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PHTH 565 RA > Hand joint counts > Flashcards

Hand joint counts Flashcards

1
Q

What are the specific Rx goals with hand Ra?

A

Local rest

ice or contreast baths (Except with raynuads)

Jt protection

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2
Q

What are 3 key points to Ax of disease activity in RA. What common sites do you find them in?

A

1) active joint count
2) vasculitis (inflam blood vessels in tips of fingers b/c smallest inflam cause black spots)
3) tenosynovitis (Synovitis - common extensor expansion, move wrist or fingers does not feel smooth w. movt)

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3
Q

What can cause tendon ruptures in Ra?

A

infiltration of adjacent synovuium (pannus)

Ischemia d/t presure by expansive synovium

Abrasion over roughened bony prom.

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4
Q

A pt is right handed and has early RA in this hand, will this hand be weaker, be at a greater risk for deformity and how would you measure ROM.

A
  • handedness does not = deformity
  • 50% will get deformity in 10yrs
  • dominant hand 20% weaker (b/c of increased phsyical demand = jt inflam)
  • measure on dorsum unless effusion, edema, jt contracture then lateral
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5
Q

What are the 5 major hand deformities in RA?

(BUST.W)

A

1) Boutonnieres
2) swan neck
3) ulnar drift
4) thumb deformity
5) wrist deformity

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6
Q

Describe the central mechanism to a BD

A

synovitis of PIPJ -> disrupts central slip-> stresses triangular lig -> lateral bands migrate volarly -> (Flexor @ PIPJ) -> ext force concentrated on distal phalanx = DIPJ hyperextension

  • prox phalanx button holes dorsally through lateral bands
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7
Q

What can you use to Rx BD?

A

Anti B splint

(ABNS) blocks PIPJ Flexoin and flex

  • work on active ext of PIPJ and active flex of DIPJ
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8
Q

What is a swan neck deformity?

A

chronic synovitis @ MCP ->triggers protective P. reflex -> intrinsic msucle (IM) spasm–> overactive IM overpower extrinsic flexors -> PIPJ hyperextension -> excessive MCP flexion cause lateral bands dorsally displaced -> DIPJ flexes in response to tension on FDP tendon

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9
Q

What test can you use to test for swan neck D. How do u know if its positive or not?

A

Bunnel littler test

  • if you get more PIPJ flexoin when the MCP is in flexion vs hypextension means the jt was stiff and needs stretching
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10
Q

What gradinig system do you use for SND and what are the levels?

A

Nalebuff

1 - no limitation of PIPJ motion in any MCPJ position

2 - limitiation in PIPJ motion with MCPJ in extension and radial devidation

3- limit. of PIPJ motion w. any MCPJ position

4 - fused - stiff PIPJ w. jt destruction on radiograph

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11
Q

what is a Rx techn. for a positive Bunnel littler test?

A

passive stretch interossei

(ext MCP and passive flex PIP hold for 30sec 2-3 reps 3 days a week)

  • can also Rx with splint
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12
Q

what is the most common patho in RA: BD, SND, Unlar drift, ext tendon sublux. /

A

Ulnar drift deformity most common

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13
Q

What are the pathomechanics of Ulnar deviation (UD)

A

synovial prolif -> attenuation of radial collateral lig and sagittla band –> EDCulnarly displaced

  • ulnar displacment force > in full ext/or flex >60
  • asymmetry in slope of metacarpal hd (radial > ulnar)
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14
Q

whats the diff b/w the mechanics behind UD and UD volar subluxation ?

A

attenuation of collateral lig & volar plate - fail to restrain extrinsic flexor force created by FDS and FDP –> the > MCPJ flexion angle = > volar sublux so the proximal phalanx subluxs

  • tight interossei make this worse by increasing the volar plate sublux
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15
Q

How do you test for UD ?

A

MCP radial collateral lig test

Extensor tendon subluxation test (look for the tendon to sublux to the ulnar side )

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16
Q

How do you grade UD?

A

Millender and Nalebuff

Graded 1-4

1 - mild UD; mcpj synoviits; full active MCP flx/ext

4- severe; fixed & MCP articular destruction

17
Q

What exs prescription and Rx exist for UD?

A

Radial finger walking

1) on table move radial; lift hand to put back dont use Ulnar muslces

( 5-10reps, once a day 2-3/wk)

  • progress to against gravity
    2) Isometric Radial intrsinsics

(70% MVC) hold 6sec

(5-10 once a day 2-3/wk)

3) education use hand so use radial muscles (jt protection)

18
Q

What is the main deformity of the thumb joint?

A

90/90 deformity that happens w. BND

Its ranked as (I) on the Nalebuff classification ratiing

19
Q

What does the BND deformity of the thumb look like? Describe the mechanics of it.

A

BND THUMB: d/t synovitis - causes the EPB tendon to ulnar deviate and valar slide

  • causes: Flexion of the MCPJ and hyper-ext of the IPJ
20
Q

What are the Rx options for thumb BND?

A

1) complete resection of the trapezoid
2) lig reconstruction

3) tendon reconstruction

21
Q

What is the difference b/w SND and BND at the thumb?

A

SND - synoviitis at the CMCJ- causes the jt to sublux dorsal and radially - also d/t spasm of ADDP

CMCJ - flex/add/sub

– > MCPJ hyperextend and the IPJ flex

Therefore the mechanics of the SND are more to do with the CMCJ then the MCPJ

  • Want to check for issues around the CMCJ for arthritis then b/c this is where this deformity starts
22
Q

What are the Rx options and Ax TESTS used for SND in the thumb?

A

1) Gind test:
- text for arthritis in CMCJ; axial compression with rotation of joint
- ++ P , +/- crepitus
2) Crank Test:
- tests or same as above
- add now dorsal and valar glide to jt
- ++ P, +/- crepitus

TREATMENT for over all THUMB EXS: FOR both deformities

1) Massage the websace 2) stretch the space (hand over other wrist watch the angle of the thumb) 3) opposition/abd exs (making a mouth with your hands working jt into abductoin)

23
Q

What are all the different deformities of the hand? Make a note about what each one looks like.

A

1) boutonnieres
2) Swan neck deformity
3) Ulnar drift
4) Thumb (#1 BND; #2 SND)
5) Wrist deformity

24
Q

What are the deformities of the wrist?

A

1) DRUJ inistability
2) Vaughn jackson deformity
3) Zig Zag deformity

25
Q

Describe a DRUJ deformity

A
  • synovitis - stretches UCL - dorsal dislocation of ulna & sup of carpus on the ulna (possibly d/t to pull of the ECU tendon which has subl on volarly)

  • ECU now flexes
  • Increases chance of tendon rupture
  • decreases ROM +/- P
  • decreased strength wrist
26
Q

Describe a Vaughn Jackson deformity.

A
  • at the wrist
  • complete ext tendon ruputre
  • send to surgeon right away
27
Q

Describe a zig zag deformity

A

synovitis - jt laxity and subluxation - carpal movt ulnarly & radial rotation of metacp - fingers go ulnar side

28
Q

Best Ax tools for wrist arthritis and deformity is what?

A

Ballottment piano key test

  • Ax DRUJ
  • elbow flex to 90
  • stab radius, sup - dorsal and ulnar glides - then do same thing in pronation
  • ++ P, +/- excessive movt, tenderness relative to the other side
29
Q

What options do you have to Rx. wrist deformities? What is the goal of Rx?

A

Rx instabiltiy d/t recurrent synovitis

protect small jts

can do flexion exs but NEED to be careful

1) AROM
2) Tendon glides
3) Splints
4) Surgery

30
Q

Describe AROM exs for the wrist

A

1) AROM of wrist
- ext MCPJ, flex the PIP , can stab MCPJ with other hand

(10 Reps 1x/day every day)

31
Q

Describe tendon gliding exs

A

Tendon glides:

32
Q

What are the main goals to tendon glides?

A
  • Jt to go through full ROM - increase jt cartilage nutrition
  • prevent adhesions- they result from synovitis
  • allow max excursion of jt & flex/ext tendons
33
Q

WHa are indiciations for surgery and what are the 4 R’s

A

1) if tendon rupture looks possible
2) relief p
3) incre func
4) cosemetics

Repaire

Remove

Replace

Rest

34
Q

What is the most common surgery performed/

A

Tendon tsf most common

35
Q

What types of splints can be sued?

A

1) Static (writing splints)
2) dynamic (Dynamic extension splints)

36
Q

What are the different kinds of grips

A

1) latera
2) trip pod
3) tip grip
4) hook grip
5) Spherical grip
6) cylindrical (hammer)

check for the normal attitude of the hand

PHTH 565 RA (5 decks)

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