Hand

Question 1

What are the affected tendons on
De Quervain’s tenosynovitis?

Answer 1

Abductor pollicis longus

Extensor pollicis brevis

Question 2

What are the signs and symptoms of De Quervain’s tenosynovitis?

Answer 2

Radial sided pain
Tenderness
Swelling
Worse with thumb movs
May have crepitus

Question 3

What are some interventions for De Quervain’s tenosynovitis?

Answer 3

Activity modification
Splinting (thumb spica)
Cryotherapy

Gradual stretching and strengthening (not on early phases)

Question 4

What is the special test for De Quervain’s tenosynovitis?

Answer 4

Finkelstein

Question 5

How is radial deviation?

Answer 5

Radial deviation is a movement that brings the thumb closer to the radial bone of the forearm.

Question 6

How is ulnar deviation?

Answer 6

Ulnar deviation draws the little finger closer to the ulnar bone, or outside of the forearm

Question 7

What is TFCC tear?

Answer 7

A tear in the ligs and cartilaginous structures of the Triangular fibrocartilage complex.

Ligacao entro o radio e a ulna no punho

Question 8

Signs of TTCC ( triangular fibrocartilage complex? Special tests?

Answer 8

Ulnar sided wrist pain

Clicking with wrist movement

Special tests: press test
Tfcc load test (sharpey’s test)

Question 9

What is the cause of carpal tunnel syndrome?

Answer 9

Compression of the median nerve as it passea through the carpal tunnel

Question 10

What are the special tests for Carpal Tunnel Syndrome?

Answer 10

Tinel test: tapping over the medial nerve

Phalen test: sustained wrist flexion

Reverse Phalen: oracao
Resisted Abd: abductor pollicis brevis w resistance

Question 11

What is ulnar tunnel syndrome?

Answer 11

Compression of the ulnar nerve as it passess through Guyon”s canal

Question 12

What is the special test for ulnar tunnel syndrome?

Answer 12

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.

Question 13

What is gamekeepers thumb?

Answer 13

Sprain of the ulnar collateral lig of the thumb

Question 14

What are the muscles innervated by the radial nerve?

Answer 14

B brachialis
E extensor of wrist
A anconeus
S supinator
T triceps

Question 15

What are the muscles innervated by the median nerve?

Answer 15

2
L lumbricais 1-2
O opponess brevis
A abd pollicis brevis
F flexor pollicis brevis

Question 16

Dupytren’s contracture

Answer 16

Contracture of the palmar fascia.

Usually seen in D4-5
Tx:splinting to maintain finger extension

Question 17

Trigger finger

Answer 17

Involves the Proximal and metacarpofalangeal joints of d3 e d4

Question 18

Mallet deformity

Answer 18

Flexion of dip at rest
Due to rupture- avulsion of the extensor tendon at its insertion

Question 19

Bouchard nodes

Answer 19

Seen in oa
Enlargement of pip

Question 20

Heberden nodes

Answer 20

seen in oa
Enlargement of dip

Question 21

Deltoid, teres minor,lateral head of the triceps.
What is the innervation?

Answer 21

Axilary nerve
C5-c6

Question 22

Triceps, brachioradialis,extensors,anconeous, abd pollicis longus and extensor pollicis brevis.
What os the innervation?

Answer 22

Radial nerve
C5-t1

Question 23

Bíceps,brachialis,coracobrachialis
What’s the nerve?

Answer 23

Musculocutaneous nerve

BBC

Question 24

Flexor carpi radialis, thenar eminence,pronator quadrado,palmaris longue and pronator teres.
What’s the nerve?

Answer 24

Medial nerve

Question 25

Flexor carpi ulnaris, hypothenar eminence. What’s the nerve?

Answer 25

Ulnar nerve

Question 26

Ape hand Which nerve is affected by? What is the position?

Answer 26

Median nerve affected Inability to opose or abd the thumb Injury to c5-8 and t1 Dr cu ma

Question 27

Which nerve is affected by? What is the position? Claw hand

Answer 27

Ulnar nerve affected Dr Cu Ma Injury to c8- t1 Hypertension of mcp and flexion on ip joints of d4-5

Question 28

Which nerve is affected by? What is the position? Wrist drop

Answer 28

Radial nerve Inability to extende the wrist at the mcp joint Dr Cu Ma

Question 29

Which nerve is affected by? What is the position? Hand of benediction

Answer 29

Median nerve affected Inability to flex d1-d3 on active movement

Question 30

What is contained in the carpal tunnel?

Answer 30

All the flexors tendons( flexor policis longus, flexor digitorum superficial and profundus) + Mendian nerve

Question 31

Thenar and hyphotenar eminence locations…

Answer 31

Thenar: thumb side Hypothenar: mindinho d5

Question 32

What is pilar pain? When does it occur?

Answer 32

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

Question 33

Pos op of carpal tunnel release. What are the contraindications?

Answer 33

Avoid active wrist flexion past neutral for 10 days And finger flexion with wrist flexed

Question 34

What is the protocol for 1-2w of post op carpal tunnel release?

Answer 34

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

Question 35

What are the muscles innervated by the ulnar nerve?

Answer 35

M edial lumb3-4 A adductor pollicis F lexors on the ul side I dorsal interossei A abd digiti mini

Question 36

75. 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.

Answer 36

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.

Question 37

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.

Answer 37

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.