4 - Wrist / Hand Flashcards
Carpal tunnel movement of choice is?
-Wrist traction. (flexion only)
What is the most common direction for carpals to misalign
? -Posterior
What is the direction of carpal misalignment in CTS
-Anterior (lunate).
What’s the best post check for wrist traction?
-Fluid motion between the carpals that were adjusted.
Where is the pain point for wrist traction?
-Right over the carpal that is misaligned.
What are your fingers on the stabilization hand stabilizing during capitate single-thumb?
-The proximal row of carpals.
What are fingers on your contact hand stabilizing during capitate single-thumb?
-The distal row of carpals except capitate and the third metacarpal.
What ROM do you take the patient’s hand through while doing scaphoid double thumb?
-Extension and radial deviation.
What carpals do you test the scaphoid against for fluid motion?
-The lunate,…..trapezium….&….trapezoid.
What are some differential diagnoses for trapezium-scaphoid subluxation?
- Scaphoid fracture,…..DJD,…..Arthritis,…..Stenosing tenosynovitis of DeQuervain,
- Subluxation(s) of scaphoid-lunate,…..trapezium-1st metacarpal,.
What tendons make up the Tunnel of DeQuervain?
- extensor pollicus brevis (brief extension)
- abductor pollicus longus (long abduction)
What makes up the carpal tunnel?
-lunate (post.),…..transverse carpal ligament (ant.)
What are the contents of the carpal tunnel?
-Nine flexor tendons and the Median Nerve (look up specifics).
First metacarpal subluxation can be identified how?
- Loss of fluid motion P-A,
- point tenderness at CMC joint,
- case history of jammed thumb, etc.
What ROM is expected at the metacarpal-carpal area?
-Not much extension or flexion, rotate as cupping hands.
How would you test for a carpal metacarpal 2nd – 5th subluxation
-Stabilize the distal row of carpals and rotate the metacarpals to see if they have fluid motion.
S/S of carpometacarpal?
-Pain over joint space after hitting the area or being stepped on or possibly after a cast is removed.
Expected ROM for metacarpophalangeal and interphalangeal?
-Should have glide from P-A and A-P, as well as rotation
Why would you do metacarpophalangeal joint traction?…
- M-C P subluxation
- Jammed fingers,
- Arthritic fingers
- DJD.
Is there a difference between arthritis and DJD?
-Arthritis has inflammation; therefore deal with the swelling first before the return of motion.
What differential diagnoses should be ruled out before adjusting Scaphoid double-thumb?
- Check for scaphoid fracture,
- radial styloid fracture,
- Stenosing tenosynovitis of DeQuervain, -other-carpal subluxations, etc.
Name the wrist adjusting procedures from least to most invasive.
- Wrist traction,
- single thumb,
- double thumb.
Where is pain point for the 1st C-MC joint?
-Right over the joint.
What direction does the 2nd C-MC most commonly subluxate?
-Rotationally
What is the best way to post-check the 2nd C-MC?
-Post fluid motion check
Of C-MC numbers 2 through 5, which is the most mobile
The 5th.
MC-P & IP traction: What type of joint pathologies are they good for?
- Any fixation, subluxation or dislocation,
- Jammed finger,
- arthritides,
- D.JD
Lunate usually misaligns in what direction
Posterior.
-However, for carpal tunnel it misaligns….-Anterior.
Is the lunate usually hypermobile or hypomobile in CTS?
-Hypermobile.
Most common wrist subluxation?
-Lunate;
-2nd most?… Capitate;
-3rd most?… Scaphoid.
Is the posterior lunate misalignment hypermobile or hypomobile?
? -Hypomobile.
Describe the wrist traction maneuver for CTS?
-Traction, flex, and back to neutral (no thrust and no extension)
Describe the wrist traction maneuver for subluxation
-Traction, flex, extend, back to neutral, release.
Differential diagnoses for CTS?
-Cervical subluxation,… pronator teres syndrome,… elbow subluxation,… shoulder subluxation, Thoracic outlet syndrome,… Reynaud’s syndrome,… Tenosynovitis of DeQuervain, Ulnar nerve palsy,… Radial nerve palsy,… Fractures, Trigger points on thumb for stomach and liver
Name two tests to verify a positive Tinel Tap?
-Phalen’s*** & ***English
Most important thing for Froment’s test in a practical?
-Be able to visualize whether patient bends thumb
Ways to verify positive Froment’s
- Thenar & hypo-thenar muscle wasting,
- loss of strength in muscle test,
- EMG
Causes of ulnar nerve palsy?
-Trauma to nerve (banged it or compressed it),…or…Elbow subluxation
Carpal Tunnel Symptomatology
-pain,… paresthesia,… numbness,… tingling in median nerve distribution,… Time for English test?…. hold it up to a minute or until CTS symptomatology appears
2 reasons the English test works
- hypoxia,
- pooling of blood around carpal tunnel increases pressure on median nerve.
Move of choice for CTS
-anterior lunate,……traction with flexion only,…no extension!!!
Which CTS test would you not do for post-check? Why?
-Reverse Phalen’s, drives the lunate anterior
What can cause positive Allen’s?
-Subluxation,… Reynaud’s,….. old fractures, scar tissue (loss of patency of arteries)
When will you most often see a positive reaction in English test?
-When you release the blood supply after it has already pooled (at the end)
Best CTS post-check
-ortho tests that were positive on pre-check
What would you do after treating CTS?
-brace or support,…..then…..strengthening exercises
Fluid motion lost between scaphoid and lunate; what is move of choice?
-Traction,…..then single thumb move for scaphoid fixation, then double thumb move.
Describe Single-thumb scaphoid procedure
-traction,….. extend,….. radially deviate….. (may add impulse if this doesn’t work at first)
What to make sure of on double thumb scaphoid?
-that all fingers are stabilizing around the scaphoid
What stabilizes the radius on double-thumb scaphoid
patient’s own body weight !
Treatment for positive Finkelstein’s?
-Ice,…..biomechanical correction
DDX for Finkelstein’s?
- Scaphoid fracture or subluxation
2 positives and 2 indications of Finkelstein’s?
- unable to bring thumb across + muscle wasting = ulnar nerve palsy
- pain = stenosing tenosynovitis of DeQuervain
With hypermobile anterior lunate, how to do wrist traction?
-Do flexion, do not do extension
What to do before adjusting scaphoid double-thumb?
-Check for scaphoid fracture,….or tenosynovitis of DeQuervain,….then try wrist traction (less invasive)
1st CMC joint –DDX possibilities? ,
-Stenosing tenosynovitis,….. scaphoid fracture,….. scaphoid subluxation,….. trapezium subluxation,… median nerve disturbance
Where is pain point for 2nd CMC?
-Right over the joint
Which CMC is the most mobile?
-5th
MCP & IP traction: what type of joint pathologies is it good for?
-Any fixation,……subluxation, or dislocation,……arthritis
