deck_1997221 Flashcards
When the radial nerve is compressed, it leads to radial tunnel syndrome and ___ syndrome. Does it mainly have motor or sensory deficits?
Posterior Interosseus Nerve (PIN) syndromeMotor
Which muscles in the thumb and fingers are innervated by the radial nerve?
Abductor pollicis longusAdductor pollicis brevisExtensor indicis
What types of loss happen with a PIN laceration?
Only motor - no sensory loss
What innervates supinator?
Radial n.
T/F: whether there is a forearm or elbow radial laceration, sensory loss is the same.
True. Only interwebbed space between 1st and 2nd digit
Radial nerve lesions: what can you do?
RLP splint to bring into some ext and help with function.
What sensory deficits come with a high level median nerve injury?
Thumb, index, middle, and radial half of ring finger (dorsal and volar)
What can you do with a median nerve lesion?
Opposition splint - puts thumb into opp.
What are some key symptoms with CTS?
-Nocturnal pain &-numbness-Clumsiness-Paresthesias-Muscle atrophy/sensory loss-Radiating pain
What are some common causes of median nerve lesion? What about ulnar nerve?
MEDIANHumeral fracturesElbow dislocationsDistal radius fracturesDislocation of lunate into carpal canalVolar wrist lacerationsULNARFracture of medial epicondyle, humerus, or olecranonLacerations (wrist level)
What key sign makes it apparent there is an ulnar nerve lesion and what is the name of the test for it? Is there something that happens in the thumb as well?
Abductor digiti minimi: Wartenberg’s signThumb: Froment’s sign - thumb IP flexion with MCP extension with attempted lateral pinch
Anastomosis between median and ulnar nerve can happen in the forearm and hand. There is a Martin Gruber and Riche-Cannieu anastomosis. Which happens where?
MG - forearm (AIN to ulnar or medain to ulnar in middle)RC - hand (in palm)
What motion provokes cubital tunnel syndrome symptoms?
Elbow flexion, esp. at night.
What diagnostic tools can you use to diagnose cubital tunnel syndrome?
Elbow flexion test-Tinel’s sign-Semmes-Weinstein-Weakness/atrophy
Describe the location of A1, A2 and A4 pulleys and their importance.
A1: at the MCP jointA2: along the proximal phlangeA3: along the PIP jointA4: along the middle phlangeA2 and A4 need to be preserved
Describe the flexor tendon zones (I-V). Hint: starts at the fingertips.
Zone I – Distal to the FDSinsertionZone II – From insertion of the FDS tendon to the A-1 pulley in the palmZone III – From the A-1 pulley to the distal end of the carpal tunnel.Zone IV –Within the carpal tunnel extending from distal and proximal borders of the flexor retinaculumZone V –Proximal to the carpal tunnelTHUMB:III = themar eminance
When is a tendon weakest post surgery?
4-5 days. From day 5-21, tensile strength increases as the collagen matures and cross linking continues. Look at AROM 3 weeks out.
What are 2 issues with tendon repair? What’s important with regards to sutures?
Gapping: occurs at repair siteAdhesion formation: within flexor sheathFewer surface loops = less surface scar tissue. Most surgeons use 4 strand core repair
Name 3 different approaches to tendon repair.
Immobilization-3 to 4 weeks in brace, no PROM or AROMEarly Passive Mobilization (Kleinhart; Duran)(Dorsal Block Splint)-24hrs to 2 days post surgery-Passive flexion glides the tendon proximally, and limited active extension glides the tendon distallyEarly Active Mobilization
What position of the hand requires maximum FDP gliding? What about FDS?
FDPFully closed fistFDSStraight fist - straight DIP
What is a protocol outline for a FDP/FDS tendon repair at 2 days, 3 weeks and 8 weeks post surgery?
DAY 2-dorsal-bloch splint-passively flex, actively extend (duran)WEEK 3-no carrying-educate with use like opening doors-don’t overextend wristWEEK 8-light gripping-no brace unless in crowd-yoga or pilates with modified hand positions;Protected functionPain should be no more than 3-4
Name the zones of the extensor tendon and name a fracture at each odd one.
I - DIP (mallet fracture)IIIII - PIP (boutonniere splint)IVV - MCPVIVII - Scaphoid/Radius
How do you characterize a brawny edema?
Presence of fibrinogen.
How do you calculate Total Active ROM?
(Summation of digit flex) – (Summation of digit ext deficits)Total ~290
