Hand Flashcards
Describe the S/Sx for CTS
- 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
What are the clinical tests for CTS?
Monofilament testing
Phalens
Tinels
APB testing (test this is palmar abduction)
Describe Mx of CTS
- 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
S/Sx for DeQuervains
- 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)
Describe the pathophysiology of DeQuervains
- 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
Clinical tests for DeQuervains?
- pain over radial styloid; swelling/thickening too
- pain on thumb extension; limited thumb extension
- crepitus
- finklesteins +ve
Mx for DeQuervains
- 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
what are 3 complications of CSI?
- skin pigment changes
- tendon deterioration
- subcut fat atrophy
Describe trigger finger
- 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
Describe distal radius fracturse
Most common
Younger people 18-25
Mx depends on stable or unstable
can have median nerve injury or intra articular damage
Describe the rehab of the STABLE distal radius fracture
- keeping DPC free:
- finger + thumb ex’s
- ## forearm/shoulder/elbow ex’s (elbow flex/ext/sup/pron/hand behind back/behind neck)
Post op rehab of distal radial fracture (ORIF)
- 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
Describe scaphoid fracture
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)
What are indications for conservative treatment for scaphoid fractures?
stable, undisplaced waist #
- this take 6-12 weeks to heal with 60-90% union)
tubercle fractures
- (wrist splint 3-4 weeks)
What are indications for surgical treatment for scaphoid?
- unstable displaced fracture
- fracture/dislocation
- proximal pole fracture
- non union
- pathological fracture
- carpal instability
- ORIF = quicker RTW/RTS