AT1 - Common Upper Limb Conditions and Treatments Flashcards
1
Q
SERIOUS PATHOLOGIES: Lyme disease
A
Infection from tic bite.
S&S: rash, fever, chills, mm weakness, pain in joints
2
Q
SERIOUS PATHOLOGIES: Osteomyelitis
A
Inflammation of bone caused by bacteria (common after surgery).
S&S: fever, chills, fatigue, lethargy, irritability, local pain, swelling, redness, reduced WB on affected limbs, bone pain, worse at night or w/ activity
3
Q
SERIOUS PATHOLOGIES: Septic arthritis
A
Infection of large joints (common after surgery).
S&S: quick onset of fever, joint swelling, redness, pain, worsens w/ movement, reduced ability to move limb
4
Q
SERIOUS PATHOLOGIES: Bone tumours
A
Common in 10-25yo males more than females, long bones of UL and LL.
S&S: pain, no Hx of injury, mass felt in area of pain, pain at rest and night (looks similar to stress fracture on bone scan)
5
Q
SERIOUS PATHOLOGIES: Rheumatoid arthritis
A
Systematic autoimmune disease characterised by symmetrical involvment of peripheral small joints
S&S: pain, swelling, warmth, redness, night pain, morning stiffness
6
Q
SERIOUS PATHOLOGIES: Osteoarthritis
A
Breakdown of subchondral bone and cartilage and other types
S&S: no correlation btw symptoms and severity, often seen as pain in joints
7
Q
SERIOUS PATHOLOGIES: Inflammatory arthritis
A
Includes RA, psoriatic arthritis, gout and SLE (systemic lupus erythematosus), all involve inflammation of synovial joints
S&S: irritation of eyes, fever, etc.
8
Q
SERIOUS PATHOLOGIES: Dermatomyositis
A
Inflammatory myopathy caused by viral infection of mm.
S&S: mm weakness, stiffness, soreness, red or purple rash over face, knuckles, neck, upper chest, shoulders, back, SOB and dysphagia
9
Q
SERIOUS PATHOLOGIES: Muscular dystrophy
A
Mm diseases with progressive weakness and reduced mobility
S&S: progressive mm wasting and weakness, gait & balance disturbance, falls, joint contractures, mm spasm
10
Q
SERIOUS PATHOLOGIES: Guillain Barre syndrome
A
Rare but serious post-infectious immune mediated neuropathy resulting from autoimmune destruction of nerves in PNS.
S&S: numbness, tingling, weakness, paralysis
11
Q
SERIOUS PATHOLOGIES: Diabetic neuropathies
A
Damage to nerves in legs and feet (can also be to digestive and urinary tract, heart and blood vessels)
S&S: pain and numbness in legs, feet and hands
12
Q
SHOULDER CONDITIONS: clavicle #
A
MOI: direct blow to anterior shoulder or fall
S&S: very painful, localised swelling and point tenderness
13
Q
SHOULDER CONDITIONS: neck of humerus #
A
MOI: direct blow/FOOSH
S&S: severe pain, swelling, disability, +/- deformity
14
Q
SHOULDER CONDITIONS: anterior glenohumeral dislocation
A
MOI: acute trauma, often where arm is forced into excessive ER and abduction
S&S: sudden onset of shoulder pain, sensation of “going out”, possible observable deformity
15
Q
SHOULDER CONDITIONS: primary impingement definition
A
Structural narrowing of subacromial space (osteophytes, bursitis, congenital sloped acromion)
16
Q
SHOULDER CONDITIONS: secondary impingement definition
A
No structural abnormalities, functional encroachment due to rotator cuff weakness, instability, scapular dyskinesis, or other kinetic chain impairment
17
Q
SHOULDER CONDITIONS: external impingement definition
A
Encroachment of soft tissue in subacromial space, often causes painful arc during active abduction
18
Q
SHOULDER CONDITIONS: internal impingement definition
A
Encroachment of rotator cuff tendons btw HOH and glenoid rim, occurs during late cocking stage of throwing motion (ER + abduction)
19
Q
SHOULDER CONDITIONS: rotator cuff tendinopathy definition
A
Pathology of rotator cuff tendons (commonly supraspinatus) resulting from tendon overload, loss of normal collagenous architecture w/in tendon, increased risk of tear
20
Q
SHOULDER CONDITIONS: rotator cuff tear definition
A
Can either be a full or partial thickness tear from excessive shear and compressive forces
21
Q
SHOULDER CONDITIONS: Labral pathology definition
A
Glenoid labrum injuries are SLAP (superior labrum anterior to posterior) or non-SLAP (degenerative, Bankart, etc.). Occurs from trauma or overuse
- excessive traction on labrum through LHoB
- impingement of biceps tendon under subacromial arch
- degeneration in older patients
22
Q
SHOULDER CONDITIONS: Instability glenohumeral joint definition
A
Traumatic (forceful abduction + ER) or atraumatic (common w/ lots of overhead activity), can affect the shoulder anteriorly, inferiorly or posteriorly - laxity of the joint capsule
23
Q
SHOULDER CONDITIONS: AC joint disorders definition
A
These occur through traumatic injuries, usually from a fall onto the point of the shoulder, and have localised pain to the AC joint
24
Q
SHOULDER CONDITIONS: Adhesive capsulitis definition
A
Self-limiting condition, consisting of three stages:
1) Freezing (inflammation, ache in shoulder, very painful)
2) Frozen (reduced pain, stiffness, muscle atrophy)
3) Unfreezing (gradual restoration of shoulder ROM and function)
25
SHOULDER CONDITIONS: primary external impingement signs
Hx: painful overhead activity (gradual onset), painful arc (70-120 degrees)
PE: painful arc, shows abnormal scapula movements, AROM: flex + abd = PROM, strength low in key muscles, tight pec minor, Hawkins Kennedy test positive
26
SHOULDER CONDITIONS: secondary external impingement signs
HX: painful overhead activity (gradual onset), painful arc, previous upper back/postural problems
PE: painful arc, AROM: flex/abd pain, lack T/S ER, flex/abd different in PROM, strength low in key muscles, tight pec minor, HK and Allinghams tests positive
27
SHOULDER CONDITIONS: internal impingement signs
Hx: gradual onset, repetitive throwing (or similar) motion, +/- change/increase in activity level, shoulder instability Hx
PE: abnormal shoulder girdle position, abnormal scapula movement in throwing motion, AROM: lack T/S ER, abd/ER most irritable, decreased ROM for IR/abd, AROM=PROM, low strength in key muscles, tight pec minor, apprehension test positive
28
SHOULDER CONDITIONS: rotator cuff tendinopathy signs
Hx: extended symptom Hx, previous similar injury, recent trauma
PE: abnormal posture, range loss in ER/IR, AROM loss/pain in flex, abd, IR, ER, PROM normal, weak in isometric, lack of muscle bulk in RC area, Empty can positive, ER lag positive, lift off positive(?)
29
SHOULDER CONDITIONS: rotator cuff tear signs
Hx: extended symptom Hx, recent trauma with significant function loss, previous similar injury
PE: abnormal posture, significant function loss, AROM large loss flex, abd, IR/ER, normal PROM, no IMT, very weak, lack of muscle bulk in RC area, Empty can positive, ER lag positive, lift off positive
30
SHOULDER CONDITIONS: labral pathology signs
Hx: traumatic injury (heavy weight) or overuse from repetitive overhead activity, posterior pain w/-w/out grinding/catching
PE: abnormal scapula position, muscle atrophy, pop/grind/clunk/click and/or pain in overhead ROM, IR reduced, PROM=AROM, IMT of biceps pain, PAM painful, pain/tenderness on post. GHJ palpation in bicipital groove, Biceps load (SLAP only) and Crank test positive, sometimes apprehension positive
31
SHOULDER CONDITIONS: instability signs
Hx: trauma (forced abd + ER), subluxation, or no trauma (overuse w/ joint laxity)
PE: humerus low, muscle atrophy, pain & apprehension in direction of instability (ER in 90+ degrees abd), increased ROM in ER/IR, PROM=AROM, PAMs hypomobility & lack of end feel, increased sulcus btw acromion process and HOH due to low humerus, apprehension test positive
32
SHOULDER CONDITIONS: AC sprain signs
Hx: traumatic fall onto point of shoulder, pain in AC joint, crepitus (popping, clicking, grinding), disturbed sleep
PE: shoulder girdle abnormal, pain overhead movements, swelling, step deformity, pain in horizontal add, overhead abd, flex, ER/IR, PROM = AROM, pain over AC joint (special test), palpable or visible step deformity
33
SHOULDER CONDITIONS: adhesive capsulitis signs
Hx: female, over 40, post shoulder surgery, difficulty sleeping at night
PE: protective postural changes, muscle wastage, limited AROM & PROM all movements, pain, elbow & neck also painful (irritated nerves through inflamed shoulder), PAMs painful, tenderness over general shoulder region
34
SHOULDER CONDITIONS: clavicle # treatment
Conservative management, heals 4-6 weeks, figure 8 brace to prevent foreshortening, self assisted ROM <90 degrees ROM to prevent stiffness
35
SHOULDER CONDITIONS: neck of humerus treatment
Conservative management, sling for 6 weeks, week 2 start pendular exercises, strengthening as able, maintain in ass. joints
36
SHOULDER CONDITIONS: primary external impingement treatment
Inferior movement of acromion presenting as poor scapular control (winging), restore scapula control (strengthening), increase ROM in restricted mm (pec minor), address T/s, C/s and rib restrictions
37
SHOULDER CONDITIONS: secondary external impingement treatment
Encroachment from above presents as anatomical abnormalities, may require surgery
38
SHOULDER CONDITIONS: internal impingement treatment
Impingement against the glenoid rim requires improved stability (exercise, taping, surgery), increased RC strength, and posterior capsule tightness needs to be addressed
39
SHOULDER CONDITIONS: rotator cuff tendinopathy treatment
Initial pain management, education re: abusive loading, gradual tendon reloading (exercises), improve stability (exercise, taping), strengthening
40
SHOULDER CONDITIONS: rotator cuff partial thickness tear treatment
Non-surgical Rx acute care management followed by rehab
41
SHOULDER CONDITIONS: rotator cuff full thickness tear treatment
Surgical repair indicated if return to sport or high-level function demands necessary
42
SHOULDER CONDITIONS: labral pathology treatment
Surgical repair if young or unstable tear, conservative Rx gradual progressive program of ROM, strength and scapular coordination exercises - no biceps loading activity for first 8 weeks!!!
43
SHOULDER CONDITIONS: dislocation treatment
Reduced ASAP by trained staff, X-ray for #, strengthen dynamic stabilisers, pain management
44
SHOULDER CONDITIONS: joint instability treatment
Start with closed chain dynamic stabiliser strengthening exercises, open chain after, avoid stretching muscles, modify aggravating activities
45
SHOULDER CONDITIONS: AC joint injury treatment
Acute stage ice and protect in sling, taping may be required for return to sport, surgical reconstruction required if significant disruption to mechanics
46
SHOULDER CONDITIONS: adhesive capsulitis treatment
Corticosteroid injections provide short term relief, management after painful stage (to tolerate Rx), graded mobilisation and stretching/strength exercises when pain controlled
47
ROTATOR CUFF TEAR REHAB: Acute phase
Promote tissue healing, reduce pain/swelling, establish non-painful ROM below 90 degrees abd., prevent atrophy, address scapula control
48
ROTATOR CUFF TEAR REHAB: Recovery phase
Achieve normal AROM & PROM (exercise, EPAs, manual therapy), restore strength, progress exercises
49
ROTATOR CUFF TEAR REHAB: Exercise progression recovery phase
Closed chain to open chain exercises, neutral to increased range of abd., slow to fast movements, light to heavy resistance
50
ROTATOR CUFF TEAR REHAB: Functional phase
Restore UL power and endurance for further recovery, integrate sport-specific activity
51
ELBOW CONDITIONS: extensor tendinopathy definition
Lateral pathology of wrist extensor tendons (commonly extensor carpi radialis brevis w/ poor blood supply) from overuse and excessive shear/compression forces from radial head in pronation
52
ELBOW CONDITIONS: lateral collateral ligament injury definition
Strain or possible tear to stabilising ligaments in lateral side of elbow, associated with trauma or overuse
53
ELBOW CONDITIONS: flexor tendinopathy definition
Medial pathology of wrist flexor tendons (pronator teres) from overuse and excessive shear/ compression forces, from radial head in supination/pronation
54
ELBOW CONDITIONS: medial collateral ligament injury definition
Acute injuries sudden onset of pain accompanied by pop sound/feel, immediate pain, unable to keep throwing. Chronic injuries gradual onset from changes in throwing load +/- ulna nn irritation
55
ELBOW CONDITIONS: posterior impingement definition
There are three types, commonly causing post. elbow pain:
1) hyperextension valgus overload (EOR extension impinged due to osteophyte formation)
2) secondary to valgus instability (abnormal olecranon tracking)
3) secondary to OA (radiocapitellar joint)
56
ELBOW CONDITIONS: olecranon bursitis
Inflammation of olecranon bursa
57
ELBOW CONDITIONS: supracondylar # definition + Rx
MOI: common in young children after FOOSH, need to assess NV status
Rx: closed reduction under GA, percutaneous splint then cast
58
ELBOW CONDITIONS: radial head # definition + Rx
MOI: common in athletes after FOOSH, excessive compression/valgus stress
Rx: if minimal displacement, conservative Rx, surgery for multiple breaks or large displacement
59
ELBOW CONDITIONS: posterior elbow dislocation definition + Rx
MOI: FOOSH associated with #, MCL may also be compromised, need to check NV status
Rx: reduction and pain management with immobilisation early for swelling
60
ELBOW CONDITIONS: extensor tendinopathy signs
Hx: common 40-60yo females, pain lateral epicondyle + proximal forearm, gradual onset (can be acute), recent activity change, agg. gripping, lifting, typing
PE: neck/upper T/s often involved, tenderness on palpation, pain free grip strength reduced, radial nn neurodynamic test positive, extensor special tests positive, IMT wrist extension, middle finger extension painful, pain on stretch (pronation, wrist flex, elbow ext)
61
ELBOW CONDITIONS: LCL injury signs
Hx: commonly following dislocation (trauma Hx)
PE: posterior lateral elbow instability, varus stress test positive for laxity (+/- pain) in 30 degrees elbow flexion
62
ELBOW CONDITIONS: flexor tendinopathy signs
Hx: recent change in activity, golfer/tennis elbow injury
PE: tender at/below medial epicondyle, positive flexor special tests, IMT wrist flexion/ pronation pain, pain on stretch
63
ELBOW CONDITIONS: MCL injury signs
Hx: medial elbow pain ass. w/ late cocking or early acceleration phase of throwing, decreased throwing speed
PE: palpation shows local tenderness over MCL, valgus stress test positive for pain w/ 30 degrees elbow flexion, restricted rotation in 90 degrees abd. common
64
ELBOW CONDITIONS: posterior impingement signs
Hx: consistent w/ one aetiology, ass. w/ repetitive extension activities
PE: painful EOR elbow extension, flexion deformity due to pain (early) or bony change (late)
65
ELBOW CONDITIONS: olecranon bursitis signs
Hx: MOI trauma to posterior elbow, resting elbows on hard surfaces, inflammatory condition
PE: noticeable egg shape swelling, tender, FROM (maybe slight flexion limitation due to swelling)
66
ELBOW CONDITIONS: extensor tendinopathy treatment
Exercise for strength (isometric > eccentric > concentric), manual therapy for trigger points, analgesics, TENs, cryotherapy, NSAIDs, taping or bracing
67
ELBOW CONDITIONS: LCL injury treatment
Brace/splint w/ forearm in pronation, AROM exercises to prevent ext. loss, taping to stabilise (surgery for chronic instability)
68
ELBOW CONDITIONS: flexor tendinopathy treatment
Controlling pain (education, NSAIDs), strengthening (I>E>C), manual therapy
69
ELBOW CONDITIONS: MCL injury treatment
Stability taping, early focus on pain-free ROM, progressive strength exercises (mm can stabilise MCL), education on throwing loads, throwing technique issues address
70
ELBOW CONDITIONS: posterior impingement treatment
Conservative Rx NSAIDs, cryotherapy, taping to minimise hyperext., strengthening exercises (helps w/ stability)
71
ELBOW CONDITIONS: olecranon bursitis treatment
Ice, rest, compression, NSAIDs, aspiration of fluid and corticosteroid injections (under LA) if non responsive
72
RADIAL ACUTE ONSET WRIST CONDITIONS: distal radius fracture definition
Discovered through X-ray, partial or complete fracture of distal end of radius
73
RADIAL ACUTE ONSET WRIST CONDITIONS: scaphoid # definition
Accounts for 80% of carpal fractures, needs to be discovered through X-ray 2 weeks after injury
74
RADIAL ACUTE ONSET WRIST CONDITIONS: carpal instability definition
Stability is provided by complex intrinsic/ extrinsic system of ligaments and bony configuration, this occurs when this is disrupted
75
RADIAL ACUTE ONSET WRIST CONDITIONS: scapholunate instability definition
X-ray required for Dx, most common carpal instability with separation of scaphoid and lunate (possible disruption of other stabilising ligaments)
76
ULNA ACUTE ONSET WRIST CONDITIONS: distal ulna fracture definition
Uncommon in isolation, but frequently ass. w/ distal radial # (in form of ulnar styloid #)
77
ULNA ACUTE ONSET WRIST CONDITIONS: triangular fibrocartilage complex injury definition
The most common ulna-sided carpal instability (can occur from acute or gradual onset injury)
78
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: metacarpal # definition
Sports-related metacarpal # common in contact sports (boxing, football, rugby, etc.)
79
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: phalangeal # definition
Common injury in ball-playing sports, may also be associated with tendon avulsion or rotational deformities
80
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: central slip injury definition
Sudden forced flexion of PIP being actively extended (+/- volar dislocation) PIPJ interruption or attenuation of extensor mechanism
81
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: mallet finger definition
Forceful extension of DIPJ on a pre-stressed extensor tendon interrupts extensor mechanism and results in loss of active DIP ext.
82
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: volar plate injury definition
Sudden forced hyperextension +/- dorsal dislocation PIPJ creates partial/complete rupture of volar plate and collateral ligament
83
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: FDP avulsion/jersey finger injury definition
Forced extension on actively flexed finger or closed avulsion of FDP tendon leads to loss of active finger flexion
84
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: Skier's thumb/UCL thumb injury definition
Sudden, forced radial deviation of thumb +/- hyperextension leads to distal avulsion of collateral ligament
85
RADIAL ACUTE ONSET WRIST CONDITIONS: distal radius # signs
MOI: 18-25yo (or >65yo), FOOSH, traumatic injury
S&S: pain on palpation, bony abnormalities, reduced range at wrist, possibly can affect median nerve
86
RADIAL ACUTE ONSET WRIST CONDITIONS: scaphoid # signs
MOI: FOOSH
S&S: pain, swelling, tenderness in anatomical snuffbox, reduced wrist and thumb ROM
87
RADIAL ACUTE ONSET WRIST CONDITIONS: carpal instability signs
MOI: FOOSH or overuse (repeated stress involving extension and ulna deviation)
S&S: laxity of ligaments, pain
88
RADIAL ACUTE ONSET WRIST CONDITIONS: scapholunate instability signs
MOI: traumatic injury or overuse
S&S: dorso-radial wrist pain, tenderness over scapholunate ligament, reduced WB tolerance, pain EOR extension, decreased grip strength, Watsons test positive
89
ULNA ACUTE ONSET WRIST CONDITIONS: distal ulna # signs
MOI: isolated ulna #, direct trauma from focal blow most common
S&S: distal radioulnar joint instability (laxity or increased range/pain for supination/pronation), constant pain, bony abnormalities, disturbed sleep
90
ULNA ACUTE ONSET WRIST CONDITIONS: TFCC injury signs
MOI: trauma (FOOSH) or overuse (twisting under load common)
S&S: ulnar-sided wrist pain, supinated carpus, UD/RD painful, decreased grip strength (esp. in pronation), positive relocation test (manual relocation of subluxed TFCC improves WB/grip)
91
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: metacarpal # signs
MOI: trauma (contact sport), immediate pain
S&S: base 1st MC is Bennett's #, 5th MC head is Boxer's #, pain around MC, bony abnormalities, loss of range, swelling, bruising
92
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: phalangeal # signs
MOI: trauma (contact, ball-sport injury), check for rotational deformity
S&S: Proximal: ass. w/ F/E tendon injury, Middle: not common, Distal: crush injury, pain at # site, reduced range, swelling, bruising
93
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: central slip injury signs
MOI: matches central slip description
S&S: pt reports PIPJ dislocation, pain and swelling dorsal PIPJ, pain & weakness PIP ext., Elson's test positive
94
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: mallet finger signs
MOI: matches mallet finger description
S&S: common young males, oedema & pain w/ dorsal pressure on DIPJ, inability to actively extend DIPJ
95
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: volar plate injury signs
MOI: matches volar plate injury description
S&S: common in young pts in contact sport, volar pain & swelling on IP palpation, PIPJ instability may be present
96
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: FDP avulsion/jersey finger injury signs
MOI: jersey tackle
S&S: ring finger affected 75%, pain/tenderness over volar distal finger, finger in slight ext. at rest compared to others, no active flexion of DIP
97
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: Skier's thumb/UCL thumb injury signs
MOI: fall or catch/pull of thumb
S&S: oedema and pain ulnar thumb MCPJ, reduced/absent pinch strength, laxity thumb MCPJ w/ valgus stress testing
98
RADIAL GRADUAL ONSET WRIST CONDITIONS: De Quervain's tenosynovitis definition
Myxoid degeneration w/ fibrous tissue deposits thickens tendon sheath, leads to entrapment of APL and EPB tendons
99
RADIAL GRADUAL ONSET WRIST CONDITIONS: intersection syndrome definition
Friction at the point where muscle bellies of EPB and APL cross over ECRL and ECRB from repetitive, forceful wrist ext/flex
100
THUMB/FINGER GRADUAL ONSET WRIST CONDITIONS: thumb CMC OA definition
OA process affecting thumb CMC joint, asymmetric loss of articular space, sub-chondral sclerosis and cyst formation, osteophyte formation, alteration in articular surfaces subluxations
101
THUMB/FINGER GRADUAL ONSET WRIST CONDITIONS: Carpal tunnel syndrome definition
Compression of median nerve in carpal tunnel, reduced blood flow, oedema formation, ischemia in the nerve
102
THUMB/FINGER GRADUAL ONSET WRIST CONDITIONS: trigger finger definition
Inflammation and hypertrophy of retinacular sheath, repeated friction causes tendon to swell and thicken, fibres bunch at end of pulley
103
THUMB/FINGER GRADUAL ONSET WRIST CONDITIONS: osteoarthritis definition
Consider potential for OA in other non-thumb joints, particularly when there is a Hx of past injury/surgery
104
THUMB/FINGER GRADUAL ONSET WRIST CONDITIONS: Dupuytrens contracture definition
Collagen proliferation within fascia leads to development of tight cord and bands, progressive contractures of fingers
105
RADIAL GRADUAL ONSET WRIST CONDITIONS: De Quervain's tenosynovitis signs
Common in females 35-55, 3rd trimester or post-partum, radial sided wrist pain agg. by thumb and wrist motions, pain and tenderness 1-2cm proximal to radial styloid, swelling, Finkelstein's test positive
106
RADIAL GRADUAL ONSET WRIST CONDITIONS: intersection syndrome signs
Common from rowing, weight lifting, racquet sports, friction and crepitus palpated 4-5cm proximal to ulna styloid during wrist flex/ext w/ radial deviation, similar to De Quervains but pain is more proximal
107
THUMB/FINGER GRADUAL ONSET WRIST CONDITIONS: thumb CMC OA signs
Pain agg. by repetitive thumb activity, localised swelling/thickening, joint line tenderness on palpation, reduced AROM/PROM, loss of function w/ weak pinch grip, flexion deformity of CMC w/ secondary MCP hyperextension, grind test positive
108
THUMB/FINGER GRADUAL ONSET WRIST CONDITIONS: carpal tunnel syndrome signs
More common females 45-60yo, paraesthesia (tingle, P&N) or numbness thumb, index, middle and radial ring finger, aching thenar eminence, weakness median nerve innervated muscles, carpal tunnel tests positive
109
THUMB/FINGER GRADUAL ONSET WRIST CONDITIONS: trigger finger signs
More common females >50yo, locking/triggering of finger when making fist, strong click/snap when attempting to straighten flexed digit, agg. by sustained or repeated gripping, pain typically @ A1 pulley (MC head)
110
THUMB/FINGER GRADUAL ONSET WRIST CONDITIONS: osteoarthritis signs
Pain agg. by repetitive thumb/finger activity, localised swelling/thickening, joint line tenderness on palpation, reduced AROM/PROM, loss of function w/ weak pinch grip, flexion deformity of CMC w/ secondary MCP hyperextension
111
THUMB/FINGER GRADUAL ONSET WRIST CONDITIONS: Dupuytren's contracture signs
More common in males, palpable nodes/cords on volar hand surface, contracture of affected digit reduces extension, nodules may be painful
112
RADIAL ACUTE ONSET WRIST CONDITIONS: distal radius # treatment
Stable: immobilise 6wks, exercise uninvolved jnts whil in cast, wrist flex, ext, sup, pro ROM exercises & heat to regain ROM after cast removal, grip/wrist strengthening exercise from 6wks
Unstable: same as stable, except managed with ORIF first 6wks and thermoplastic resting splint
113
RADIAL ACUTE ONSET WRIST CONDITIONS: scaphoid # treatment
Stable: immobilise 6-8 weeks, X-ray to confirm union before removing cast, exercise for ROM and strength
Unstable: same as stable but ORIF (also for displaced waist or proximal pole #)
114
RADIAL ACUTE ONSET WRIST CONDITIONS: scapholunate ligament sprain/carpal instability treatment
Non-operative management uses splint or cast immobilisation, ROM exercises (RD, ext.), gradual strengthening, promotion of smooth, balanced, painfree wrist range
115
ULNA ACUTE ONSET WRIST CONDITIONS: distal ulna # treatment
Immobilise 6wks, exercise uninvolved jts (thumb/fingers, elbow), wrist flex/ext/sup/pro ROM + heat to regain ROM after cast removal, grip/wrist strengthening progression from 6wks
116
ULNA ACUTE ONSET WRIST CONDITIONS: TFCC injury treatment
Taping to reposition ulna, wrist widget to reposition, activity modification, wrist/grip strengthening, hypothenar strength
117
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: MC/P finger # treatment
Unstable>stabilised (or stable start) > protect and move, mobilise early and use POSI splint (position of safe immobilisation), avoid prolonged immobilise, pain free exercise of affected fingers, oedema management, grip strengthening to prevent weakness
118
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: central slip injury treatment
Surgical repair required for open injuries, closed injuries managed with PIP splinting 6-8wks (barrel splint), exercises for ROM maintenance (DIP flexion in splint, controlled PIP ROM can be introduced as early as 3wks, often not until 6wks though)
119
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: mallet finger injury treatment
Splinting of DIPJ to slight hyperextension for 6-8 weeks 1st Rx option, reduce splint use to risk activities and night, exercises for ROM
120
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: volar plate injury treatment
Education - avoid hyperextension forces on PIPJ, importance of early ROM, common to have pain, swelling, stiffness for 6-12 months, splint for dorsal blocking at neutral extension, wean splint 2-4wks, exercise early active flexion and extension w/in splint
121
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: FDP avulsion/jersey finger injury treatment
Will not heal w/out surgical repair, strict immobilisation (if pt compliance low), passive ROM approach, active ROM approach (preferred, must start btw days 2-5), splinting and pt education (no use of hand 6wks, avoid finger extension beyond splint)
122
THUMB/FINGER ACUTE ONSET WRIST CONDITIONS: thumb UCL/Skier's thumb injury treatment
Surgery likely for complete tear or Stener's lesion complication, splint/brace - wean 4-6wks as pain allows, education (avoid tip pinch grip until 8wks), exercises for ROM, thumb/grip strengthening
123
RADIAL GRADUAL ONSET WRIST CONDITIONS: De Quervain's treatment
Splint/brace, wrist 20 degrees ext., thumb add., education on avoiding activities w/ sustained grip and lifting w/ wrist deviation, exercises pain free AROM, careful progression to grip & upper extremity strength exercises
124
RADIAL GRADUAL ONSET WRIST CONDITIONS: intersection syndrome treatment
Rest, use of thumb spica splint, anti-inflammatory drugs, progressive stretch and strength exercise after 2-3wks
125
THUMB/FINGER GRADUAL ONSET WRIST CONDITIONS: thumb CMC OA treatment
Education on joint protection, heat for pain & stiffness, thumb ROM exercises, preserve web space through massage, weight loss, thumb proprioception and strength exercises
126
THUMB/FINGER GRADUAL ONSET WRIST CONDITIONS: carpal tunnel syndrome treatment
Splint/brace full time 10 days, wean to night use for 6wks, education on posture, workplace Ax, assistive device, avoid repeated grip, pinch, strength, exercises median nerve slide/glide, strengthen atrophied muscles
127
THUMB/FINGER GRADUAL ONSET WRIST CONDITIONS: trigger finger treatment
Splint/brace to block MCP or PIP flexion, education to avoid full & repeated composite flexion, exercise AROM hook fist motion in splint PROM all joint, massage tendon/sheath unit
128
THUMB/FINGER GRADUAL ONSET WRIST CONDITIONS: Dupuytren's contracture treatment
No cure, corticosteroid injection may slow progression of contracture, surgical release & splint + ROM exercise can do the same
