Conditions of the elbow, wrist and hand Flashcards
1
Q
What are 5 possible categories for differential diagnosis?
A
- visceral
- osseous
- neurovascular
- articular
- muscular
2
Q
MOI of supracondylar #?
A
fall onto an outstretched arm from a height
3
Q
Surpacondylar #’s are more common in ~ ___ yo compared to adults
A
12
4
Q
MOI of olecranon #?
A
fall onto an outstretched hand or from direct trauma to the elbow
5
Q
____ ____ # = most common # of elbow in athletes
A
radial head
6
Q
MOI of radial #?
A
fall onto an outstretched hand
7
Q
Coronoid # most commonly occurs with ______ _____
A
terrible triad
8
Q
What 3 things makes up the terrible triad in the elbow?
A
- radial head #
- elbow dislocation
- coronoid #
9
Q
_____ _____ is the most serious acute elbow injury
A
posterior dislocation
10
Q
MOI of post dislocation?
A
FOOSH with shoulder abducted, axial compression, forearm in supination and then forced flexion of elbow
11
Q
Radial head subluxation = common in children under ___ years old
A
5
12
Q
With radial head subluxation, child will usually hold arm in ______ by their side and does not use it due to pain
A
extension
13
Q
Radial head subluxation requires reduction (T/F).
A
TRUE
14
Q
When doing the elbow extension test, is pt is unable to fully extend, there is a ___ % of an elbow #
A
50
15
Q
Lateral elbow tendinopathy = most common in __ - __ yo
A
30-60
16
Q
Lateral elbow tendinopathy = worse with _____ or wrist ______
A
grippig; extension
17
Q
Lateral elbow tendinopathy = most common in what tendon?
A
ECRB
18
Q
What are 3 findings in the objective exam of someone with lateral elbow tendinopathy?
A
- reduced pain-free grip strength
- neurodynamic tests, particularly radial nerve test
- decreased cervical ROM
19
Q
3 components of exercise treatment for lateral elbow tendinopathy ?
A
- increased strength and endurance in forearm muscles
- increased flexibility in forearm muscles
- include upper limb coordination exercise
20
Q
Lateral elbow tendinopathy manual therapy: _______ glide of radius and ulna on humerus while the pt either grips of extends the wrist against resistance as long as it is now pain free
A
lateral
21
Q
Lateral elbow tendinopathy: if using counter force brace, apply __ cm below elbow jt
A
10
22
Q
_____ collateral ligament is primary restraint to varus forces
A
lateral
23
Q
Symptoms of lateral ligament sprain?
A
- pain
2. clicking, catching, often with elbow extension of when pushing arms off chair
24
Q
Treatment for acute lateral ligament strain?
A
- relative rest; allow ligament to heal as best as possible until swelling goes down
- AROM to surrounding joints
25
Treatment for lateral ligament strain, after acute phase?
1. ROM to elbow joint
2. strengthening of muscles around joint
3. proprioceptive exercises
26
Radial tunnel syndrome is also known as?
posterior interosseous nerve entrapment
27
The radial nerve divides into the superficial radial nerve and the PIN at the ________ joint
radiohumeral
28
PIN enters the arcade of _____ where is may become compressed
Frohse
29
Where is the arcade of Frohse located, and what is it made out of?
semicircular fibrous arch at the proximal head of the supinator muscle
30
Radial tunnel syndrome is seen in pt's who repetitively ____/____ the forearm
pronate/supinate
31
4 symptoms of radial tunnel syndrome?
1. pain over forearm extensor muscle
2. aching wrist and middle of upper 1/3 forearm pain
3. tenderness over supinator muscle
4. neurodynamic tests for radial nerve may reproduce symptoms
32
What are 3 treatments of radial tunnel syndrome?
1. soft tissue techniques over supinator muscle at site of entrapment
2. neural tissue mobilization (radial n glides)
3. strengthening exercises targeting strength deficits in forearm muscles
33
_______ ______ = pain associated with excessive activity of wrist flexors
flexor/pronator tendinopathy
34
_______ _______ = localized tenderness just at or below the medial epicondyle with pain on resisted wrist flexion and resisted forearm pronation
flexor/pronator tendinopathy
35
_____ produces valgus elbow stress
throwing
36
4 aspects of treatment of MCL sprains?
1. modify activity
2. correcting faulty throwing technique
3. soft tissue techniques to the medial ligament
4. strengthen forearm flexors and pronators
37
Inflammation of ulnar nerve can occur because of what 5 things ?
1. traction injury to the nerve due to throwing
2. compression at the cubital tunnel due to inflammation and adhesions from repetitive stresses
3. compression between 2 heads of FCU due to muscle overdevelopment
4. recurrent subluxation of the nerve due to laxity from receptive stress of trauma
5. irregularities in the ulnar groove in older throwers
38
Ulnar nerve entrapment 5 S&S's?
1. posteromedial elbow pain and numbness/tingling in ulnar nerve distribution
2. tenderness to palpation behind medial epicondyle
3. tingles tap may reproduce symptoms
4. Froments' sign - adductor pollicus
5. Wartenburg's sign - 5th finer adduction
39
Treatment of olecranon bursitis?
ice, rest, compression, anti-inflammatories
40
What is the most common cause of posterior elbow pain?
posterior impingement
41
Posterior impingement causes in the young athlete?
repetitive hyperextension valgus stress leading to impingement of the posteromedial corner of the olecranon tip on the olecranon fossa
42
Posterior impingement causes in the older athlete?
OA with the growth of osteophytes
43
Treatment of post impingement?
1. taping to minimize hyperextension
2. manual therapy
3. strengthening and flexibility exercises
44
_____ _____ syndrome = median nerve entrapment
pronator teres
45
Pronator teres syndrome presents as diffuse _______ elbow pain that radiates distally into the forearm with paraesthesia in the median nerve distribution and weakness of the _____ muscles
anterior; thenar
46
Most common cause of pronator teres syndrome?
forceful pronation such as throwing sports
47
Treatment for pronator teres syndrome?
1. soft tissue techniques to pronator teres
| 2. nerve mobilization of median nerve
48
______ # is the most common type of distal radius #
colles
49
In colles #, posterior displacement of radius leads to "_____ ____" deformity
dinner fork
50
Stable colles #'s are reduced and casted for ~ ___ weeks
6
51
Management of distal radius # during immobilization period?
1. AROM at shoulder, elbow and hand
2. Maintain web space and shoulder ROM
3. Reduction of edema
4. elevation of UE above shoulder height
5. Report S & S and severe pain, numbness, persistent edema and shiny skin
52
Management of distal radius # after cast is removed?
1. edema mngment
| 2. begin ROM several times a day
53
6 treatments in mngment of distal radius # once # is healed?
1. joint mob to restore joint play
2. modalities to decease pain/increase circulation
3. stretching
4. progress to resistive exercises
5. isokinetics may begin at 8 weeks
6. functional activities/ job simulation
54
5 complications of colles #?
1. malunion
2. median n damage
3. CRPS
4. CTS
5. late rupture of EPL tendon
55
CRPS is more common following ____ fracture than any other injury
colles
56
_____ # = most common carpal #
scaphoid
57
6 key findings in scaphoid #?
1. tenderness in anatomical snuffbox
2. may have minimal swelling
3. loss of grip strength
4. pain with loaded wrist extension
5. pain on axial compression of thumb towards radius
6. pain with direct pressure on scaphoid tuberosity while radially deviating the wrist
58
Unstable or displaced scaphoid #'s require surgery due to risk of ______ ______; fracture may disrupt blood supply to ____ pole of scaphoid
avascular; proximal
59
How long are scaphoid #'s immobilized for?
8-12 weeks
60
Based on amsterdam wrist rules, for a distal radius #, what 7 factors increase likelihood of #?
1. increased age
2. swelling of wrist
3. visible deformation
4. distal radius tender to palpation
5. pain on palmar flexion
6. pain on supination
7. painful RU ballottement test
61
Based on amsterdam wrist rules, for any wrist #, what 7 factors increase likelihood of #?
1. increased age
2. male sex
3. visible deformation
4. swelling of wrist
5. swelling of anatomical snuffbox
6. distal radius tender to palpation
7. pain on radial deviation
62
_________ tenosynovitis = affects synovial sheath of the abductor pollicus longus and extensor pollicis brevis tendons
DeQuervains
63
______ ______ is common in new mothers
DeQuervains tenosynovitis
64
DeQuervains tenosynovitis = + _______ test
Finkelsteins
65
Treatment for DeQuervains tenosynovitis ?
1. change ergonomics of aggravating task
2. splinting
3. stretches
4. strengthening
66
What is the main difference between radial sensory nerve compression and DeQuervains tenosynovitis ?
DeQuervains tenosynovitis does not have sensory changes
67
Radial sensory nerve compression = compression of the _____ _____ sensory nerve
dorsal radial
68
4 causes of radial sensory nerve compression?
1. radial styloid fracture
2. tight cast
3. repetitive trauma in sports
4. compression between brachioradialis and ECRL tendons during rapid repeated supination/pronation
69
Radial sensory nerve compression has sensory changes over ________ aspect hand
radiodorsal
70
______ ______ # = present in 50% of distal radius #'s
ulnar styloid
71
Fracture of hook of hamate typically occurs with direct blood and may compress branches of _____ nerve, leading to sensory and motor changes
ulnar
72
Symptoms of hook of hamate #?
decrease grip strength and ulnar wrist pain
73
of ________ = second most common carpal #
triquetrum
74
of ______= pain on ulnar side of wrist after dorsal impact, trauma or falling on an outstretched hand
triquetrum
75
of ______ = point tenderness over dorsal wrist and pain with wrist flexion
triquetrum
76
TFCC = sandwiched between distal end of ___ and proximal ____ row
ulna; carpal
77
TFCC = major stabilize in _______ ______ jt
distal radioulnar
78
Central portion of TFCC is ______ and not able to heal if damaged
avascular
79
Symptoms of TFCC tear?
1. ulnar sided wrist pain
| 2. worst with grip, rotation, WB
80
5 findings on assessment of TFCC tear?
1. tenderness, swelling over dorsal wrist
2. pain on reissued wrist extension and ulnar deviation
3. wrist clicking on movement
4. reduced grip strength
5. "press test" = ulnar axial load reproduces symptoms
81
The _____ and _____ aspects of the TFCC act as the ligaments of the distal RU jt
dorsal; volar
82
Damage to the dorsal and solar ligaments of the TFCC results in ______ of the ulna
subluxation
83
Dorsal subluxation of the ulnar head more common due to repetitive or forceful _______
pronation
84
TFCC tear management ?
1. Brace for 4-6 wks
2. NSAIDs; possible cortisone injection
3. AAROM
4. resisted strengthening
5. plyometrics
6. sports specific training
85
What are the borders of the carpal tunnel?
1. scaphoid tubercle
2. ridge of trapezium
3. hook of hamate
4. pisiform
5. roof = flexor retinaculum
86
What 10 things are in the CT?
1. median nerve
2. FDP (4 tendons)
3. FDS (4 tendons)
4. FPLT
87
_____ = most common peripheral neuropathy
CTS
88
In CTS, ________ thickens from irritation or inflammation which causes pressure to increase within the carpal tunnel;
tenosynovium
89
CT cannot stretch in response to added swelling and the _____ n is compressed against flexor retinaculum
median
90
5 clinical features of CTS?
1. tingling and numbness in tips of first 3 fingers
2. nocturnal pain
3. pain in forearm and wrist
4. activities involving wrist flexion are uncomfortable
5. weakness of clumsiness of the hand
91
2 objective findings of CTS?
1. thenar atrophy and muscle weakness
| 2. sensory loss with more advanced stages including 2-pt discrimination
92
5 special tests for CTS?
1. Tinel's tap
2. Phalens, reverse phalens
3. carpal compression test
4. ULTT with median n bias
5. sensory testing
93
Having 4/5 of what 5 positive tests has a high level of specificity, meaning it rules in the condition?
1. flick maneuver
2. thumb sensation reduced compared to thenar eminence
3. wrist ratio index (ratio of anterior/posterior width to medial/lateral width >0.67)
4. hand symptom severity scale >1.9
5. over 45 yo
94
4 potential differential diagnosis for CTS?
1. general overuse syndromes
2. ulnar neuropathy
3. cervical nerve root compression (C6/C7)
4. TOS
95
7 managements of CTS?
1. wrist splint in neutral position for nighttime wear
2. day splint during acute stage
3. postural correction
4. manual therapy
5. median nerve gliding
6. anti-inflammatory medication
7. cortisone injections into CT
96
Ulnar nerve may become compressed as it passes through ______ ______
guyons tunne l
97
Where is guyons tunnel located
between pisiform and hamate
98
Ulnar nerve compression is common in ______
cyclists
99
Zone 1 compression of ulnar nerve?
mixed motor and sensory
100
Zone 2 compression of ulnar nerve?
motor only
101
Zone 3 compression of ulnar nerve?
sensory only
102
2 symptoms of ulnar nerve compression ?
1. pain and paraethesia to 5th finger and ulnar border of 4th finger
2. weakness to dorsal and palmar interossei, 3rd and 4th lumbricals, adductor pollicis and part of flexor pollicis brevis
103
2 objective findings of ulnar nerve compression?
1. wasting of intrinsic muscles of hand
| 2. sensory exam of ulnar nerve distribution distal to Guyons tunnel
104
4 special tests for ulnar nerve compression?
1. card test
2. tinels tap at guyons tunnel
3. ulnar neurodynamic test
4. Froment's test
105
4 management for ulnar nerve compression?
1. splinting to protect Guyon tunnel during function
2. NSAIDs
3. change bike set up
4. home exercises to address impairments in strength, ROM, ulnar nerve gliding
106
PT management of MC #'s?
1. edema control in early stages
2. splinting
3. AROM above and below
4. tendon gliding
5. passive motion
6. strengthening
7. functional tasks
107
Tendon gliding exervises FITT principles?
10x every 3-4 hrs, daily
108
Distal tuft fractures usually splinted in extension for __ - __ weeks
2-3
109
______ _____ = # at base of distal phalanx + rupture or avulsion of the extensor tendon
mallet finger
110
For mallet finger, splint in DIP extension for __ weeks
8
111
With mallet finger, expect a slight extensor lag of __ - __ degrees after immobilization; if there is > __ deg extensor lag, should splint for another 1-2 months
5-10; 20
112
Most extra-articular, non-displaced shaft #'s of the middle and proximal phalanges can be treated with ____-____ and early motion for 3-4 weeks
buddy-taping
113
2 common sites of OA in the thumb?
1. CMC
| 2. trapezioscaphoid
114
______ _____ = caused by disparity in size of flexor tendons and pulley system at first annular (A1) pulley at MCP
trigger finger
115
Acute management of trigger finger?
1. custom splint
2. activity modification
3. glucocorticoid injection
116
________ contracture = progressive fibrosis of the palmar fascia
dupuytrens
117
dupuytrens contracture will lead to loss of full _______ of affected fingers at MCP joint
extension
118
Is dupuytrens painful?
No
119
With dupuytrens, discrete _____ may be visible and palpable near distal palmar crease
nodules
120
In dupuytrens, nodules or cords may also originate in the digits which can lead to ____ joint contraction
PIP
121
How big of a role does PT have in dupuytrens?
small; maybe help with modifying tools if mild
122
_____ ______ = avulsion of flexor digitorum profundus
jersey finger
123
Treatment for jersey finger?
surgical repair within 10 days
124
Complete ulnar collateral ligament teat of 1st MCP joint?
laxity in radial direction >15 degrees with soft end feel
125
Partial tear of ulnar collateral ligament of 1st MCP joint ?
laxity in radial direction < 15 degrees with soft end feel
126
Treatment of partial tears of PIP joint sprains?
10 days of finger based splinting with PIP in neutral, then buddy-taping, swelling management and active exercises
127
Treatment of complete tears of PIP joint sprains?
splint in 10 degrees of flexion more than the point of instabilty; gradually adjust splint toward neutral over period of 3 weeks
128
_______ Raynauds = no underlying disease of associated medical problem that could provoke vasospasm; most common form
primary
129
________ Raynauds = caused by underlying problem and tends to be a more serious disorder
secondary
130
_______ = chronic regional pain that is out of proportion to the original injury
CRPS
131
______ will present with abnormal sensory, motor, vasomotor and trophic findings
CRPS
