Exam 5: Wrist and Hand Flashcards
The hand is involved in approximately 90% of upper limb function (true/false)
true
Which finger is the most involved in hand function?
a. thumb
b. index finger
c. middle finger
d. little finger
thumb
Which styloid is shorter?
a. radial styloid
b. ulnar styloid
ulnar styloid
Which side has more deviation?
a. radial deviation
b. ulnar deviation
ulnar deviation
Which ligament holds the extensor mechanism at the PIP joint?
a. Oblique retinacular ligament
b. Ulnar collateral ligament
c. Radial collateral ligament
d. Transverse retinacular ligament
Transverse retinacular ligament
The volar plate attaches to the
a. Distal phalanx
b. Proximal phalanx
proximal phalanx
What serves as an attachment for the thenar and hypothenar muscles?
a. Extensor hood
b. Extensor retinaculum
c. Flexor retinaculum
d. ulnar collateral ligament
flexor retinaculum
The flexor retinaculum serves to protect which nerve?
a. Radial nerve
b. Median nerve
c. Ulnar nerve
d. axillary nerve
median nerve
What carpal ligaments provide the majority of wrist stability?
a. Intrinsic ligaments
b. Extrinsic ligaments
c. Collateral ligaments
d. Retinacular ligaments
Extrinsic ligaments
What carpal ligaments serve as a rotation restraint?
a. Intrinsic ligaments
b. Extrinsic ligaments
c. Collateral ligaments
d. Retinacular ligaments
Intrinsic ligaments
The function of the extensor hood is to
a. provide stability for the lumbricals
b. serve as a protection
c. Allow the lumbricals to assist in the flexion of the MP joints
d. assist in finger and wrist extension
Allow the lumbricals to assist in the flexion of the MP joints
The Transverse Carpal Ligament or flexor retinaculum functions to
a. absorb force to the palmar side of the hand
b. Help maintain the transverse carpal arch and protect the median nerve
c. protects the ulnar nerve
d. protect the palmar surface
Help maintain the transverse carpal arch and protect the median nerve
The function of the triangular fibrocartilage complex (TFCC) is to
a. Improve joint congruency
b. Cushion against compressive forces
c. protect the distal radius and ulna
d. a and b
Improve joint congruency
Cushion against compressive forces
A condition in which ordinarily nonpainful stimulus evokes pain
a. Allodynia
b. Hyeralgesia
c. Hyperesthesis
d. Hyperpathia
Allodynia
Excessive sensitivity to pain describes
a. Allodynia
b. Hyperalgesia
c. Hyperesthesia
d. Hyperpathia
Hyperalgesia
Unusual increased or altered sensitivity to sensory stimuli
a. Allodynia
b. Hyperalgesia
c. Hyperesthesia
d. Hyperpathia
Hyperesthesia
Increased reaction to a stimulus, especially a repetitive stimuli
a. Allodynia
b. Hyperalgesia
c. Hyperesthesia
d. Hyperpathia
Hyperpathia
At what stage of CRPS is there marked wasting of tissue and it may become irreversible?
a. Stage I
b. Stage II
c. Stage III
Stage III
At what stage of CRPS does muscle wasting begin and this stage will last for 3-6 months?
a. Stage I
b. Stage II
c. Stage III
Stage II
What is the function of the pulley system?
to prevent bowstringing
What transmits a load from the hand and forearm?
Triangular Fibrocartilage Complex (TFCC)
Which nerve radiates on the dorsal surface from the thumb to the middle of the ring finger?
a. median nerve
b. radial nerve
c. ulnar nerve
d. axillary nerve
radial nerve
Which nerve radiates on the dorsal and palmar surface in the pinky and half of the ring finger?
a. radial nerve
b. median nerve
c. ulnar nerve
d. digital nerve
ulnar nerve
Which nerve radiates on the palmar side from the part of the thumb to the lateral side of the ring finger?
a. radial nerve
b. ulnar nerve
c. median nerve
d. axillary nerve
median nerve
What motion is limited by the interosseous membrane and the bony impaction between the notch of the radius and the ulnar styloid process?
a. pronation
b. supination
c. flexion
d. extension
supination
What motion is limited by bony impaction between the radius and ulna?
a. pronation
b. supination
c. flexion
d. extension
pronation
What motion is limited by impact of the scaphoid onto the radial styloid and the UCL?
a. ulnar deviation
b. radial deviation
c. pronation
d. supination
radial deviation
The functional arches of the hand allow for the fingers/thumb to
hold objects in the hand
Which functions to maintain the constant relationship between the tension and joint axis to provide for max joint motion within the limits of the muscle excursion?
a. pulley system
b. extensor mechanism
c. flexor retinaculum
d. TFCC
pulley system
What two pulleys are critical for creating composite flexion?
a. A1 and A2
b. A2 and A3
c. A2 and A4
d. A1 and A3
A2 and A4
A pain syndrome triggered by a noxious event that is not limited to a single peripheral nerve
CRPS Type I: RSD
What clinical characteristics can be seen with CRPS?
pain allodynia hyperalgesia hyperesthsia hyperpathia
What SNS changes are common with CRPS?
swelling
abnormal color or temp
sweating
trophic changes
At what stage of CRPS is pain limited to the site of the injury?
a. stage I
b. stage II
c. stage III
stage I
At this stage of CRPS there is increased sensitivity of skin to touch and light pressure
a. stage I
b. stage II
c. stage III
stage I
Patient is experiencing muscle cramps, stiffness and limited mobility, sensitive to touch, skin is warm, red and dry. What stage of CRPS?
a. stage III
b. stage II
c. stage I
stage I
Patient presents with pain that is diffuse, swelling has become hard, muscle wasting is seen. What stage of CRPS?
a. stage III
b. stage II
c. stage I
stage II
Patient presents with marked wasting of tissue that may be irreversible. What stage of CRPS?
a. stage III
b. stage II
c. stage I
stage III
RSD is more (regional/focused) and Causalgia is more (regional/focused)
RSD regional
Causalgia focused
This type of treatment may provide a permanent cure or partial remission and blocks the SNS
sympathetic block
A sympathetic block will provide
prognostic info about potential merits of other treatments
Sympathectomy is for (acute/chronic) patients with intractable sympathetic (intermittent/maintained) pain
and have responded _ to _
chronic intractable sympathetic maintained pain and have responded favorably to a series of blocks
This type of treatment for CPRS is an implantation of an electrode using low intensity impulses along the spinal cord
spinal cord stimulation
with CRPS patients it is important to immobilize (true/false)
false
do NOT immobilize
Prognosis of CRPS is _ for stage I or intervention has begun 3-6 months after onset
good
Prognosis of CRPS is _ for stage II or intervention has begun 6-12 months after onset
variable
Prognosis of CRPS is _ for stage III or intervention has begun 1 year after onset
poor
Patient presents with pain over the radial styloid process with gripping activities, what is your initial hypothesis?
a. Capral Tunnel
b. DeQuervain Syndrome
c. Ulnar Nerve compression
d. Dupuytren
DeQuervain Syndrome
Patient reports an insidious onset of numbness and tingling in the first 3 fingers, and possible report of worse pain at night, what is your initial hypothesis?
a. Capral Tunnel
b. DeQuervain Syndrome
c. Ulnar Nerve compression
d. Dupuytren
Capral Tunnel Syndrome
Patient reports of paresthesias over dorsal aspect of ulnar border of hand and finger 4-5, what is your initial hypothesis?
a. Capral Tunnel
b. DeQuervain Syndrome
c. Ulnar Nerve compression at canal of Guyon
d. Dupuytren
Ulnar Nerve Compression at canal of Guyon
Patient reports inability to extend MCP or IP joint, what is your initial hypothesis?
a. Capral Tunnel
b. DeQuervain Syndrome
c. Ulnar Nerve compression
d. Dupuytren or trigger finger
Dupuytren or trigger finger
Patient reports of falling on hand with wrist hyperextended, reports of pain with loading of wrist, what is your initial hypothesis?
a. Carpal Tunnel
b. Scaphoid fracture or carpal instability
c. radial fracture
d. ulnar nerve compression
scaphoid fracture or carpal instability
Trigger finger is a _ of the _ tendon sheath
thickening
flexor tendon
What can result in trigger finger?
repetitive trauma
_ on the tendon and thickening of the _ = trigger finger
nodules
annular pulley
Which finger is the most common to get a trigger finger?
a. index
b. middle
c. ring
d. thumb
thumb
Trigger fingers are more common in males (true/false)
false
females
Trigger fingers are associated with
RA
Dupuytren’s
Diabetes
With trigger finger, the patient will have pain at the _ joint of the finger or MP of the thumb
a. DIP
b. PIP
c. CMC
d. IP
PIP
In trigger finger, it will lock in a _ or _ position
flexed or extended position
A palpable nodule is found at the _ pulley with trigger finger
A1
Non-operative options for trigger finger
steroid injection
return to normal activities
splinting
Patient with trigger finger can return to activities when?
a. 1 week
b. 10 days
c. 2 weeks
d. 3 weeks
3 weeks
Which of the following is described as a dorsal displacement of distal radius “dinner fork” deformity?
a. Colles fracture
b. Smith fracture
c. scaphoid fracture
d. ulna fracture
Colles fracture
What is the MOI for a Colles fracture?
FOOSH
in a Colles fracture, the wrist is _ with a _ hand
hyperextended and pronated hand
Which of the following describes a complete fracture of the distal radius with volar displacement of the distal fragment?
a. Colles fracture
b. Smith fracture
c. scaphoid fracture
d. ulna fracture
Smiths fracture
Smiths fracture is with the wrist _ during injury
flexed
What is the most commonly fractured bone in the wrist?
a. radius
b. scaphoid
c. phalanges
d. metacarpals
scaphoid
For a scaphoid fracture, it is common to immobilize in a _ cast for 6 weeks followed by 6 weeks in a _ cast
long arm thumb spica
short arm cast
If there is still a non-union after a scaphoid fracture at _ weeks, will undergo ORIF
a. 6 weeks
b. 3 weeks
c. 8 weeks
d. 12 weeks
12 weeks
Which type of management is immobilization in a long arm thumb spica or short arm thumb spica cast with the wrist in slight extension and radial deviation?
a. waist
b. proximal pole
c. distal third
d. tuberosity
proximal pole
Which type of management is immobilization in a short arm thumb spica cast for 6-8 weeks?
a. waist
b. proximal pole
c. distal third
d. tuberosity
distal third
Which of the following types of management is immobilization in a long or short arm thumb spica for 5-6 weeks?
a. waist
b. proximal pole
c. distal third
d. tuberosity
tuberosity
It is more common for the elderly population to have metacarpal fractures (true/false)
false
younger more active
Which of the following is described as progressive tenosynovitis which affects the tendon sheath of the 1st dorsal compartment of the wrist resulting in a thickening of the extensor retinaculum causing compression and entrapment of the associated tendons?
a. Tendonitis
b. Dequervain’s
c. Trigger Finger
d. Tenosynovitis
Dequervain
A patient with Dequervain’s Tenosynovitis will have pain where?
a. ulnar side of the wrist
b. down the center of the hand
c. radial aspect of the wrist and may radiate into the thumb or forearm
d. on the dorsal side of the hand
radial aspect of the wrist and may radiate into the thumb or forearm
A patient has pain with activities such as gripping, holding, and twisting, what would you assume they might be diagnosed with?
a. Trigger Finger
b. Fracture
c. Dequervain
d. Ganglion cyst
Dequervain’s
Therapy for Dequervain’s can include mobilization with _
_ glide of carpals
movement
radial glide of carpals
When can patients with Dequarvains expect to return to activities?
a. 6-8 weeks
b. 4-5 weeks
c. 4-6 weeks
d. 8-10 weeks
6-8 weeks
A patient presents with a swelling on the dorsal or volar surface of the wrist and has a recent history of wrist sprain, which of the following could they have?
a. Trigger Finger
b. Fracture
c. Dequervain
d. Ganglion cyst
Ganglion cyst
With a Ganglion cyst, a visible nodule will be on the _ surface of the wrist
dorsal or volar
Carpal Tunnel can be due to
trauma overuse disease (RA, DM, Gout) pregnancy use of crutches chronic pressure (cyclists) jackhammers (vibration)
Patient is experiencing pain and paresthesias in the median nerve distribution, what can they be diagnosed with?
a. Ganglion cyst
b. Dequervain
c. Carpal Tunnel
d. none of the above
Carpal Tunnel Syndrome
Onset of symptoms with Carpal Tunnel is insidious (true/false)
false
gradual
Patient is experiencing pain in their wrist at night and it feels stiff in the morning, so they shake it to make it feel better. What is their diagnosis?
a. Ganglion cyst
b. ulnar nerve compression
c. Dupuytren
d. Capral Tunnel
Carpal Tunnel Syndrome
Thenar atrophy may be seen with Carpal Tunnel Syndrome (true/false)
true
Resistive testing to test for Carpal Tunnel will find
a. weak distally
b. weak proximally and distally
c. weak proximally and normal distally except for grip and pinch
d. strong distally and proximally
weak proximally and normal distally except for grip and pinch
What ULNT test will be positive for Carpal Tunnel?
a. ULNT 1
b. ULNT 2a
c. ULNT 2b
d. ULNT 3
ULNT1 or ULNT2a
After carpal tunnel surgery, when can tendon glides start?
a. 5 days
b. 3 days
c. 1 week
d. 2 weeks
3 days
When can strengthening and nerve gliding begin after carpal tunnel surgery?
a. 1 week
b. 2 weeks
c. 3 weeks
d. 4 weeks
3 weeks
What are the 3 types of pinch to test?
tip pinch
3-point
key pinch or lateral pinch
This type of test is when you grab the first metatarsal and load it down into the bone, what test is this?
a. Gamekeepers
b. Finkelsteins
c. Scaphoid compression
d. Phalens
Scaphoid compression
A positive Scaphoid compression test will indicate
a. tingling
b. weakness
c. sensitivity
d. pain
pain
Snuff box tenderness is positive if the patient experiences
reproduces symptoms
Gamekeepers test is used to test for
a. scaphoid fracture
b. tenosynovitis
c. instability
d. carpal tunnel
thumb instability
The therapist will hold the thumb into extension and apply a valgus stress to the MCP joint to stress the ulnar collateral ligament, which test is this describing?
a. Gamekeeprs
b. Finkelsteins
c. Phalens
d. Scaphoid compression
Gamekeepers
A positive Gamekeepers test can be indicated by
a. numbness and tingling
b. gaping of the joint and pain
c. pain
d. weakness
gaping of the joint and pain
The patient makes a fist with the thumb inside the fingers then ulnarly deviates, the therapist will resist. What test is this describing?
a. Gamekeeprs
b. Finkelsteins
c. Phalens
d. Scaphoid compression
Finkelsteins
A positive Finkelsteins test will be indicated by
a. weakness
b. pain
c. inability to flex fingers
d. tingling
pain
For this test the patient will bend their elbow and flex their wrists then hold it for 60 seconds, what test is this?
a. Gamekeeprs
b. Finkelsteins
c. Phalens
d. Scaphoid compression
Phalens
What is the most common test used for carpal tunnel?
Phalen’s
A positive Phalens test will be indicated by
a. pain in the thumb
b. tingling
c. reproduced symptoms along median nerve distribution
d. reproduced symptoms along ulnar nerve distribution
reproduced symptoms along median nerve distribution
Which test is a tap of the fingers on the median distribution of the arm?
a. Finkelsteins
b. Phalens
c. Tinel test
d. Median Nerve compression
Tinel test
Which 3 tests are very similar and involve compressing on the median nerve?
Tinel test
Median nerve compression
Median nerve compression/pressure provocation test
For this test compress on the median nerve between the flexor carpi radialis and palmaris longus and hold for 15 seconds to 2 minutes
a. Tinel test
b. medial nerve compression/pressure provocation test
c. median nerve compression
d. Phalens test
medial nerve compression/pressure provocation test
What does a positive medial nerve compression/pressure provocation test produce?
symptoms along median nerve distribution
A positive two-point discrimination test will be indicated by
a. inability to feel 4 mm or more
b. inability to feel 1 mm or more
c. inability to feel 2 mm or more
d. inability to feel 6 mm or more
inability to feel 6 mm or more
A Semmes Weinstein test is used to test for
a. carpal tunnel syndrome
b. scaphoid fracture
c. wrist instability
d. cubital tunnel syndrome
carpal tunnel syndrome
A positive Semmel Weinstein test is indicated by
feeling the monofilament at 2.83 milligram
This test is completed by the patient raising their hands over their head and flexing their wrists for 2 minutes
a. phalens
b. hand elevation
c. Tinel test
d. Finkelsteins
Hand Elevation
The hand elevation test is used to test for
a. carpal tunnel syndrome
b. scaphoid fracture
c. wrist instability
d. cubital tunnel syndrome
carpal tunnel syndrome
the carpal compression test is pressure on the median nerve holding for _
30 seconds
Wrist extension test is
putting hands together in wrist extension in front of chest
Wainner’s clinical prediction rule for CTS is 2 or more of
hand shaking improving symptoms wrist ratio > 0.67 SSS score > 1.9 decrease in sensation of median nerve over thumb age > 45
Joint mobilizations for the wrist and hand
a. not suppose to mobilize the wrist and hand
b. only 3 or 4
c. only 1 and 2
d. only 1’s
only 3 and 4
Which soft tissue release is when you wrap your hands around their palm and with fingernails touching you push out and spread the hand
a. TCL spread
b. palmar raking
c. tendon mobilization under TCL
d. pronator teres release
TCL spread
Which soft tissue release is putting the fingers between theirs and pulling on the palmar fascia
a. TCL spread
b. palmar raking
c. tendon mobilization under TCL
d. pronator teres release
palmar raking
Which soft tissue release is putting pressure on ligament then sliding tendons underneath ligament?
a. TCL spread
b. palmar raking
c. tendon mobilization under TCL
d. pronator teres release
tendon mobilization under TCL
What does a pronator teres release help to improve?
median nerve pain
for soft tissue release, how long should it be held?
3-5 seconds
3-5 times
soft tissue release should go from (proximal to distal/distal to proximal)
distal to proximal
Where is the tunnel of gyon located?
superficial to the flexor retinaculum, between the hook of the hamate and the pisiform bones
What is the function of the tunnel of gyon?
passageway for the ulnar nerve
artery into the hand
The extensor mechanism creates a cable system that extends the _ and _
MPs and IPs
What allows for a lumbrical grip?
extensor mechanism
radial deviation occurs between _ and _
proximal and distal rows
ulnar deviation occurs
primarily at the radiocarpal joint
What are the arches of the hand?
transverse
longitudinal
Does the moment arm increase or decrease when bowstringing happens?
increase
What is the diagnostic criteria for CRPS?
initiating noxious event or cause of immobilization
pain, allodynia, hyperalgesia - disproportionate to event
edema, change in skin BF
rule out everything else
What can be seen with mild cases of CRPS in the first stage?
lasts a few weeks
subsides spontaneously
responds rapidly to treatment
What is the cornerstone of treatment for RSD?
normal use of the affected part as much as possible
AROM should be performed immediately after operative treatment for trigger finger (true/false)
true
Your patient has pain with gripping, holding, and twisting activities, there is swelling over the 1st dorsal compartment and pain with active, passive, and resistive testing. What is his diagnosis?
Dequervains
When can you start doing nerve glides after carpal tunnel surgery?
3 weeks
