Hand Flashcards
What are the affected tendons on
De Quervain’s tenosynovitis?
Abductor pollicis longus
Extensor pollicis brevis
What are the signs and symptoms of De Quervain’s tenosynovitis?
Radial sided pain
Tenderness
Swelling
Worse with thumb movs
May have crepitus
What are some interventions for De Quervain’s tenosynovitis?
Activity modification
Splinting (thumb spica)
Cryotherapy
Gradual stretching and strengthening (not on early phases)
What is the special test for De Quervain’s tenosynovitis?
Finkelstein
How is radial deviation?
Radial deviation is a movement that brings the thumb closer to the radial bone of the forearm.
How is ulnar deviation?
Ulnar deviation draws the little finger closer to the ulnar bone, or outside of the forearm
What is TFCC tear?
A tear in the ligs and cartilaginous structures of the Triangular fibrocartilage complex.
Ligacao entro o radio e a ulna no punho
Signs of TTCC ( triangular fibrocartilage complex? Special tests?
Ulnar sided wrist pain
Clicking with wrist movement
Special tests: press test
Tfcc load test (sharpey’s test)
What is the cause of carpal tunnel syndrome?
Compression of the median nerve as it passea through the carpal tunnel
What are the special tests for Carpal Tunnel Syndrome?
Tinel test: tapping over the medial nerve
Phalen test: sustained wrist flexion
Reverse Phalen: oracao
Resisted Abd: abductor pollicis brevis w resistance
What is ulnar tunnel syndrome?
Compression of the ulnar nerve as it passess through Guyon”s canal
What is the special test for ulnar tunnel syndrome?
Froment’s sign: colocar um pedaco de papel no polegar e index finger e ae o fisio vai puxar o papel. O pt tem q segurar.
. Testa o aductor pollicis q eh inervado pelo ulnar nerve.
What is gamekeepers thumb?
Sprain of the ulnar collateral lig of the thumb
What are the muscles innervated by the radial nerve?
B brachialis
E extensor of wrist
A anconeus
S supinator
T triceps
What are the muscles innervated by the median nerve?
2
L lumbricais 1-2
O opponess brevis
A abd pollicis brevis
F flexor pollicis brevis
Dupytren’s contracture
Contracture of the palmar fascia.
Usually seen in D4-5
Tx:splinting to maintain finger extension
Trigger finger
Involves the Proximal and metacarpofalangeal joints of d3 e d4
Mallet deformity
Flexion of dip at rest
Due to rupture- avulsion of the extensor tendon at its insertion
Bouchard nodes
Seen in oa
Enlargement of pip
Heberden nodes
seen in oa
Enlargement of dip
Deltoid, teres minor,lateral head of the triceps.
What is the innervation?
Axilary nerve
C5-c6
Triceps, brachioradialis,extensors,anconeous, abd pollicis longus and extensor pollicis brevis.
What os the innervation?
Radial nerve
C5-t1
Bíceps,brachialis,coracobrachialis
What’s the nerve?
Musculocutaneous nerve
BBC
Flexor carpi radialis, thenar eminence,pronator quadrado,palmaris longue and pronator teres.
What’s the nerve?
Medial nerve
Flexor carpi ulnaris, hypothenar eminence.
What’s the nerve?
Ulnar nerve
Ape hand
Which nerve is affected by?
What is the position?
Median nerve affected
Inability to opose or abd the thumb
Injury to c5-8 and t1
Dr cu ma
Which nerve is affected by?
What is the position?
Claw hand
Ulnar nerve affected
Dr Cu Ma
Injury to c8- t1
Hypertension of mcp and flexion on ip joints of d4-5
Which nerve is affected by?
What is the position?
Wrist drop
Radial nerve
Inability to extende the wrist at the mcp joint
Dr Cu Ma
Which nerve is affected by?
What is the position?
Hand of benediction
Median nerve affected
Inability to flex d1-d3 on active movement
What is contained in the carpal tunnel?
All the flexors tendons( flexor policis longus, flexor digitorum superficial and profundus)
+
Mendian nerve
Thenar and hyphotenar eminence locations…
Thenar: thumb side
Hypothenar: mindinho d5
What is pilar pain? When does it occur?
Pilar pain occurs after the carpal tunnel release.
Pain is located at the base of the hand, within the muscles at the thumb and the muscles at the base of the small finger
Pos op of carpal tunnel release.
What are the contraindications?
Avoid active wrist flexion past neutral for 10 days
And finger flexion with wrist flexed
What is the protocol for 1-2w of post op carpal tunnel release?
Arom thumb opposition,fingers,forearm,elbow and shoulder
Arom radial and ulnar deviation
Arom wrist extension and PROM wrist flex
Tendond glides gentle
Median nerve gliding
Dexterity exercs
What are the muscles innervated by the ulnar nerve?
M edial lumb3-4
A adductor pollicis
F lexors on the ul side
I dorsal interossei
A abd digiti mini
- Your patient returns to the clinic complaining of pain in their 4th finger. Upon assessment, you determine they have a boutonniere deformity. Which of the following would be the most effective treatment?
a. Splint PIP joint in full flexion and DIP joint in full flexion.
b. Splint PIP joint in full extension.
c. Splint PIP joint in full flexion.
d. Splint PIP joint in full extension and DIP joint in full extension.
B
In a boutonniere deformity, the PIP is in flexion and the DIP is in extension. This is due to the rupture of the central band (central slip) of the extensor hood.
If the goal of treatment is to decrease drifting of the fingers, what would be the most effective treatment technique?
a Finger isometrics into radial deviation.
b. Finger isometrics into ulnar deviation.
c. Gentle stretching of the collateral ligaments at the MCP joint.
d. Grip strengthening exercises.
Finger isometrics into radial deviation - Correct
• With rheumatoid arthritis, the fingers drift in the ulnar direction, therefore, we would want to strengthen with isometrics in the radial direction to help prevent this drift.
• Finger isometrics into ulnar deviation - Incorrect
Incorrect direction, would exacerbate the unar drift
• Gentle stretching of the collateral ligaments at the MCP joint - Incorrect
With ulnar drift, there is already too much stretching of the collateral ligaments at the MCP joint. In some patients, the ligament has even ruptured.
• Grip strengthening exercises - Incorrect
We would want to focus on strengthening the hands in a gentle, functional manner and avoid repeated gripping exercises as they can exacerbate the ulnar drift.
