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OPP 3-2 > 5- Wrist and Hand (Kusienski) > Flashcards

5- Wrist and Hand (Kusienski) Flashcards

1
Q

T or F? Wrist/hand pain can be referred from more proximal sites

A

True! Like the cervical spine.

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2
Q

T or F? The Ulna is a part of your true wrist joint.

A

False! The fibrocartilage complex is what articulates, not the ulna.

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3
Q

T or F? The Radius is a part of your true wrist joint.

A

True

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4
Q

What ligament restricts bowing of the fingers and protects the median nerve?

A

Transverse Carpal/Flexor Retinaculum

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5
Q

What are your “grpping” hand muscles?

A

Lumbricles/Interossei, ED, FDS, FDP, Muscles of thenar/hypothenar eminence.

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6
Q

The radial nerve does NOT innervate?

A

Intrinsic muscles of the hand

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7
Q

With wrist flexion, the carpals glide……

A

dorsally

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8
Q

With wrist extension, the carpals glide……

A

ventrally

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9
Q

With flexion of phalanges, the carpals glide…..

A

volarly

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10
Q

Test strength against…….whenever possible!

A

Gravity

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11
Q

What test is an evaluation of arterial circulation of the hand?

A

Allen’s test

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12
Q

What test is an evaluation of DeQuarvains disease?

A

Finkelstein’s test

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13
Q

Prayer and phalen tests diagnose what?

A

Carpal Tunnel

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14
Q

Where do you test for radial nerve sensation?

A

DOrsal web space between thumb and index finger

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15
Q

Where do you test for Median nerve sensation?

A

Radial side of distal index finger

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16
Q

Where do you test for Ulnar nerve sensation?

A

Ulnar side of distal little finger

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17
Q

Patient presents with numbness and tingling of the thumb and adjacent 2.5 fingers. She has pain at night, noted thenar atrophy, thumb weakness, and a positive Tinel’s sign. Dx?

A

Carpal Tunnel

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18
Q

What gives you a definitive dx of carpal tunnel?

A

EMG Nerve studies.

19
Q

What kind of OMT can you use for carpal tunnel?

A

Myofascial release, HVLA, articulatory technques

20
Q

What are the goals of carpal tunnel OMT?

A

Loosen tense fascia, release edema, stretch fibrous bands, correct joint restrictions.

21
Q

A 23 year old gamer presents with tenosynovitis of his abductor pollicis longus and extensor pollicis brevis. Possible dx?

A

DeQuervain’s disease

22
Q

Pt presents with pain and tenderness of thumb with radiation into hand/forearm. Pt has a positive finkelstein test and pain in the snuff box, but it is not pinpoint. Dx?

A

DeQuervain’s

23
Q

How do you treat DeQuervains?

A

Thumb spica splint- If pain is pinpoint, wrist splint, OMT, PT, NSAIDS, Corticosteroid injection, Surgery (last resort)

24
Q

14 year old falls onto an outstretched hand while rollerblading, what bone did he most likely break?

A

Scaphoid

25
Q

X rays on a child who fell onto his outstretched hand are negative, although he has pain in his anatomical snuff box. What do you do?

A

Thumb spica splint/cast, repeat x ray in 7 days. Initial x rays can be negative!

26
Q

What happens if you fail to treat a scaphoid fracture?

A

Delayed or nonunion healing, degenerativ joint disease, avascular necrosis, surgery.

27
Q

25 year old male presents with palpitations, shortness of breath, and claims he is “distracted by the most beautiful thing in the world”. What is the cause of his symptoms?

A
28
Q

18 year old student presents with a history of vague, ulnar sided wrist pain. The patient admits to be wrestler on his school’s wrestling team. Upon pysical exam his wrist has pain upon compression and a “click” is felt when moving it. There is also pain with anterior movement of the ulna. Dx?

A

Triangular Fibrocartilage Complex Tear

29
Q

What imaging provides a definitive diagnosis for a TFCT?

A

MRI

30
Q

30 year old female presents with a sudden snapping sensation of her finger during flexion and extension. Exam reveals a nodule in the flexor tendon that is restricting motion. Dx?

A

Trigger Finger

31
Q

Patient presents with a large cyst on their dorsal wrist. What is it and how do you treat it?

A

Ganglion cyst, Aspiration or surgery.

32
Q

Patient presents with thickening of the palmar skin with dimpling and nodule formation. Hx includes being an alcoholic, epileptic, and TB infection. Dx?

A

Dupuytrens Contracture.

33
Q

What is the initial treatment for Dupuytren’s contracture?

A

OMT

34
Q

As your math teacher points at your face, you notice she has a fingertip that is slightly bent with no extension. She needs to actuall bend her finger to straighten the joint and also has slight tenderness between the nail and first DIP. Dx?

A

Mallet Finger

35
Q

You have used Xray to rule out a large avulsion in a pt with mallet finger. What do you do for treatment?

A

Splint for 6 weeks, OMT at conclusion, pt may play while splint is on.

36
Q

During a tackle, a football player experienced hyperextension of his DIP upon finger flexion, causing avulsion of his ring finger FDP tendon. Dx?

A

Jersey Finger

37
Q

Is there any conservative treatment in Jersey finger that can bring flexor tendon length back.

A

Hell no. You need immediate surgery and splinting for 4 weeks.

38
Q

What OMT can be done in Jersey Finger?

A

Positional release of FDP, friction to decrease scar/calcium deposits.

39
Q

To put it simply, Jersey finger-Blank, Mallet Finger- Blank

A

Jersey finger- surgery, Mallet Finger- Splint

40
Q

A skier with a hx of sucking at skiing presents with pain in his thumb web space at side of MCP joint. He has instability when the joint is tested in 20 degress of abduction. What ligament was likely ruptured and what is the dx?

A

Ulnar collateral ligament of thumb, Skier’s/Gamekeepers thumb

41
Q

What do you need to do before testing a thumb for Skier’s/Gamekeepers thumb?

A

X Ray!

42
Q

If there is instability at greater than 30 degrees in Gamekeepers thumb?

A

Total Rupture

43
Q

Tx for partial and complete Skier’s thumb rupture?

A

Partial-Spica Cast, Total- Surgery

OPP 3-2 (8 decks)

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