Hand and Upper Extremity Disorders and Injuries Flashcards
Wrist Drop
Radial Nerve; hand is flexed at wrist, digits remain flexed
Carpal Tunnel Syndrome
Caused by repetition, awkward positions, pregnancy, lesions
Symptoms: parasthesia (tingling), hypothesia (decreased sensation), anesthesia (no tactile), eventually atrophy of thenar eminence
Positive Tinel’s Sign, Positive Phalen’s sign
Treatment: • Wrist splint in neutral • Median nerve gliding • Ergonomics (most common work related injury) • Surgical: Carpal Tunnel Release
Adhesive Capsulitis
“Frozen Shoulder”
What: Restricted ROM in one shoulder
Greatest limitation is external rotation
Why: Inflammation and immobility
How: ADL use, PROM, modalities
Claw Hand
What: MP extension with PIP and DIP flexion
unable to straighten 4th and 5th digits
Why: ulnar nerve damage, atrophy of interosseous muscles
How:
Splint with MP flexion of the 4th and 5th digits
Cubital Tunnel Syndrome
What: ulnar nerve compression at elbow
Sensory Loss: 1/2 of 4th, all of 5th, ulnar half of hand
Why: pressure at elbow, extreme elbow flexion
Symptoms:
• Numbness and tingling along ulnar aspect of forearm and hand
• Pain at elbow with extreme position of elbow flexion
• Weakness of power grip
• Positive Tinel’s sign at elbow
• Advanced stages- atrophy of FCU, FDP, ulnar nerve intrinsic muscles
How: • Elbow splint to prevent positions of extreme flexion • Elbow pad to decrease compression • Surgical: decompression or transposition • Post Op: • Edema • Scar management • AROM and nerve gliding • Strengthening • MCP flexion splint if clawing noted
Complex Regional Pain Syndrome
What: vasomotor dysfunction resulting from abnormal reflex
Symptoms: Pain, edema, discoloration, temperature changes
Why: Resulting from trauma or fracture
How: modalities for pain edema care AROM Stress Loading Splinting
Avoid: PROM passive stretching joint mobilization dynamic splinting casting
DeQuervain’s Syndrome
What: tenosynovitis of APL and EPB
Symptoms:
pain and swelling over radial styloid
Positive Finkelstein’s test
How:
forearm based thumb spica splint leaving the IP joint free
ice massage
gentle AROM over wrist and splint
Dupuytren’s Disease
What: disease of fascia over palm and digits
Symptoms: flexion deformities
How: wound care edema control extension splint A/PROM
Guyon’s Canal
What: ulnar nerve compression at wrist
Symptoms: numbness and tingling in ulnar nerve distribution motor weakness positive tinel's sign atrophy of ulnar musculature
Why:repetition, ganglion, fascia thickening
How:
wrist splint in neutral
surgical: decompression
Tinel’s Sign
How: tap over palmar surface of wrist at carpal tunnel
Positive finding: tingling or parasthesia along median nerve distribution = median nerve pathology at carpal tunnel
Could indicate: Carpal Tunnel Syndrome (at wrist), Cubital Tunnel Syndrome (at elbow), Guyon’s Canal
Finkelstein Test
How: bend thumb across palm of hand and bend fingers down over thumb, then bend wrist toward little finger
Positive Finding: pain on thumb side of wrist = DeQuervain’s tendosynovitis
Froment’s Sign
How: hold something between thumb and index finger using key grip pattern; clinician attempts to move object from grip
Positive finding: flexion of IP joint of thumb = paralysis of adductor pollicis muscle secondary to ulnar nerve injury
Phalen’s Test
How: push dorsal surfaces of both hands together for 30-60 seconds
Positive finding: causes tingling or other capal tunnel symptoms, indicates carpal tunnel syndrome
Reverse Phalen’s Test
How: push palms together in prayer position and hold
Lateral Epicondylitis
What: Tennis Elbow
Symptoms:
• Pain felt over lateral epicondyle and radiates down posterior surface of forearm
• Often feel pain when opening a door or lifting a glass
Why: repetitive use of wrist extensors, especially ECRB
How: • Elbow strap, wrist splint • Ice and deep friction massage • Stretching • Add strengthening as pain decreases
Medial Epicondylitis
What: Golf Elbow
How: • Elbow strap, wrist splint
• Ice and deep friction massage
• Stretching
• Add strengthening as pain decreases
Swan Neck Deformity
What: deformed position of the finger, in which the joint closest to the fingertip is permanently bent toward the palm while the nearest joint to the palm is bent away from it (DIP hyperflexion with PIP hyperextension)
Why: injury or inflammatory conditions
How:
splint with Slight PIP flexion
Median Nerve Laceration
Symptoms:
Sensory Loss:
• Central palm
• Palmar surface of thumb, index, middle, radial ½ of 4th
• Dorsal surface of index, middle, radial ½ ring
Motor Loss: low lesion at wrist • MCP flexion of digits II & III • Opposition • Abduction • Flexion of thumb MCP
Motor Loss: high lesion
• Flexion of tip of index, middle, thumb
• Inability to flex radial aspect of wrist
Deformities:
• Flattening of thenar eminence (ape hand)
• Clawing of index and middle (low injury)
• Benediction sign (high injury)
Functional Loss:
• Loss of thumb opposition
• Weakness of pinch
Treatment:
• Dorsal protection splint with wrist positioned in 30° flexion (low) and elbow flexed 90° (if high)
• opponens splint, C-bar, or thumb post splint
• A/PROM
• Scar management
• Sensory reeducation
Pronator Teres Syndrome
What: median nerve compression between 2 heads of pronator teres
Why: caused by repetitive pronation/supination
Symptoms: same as CTS + aching forearm pain
Interventions: • Elbow splint at 90° with forearm in neutral • Surgical: decompression • Post Op: • AROM • Nerve gliding • Strengthening • Sensory reeducation
Radial Nerve Laceration
Sensory Loss: high lesions at level of humerus
• Medial aspect of dorsal forearm
• Radial aspect of dorsal palm, thumb, index, middle, radial ½ of ring
Motor Loss: low lesion at level of forearm
• Loss of wrist extension due to absent or impaired innervation to ECU
• MCP extension
• Thumb extension
Motor Loss: high lesion at level of humerus
• Brachoiradialis
• Possible loss of triceps
Functional Loss:
• Inability to extend digits to release objects
• Difficulty manipulating objects
Deformities:
• Wrist drop
Interventions:
• Dynamic extension splint
• ROM
• Sensory reeducation
Radial Nerve Palsy
What: radial nerve compression
Why: Caused by sleeping in position that places stress on radial nerve or by humeral shaft fracture
Symptoms:
• Weakness or paralysis of extensors to wrist, MCPs, thumb
• Wrist drop
Interventions:
• Dynamic extension splint
• Strengthening wrist and finger extensors when motor function returns
Rotator Cuff Tendonitis
What: Subscapularis, Supraspinatus, Infraspinatus, Teres minor
Why: repeated overuse, weakness, ligament or capsule tightness, trauma
Interventions:
• Activity modification: avoid above shoulder level activities
• Adjust sleeping posture
• Decrease pain: positioning, modalities, rest
• Strengthening below shoulder level
Shoulder Dislocation
What: most common is anterior shoulder
Why: trauma or overuse
Intervention:
ROM
Reduce Pain
Strengthen Cuff
Skier’s Thumb
What: rupture of ulnar collateral ligament of MCP joint of thumb
Intervention:
• Thumb splint 4-6 weeks
• AROM and pinch strengthening
• ADL requiring opposition
