Hand and Wrist Flashcards
what type of joint is the distal radioulnar joint?
pivot joint
what type of joint is the radiocarpal joint?
diarthrodial ellipsoid
open packed position of wrist
10 degrees of wrist flexion w/ slight ulnar deviation
closed packed position of wrist
extension w/ radial deviation
CPR of wrist
limited flex>ext
closed packed position of midcarpal
extension with ulnar deviation
CPR of midcarpal joints
limited flex>ext
closed pack position of intercarpal joints
extension
CPR of thumb
limited abduction and slight limitation of extension
closed pack position of thumb
full opposition
open packed position of thumb
mid range between abduction/adduction and flex/ext
CPP of MCP/IP joints
MCP full flexion, IP full extension
test for carpal tunnel
Tinel’s sign, phalen’s test
describe tinel’s sign
tap over carpal tunnel for 20 sec. is there N/T or pain in median nerve distal to point of tapping?
phalen’s test
prayer hands or reverse prayer hands, hold for 60 sec. pos. if N/T occurs w/in 45-60 sec. compresses med. nerve
Finkelstein’s test tests which tendons for which syndrome?
APL and EPB for DeQuervain’s tenosynovitis.
What is froment’s sign and what does it indicate?
inability to graps a piece of paper between your thumb and the side of the proximal phalanx of your pointer finger without flexing the IP joint of your thumb, its a sign of ulnar neuropathy
why does froment’s sign indicate ulnar neuropathy
bc its an inhibition sign of adductor pollicis which is innervated by the ulnar nerve.
What does a positive allen’s test indicate?
insufficient ulnar or radial AA performance, or reynauds syndrome if both are insufficient``
How is a Watson’s sign found?
a.k.a scaphoid shift test, pt passively moved from UD to RD with arm pronated and scaphoid stabilized, + Watson’s sign= dosral movement of bones, clunk or pain
what does a + Watson’s sign indicate?
scaphoid-lunate deviation
Distal radioulnar joint:
pronation
volar
distal radioulnar joint supination
dorsal
radiocarpal joint: flexion
dorsal
radiocarpal joint: extension
volar
radiocarpal joint: ulnar deviation
radial glide
radiocarpal joint: radial deviation
ulnar glide
CMC joint: flexion extension
volar (ulnar)/dorsal (radial) glides
CMC joint: adduction/abduciton
volar and dorsal glide?
carpal tunnel compresses what nerve
median N.
what is a classic sign of carpal tunnel
“shakes out” their hand
PT tx of capral tunnel?
rest, ergonomics, ice, LILT, manual therapy, stretching, US, splinting, median N glides
colles fracture diplaces in which direction?
dorsally
a colles fracture occurs in which bone?
distal radius, transverse fracture
which fracture is also known as the dinner fork deformity?
colles fracture
how does a colles fx occur?
FOOSH
tx for colles fx
surgery, casting, strength and ROM when out of cast
what causes claw deformity
ulnar neuropathy
what is it called when there is abduction of the 5th digit secondary to ulnar neuropathy
Wartenburg’s sign
OE of ulnar neuropahty
dec. grip strength, claw and wartenburg’s deformity
tx of ulnar neuropathy
ulnar glides, ROM, strength of hand and wrist, cervical and elbow ROM
CRPS: type 1
abnormal reaction of the sympathetic nervous system following an injury, trauma or surgery
tx for CRPS
desensitization, ther ex
TFCC
triangular fibrocartilage disc injury.
where is the triangular disc?
between triquetrum and distal ulna
TFCC causes?
compression on UD wrist, FOOSH, overuse of repetetive twisting w/ palmar rotation
tx of TFCC?
immobilize first, then wrist ROM, inc. circulation, improve circulation
TFCC S&S
piano key,
What is DeQuervain’s associated with?
pregnancy and RA
tx for DeQuervain’s
friction message, rest from UD/RD, spica splint
Gyon’s canal in entrapment of which nerve?
ulnar nerve
where is guyon’s canal?
tween pisoform and hamate
guyon’s canal syndrome S&S?
N/T in the medial half of 4th digit and whole 5th digit, froment’s sign and thenar emincence atrophy
causes of guyon’s canal
biking, using crutches, vibrations (like when jackhammering)
cause of raynaud’s phenomenon
constritcion of small blood vv in hands and feet via reversible vasospasm
test for raynauds
allen’s test
tx for raynaud’s
exercise to inc. blood flow, vasodilators, lifestyle changes (stop smoking, etc. )
Duputryen’s contracture
abnormal thickening of palmar and digital fascia of 4th and 5th digits
Causes of duputryen’s
alcoholism, diabetes, elipesy, idiopathic
tx for duyptryen’s
friction massage, stretching, sx and injections
smith’s fx, a.k.a…
“reverse colles fx”, fx of distal radius w/ volar displacement
MOI of smith’s fx?
fall onto back of flexed hand…
boxer’s fx
5th MC
MOI lunate dislocation
fall on extended hand causes lunate to become displaced between capitate and radius
tx of lunate dislocation
surgical reduction, immobilization 3-4 wks, limit wrist extension 2 months.
complications of lunate dislocation
AVN comprimise, median nerve injury
Bennett fx
base of 1st MC
what fx is karma for losing your temper and punching a wall
bennett’s fx
Other MOI for bennett’s fx
falling onto your thumb
mallet finger (Lou’s finger) is an avulsion of which tendon?
extensor digitorum longus tendon from the distal phalanx, leaving the DIP always flexed and unable to extend
MOI scaphoid fx
FOOSH, direct trauma
S&S scaphoid fx
dorsal wrist pain
where is there pain with palpation in the case of a scaphoid fx
over the anatomical snuff box
complications with scaphoid fx?
non-union of bone, bone necrosis
Keinbock’s disease
osteonecrosis/avascular necrosis of lunate following a fx
tx of keinbock’s disease
thermal modalities to inc. revascularization, ROM/glides
Gamekeeper’s/Skier’s thumb is a sprain of which ligament?
ulnar collateral ligament of 1st MCP joint
what injury to you get from hyperextension/abduction of thumb?
Gamekeeper’s/Skier’s thumb
tx of gamekeeper’s thumb
taping, possible sx. strengthening
