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MSK 2 > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

what is the major contribution of the wrist complex?

A

To control the length tension relationships to allow fine adjustment of grip

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2
Q

how many carpal bones

A

8

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3
Q

phalange bases are convex or concave

A

concave

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4
Q

phalange heads are convex or concave

A

convex

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5
Q

MCP joint is loose in what position

A

extension

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6
Q

MCP joint is tight in what position

A

flexion

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7
Q

where is the volar plate

A

loosely attached to metacarpal and firmly attatched to the proximal phalanx.

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8
Q

when does the volar plate sldie

A

during flexion

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9
Q

what is the function of the volar plate

A

stability, allow for circumduction, and increases the extension at the MCP

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10
Q

what type of joint is the MCP joint

A

condyloid

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11
Q

what type of joints are the PIP and DIP joints

A

hinge

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12
Q

which has more mobility DIP or PIP

A

DIP (we get more mobile the distal we go)

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13
Q

function of the pulley systems in the hand

A

to keep efficiency of the tendons and prevent bowstrining

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14
Q

what innervates the dorsal and volar interossei

A

Deep branch of the ulnar nerve

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15
Q

what innervates lumbricals 1-2

A

median n

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16
Q

what innervates lumbricals 3-4

A

ulnar n

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17
Q

function of the lumbricals

A

extensor of the IP joints and flexor of the MCP joints

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18
Q

Lateral thenar muscles are innervated by what and do what

A
  1. median n

2. control fine positioning of the thumb

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19
Q

Medial thenar (adductor pollicis and deep head of FPB) muscles are innnervated by what nerve and do what

A
  1. Ulnar n

2. give thumb strength

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20
Q

function of palmar aponeurosis

A

protects underlying neruovascular and tendon structures

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21
Q

are flexor or extensor tendons more vulnerable

A

flexor

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22
Q

do flexor or extensor tendon heal with a lag

A

extensor

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23
Q

does the dorsal or palmar side of the hand have looser skin

A

dorsal

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24
Q

Functional position of the hand (where we tend to rest it)

A
  1. Wrist extended 20 degrees
  2. Ulnar deviation of 10 degrees
    - fingers joints slighly flexed
    - thumb at mid-range
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25
Q

most commonly dislocated carpal bone and most commonly fractured carpal bone

A

lunate, scaphoid

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26
Q

80% of compressive force of the wrist occurs thru what joint

A

radiocarpal

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27
Q

resting position of RC joint

A

neutral

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28
Q

closed packed position of the RC joint

A

extension

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29
Q

resting position of distal radioulnar joint

A

10 degrees of supination

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30
Q

closed packed position of distal radioulnar joint

A

5 degrees of supination

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31
Q

what is the primary stabilizer of the distal radioulnar joint

A

TFCC

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32
Q

what does the TFCC do

A

cushions and protects the ulna

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33
Q

is the TFCC thicker or thinner on the inside

A

thinner (thicker on the outside)

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34
Q

where does most of the motion come from in wrist flex

A

midcarpal joint

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35
Q

where does most motion occur with wrist extension

A

at the radiocarpal joint

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36
Q

ulnar deviation occurs with wrist flex or ext

A

flex

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37
Q

radial deviation occurs with wrist flex or ext

A

ext

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38
Q

most radial deviation comes from where

A

radiocarpal joint

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39
Q

most ulnar deviation comes from where

A

midcarpal joint

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40
Q

true or false: full ROM of forearm rotation (supination and pronation) is limited with full elbow extension bc the olecranon becomes fixed in the hinge

A

true

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41
Q

where would suspect the issue to be if there is pain with wrist flex and/or ulnar dev

A

midcarpal joint

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42
Q

where would you suspect the issue to be if there is pain with wrist ext and/or radial deviation

A

radiocarpal joint

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43
Q

Pain with grasp or loading may indicate what type of pathology

A

TFCC pathology

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44
Q

function of the extensor retinaculum

A

to prevent bowstrining of the extensor tendons

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45
Q

what two tendons are in extensor compartment 1?

A

Abductor pollicis longus

Extensor pollicis brevis

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46
Q

which dorsal compartment does Dequarvains occur in and what two tendons are affected

A

1,
Abductor Pollicis longus
Extensor Pollicis brevis

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47
Q

which two dorsal compartments does intersection syndrome occur in

A

1 and 2 (the intersection of these two)

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48
Q

which dorsal compartment does EPL insert into and is the site of Drummer’s wrist/EPL tenosynovitis

A

3rd

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49
Q

which dorsal compartment does EDC tendosynotivits occur in

A

4th

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50
Q

purpose of the flexor retinaculum (aka transverse carpal ligament)

A

to preposition tendons for power and creates the tunnel for the carpal tunnel

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51
Q

conservative management for DeQuervain’s

A

1.) thumb spica
2.) 1st dorsal compartment stretches (gently)
3.) anti inflammatory
4.) soft tissue mobs
5

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52
Q

what two tendons are invovled with intersection syndrome

A

ECRL and ECRB

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53
Q

is pain more ventral or dorsal with intersection syndrome compared to DeQuervains

A

dorsal

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54
Q

where does OA of the thumb most often occur

A

at the CMC/TMCJ (more force proximally at the thumb than distally)

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55
Q

clinical signs of OA of the CMC/TMCJ

A
  • TTP at base of 1st metacarpal
  • pain with ROM, sustained pinch/grasp,
  • squaring or boxing of the 1st metacarpal head
  • dorsal subluxation of the CMC/TMCJ
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56
Q

test for OA at the thumb

A

grind test (axial compression with rotation and shift of the 1st metacarpal on the trapezium)

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57
Q

treatment for OA of the thumb

A
  1. pain relief is #1 goal
  2. functional ROM
  3. modalities (heat)
  4. ) protective/positional splinting for stablization
58
Q

what is a Bennet’s fracture?

A

fracture or dislocation of the 1st MC base

59
Q

what is a Rolando’s fracture?

A

communited intraarticular fracture of the 1st metacarpal base (3+ fragments)

60
Q

what is gamekeeper’s (skier’s) thumb?

A

insufficiency of the UCL of the MCP joint of the thumb

61
Q

Most common MOI for UCL tear/gamekeeper’s thumb

A

hyperextension of the MCP

62
Q

what is trigger thumb

A

thickening of the FPL tendon or A1 pulley at the pulley site

basically a nodule of the tendon/restriction in the pulley that does not allow for normal excursion and glide of the FPL

63
Q

what would suspect if someone had clicking at the IPJ of the thumb

A

Trigger thumb/stenosing tenosynovitis

64
Q

what can trigger thumb progress to

A

locking of the IPJ into flexion or lack of adequate IPJ flexion

65
Q

what pulley is the issue with trigger thumb

A

A1

66
Q

true or false: elevated tunnel pressure can lead to carpal tunnel syndrome

A

true

67
Q

true or false: flexor tendon synovial thickening causes pressure to increase within the carpal tunnel and can lead to CTS

A

true

68
Q

true or false: elevated BP can lead to CTS

A

true

69
Q

does CTS occur more often in men or women

A

women

70
Q

name some risk factors for CTS

A
  1. obesity
  2. diabetes
  3. OA
  4. family history
  5. CV issues
  6. age over 50
71
Q

what is the strongest link to CTS

A

forceful hand exertion (lots of gripping and repeitive work)

72
Q

best reliability and diagnositic accuracy when patient shades where in their body chart? (THIS WILL BE A TEST QUESTION)

A

Volar middle finger

73
Q

true or false: short. wide hands are more at risk for CTS

A

true

74
Q

what muscle can lose bulk with CTS

A

Abductor Pollicis Brevis

75
Q

describe the carpal compression test

A

direct compression to median nerve and then hold for 30 seconds and see if pain and numbness occurs

76
Q

is there added value of doing a nerve conduction study if both phalen’s and tinel is postiive

A

no

77
Q

does grip strength improve following CTS surgery

A

no

78
Q

what is the purpose of conservative management with CTS

A

to reduce compression on median nerve, decrease demands on hand/wrist and reduce inflammation

79
Q

what type of wrist position should be used with CTS

A

neutral

80
Q

warm or cold for CTS

A

warm

81
Q

phono or ionto for CTS

A

phono

82
Q

how long to see improvment in CTS with conservative care

A

6-12 wks

83
Q

indications for surgical tx

A
  1. thenar atrophy
  2. sensory loss
  3. sx presist longer than a year
84
Q

Post op Precautions for CTS (ON TEST!!)

A
  1. avoid active wrist flex past neutral for 10-14 days post op
  2. avoid finger flexion with wrist flexion
  3. use extreme caution for first 3 weeks to prevent bowstrining of flexor tendons
85
Q

position of max grip strength

A
  • 35 degrees of wrist ex

- 7 degrees of ulnar deviation

86
Q

ability to identify a number traced on the hand

A

graphesthesia

87
Q

ability to distinguish between various shapes or textrues by touch

A

sterognosis

88
Q

ability to distinguish between different weight

A

barognosis

89
Q

what measures constant touch

A

Semmes Weinstein

90
Q

most sensitvie clinical test for detecting nerve compression

A

Semmes-Weinstein

91
Q

when will nocturnal CTS symptoms be the worst

A

when wrist is in a flexed positon

92
Q

how is CTS surgery done

A

open incision. division of the transverse carpal ligament

93
Q

what is the main issue that is seen with Dequervain’s

A

pinching and grasping

94
Q

what is a Dupurtens contractrue

A

fibro proliferation of the palmar aponeurosis. seen in white men over the age of 40. a flexion contracture of the palmar fascia occurs

95
Q

what happens in a colles fracture

A

the lunate strikes the distal radius and the distal end of the radius is what shears

96
Q

Tx for colles fracture

A

surgery. immobilized for 6-8 weeks, then splint another 6-8 weeks.

97
Q

true or false: edema management to prevent CTS from occuring is key in someone who has a colle’s fx

A

true; edema can lead to CTS

98
Q

complications that can occur with a colle’s fracture

A
  1. CTS
  2. Shortened Radius
  3. Complex Regional Pain Syndrome (CRPS)
99
Q

true or false: scaphoid fracture can lead to AVN

A

true

100
Q

positive Watson’s test (scaphoid shift test) will be seen with people who have what

A

scaphoid fracture OR scaphoid instability

101
Q

is the proximal or distal part of the scaphoid most a t risk for AVN following a scaphoid fx

A

proximal

102
Q

will ORIF or thumb spica allow someone to recover faster following scaphoid fx

A

ORIF

103
Q

how long will someone be in a spica with ORIF following a scaphoid fx

A

8 weeks (can begin strengtheing at 10 weeks)

104
Q

when can someone begin strengenthening following a scaphoid fracture if ORIF was done

A

10 weeks

105
Q

when can someone begin strengthening if a thumb spica is used for a scaphoid fx (no ORIF)

A

18 weeks

106
Q

what is the primary stabilizer of the DRUJ

A

TFCC

107
Q

true or false: the TFCC has poor central vascularity

A

true

108
Q

true or false: the TFCC has good central vascularity

A

false

109
Q

true or false: the TFCC has poor peripheral vasculaitty

A

false (good peripheral vascularity)

110
Q

what would you suspect if someone has ulnar sided wrist pain or crepitus with rotation/grip/ulnar deviation

A

TFCC injury

111
Q

what zone do flexor tendon injuries occur in

A

zone 2

112
Q

MOI for flexor tendon injuries

A

trauma

113
Q

what zone is the biggest and most difficult to repair

A

zone 2

114
Q

Immobilization protocol for flexor tendon injury

A

-dorsal blocking splint in neutral wrist for 6 weeks allowing only PROM into flexion while in brace for 4 weeks; full hand use 12 weeks

115
Q

early passive protocol for flexor tendon injury

A

dorsal blocking splint with wrist flexed. active ext at 5 weeks; begin active flexion at 5 weeks

116
Q

early active protocol for flexor tendon injury

A

dorsal blocking splint with wrist flexed. Allow active flexion within 24-48 hours

117
Q

which protocol is best for allowing increased strength sooner but can only be done if there is a clean repair (in regards to flexor tendon injuries)

A

early active

118
Q

what tendon is inovled with mallet finger

A

Extensor Digitorum Longus (EDL)

119
Q

true or false: extensor tendon injuries come from trauma

A

false (execept for mallet finger)

120
Q

which zone does mallet finger occur in

A

zone 1

121
Q

Result of tendon avulsion of EDL where it inserts into distal phalanx

A

Mallet finger

122
Q

finger unable to extend due to EDL injury (unopposed pull of flexor digitorum)

A

Mallet finger

123
Q

post op management for Mallet finger with an avulsion fx

A

Splint for 6-8 weeks. Night splint for another 4-6 weeks

124
Q

post op management for Mallet finger without fracture

A

Immoblization of DIP in slight hyperextension for 6-8 weeks. Night splint for another 4-6 weeks

125
Q

Closed Mallet finger deformity at the DIP can lead to what at the PIP due to secondary compensations

A

Swan neck at the PIP

126
Q

true or false: zone 2 injuries are secondary to a laceration or crush injury

A

true

127
Q

what zone do Boutonniere and Swan Neck deformities occur in

A

zone 3

128
Q

what is it called when the PIP is in flexion and the DIP is in hyperextension

A

Boutonniere Deformity

129
Q

what is it called when the pull of the extensor tendon is below the joint line

A

Boutonniere Deformity

130
Q

what is the causes for a Boutonniere Deformity

A

Disruption of central slip at PIP

131
Q

what is it called when there is hyperextension at the PIP and flexion of the DIP

A

Swan neck deforomity

132
Q

is Swan neck or Boutonniere more common with RA

A

Swan Neck

133
Q

what is the MOI for a Boutonniere Deformity

A

involuntary forceful flexion on an actively extended finger

134
Q

what is the cause for a Swan Neck Deformitty

A

overly forceful intrinsice muscle contraction transmiting abnormally high forces thru the central slip, hyperextending the PIP

135
Q

a tri point splint should be used for what

A

Swan neck deformity

136
Q

most common place to see OA in the hand

A

CMC of the thumb

137
Q

when is wrist arthroplasty most often used

A

late stage RA to improve ulnar drift

138
Q

true or false: trigger finger is caused by size disparity in flexor tendons and pulley system

A

true

139
Q

what is progressive fibrosis of the palmar fascia

A

Dupuytren’s contracture

140
Q

true or false: Dupuytren’s contractures can become chronic and fixed

A

true

141
Q

what type of contracture do Dupuytren’s contractures casue

A

flexion contracture of the MCP joint. can lead to PIP joint contracture

142
Q

things to rule out with Dupuytren’s contracture

A

trigger finger and arthtiris

MSK 2 (3 decks)

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