Exam 2 Flashcards
Inflammation or tendonosis of the sheath of the tendons in the first extensor compartment
DeQuervain’s Tenosynovitis
Symptoms of DeQuervain’s Tenosynovitis include pain on which side of the thumb when pinching or grasping objects
radial side
What muscles are in the 1st dorsal extensor compartment
Abductor pollicus longus and extensor pollicis brevis
Test where you grab the MC and compress/push down and grind the joint
CMC grind test
What muscles are in the 2nd dorsal extensor compartment
ECRL and ECRB
What muscles are in the 3rd dorsal extensor compartment
EPL
What muscles are in the 4th dorsal extensor compartment
EDC and Extensor Indicis Proprius
What muscles are in the 5th dorsal extensor compartment
Extensor Digiti Minimi
What muscles are in the 6th dorsal extensor compartment
Extensor Carpi Ulnaris
Test for 1st compartment tenosynovitis/DeQuervain’s where the pt performs flexion of thumb grasped with fingers and ulnarly deviates
Finkelstein’s Test
Causes of DeQuervain’s
Frequently results from repetitive motion
Could also result from blunt trauma to the styloid process
Overuse and improper mechanics of gripping and wringing
PREGNANCY-Prolactin
Sxs of DeQuervain’s
Pain with grasp/release activities near base of thumb
Edema near base of thumb
Decreased range of motion: specifically in thumb flexion
What type of splint can be used with DeQuervain’s or Intersection Syndrome
Thumb Spica. Wrist 15º extension, thumb MP 10º flexion; thumb MCP midway between palmar and radial abduction
Tensosynovitis of second dorsal compartment where the first dorsal compartment crosses it in the radial dorsal 4 arm
Intersection Syndrome
Patient education for intersection syndrome should include:
Avoid repetitive wrist flexion and extension with combined power grip
what type of ultrasound would you use for acute condition
pulsing
what type of ultrasound would you use for chronic condition
continuous
what 2 sources supply the tendon nutrition
Intrinsic: Vascular perfusion.
Extrinsic: Diffusion from synovial fluid.
intrinsic nutrition for the tendon comes form what artery
common digital artery
The vascular supply is mainly on the _____ side of the tendons
dorsal
What actually supplies the blood to the tendon intrinsically
vinculi
Extrinsic nutrition is provided by ______ diffusion
synovial fluid
Name where the profundus comes up through the (forking) bifurcation of the FDS
Camper’s Chiasm
Impairment to the pulley system will cause _______
bowstrining
How many zones are on the flexor side
5
Flexor Zone 1 extends from the ______ to the _____ of the middle phalanx
fingertip, midportion
In flexor zone 1, the _____ muscle is involved. A laceration causes inability to bend tip of finger
Flexor digitorum profundus
An injury to flexor Zone 1 is called _______
jersey finger
laceration of the flexor digitorum profundus (FDP) leading to inability to flex at the DIPJ
jersey finger
Flexor Zone 2 extends from the midportion of the ____ phalanx (FDS Insertion) to the ___________
middle, distal palmar crease
Flexor Zone 3 extends from the ________ to the distal portion of the ___________
distal palmar crease, transverse carpal ligament
Flexor Zone 4 overlies the ________________
transverse carpal ligament
Flexor Zone 5 extends from the _____ to the level of the musculotendinous junction of the flexor tendons
wrist crease
Flexor Zone 1 of Thumb (T1) contains which muscle
FPL
Flexor Zone 2 of Thumb (T2) contains which muscle
PBL and FPB
When does primary repair happen for surgical tendon repairs
Within the first 2 weeks
What is the optimal time for repair of the flexor tendons
within 24 hours (and definitely within 2 weeks)
What type of repair would occur if the tendon ends and tendon sheaths become scarred,
The musculotendinous units retract.
secondary repair
An immobilized tendon(one that was in a cast) is __% weaker day 5-10 than at day one of repair
50
Estimated core suture tensile strength decreases by __% by the end of week one
50
Tendon repair is at its weakest day __-___
10-12
Ends of a repaired tendon take about __ days to stick together
21
3 main approaches to hand rehab
Controlled mobilization
Early active mobilization
Immobilization
Precautions before therapy: instruct patient to NEVER bend ___ by themselves – only bend them using uninjured hand.
NEVER make a ____ with injured hand.
NEVER ____ anything using injured hand.
NEVER ____ fingers using uninjured hand.
fingers, fist, pick up, straighten
After 6 weeks, wristband is discontinued. instruct patient NOT to:
___ anything with injured hand.
__ any heavy objects.
Push. lift
What is the major problem with Kleinert Protocol
PIP Flexion Contractures
Seddon Nerve classification where: Axon is preserved No wallerian degeneration Local demylenation Local conduction block Full recovery expected
Neuropraxia=Myelinopathy
Seddon Nerve classification where: Interruption of axons / myelin sheath
Wallerian Degeneration
Good Prognosis
Healing through axonal
sprouting guided by the Neural tube
Axonotmesis=Axonopathy
Seddon Nerve classification where:
Loss of axon and endoneurial tube continuity. Nerve completely severed.
Most severe type of nerve injury. May require surgical intervention.
In surgery they check to see if they can get firing of the muscle tissue at the end plate for motor nerves. If the muscle doesn’t fire the prognosis is worsened. Muscles atrophy and develop fatty striations and fibrosis.
Neurotmesis: Seddon Stage III=Severance
Prognosis better for ____ return than ____
sensory, motor
