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PT OCS Exam > Elbow/Wrist/Hand > Flashcards

Elbow/Wrist/Hand Flashcards

1
Q

Dorsal wrist Compartments

A

1) EPB AbPL
2) ECRB/ECRL
3) EPL
4) EDC/EDI
5) EDM
6) ECU

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2
Q

DeQuervain’s Tenosinovitis

A

*Most Common
Dx: (+ pain) Finkelstein *test Bilat.

Effects the 1st dorsal compartment (EPB/AbPL)

Tx: Rest with thumb spica to allow IP to move, steroids can also be effective if rest doesn’t help

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3
Q

Intersection Syndrome

*Also called texter’s or gamekeeper’s thumb

A

Effects 1st and 2nd dorsal compartments (AbPL/EPB and ECRB/ECRL)

Dx: Pain with wrist extension and thumb circumduction
TTx: Rest, Splint, NSAIDS

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4
Q

ECU subluxation

A

Consider in DDx of ulnar side wrist pain

Caused by traumatic UD and wrist flexion rupturing tendon sheath

Dx: ECU tendon subluxes with UD while in full supination
Tx: Cast in Pronation/Ext for 6 weeks

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5
Q

ECU tendonitis

A

2nd most common, occurs in racquet sports from overuse and trauma
*Associated with injury to TFCC
Tx:Rest, splint, NSAIDs, injections

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6
Q

MCP UCL rupture

A

Loss of Thumb pinch grip

MOI: “Skier’s thumb” rupture or “Gamekeeper’s thumb” laxity (microtrauma)

Dx: Valgus stress test (+ if >15 deg of uninvolved or >35 deg)

XR if Stener lesion suspected (non-healing avulsion fx)

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7
Q

Volar Plate Avulsion

A

MOI:Common in ball sports

Keep’s finger from hyperextension (normal flexion ROM approx. 110 deg @ PIP)

XR if swelling/pain in palmar PIP

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8
Q

FDB Avulsion “Jersey Finger”

A

4th finger is most common

MOI: Forced extension while trying to flex at DIP

Unable to make a fully closed fist due to lost DIP flx

Tx: Surgery referral

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9
Q

Bennett Fx

A

1st MCP fx (Most Common MC Fx)

MOI: Fall on Flexed Thumb

Avulsion Fx medially by APL tendon

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10
Q

Scaphoid Fx

A

TTP anatomical snuff box
(+) Watson’s test (Axial Thumb Load)
If Radial wrist pain with extension suspect fracture and may require CT scan to confirm

MOI is fall backward on to hand

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11
Q

Hook of Hamate Fx

A

MOI: Shearing from 4/5 flexor tendons
Dx: Made by CT/Bone Scan
Might present with ulnar neuropathy (Close to Guyon’s tunnel)

Tx:Surgical excision is most effective

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12
Q

Criteria to Dx a wrist Fx

A

Pain with gripping
Pain with supination
Pain with A/PROM wrist extension
Local tenderness/edema

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13
Q

Pisiform Fx

A

MOI: Direct blow or Racquet sport
Tx: Surgical Excision

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14
Q

Lunate Fx

A

*Rare, Kienbock’s disease (Lunate AVN)

Dec. Grip strength
Dx: MRI
Microtrauma

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15
Q

Distal Radius Fx (3 types)

A 
Colles' Fx (Dorsal displacement)
Smith Fx (Volar displacement)
Barton Fx (Intra-articular fx, dorsal or volar dislocation)

Most common Fx seen in ED
Very Common and present with “dinner fork” deformity
*Important to examine the Median N.
Tx: Closed Reduction with splint followed by cast

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16
Q

Wrist Ligament injuries

A

Scapholunate (Most Common), MOI: FOOSH on pronated hand (wrist ext/UD), Dx: Stress view XR (Fist)

Lunotriquetral, MOI: FOOSH with wrist in ext/RD

Midcarpal instability (often Bilat.)
Dx: XR, Tx: Splint immobilization

Carpal Dislocation, MOI: Collision sports and usually affects the scapholunate joint. Tx: Surgery

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17
Q

DRUJ injuries

A

Involved the TFCC which is main stabilizer (especially when wrist is in pronation)
MOI: FOOSH or tensile overuse (traction force)

Dx: Piano Key sign, Press Test (Use hands to stand up), hypermobility at DRUJ

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18
Q

Boxer’s Fx

A

MOI: Fracture of MC shaft/head from direct trauma
Tx: Splinting

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19
Q

Mallet Finger

A

Distal extensor tendon avulsion
MOI: rapid forced flexion of finger (ball hits finger tip)
Tx: Splint in full extension

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20
Q

CPR for Hand OA (4+/5)

A

Hand pain, ache, stiffness

Hard tissue enlargement of 2 or more joints (CMC, 2nd/3rd PIP/DIP)

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21
Q

Swan-neck deformity

A

DIP flexed and PIP hyperextends
will require surgery

Association with RA

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22
Q

Boutonniere deformity

A

DIP hyperextended
PIP flexed
Responds well to splinting and exercise

23
Q

Trigger Finger

A

Usually involves the A1 pulley

24
Q

Pronator Teres Syndrome

A

Volar forearm pain
Sensory neuropathy of thumb and 2,3, 1/2 of 4th finger on palmar surface
Weak thumb, index and middle fingers
(-) compression at pronator border

PT is spared

25
Q

Carpal Tunnel Syndrome

A

Entrapment of Median N. in the flexor retinaculum
Presents with numbness and paraesthesia in finger tips of median nerve distribution, nocturnal paraesthesia
MOI: repetitive wrist flexion (i.e. typing, forceful gripping)
Thenar Atrophy

*R/O peripheral neuropathy in alcoholics, renal disease and DM

26
Q

Cubital Tunnel Syndrome

A

Entrapment of Ulnar N. at cubital tunnel or arcade of struthers

Froment’s sign (+) unable to maintain key grip due to weakness of the AddPB and FPB, uses FPL instead (AIN innervation)
(+) Wartenberg’s sign (unable to adduct pinky)
(+) Ulnar Nerve compression test

(+) Elbow flexion test (AROM held for 60 sec) excellent test to R/I, moderate to R/O

27
Q

Nerve Injuries

A

Neuropraxia (compression or strain injury which heals between a few days and a few months, great prognosis)

Axonotmesis (crush or traction injury which takes longer to heal, 1mm per day or 1” per month)

Neurotmesis (nerve transection, poor healing and requires surgery)

*Ventral Root is motor, Dorsal Root is sensory

28
Q

Ulnar Nerve Palsy (C8-T1)

A

Entrapped at Pec. Minor, Cubital Tunnel or Guyon’s tunnel

Hypothenar atrophy

29
Q

Volkmann’s Ischemia

A 
Compartment syndrome characterized by:
Palor
Pulselessness
Paresthesia
Pain
Pain with passive stretch
30
Q

Radial Nerve Palsy (C5-C8)

A

Drop Arm caused by compression of the Radial Nerve
MOI: Honeymooner’s palsy, Saturday Night Palsy, fracture through the radial groove

Proximal injury: Crutch Palsy, Humeral shaft fracture

Distal injuries at arcade of frohse will effect the PIN (no sensory involvement)

31
Q

Musculocutaneous Nerve (C5-C7)

A

Biceps, Brachialis, Coracobrachialis

Ant.Lat. arm cutaneous sensation

32
Q

Dupuytren Disease

A

Fibrosis of the palmar aponeurosis

Presents as flexion contractures of the MP and PIP joints

33
Q

DRUJ Fx

A 
Essex-Lopresti Fx (Radial head Dx, DRUJ dislocation)
Galeazzi Fx (Distal 1/3 radius, DRUJ dislocation)
34
Q

AIN syndrome (FDP, FDL, PQ)

A

Inability to make the “OK sign”, weak FPL and FDP (lateral 2)

NO sensory loss

35
Q

PIN syndrome

A

Lateral forearm/elbow pain
Wrist extension with radial deviation (ECU weakness)
Weakness of the finger extensors
Thumb extension elicits pain at lateral epicondyle

NO sensory loss

36
Q

CRPS

A 
Hyperaesthesia
Sudomotor changes
Allodynia
Inc. temperature
Redness
37
Q

Guyon’s tunnel

A

Entrapment sites proximal (sensory and motor), distal to ulnar tunnel (sensory), between ADM and FDM (motor only)

38
Q

Wartenberg Syndrome

A

Causes pain and paraesthesia along the lateral dorsum of the hand usually from tight casting

39
Q

Claw deformities

A 
Median Nerve (Ape Hand: unable to make a oppose thumb, or flex 2nd/3rd fingers due to loss of DFP and lumbricals)
Ulnar Nerve (unable to extend the 4th/5th digits due to loss of IO)
40
Q

UCL injury

A

Moving valgus test 70-120 deg (excellent to R/O)
Valgus stress test at 25 deg
TTP at ant. UCL

41
Q

Lateral epicepicondylitis

A

ECRB test
Dec. grip strength (wrist extension required for strong gripping)
TTP anterior epicondyle

Tx: responds well to dorsal to volar HVLA at the wrist
Always R/O C2-C7 involvement
MWM also effective
Counter-force brace good for pain-free grip

P.T. > injection early on due to tendency to return to activity too soon after injection due to immediate relief

42
Q

Radial Tunnel Syndrome

A

Painless weakness through the EPL, EDM, supinator

43
Q

Normal grip strength

A

76 lbs. +/- 13 lbs. for setting goals (1N = .22 lbs)

44
Q

Medial Epicondylalgia

A

Weak flexors and pronators but grip strength not usually affected

45
Q

CPR for CTS (4+/5)

A

Age > 45
Shaking hands relieves symptoms
Wrist Ratio index > .67 (wrist width A/P divided by M/L)
Reduced median sensory field 1st digit (thumb sensation vs. thenar eminence)
Symptom severity scale >1.9

46
Q

Tendon glides

A

5 steps into making a fist:

Straight, hook, fist, tabletop, straight fist

47
Q

Nerve glides

A

6 steps into opening the hand followed by the thumb

48
Q

Wartenberg’s sign

A

Inability to Abduct 5th digit after finger have been passively spread (IO weakness)

49
Q

Martin-Gruber Anastomosis

A

Ulnar nerve to median nerve allows for funky patterns of regeneration as well as altered symptom distribution

50
Q

Axillary Nerve Palsy

A

Deltoid weakness and Teres Minor weakness caused by dislocation or surgical neck fracture

51
Q

LTN Palsy

A

Backpacker’s palsy, scapular winging due to SA weakness

52
Q

CNXI Palsy

A

Shoulder Sag due to trap weakness

53
Q

Carpal Bones (Radial to Ulnar)

A

*Some Lovers Try Positions That They Can’t Handle

Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate

54
Q

Lig. of Struther’s syndrome

A

PT Syndrome + PT Involvement (sensory and motor)

PT OCS Exam (8 decks)

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