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Clinical Interventions > Elbow, Wrist, and Hand > Flashcards

Elbow, Wrist, and Hand Flashcards

1
Q

definition: Reflex neurovascular disease that is common after a Colle’s Fx occurs

A

RSD/CRPS/Shoulder-Hand Syndrome

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2
Q

What is the most common syndrome after surgery and/or trauma?

A

RSD/CRPS/Shoulder-Hand Syndrome

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3
Q

What are the s/s of RSD/CRPS/Shoulder-Hand Syndrome?

A
  • pain or hyperesthesia at the shoulder, wrist, or hand
  • limitation of shoulder ABD and ER
  • limitation of Wrist EXT
  • limitation of hand MCP and PIP FLX
  • edema of dorsal hand and wrist
  • vasomotor instability
  • trophic skin changes
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4
Q

(true/false) With progression of RSD/CRPS/Shoulder-Hand Syndrome over time… pain and ROM decrease.

A

true

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5
Q

With progression of RSD/CRPS/Shoulder-Hand Syndrome over time… why does pain decrease, but ROM does not improve?

A

Because of the swelling/edema in the area

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6
Q

What can you possibly develop with RSD/CRPS/Shoulder-Hand Syndrome?

A

CVA
MI
Cervical DJD

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7
Q

(true/false) It can take up to 18-24 months to heal RSD/CRPS/Shoulder-Hand Syndrome

A

true

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8
Q

definition: : compression of subclavian artery or brachial plexus due to cervical rib, tight anterior or middle scalene(s), tight pec minor or major, first rib and clavicle, trauma, (swelling guarding), postural dysfunction

A

TOS

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9
Q

What muscles should you stretch when a patient has TOS?

A

pec mj/minor
scalenes
Lev scapulae

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10
Q

What muscles should you strengthen when a patient has TOS?

A

scapular retractors
Upward rotators
shoulder ERs
thoracic extensors

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11
Q

What is the most important part of treatment for TOS?

A

Postural training and education

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12
Q

Little league tear is a ____ tear from repeated (varus/valgus) stress.

A

UCL, Valgus

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13
Q

How do you confirm a little league tear?

A

Valgus stress test with full elbow EXT and 10 degrees of FLX

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14
Q

What muscles can be torn due to hyperextension in a little league tear?

A

Brachialis, BB, BR

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15
Q

definition: swelling or tearing of tendons in the lateral aspect of the arm (common extensor origin)

A

lateral epicondylitis (Tennis Elbow)

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16
Q

What is the most common muscle to be affected by lateral epicondylitis?

A

ECRB

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17
Q

What are the s/s of lateral epicondylitis?

A
  • gradual increase in pain with specific motions
  • severe pain
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18
Q

definition: swelling or tearing of tendons in the medial aspect of the arm (Common flexor origin)

A

medial epicondylitis (Golfer’s Elbow)

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19
Q

What are the s/s of medial epicondylitis?

A

Increased pain with elbow FLX, lifting with palm up, and palpation

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20
Q

What are the s/s of UCL laxity?

A

pain and instability with valgus stress

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21
Q

What can cause UCL laxity?

A

repetitive valgus stress or trauma

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22
Q

What can cause RCL laxity?

A

elbow dislocation/subluxation

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23
Q

What are the s/s of RCL laxity?

A
  • recurring clicking
  • locking of the elbow with EXT and SUP
  • gapping with varus stress
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24
Q

definition: bony deposits in muscle after trauma and bleeding

A

myositis ossificans

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25
Q

What are the common muscles in the body that experience myositis ossificans?

A

quadriceps and brachialis

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26
Q

definition: Fx in the distal forearm that is common post-neural damage and must be surgically released (causes elbow instability)

A

Volkmans ischemic contracture

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27
Q

What are the ulnar nerve roots?

A

C8-T1

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28
Q

What are common areas of ulnar nerve entrapment? What is the most common?

A
  • arcade of struthers
  • cubital tunnel (medial aspect of elbow)
  • between the heads of FCU (most common)
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29
Q

What is the most common neural injury in the elbow?

A

ulnar nerve compression

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30
Q

What are the median nerve roots?

A

C5-T1

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31
Q

What are the common sites of entrapment of the median nerve? Which are the most common in the forrearm and wrist?

A
  • ligament of struthers
  • bicipital aponeurosis
  • 2 heads of PT ( most common in forearm)
  • carpal tunnel (most common in wrist)
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32
Q

What are the musculocutaneous nerve roots?

A

C5-C7

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33
Q

What are common sites of musculocutaneous nerve entrapment?

A

between biceps tendon and brachial fascia

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34
Q

What are the radial nerve roots?

A

C6-C8

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35
Q

What are the common radial nerve entrapment sites?

A
  • radial groove
  • radial head
  • supinator
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36
Q

What nerve impingement often leads to wrist drop?

A

radial nerve impingement

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37
Q

Open packed position of humeroulnar joint.

A

70 degrees elbow EXT
10 degrees supination

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38
Q

Close packed position of humeroulnar joint.

A

full EXT and SUP

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39
Q

What motion(s) do medial glides of the humeroulnar joint help restore?

A

EXT, SUP/PRON

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40
Q

What motion(s) do lateral glides of the humeroulnar joint help restore?

A

FLX

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41
Q

Mobilization of the ___ joint helps assess medial and lateral gapping.

A

humeroulnar

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42
Q

Open packed position of the humeroradial joint.

A

Full EXT and SUP

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43
Q

close packed position of the humeroradial joint.

A

90 degrees elbow FLX
5 degrees SUP

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44
Q

Distraction of the humeroradial joint at ___ degrees increases all motion.

A

70

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45
Q

What motion(s) do posterior glides of the humeroradial joint help restore?

A

EXT

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46
Q

What motion(s) do anterior glides of the humeroradial joint help restore?

A

FLX

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47
Q

Open packed position of proximal radioulnar joint

A

70 degrees FLX
35 degrees SUP

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48
Q

Close packed position of proximal radioulnar joint.

A

5 degrees SUP

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49
Q

What motion(s) do anterior glides of the proximal radioulnar joint help restore?

A

SUP

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50
Q

What motion(s) do posterior glides of the proximal radioulnar joint help restore?

A

PRON

51
Q

Open packed position of distal radioulnar joint.

A

10 degrees SUP

52
Q

What motion(s) do anterior glides of the distal radioulnar joint help restore?

A

PRON

53
Q

What motion(s) do posterior glides of the distal radioulnar joint help restore?

A

SUP

54
Q

What joint is important to mobilize after a Colle’s Fracture? What can you observe while doing this mobilization?

A

Distal Radioulnar joint
–> may hear a “snap or pop” when adhesions and scar tissue are broken during grade III and IV mobs so it’s important to warn pts

55
Q

With a FOOSH, children are more likely to injure their _____.

A

AC joint

56
Q

With a FOOSH, adults are more likely to have a ____ or _____ injury.

A

distal radius fracture (Colle’s Fracture)
Radial head subluxation

57
Q

What specific tests are used for Lateral Epicondylitis?

A

Cozen’s
Mills
Resisted 3rd finger EXT

58
Q

What specific tests are used for medial epicondylitis?

A

Passive wrist and elbow EXT while Supinating the forearm

59
Q

What specific tests are used for ulnar nerve impingement?

A

ulnar nerve FLX
tinels sign

60
Q

What specific tests are used for median nerve impingement?

A

PT test

61
Q

definition: Fracture of the distal radius w/ or w/o involvement of the ulna

A

Colle’s FRacture

62
Q

What is the most common population ot experience a Colle’s Fracture?

A

Female > 50 y/o

63
Q

What are the 3 types of Colle’s Fracture?

A

Undisplaced Fx
Displaced Fx: 1 main transverse Fx with minimal cortical comminution (heals well)
Unstable Fx: broken in 2+ pieces

64
Q

definition: Reverse Colle’s fracture

A

Smith Fracture

65
Q

How does one cause a smith fracture?

A

Fall onto a flexed wrist

66
Q

How does one cause a colle’s fracture?

A

FOOSH

67
Q

IF a patient has a smith fracture, check for ____ involvement.

A

ulnar bone

68
Q

Distal Fragments of a smith fracture are displaced in a ___ direction.

A

anterior

69
Q

With a Colle’s Fx, the lunate acts as a wedge and shears off part of the radius in a ___ direction.

A

dorsal

70
Q

(flexor/extensor) tendons taker longer to heal.

A

Extensor

71
Q

With a tissue Injury, avoid passive stretching for ___-___ weeks post-op

A

6-8 weeks

72
Q

When stretching tendons over the wrist, do NOT let the PIP and MCPs ______.

A

hyperextend

73
Q

(true/false) With tendon repairs, you can do more damage with PROM than AROM

A

True

74
Q

definition: intra-articular fx of the medial aspect of the first MC base

A

Bennet’s Fracture

75
Q

What normally causes a bennet’s Fracture?

A

FOOSH and axial compression of 1st MC

76
Q

After a Bennet’s Fracture surgery, AROM of the thumb and wrist begin ___ weeks after the pins are removed.

A

4 weeks

77
Q

definition: Rupture of the UCL of the MCP joint of the thumb due to valgus stress; ligament may rupture or cause avulsion fx.

A

Gamekeeper’s/skiers thumb

78
Q

How does one diagnose gamekeeper’s/skiers thumb?

A

Stress test for laxity and pain

79
Q

definition: Fx of 5th metacarpal at neck; often sustained after punching or a fight

A

Boxer’s Fracture

80
Q

Resistance should be avoided until week ___ of boxer’s fracture rehabilitation.

A

6

81
Q

definition: flexion of MCP and DIP, hyperextension of the PIP; due to contracture of the intrinsic muscles

A

swan neck deformity

82
Q

What deformity of the finger is normally seen with RA?

A

Swan neck deformity

83
Q

definition: extension of MCP and DIP with flexion of PIP; due to rupture of the central tendinous slip of the extensor hood

most often s/p trauma or RA

A

boutonniere Deformity

84
Q

definition: DIP resting in flexed position due to rupture or avulsion of the extensor tendon where it inserts in the distal phalanx

A

mallet finger

85
Q

With mallet finger, the finger can move into _____ but NOT actively.

A

EXT

86
Q

definition: sticking of the tendon when the pt attempts to flex their finger; may snap, catch, click; due to thickening of the flexor tendon sheath

A

trigger finger

87
Q

definition: fixed flexion deformity of the MCP and PIP, usually in the 4th or 5th finger; due to contracture of the palmar fascia

A

dupuytren’s contracture

88
Q

Who is most commonly affected by dupuytren’s fracture?

A

Men, 50-70 y/o

89
Q

What deformity looks like a pope’s hand?

A

dupuytren’s contracture

90
Q

definition: tenosynovitis in the thumb affecting the abductor pollicis longus and extensor pollicis brevis

A

De Quervain’s syndrome (Hoffman’s Syndrome)

91
Q

De Quervain’s syndrome will show a (+) _______ test.

A

Finkelstein’s test

92
Q

When splinting De Quervain’s syndrome, position the thumb in ___ and ___.

A

EXT and ABD

93
Q

definition: avulsion fx from high eccentric load on flexor side

A

jersey finger

94
Q

What does the median nerve pass through in the wrist along with the flexor tendons?

A

Carpal tunnel

95
Q

What are the sensory symptoms of median nerve entrapment in the wrist?

A

sensory changes in radial 2/3 of palm, palmar surface of the first 3.5 digits, and dorsum of distal phalanges

96
Q

What deformities can median nerve entrapment at the wrist cause?

A

Ape Hand Deformity
Hand of papal benediction

97
Q

definition: muscle wasting in hypothenar eminence

A

ape hand deformity

98
Q

Treatment for median nerve entrapment at the carpal tunnel includes splinting of the thumb in ___.

A

ABD

99
Q

What are the sensory symptoms of ulnar nerve entrapment in the wrist?

A

sensory changes in the ulnar 1/3 of the hand, entire 5th digit, and ulnar side of the 4th digit

100
Q

What nerve impingement at the wrist is most common in cyclists or with FOOSH injuries?

A

ulnar nerve

101
Q

What nerve impingement at the wrist can be caused by compression at the cubital tunnel or Guvan’s canal?

A

Ulnar nerve

102
Q

What deformities can ulnar nerve entrapment at the wrist cause?

A

Claw hand
loss of effective grasping

103
Q

Treatment for ulnar nerve entrapment at the wrist includes splinting of the MCPs in ____ and IPs in ____.

A

MCP FLX, IP EXT

104
Q

The radial nerve enters the hand as the ___ nerve.

A

Superficial radial nerve (sensory)

105
Q

What are the sensory symptoms of radial nerve entrapment in the wrist?

A

sensory changes over the radial 2/3 of the dorsum of the hand and thumb, the proximal phalanx of the 2nd and 3rd and half of the 4th digit

106
Q

Treatment for radial nerve entrapment at the wrist includes splinting to maintain wrist ______.

A

wrist EXT

107
Q

Anterior glide of the radiocarpal joint restores _____.

A

wrist EXT

108
Q

Posterior glide of the radiocarpal joint restores _____.

A

wrist FLX

109
Q

Ulnar glide of the radiocarpal joint restores _____.

A

radial deviation

110
Q

radial glide of the radiocarpal joint restores _____.

A

ulnar deviation

111
Q

What is the splinting position of the radiocarpal joint?

A
  • slight wrist extension
  • 70* MCP flexion
  • IP in neutral or slight flexion
  • thumb abducted and/or opposed
112
Q

Ulnar glide of the thumb CMC joint helps restore ____.

A

FLX

113
Q

Radial glide of the thumb CMC joint helps restore ____.

A

EXT

114
Q

Posterior glide of the thumb CMC joint helps restore ____.

A

ABD

115
Q

radial glide of the thumb CMC joint helps restore ____.

A

ADD

116
Q

Anterior/palmar/volar glide of the 2nd-5th CMC joints helps restore ___.

A

FLX

117
Q

Posterior/dorsal glide of the 2nd-5th CMC joints helps restore ______.

A

EXT

118
Q

Anterior glide of MCP, PIP, and DIP joints helps restore ___.

A

FLX

119
Q

Posterior glide of MCP, PIP, and DIP joints helps restore ___.

A

EXT

120
Q

Radiocarpal joint movement is (convex/concave) on (convex/concave)

A

convex on concave

121
Q

Thumb CMC joint movement is (convex/concave) on (convex/concave) for FLX/EXT

A

concave on convex

122
Q

Thumb CMC joint movement is (convex/concave) on (convex/concave) for ABD/ADD

A

convex on concave

123
Q

The 2nd-5th CMC joint movement is (convex/concave) on (convex/concave)

A

concave on convex

124
Q

The MCP, PIP, and DIP joint movements are (convex/concave) on (convex/concave)

A

concave on convex

Clinical Interventions (25 decks)

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