Hand and wrist. Flashcards
Where do Herberden’s nodes show up?
posterior surface of DIP joints.
Where do bouchard’s nodes show up?
posterior surface of PIP joint
What are some extra things to look for in observation of hand?
Herberden and Bouchard’s nodes
Thenar atrophy
Clubbing fingers.
What are alignment impairments associated with rheumatoid arthritis ?
Swans neck
boutonnieres hand
thumb z hand
ulnar drift
excessive PIP extension and DIP flexion.
Swans neck
What are causes of swans neck?
- synovitis of MCP causing intrinsic spasm
- synovitis of PIP causing lateral restraint
excessive PIP flexion and DIP extension.
boutonniere’s hand.
thumb positions in MCP flexion and IP extension
Thumb Z hand.
wrist in radial deviation and MCP in ulnar deviation
ulnar drift.
what alignment impairments are associated with peripheral nerve injury?
ape hand
bishops hand
claw hand
drop wrist
thump MCP in same plane as digits 2-5.. can’t move into opposition
due to
ape hand.
median nerve damage.
can’t extend IP jt of digit 4 and 5?
Bishops hand
ulnar nerve damage.
IP of all fingers flexed and mcp hyperextended
claw hand.
ulnar and median.
wrist and fingers position in flexion and cannot extend actively.
drop wrist
radial nerve damage.
Along with hand and wrist ROM you should take
shoulder and elbow.
especially in on splint.
grip strength done with:
men normals:
women normals:
how much grip strength needed for ADLs?
dynamometer
102-113 pounds
60-71 pounds.
3-5 lbs.
Special tests of hand/wrist
Phalens
Tinels
Finkelstein
Contracture of palmar fascia.
common area?
dupytren’s contracture.
digit 4-5
compression of anterior compartment of forearm, resulting occlusion of radial artery and subsequent contracture of long flexors.
Volkmann’s ischemic contracture
compartment syndrome.
numbness and tingling in radial 3 digits worse at night
carpal tunnel syndrome.
physical finding of wrist fractures
pain with AROM
localized tenderness
Pain with PROM
pain with gripping/ supination.
Fall on outstretched arm, with forearm pronated and wrist extended
colles fracture.
what do patient heal in for college fracture?
wrist extension
wrist radial deviation
forearm supination
with collet fracture patients may limit ROM in
wrist flexion
wrist ulnar deviation
forearm pronation.
interventions for college fracture?
6 weeks in cast. or surgery if angle is severe.
Tx. address wrist ROM, accessory motion, strength, pain, swelling.
> 70% of all carpal fractures
scaphoid fractures.
___ %Scaphoid Fx. heal with _____
if Dx. delayed, there is risk of
90%/early treatment.
malunion/nonunion/avascular necrosis.
With is TFCC. how is it characterized and who commonly gets it?
triangular fibrocartilage complex tear.
ulnar writ pain and clicking. lunotriquetrial tenderness
common in athletes.
how is TFCC Dx? and what is the immediate Tx?
MRI or arthrogram
immobilization or surgery.
CRPS _____ times more common in what?
4x> in women than men.
characteristics of CRPS in acute stage?
- burn/ache in “stocking glove distribution”
- edema
- warm/dry/red skin
- Hyperesthesia
Characteristics of CRPS in dystrophic stage?
- burn/ache/throbbing pain.
- edema
- cool/grey/cyonatic skin
- slowed hair/nail growth
- muscle wasting/stiff joints.
Characteristic of CRPS in atrophic stage?
pain
cool/thin skin
atrophy + contractures.
Severe osteoporosis.
management of CRPS?
nerve blocks.
sympathectomy
Meds.
PT interventions for CRPS
stress loading exercise Massage Limb desensitization Compression garments Graded motor imagery.
3 components of graded motor imagery?
1: Laterality: RvsL.
2: Imagery: mental practice
3: Mirror therapy
a neuro-rehabilitation technique designed to remodulate cortical mechanisms by using vision to reprogram motor and sensory processes.
mirror therapy.
Etiology of CPS is _
attributed to
unknown.
prolonged typing/ repetitive activity of wrist extension and finger flexion.
Characteristics of CPS?
numb/tingle/motor loss in area innervated by median nerve.
Differential Dx. of Carpal Tunnel Syndrome
- tendinopathy of finger flexor
- lesion of median nerve proximal to carpal tunnel.
- double crush injury
