Q

what does a swan neck deformity in RA look like

A

flexion at DIP and hyper-ext at PIP

126
Q

what is the most important intervention during a flare up of RA

A

pain reduction - want to avoid overstressing tissues

127
Q

what is the most important intervention after a flare of RA

A

teach joint conservation techniques

128
Q

where in the wrist/hand is OA the most common and why

A

1st CMC or scaphoid articulations
- likely d/t amt of mobility that is there

129
Q

what is the goal of interventions in OA

A

maximize mobility and strength
- try to redistribute load so that nearby ms can do more work and dec load at joint

130
Q

what should be avoided with interventions for OA and why

A

end range positions
- more load on joint

131
Q

why is imaging so important

A

is fx in vulnerable area - blood flow?
quality of healing?

132
Q

what should be considered ab soft tissues when managing hand/wrist complex injuries

A

trying to unload these tissues
- when tissue calm down, can work on gradually changing overall mechanics

MSK 1 (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions