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Management of MS Disorders > Exam 5: Wrist and Hand > Flashcards

Exam 5: Wrist and Hand Flashcards

1
Q

The hand is involved in approximately 90% of upper limb function (true/false)

A

true

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2
Q

Which finger is the most involved in hand function?

a. thumb
b. index finger
c. middle finger
d. little finger

A

thumb

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3
Q

Which styloid is shorter?

a. radial styloid
b. ulnar styloid

A

ulnar styloid

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4
Q

Which side has more deviation?

a. radial deviation
b. ulnar deviation

A

ulnar deviation

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5
Q

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

A

Transverse retinacular ligament

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6
Q

The volar plate attaches to the

a. Distal phalanx
b. Proximal phalanx

A

proximal phalanx

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7
Q

What serves as an attachment for the thenar and hypothenar muscles?

a. Extensor hood
b. Extensor retinaculum
c. Flexor retinaculum
d. ulnar collateral ligament

A

flexor retinaculum

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8
Q

The flexor retinaculum serves to protect which nerve?

a. Radial nerve
b. Median nerve
c. Ulnar nerve
d. axillary nerve

A

median nerve

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9
Q

What carpal ligaments provide the majority of wrist stability?

a. Intrinsic ligaments
b. Extrinsic ligaments
c. Collateral ligaments
d. Retinacular ligaments

A

Extrinsic ligaments

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10
Q

What carpal ligaments serve as a rotation restraint?

a. Intrinsic ligaments
b. Extrinsic ligaments
c. Collateral ligaments
d. Retinacular ligaments

A

Intrinsic ligaments

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11
Q

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

A

Allow the lumbricals to assist in the flexion of the MP joints

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12
Q

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

A

Help maintain the transverse carpal arch and protect the median nerve

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13
Q

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

A

Improve joint congruency

Cushion against compressive forces

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14
Q

A condition in which ordinarily nonpainful stimulus evokes pain

a. Allodynia
b. Hyeralgesia
c. Hyperesthesis
d. Hyperpathia

A

Allodynia

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15
Q

Excessive sensitivity to pain describes

a. Allodynia
b. Hyperalgesia
c. Hyperesthesia
d. Hyperpathia

A

Hyperalgesia

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16
Q

Unusual increased or altered sensitivity to sensory stimuli

a. Allodynia
b. Hyperalgesia
c. Hyperesthesia
d. Hyperpathia

A

Hyperesthesia

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17
Q

Increased reaction to a stimulus, especially a repetitive stimuli

a. Allodynia
b. Hyperalgesia
c. Hyperesthesia
d. Hyperpathia

A

Hyperpathia

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18
Q

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

A

Stage III

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19
Q

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

A

Stage II

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20
Q

What is the function of the pulley system?

A

to prevent bowstringing

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21
Q

What transmits a load from the hand and forearm?

A

Triangular Fibrocartilage Complex (TFCC)

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22
Q

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

A

radial nerve

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23
Q

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

A

ulnar nerve

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24
Q

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

A

median nerve

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25
Q

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

A

supination

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26
Q

What motion is limited by bony impaction between the radius and ulna?

a. pronation
b. supination
c. flexion
d. extension

A

pronation

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27
Q

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

A

radial deviation

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28
Q

The functional arches of the hand allow for the fingers/thumb to

A

hold objects in the hand

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29
Q

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

A

pulley system

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30
Q

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

A

A2 and A4

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31
Q

A pain syndrome triggered by a noxious event that is not limited to a single peripheral nerve

A

CRPS Type I: RSD

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32
Q

What clinical characteristics can be seen with CRPS?

A 
pain 
allodynia
hyperalgesia
hyperesthsia
hyperpathia
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33
Q

What SNS changes are common with CRPS?

A

swelling
abnormal color or temp
sweating
trophic changes

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34
Q

At what stage of CRPS is pain limited to the site of the injury?

a. stage I
b. stage II
c. stage III

A

stage I

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35
Q

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

A

stage I

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36
Q

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

A

stage I

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37
Q

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

A

stage II

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38
Q

Patient presents with marked wasting of tissue that may be irreversible. What stage of CRPS?

a. stage III
b. stage II
c. stage I

A

stage III

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39
Q

RSD is more (regional/focused) and Causalgia is more (regional/focused)

A

RSD regional

Causalgia focused

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40
Q

This type of treatment may provide a permanent cure or partial remission and blocks the SNS

A

sympathetic block

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41
Q

A sympathetic block will provide

A

prognostic info about potential merits of other treatments

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42
Q

Sympathectomy is for (acute/chronic) patients with intractable sympathetic (intermittent/maintained) pain
and have responded _ to _

A

chronic intractable sympathetic maintained pain and have responded favorably to a series of blocks

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43
Q

This type of treatment for CPRS is an implantation of an electrode using low intensity impulses along the spinal cord

A

spinal cord stimulation

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44
Q

with CRPS patients it is important to immobilize (true/false)

A

false

do NOT immobilize

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45
Q

Prognosis of CRPS is _ for stage I or intervention has begun 3-6 months after onset

A

good

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46
Q

Prognosis of CRPS is _ for stage II or intervention has begun 6-12 months after onset

A

variable

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47
Q

Prognosis of CRPS is _ for stage III or intervention has begun 1 year after onset

A

poor

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48
Q

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

A

DeQuervain Syndrome

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49
Q

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

A

Capral Tunnel Syndrome

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50
Q

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

A

Ulnar Nerve Compression at canal of Guyon

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51
Q

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

A

Dupuytren or trigger finger

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52
Q

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

A

scaphoid fracture or carpal instability

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53
Q

Trigger finger is a _ of the _ tendon sheath

A

thickening

flexor tendon

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54
Q

What can result in trigger finger?

A

repetitive trauma

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55
Q

_ on the tendon and thickening of the _ = trigger finger

A

nodules

annular pulley

56
Q

Which finger is the most common to get a trigger finger?

a. index
b. middle
c. ring
d. thumb

A

thumb

57
Q

Trigger fingers are more common in males (true/false)

A

false

females

58
Q

Trigger fingers are associated with

A

RA
Dupuytren’s
Diabetes

59
Q

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

A

PIP

60
Q

In trigger finger, it will lock in a _ or _ position

A

flexed or extended position

61
Q

A palpable nodule is found at the _ pulley with trigger finger

A

A1

62
Q

Non-operative options for trigger finger

A

steroid injection
return to normal activities
splinting

63
Q

Patient with trigger finger can return to activities when?

a. 1 week
b. 10 days
c. 2 weeks
d. 3 weeks

A

3 weeks

64
Q

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

A

Colles fracture

65
Q

What is the MOI for a Colles fracture?

A

FOOSH

66
Q

in a Colles fracture, the wrist is _ with a _ hand

A

hyperextended and pronated hand

67
Q

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

A

Smiths fracture

68
Q

Smiths fracture is with the wrist _ during injury

A

flexed

69
Q

What is the most commonly fractured bone in the wrist?

a. radius
b. scaphoid
c. phalanges
d. metacarpals

A

scaphoid

70
Q

For a scaphoid fracture, it is common to immobilize in a _ cast for 6 weeks followed by 6 weeks in a _ cast

A

long arm thumb spica

short arm cast

71
Q

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

A

12 weeks

72
Q

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

A

proximal pole

73
Q

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

A

distal third

74
Q

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

A

tuberosity

75
Q

It is more common for the elderly population to have metacarpal fractures (true/false)

A

false

younger more active

76
Q

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

A

Dequervain

77
Q

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

A

radial aspect of the wrist and may radiate into the thumb or forearm

78
Q

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

A

Dequervain’s

79
Q

Therapy for Dequervain’s can include mobilization with _

_ glide of carpals

A

movement

radial glide of carpals

80
Q

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

A

6-8 weeks

81
Q

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

A

Ganglion cyst

82
Q

With a Ganglion cyst, a visible nodule will be on the _ surface of the wrist

A

dorsal or volar

83
Q

Carpal Tunnel can be due to

A 
trauma 
overuse
disease (RA, DM, Gout)
pregnancy
use of crutches 
chronic pressure (cyclists) 
jackhammers (vibration)
84
Q

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

A

Carpal Tunnel Syndrome

85
Q

Onset of symptoms with Carpal Tunnel is insidious (true/false)

A

false

gradual

86
Q

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

A

Carpal Tunnel Syndrome

87
Q

Thenar atrophy may be seen with Carpal Tunnel Syndrome (true/false)

A

true

88
Q

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

A

weak proximally and normal distally except for grip and pinch

89
Q

What ULNT test will be positive for Carpal Tunnel?

a. ULNT 1
b. ULNT 2a
c. ULNT 2b
d. ULNT 3

A

ULNT1 or ULNT2a

90
Q

After carpal tunnel surgery, when can tendon glides start?

a. 5 days
b. 3 days
c. 1 week
d. 2 weeks

A

3 days

91
Q

When can strengthening and nerve gliding begin after carpal tunnel surgery?

a. 1 week
b. 2 weeks
c. 3 weeks
d. 4 weeks

A

3 weeks

92
Q

What are the 3 types of pinch to test?

A

tip pinch
3-point
key pinch or lateral pinch

93
Q

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

A

Scaphoid compression

94
Q

A positive Scaphoid compression test will indicate

a. tingling
b. weakness
c. sensitivity
d. pain

A

pain

95
Q

Snuff box tenderness is positive if the patient experiences

A

reproduces symptoms

96
Q

Gamekeepers test is used to test for

a. scaphoid fracture
b. tenosynovitis
c. instability
d. carpal tunnel

A

thumb instability

97
Q

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

A

Gamekeepers

98
Q

A positive Gamekeepers test can be indicated by

a. numbness and tingling
b. gaping of the joint and pain
c. pain
d. weakness

A

gaping of the joint and pain

99
Q

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

A

Finkelsteins

100
Q

A positive Finkelsteins test will be indicated by

a. weakness
b. pain
c. inability to flex fingers
d. tingling

A

pain

101
Q

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

A

Phalens

102
Q

What is the most common test used for carpal tunnel?

A

Phalen’s

103
Q

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

A

reproduced symptoms along median nerve distribution

104
Q

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

A

Tinel test

105
Q

Which 3 tests are very similar and involve compressing on the median nerve?

A

Tinel test
Median nerve compression
Median nerve compression/pressure provocation test

106
Q

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

A

medial nerve compression/pressure provocation test

107
Q

What does a positive medial nerve compression/pressure provocation test produce?

A

symptoms along median nerve distribution

108
Q

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

A

inability to feel 6 mm or more

109
Q

A Semmes Weinstein test is used to test for

a. carpal tunnel syndrome
b. scaphoid fracture
c. wrist instability
d. cubital tunnel syndrome

A

carpal tunnel syndrome

110
Q

A positive Semmel Weinstein test is indicated by

A

feeling the monofilament at 2.83 milligram

111
Q

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

A

Hand Elevation

112
Q

The hand elevation test is used to test for

a. carpal tunnel syndrome
b. scaphoid fracture
c. wrist instability
d. cubital tunnel syndrome

A

carpal tunnel syndrome

113
Q

the carpal compression test is pressure on the median nerve holding for _

A

30 seconds

114
Q

Wrist extension test is

A

putting hands together in wrist extension in front of chest

115
Q

Wainner’s clinical prediction rule for CTS is 2 or more of

A 
hand shaking improving symptoms 
wrist ratio > 0.67
SSS score > 1.9
decrease in sensation of median nerve over thumb 
age > 45
116
Q

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

A

only 3 and 4

117
Q

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

A

TCL spread

118
Q

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

A

palmar raking

119
Q

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

A

tendon mobilization under TCL

120
Q

What does a pronator teres release help to improve?

A

median nerve pain

121
Q

for soft tissue release, how long should it be held?

A

3-5 seconds

3-5 times

122
Q

soft tissue release should go from (proximal to distal/distal to proximal)

A

distal to proximal

123
Q

Where is the tunnel of gyon located?

A

superficial to the flexor retinaculum, between the hook of the hamate and the pisiform bones

124
Q

What is the function of the tunnel of gyon?

A

passageway for the ulnar nerve

artery into the hand

125
Q

The extensor mechanism creates a cable system that extends the _ and _

A

MPs and IPs

126
Q

What allows for a lumbrical grip?

A

extensor mechanism

127
Q

radial deviation occurs between _ and _

A

proximal and distal rows

128
Q

ulnar deviation occurs

A

primarily at the radiocarpal joint

129
Q

What are the arches of the hand?

A

transverse

longitudinal

130
Q

Does the moment arm increase or decrease when bowstringing happens?

A

increase

131
Q

What is the diagnostic criteria for CRPS?

A

initiating noxious event or cause of immobilization
pain, allodynia, hyperalgesia - disproportionate to event
edema, change in skin BF
rule out everything else

132
Q

What can be seen with mild cases of CRPS in the first stage?

A

lasts a few weeks
subsides spontaneously
responds rapidly to treatment

133
Q

What is the cornerstone of treatment for RSD?

A

normal use of the affected part as much as possible

134
Q

AROM should be performed immediately after operative treatment for trigger finger (true/false)

A

true

135
Q

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?

A

Dequervains

136
Q

When can you start doing nerve glides after carpal tunnel surgery?

A

3 weeks

Management of MS Disorders (18 decks)

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