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PHTY5207 > Hand > Flashcards

Hand Flashcards

1
Q

Describe the S/Sx for CTS

A
  • compression of med nerve > reduced blood flow > edema > ischemia to the nerve
  • paresthesia median nerve distribution
  • reduced grip strength
  • abductor poll brev wasting (usually in older people who’ve ignored it for awhile)
  • sensory changes before motor
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2
Q

What are the clinical tests for CTS?

A

Monofilament testing
Phalens
Tinels
APB testing (test this is palmar abduction)

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3
Q

Describe Mx of CTS

A
  • night spint in neutral - 10 days to 6 weeks
  • nerve flossing
  • postural advice
  • APB strengthening

When to refer?

  • failure to improve
  • APB wasting
  • constant numbness
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4
Q

S/Sx for DeQuervains

A
  • radial wrist pain related to overuse
  • APL + EPB - degenerative tendinosis in 1st dorsal compartment
  • 30-50yrs;F>M
  • thumb abd + RD+UD
  • can also be d/t blunt trauma/cyst/tumor (rare)
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5
Q

Describe the pathophysiology of DeQuervains

A
  • repetitive gliding from mm use in the first dorsal compartment causes shear trauma
  • non inflammatory process
  • thickened retinaculum, narrowed canal so imparied gliding of tendons in the canal
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6
Q

Clinical tests for DeQuervains?

A
  • pain over radial styloid; swelling/thickening too
  • pain on thumb extension; limited thumb extension
  • crepitus
  • finklesteins +ve
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7
Q

Mx for DeQuervains

A
  • thermoplastic splint for 6 weeks - then start strengthening + replace with neoprene splint
  • ice
  • avoid agg activities (pulling up the sheets is characteristically painful!)
  • radial nerve glides if needed
  • gentle ROM ex
  • steroid injection might be needed if not improving- cures 83% of cases
  • surgery = longitudinal release of the tendon
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8
Q

what are 3 complications of CSI?

A
  • skin pigment changes
  • tendon deterioration
  • subcut fat atrophy
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9
Q

Describe trigger finger

A
  • nodule is caught proximal to A1 pulley
    (A1 @ MCP, A3 @ PIP, A5 @ DIP)
  • click or snap when trying to straigthen out the fingers
  • agg by repeated gripping
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10
Q

Describe distal radius fracturse

A

Most common
Younger people 18-25
Mx depends on stable or unstable
can have median nerve injury or intra articular damage

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11
Q

Describe the rehab of the STABLE distal radius fracture

A
  • keeping DPC free:
  • finger + thumb ex’s
  • ## forearm/shoulder/elbow ex’s (elbow flex/ext/sup/pron/hand behind back/behind neck)
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12
Q

Post op rehab of distal radial fracture (ORIF)

A
  • RICE
  • thermoplastic resting splint over a tubifast sleeve with padded straps with DPC and thenar eminence free
  • Scar care
  • ROM ex + tendon gliding ex as well
    (ROM eg. table top, hook fist for FDS/FDP, wrist ext/flex, supin/pron)
  • begin strengthening at 6-8 weeks
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13
Q

Describe scaphoid fracture

A

FOOSH injury
px in snuffbox
XR might be negative for 10days to 2 weeks so treat as if they do have a fracture
Can do bone scan at 48 hrs (15% false +ve)

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14
Q

What are indications for conservative treatment for scaphoid fractures?

A

stable, undisplaced waist #
- this take 6-12 weeks to heal with 60-90% union)
tubercle fractures
- (wrist splint 3-4 weeks)

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15
Q

What are indications for surgical treatment for scaphoid?

A
  • unstable displaced fracture
  • fracture/dislocation
  • proximal pole fracture
  • non union
  • pathological fracture
  • carpal instability
  • ORIF = quicker RTW/RTS
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16
Q

What is post op Mx for scaphoid #?

A
  • immob for 7-10 days
  • gently unresisted ROM ex - splint between ex sessions
  • avoid contact sports until healing/union confirmed with XR - can be 3 months
  • most regain good motino with simple home program
17
Q

Describe the scaphoid shift test

A
  • apply pressure AP to the scaphoid tubercle with wrist in UD
  • bring wrist into RD passively
  • if there’s SLL laxity then will be able to push the scaphoid back over rim of the radius
  • on release might here a clunk as scaphoid relocates back into lunate fossa
18
Q

What is the ring sign and when do you see it?

A
  • when there is rotation of the scaphoid as seen with scapholunate dissociation, the ring sign appears due to the the foreshortening of the scaphoid
  • also see Terry Thomas sign
19
Q

What is mx for SLL?

A
  • splint 6 weeks
  • exercise in dart throwing motion of wrist (minimizes motino between scaph+lunate)
  • grip strengthening only when pain free
  • progress to proprioception (slosh pipe)
20
Q

Which muscles are good for the SL and which are bad?

A

Good:

  • ECRL
  • APL
  • FCU

Bad:
- ECU

21
Q

What are S/Sx of TFCC injury?

A
  • ulnar wrist pain
  • prominent ulnar styloid (aka supinated carpus)
  • reduced grip strength
  • weak grip/pain in pronation = ulnar impingment or TFCC
22
Q

Describe the TFCC shear test

A
  • stabilize ulna and glide the piso-triquetral complex dorsally
  • +ve if there’s pain
  • sens/spec = 66%
23
Q

Describe the TFCC shear test with compression

A
  • still gliding PT complex AP but adding axial compression and ulnar deviation whilst doing it
24
Q

Describe the Gripping Rotary Impaction test (GRIT test)

A
  • arm by side at 90º flexion
  • measure grip in full sup/full pron/neutral position
  • ratio of supinated grip/pronated grip
  • if > 1 then ulnar impaction syndrome
  • UIS = abutment of the ulnar into the TFCC and ulnar sided carpals which results in degeneration of the TFCC and chondromalacia of the ulna+carpas + disruption of triquetrolunate ligament
25
Q

What is the management for TFCC injury (conservative?)

A
  • might need to support ulnar carpals for 4-6 months
  • activity mod - avoid loading ulnar side
  • PQ strengthening
  • grip strengthening in pain free ranges of wrist rotation
26
Q

What is the presetnation of TMC OA? (OA of the first MCPJ)

A
  • painful, achy, locally tender
  • joint thickening
  • deformity with subluxation at base of 1st MC
27
Q

What is the TM grind test?

A

Stabilise the trapezium and axially load and rotate the metacarpal

28
Q

Describe self management for CMC OA

A
  • Education (proper alignment, better work methods to reduce joint stress)
  • Aids to help with ADLs without causing pain
  • Cryotherapy/heat therapy
  • Massage
  • Preserving PROM of CMC joint - web stretch/trigger point/self traction
  • Weight loss (OA and obesity has inflamm link)
29
Q

What are other options for treating CMC OA besides self management?

A
  1. Splinting
  2. Exercise (proprio/neuromm/strength)
  3. Neural glides
30
Q

What predisposes one to CMC OA?

A
  1. Genetics
  2. Joint incongruity
  3. Thumb ligament insufficiency
  4. Poor neuromm control of joint

PHTY5207 (11 decks)

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