conditions of the wrist and hand

Question 1

in what activities do the hand and wrist play an important role in and what types of mvt are involved

Answer 1

integral role in ADLs

gripping, fine motor control, end of kinetic chain

Question 2

what tendons make up the anatomical snuffbox

Answer 2

extensor pollicis brevis and longus and abductor pollicis longus

Question 3

what is a colles fracture (moi, s/s, what age group is more vulnerable)

Answer 3

foosh is common moi
distal radius is driven dorsally, obvious deformity
vulnerable children and adolescence (skeletal immaturity)

s/s: pain w mvt, decreased grip strength, swelling, deformity, sharp pain, feel of cracking sensation

Question 4

what is a smith fracture (moi, s/s)

Answer 4

reverse colles fracture, distal radius is fx and pushed palmarly
moi: falling w wrist flexed
s/s: pain w mvt, decreased grip strength, swelling, deformity, sharp pain, cracking sensation

Question 5

monteggia fx (what is it, moi, s/s)

Answer 5

a fx dislocation (fx of prox 3rd of ulna on medial aspect, dislocation of the radial head on lateral side)
moi: foosh
s/s: rapid swelling (could lead to compartment syndrome), protective spasm, discoloration, unwillingness to move (radial n. could be affected bc of dislocation, ulnar n. affected bc of the fx)

Question 6

galeazzi fx (what is it, moi, s/s)

Answer 6

fracture dislocation (fx of distal 1/3 of radius, dislocation of distal ulna at the wrist)
moi: foosh
s/s: rapid swelling, protective spasm, unwilling to move, discoloration (splint be4 sending them off)

Question 7

what is the most common mass or lump in the hand/wrist

Answer 7

ganglion cyst

Question 8

what is a ganglion cyst

Answer 8

a non cancerous, fluid filled cyst developed in high friction areas that arise from the lig, joint lining, tendons sheats when irritated or inflamed (can be hard or squishy)
can disappear or change quickly

Question 9

is there treatment for a ganglion cyst if its not painful

Answer 9

no treatment, only treat if painful

compression can help

Question 10

70% of carpal fx involve the ___ due to its ____

Answer 10

scaphoid b. roll in bony block limiting wrist extension

Question 11

what moi causes a scaphoid fx (what kinds of fx)

Answer 11

foosh
high incidence of non union (doesn’t heal at all) fx and malunion (doesn’t heal well) (fx compromises blood supply to prox end, gets blood supply from radial a.)

Question 12

why is there an increased risk for scaphoid b. death w scaphoid fx

Answer 12

bc not good vascular supply, only innervates the distal portion so it affects its ability to heal

Question 13

what can an unresolved fx or impared circulation following a scaphoid fx do?

Answer 13

preiser’s disease (needs a proper splint to prevent it)
avascular necrosis of the scaphoid
instability of the proximal row

Question 14

s/s scaphoid fx

Answer 14

• point tenderness in anatomical snuffbox and on palmar side (scaphoid precisely)
• swelling
• pain w thumb ext and abd and wrist ext and radial deviation
• decrease in grip strength
• may not be seen on x-ray

Question 15

hook of hamate fx (common in what sports, s/s)

Answer 15

common in sports where gripping and vibrations occur (batting and cycling)

s/s: pt tenderness on palmar aspect, potential ulnar n. involvement, pain w wrist flexion (wrist flexors attach to the hamate), pain w opposition, pain w gripping

Question 16

boxer’s fx (what is it, moi, s/s)

Answer 16

fx to the neck of the 5th metacarpal (sometimes the 4th)
moi: axial loading at metacarpal
s/s: depression where knuckle should be, swelling over the knuckle, decreased ability to make a fist (crepitus if you move knuckles)

Question 17

what dislocates in a lunate and perilunate dislocation

Answer 17

where the lunate dissociates from the connecting carpals
where the proximal row of carpals is being stripped from the lunate( all of the other b. move and the lunate stays in its place)

Question 18

what are the moi for lunate and perilunate dislocations

Answer 18

lunate: forced hyperextension of the wrist (may displace dorsally or palmarly), rupturing the palmar interosseous lig (connect scaphoid to lunate, median n. is affected causing numbness in 3 middle fingers)
perilunate: forced hyperextension of the wrist (displacement of the carpals dorsally compared to the lunate)

Question 19

s/s perilunate and lunate dislocations

Answer 19

obvious deformity (bump on ant aspect), swelling, complaining of a strained wrist (on palmar aspect), median n. irritation, limited wrist extension (need all carpal b. to be able to extend), point tenderness over the lunate, pain increases w gripping

Question 20

where is a wrist sprain located commonly and what athletes is it common with

Answer 20

its the most common ligamentous instability is between the scaphoid and the lunate
common in gymnasts

Question 21

s/s wrist sprain

Answer 21

complain of pain and instability in the wrist, weakness in the wrist during functional tasks, strain in the flexors

Question 22

keinbock’s disease (what is it, s/s, maybe secondary to what)

Answer 22

avascular necrosis of the lunate b.
maybe secondary to a dislocation (if not treated properly or if just not spotted)

pain typically a gradual onset, chronic wrist ache (more towards scaphoid), pain over lunate, pain when tapping 3rd metacarpal, decrease ROM, decrease in grip strength

Question 23

triangular fibrocartilaginous complex injury (moi, what is it)

Answer 23

forces ulnar deviation w rotation, rotational stress to the distal radioulnar joint

btw 1st row of carpals and radius/ulna

moi: fall onto pronated hyperextended wrist (foosh), distraction applied to forearm/wrist (twisting motion; irritation over time)

Question 24

TFCC s/s (what athletes is it common with)

Answer 24

• painful grinding or clicking w wrist rom (especially extension and ulnar deviation; active and passive)
• weakness in rom especially in extension and ulnar deviation (maybe okay in neutral position)
• pain pushing up from a chair or weight bearing
• ulnar deviation causes clicking and wrist pain
• point tenderness distal to the ulna along the medial one half of the wrist joint line

common w gymnast and industrial workers

Question 25

ulnar/radial collateral lig sprain of the radiocarpal joint can be injured how and what side of the joint does each type of sprains open

Answer 25

ulnar dev: opens up medial side
radial dev: opens up lateral side
helps to stabilize the radiocarpal joint
can be injured thru repetitive ulnar and radial deviation

Question 26

s/s of ulnar/radial collateral lig sprain of the radiocarpal joint

Answer 26

pain w valgus and varus stress test, pain w ulnar and radial deviation (stretching of the lig), feeling of instability of the wrist

Question 27

ulnar n. compression can happen where (where does that n. runs thru)

Answer 27

can happen at the elbow and the wrist

ulnar n. runs thru the tunnel of guyon (btw hamate and pisiform- pisohamate lig)

Question 28

what is cyclist palsy

Answer 28

mimics ulnar n. entrapment from the cte vibration and pressure of the ulnar n. (over long periods of time)
usually resolves after the ride

Question 29

ulnar n. compression s/s

Answer 29

burning or numbness in 4th and 5th finger
atrophy of the hypothenar eminence (with time)
decrease in grip strength

Question 30

what is carpal tunnel syndrome (what is it, moi, s/s)

Answer 30

compression of the median n. thru the carpal tunnel

moi:
- overuse- typing, repetitive flexion/extension
- compression: flexed position for a long time
- fluid retention- pregnant women (poor circulation)
- secondary to trauma-swelling

s/s:
-tinel’s sign positive (tap on n. to see if pain radiates)
-numbness and tingling (2,3,4th fingers)
-progressive weakness of the thenar m.
maybe TOS (may come from sh and radiates to wrist)

Question 31

what is a gymnasts wrist (where is it, what athletes, moi, s/s)

Answer 31

dorsal carpal impingement syndrome (m. gets thight and becomes impinged, b. on b. w radius and carpal b.) /distal radial epiphyseal plate fx (more on younger gymnast when growth place hasn’t fused)

typically occurs in young gymnasts

moi: repetitive extension of the wrist

s/s: activity related pain at dorsum of the wrist (w hyperextension and loading), point tender along dorsum of radiocarpal joint, sharp pain w abrupt extension of the wrist, swelling (can put pressure on those n.)

Question 32

ulnar collateral lig sprain (MCP)- game keeper’s thumb what kind of injury is it, what is the special test for it and what is the moi

Answer 32

acute or chronic
moi: hyperextension or hyperabduction of the first MCP joint
valgus stress test to test it

Question 33

s/s of UCL sprain of 1st MCP joint

Answer 33

• pain along ulnar aspect of 1st MCP
• localized swelling
• loss of grip strength
• possible ecchymosis
• pain during active extension, abd and extension
• weakness in MCP flexion and add, pinch grip decreased (resisted rom w add will hurt)
• passive pain w thumb extension and abd

Question 34

dequervain’s tenosynovitis is located w which m. and tendons and what is the moi

Answer 34

tenosynovitis of the extensor pollucis brevis and abductor pollicis longus tendons (to tendon sheet of tendon): first extensor compartment

moi: repetitive radial deviation (new moms; cte lifting of child), pregnancy (fluid retention that can put pressure on structures =irritation), maybe associated w inflammatory arthritis

Question 35

dequervain’s syndrome s/s

Answer 35

• swelling over styloid process of radius
• pain over styloid process of radius and dorsum of thumb (tendons on dorsal hand)
• radial and ulnar deviation of the wrist is painful (as well as flexion, extension, abd of the thumb)

Question 36

bennett’s fx where is it located and what is the moi

Answer 36

fx of the base of the 1st metacarpal (very close to scaphoid)
moi: axial compression of the metacarpal, direct trauma, hyperextension of the thumb

Question 37

collateral ligament injuries (moi, s/s, common w which athletes)

Answer 37

moi: stress applied to extended finger, valgus and varus stress (discomfort)

s/s: pain w active and passive motions, swelling, ecchymosis

common in basketball players; jams and missed ball on extended fingers

Question 38

finger dislocation (can occur at which joints and what is the tx)

Answer 38

can occur at the PIP, DIP and MCP joints
passive flexion rom to pop back in (make them do it theirselves)
splint it and hospital

Question 39

what is boutonniere deformity (resulting in what mvt of DIP, MCP and PIP)

Answer 39

a rupture of the central extensor tendon causes the lateral bands to slip palmarly on each side of the PIP joint (changes line of pull on this joint from an extensor to a flexor)

resulting in extension of DIP and MCP and flexion of the PIP joint (avulsion or rupture of the hood of the middle phalanges)

Question 40

what is a mallet finger (moi, tx?)

Answer 40

avulsion or rupture of an extensor tendon
results in inability to fully extend the distal phalanx

moi: DIP forced into flexion (finger tip struck by a ball)

splint in extension to approximate joint

Question 41

what is a jersey finger (moi, s/s and tx)

Answer 41

avulsion of the flexor digitorum profondus tendon off the palmar aspect of the DIP joint, inability to actively flex the DIP joint

moi: finger forced into hyperextension (grabbing another jersey)

s/s: on observation looks normal, finger painful, possible swelling, fingers appear to flex and extend normal (isolation of the DIP joint- patient is unable to actively flex)

splint in natural 30-40° of flexion of the fingers

Question 42

what is swan neck deformity (what is it, what conditions loosen the structures around the PIP joint that cause hyperextension)

Answer 42

hyperextended PIP joint (loose palmar lig) and flexed DIP joint (someone w arthritis that used their hands a lot)

weaken volar plate, rheumatoid arthritis, chronic inflammation

Question 43

what is a trigger finger (moi)

Answer 43

snapping flexor tendons (stuck in flexed position)
thickening of the tendon sheath (prevents tendon from sliding in annular lig, nodule)
finger becomes locked in flexion

moi: trauma to palmar aspect of hand, or repetitive clenching of fingers (lifting and grabbing stuff w only 1 or 2 fingers for long periods of time)