conditions of the wrist and hand Flashcards
in what activities do the hand and wrist play an important role in and what types of mvt are involved
integral role in ADLs
gripping, fine motor control, end of kinetic chain
what tendons make up the anatomical snuffbox
extensor pollicis brevis and longus and abductor pollicis longus
what is a colles fracture (moi, s/s, what age group is more vulnerable)
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
what is a smith fracture (moi, s/s)
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
monteggia fx (what is it, moi, s/s)
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)
galeazzi fx (what is it, moi, s/s)
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)
what is the most common mass or lump in the hand/wrist
ganglion cyst
what is a ganglion cyst
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
is there treatment for a ganglion cyst if its not painful
no treatment, only treat if painful
compression can help
70% of carpal fx involve the ___ due to its ____
scaphoid b. roll in bony block limiting wrist extension
what moi causes a scaphoid fx (what kinds of fx)
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.)
why is there an increased risk for scaphoid b. death w scaphoid fx
bc not good vascular supply, only innervates the distal portion so it affects its ability to heal
what can an unresolved fx or impared circulation following a scaphoid fx do?
preiser’s disease (needs a proper splint to prevent it)
avascular necrosis of the scaphoid
instability of the proximal row
s/s scaphoid fx
- 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
hook of hamate fx (common in what sports, s/s)
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
boxer’s fx (what is it, moi, s/s)
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)
what dislocates in a lunate and perilunate dislocation
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)
what are the moi for lunate and perilunate dislocations
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)
s/s perilunate and lunate dislocations
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
where is a wrist sprain located commonly and what athletes is it common with
its the most common ligamentous instability is between the scaphoid and the lunate
common in gymnasts
s/s wrist sprain
complain of pain and instability in the wrist, weakness in the wrist during functional tasks, strain in the flexors
keinbock’s disease (what is it, s/s, maybe secondary to what)
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
triangular fibrocartilaginous complex injury (moi, what is it)
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)
TFCC s/s (what athletes is it common with)
- 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
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
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
s/s of ulnar/radial collateral lig sprain of the radiocarpal joint
pain w valgus and varus stress test, pain w ulnar and radial deviation (stretching of the lig), feeling of instability of the wrist
ulnar n. compression can happen where (where does that n. runs thru)
can happen at the elbow and the wrist
ulnar n. runs thru the tunnel of guyon (btw hamate and pisiform- pisohamate lig)
what is cyclist palsy
mimics ulnar n. entrapment from the cte vibration and pressure of the ulnar n. (over long periods of time)
usually resolves after the ride
ulnar n. compression s/s
burning or numbness in 4th and 5th finger
atrophy of the hypothenar eminence (with time)
decrease in grip strength
what is carpal tunnel syndrome (what is it, moi, s/s)
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)
what is a gymnasts wrist (where is it, what athletes, moi, s/s)
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.)
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
acute or chronic
moi: hyperextension or hyperabduction of the first MCP joint
valgus stress test to test it
s/s of UCL sprain of 1st MCP joint
- 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
dequervain’s tenosynovitis is located w which m. and tendons and what is the moi
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
dequervain’s syndrome s/s
- 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)
bennett’s fx where is it located and what is the moi
fx of the base of the 1st metacarpal (very close to scaphoid)
moi: axial compression of the metacarpal, direct trauma, hyperextension of the thumb
collateral ligament injuries (moi, s/s, common w which athletes)
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
finger dislocation (can occur at which joints and what is the tx)
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
what is boutonniere deformity (resulting in what mvt of DIP, MCP and PIP)
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)
what is a mallet finger (moi, tx?)
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
what is a jersey finger (moi, s/s and tx)
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
what is swan neck deformity (what is it, what conditions loosen the structures around the PIP joint that cause hyperextension)
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
what is a trigger finger (moi)
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)
