Hand Therapy Flashcards
What are the main joints in the hand.
Distal interphalangeal joint, Proximal interphalangeal joint, Metacarpophalangeal joint, Carpmetacarpal joint, Radiocarpal joint.
What are the main joints in the thumb
- Interphalangeal joint,
- metacarpophalangeal joint,
- carpometacarpal joint,
- Radiocarpal joint.
What are the bones in the fingers and hand
Distal phalange, Middle phalange, Proximal phalange, Metacarpals, Carpals, Radius, Ulna
Main bones in the thumb
Distal phalange, Proximal phalange, Metacarpals, Carpals. Radius, Ulna
What are the 8 carpal bones
Bottom 3 Left to Right:
- Scaphold,
- Lunate,
- Triquetrum
Top 5 left to Right:
- Trapezium,
- Trapezoid,
- Capitate,
- Hamate,
- Pisiform.
What are the 9 creases of the hand
DIP crease, PIP crease, IP crease, Palmar digital crease, Distal palmar crease, Proximal palmar crease, Median crease, Thenar crease, Wrist crease.
What are the 3 main arches of the hand
1) Proximal transverse arch,
2) Distal transverse arch,
3) Longitudinal arch.
What is a tendon.
-A tendon is a fibrous connective tissue that attaches muscle to bone
What is the role of a ligament
- Ligaments are bands of tissue that help connect bones, joints and organs and hold them in place,
- Hold bones together,
- Stabilise muscles and bones + strengthen joints.
- Allow joint to move in direction it’s meant too.
What are the two sides of the hand
Palmar and dorsal
What is the role of the Volar plate
- Volar plate is a small piece of ligament on the palm side of the middle phalanx on your finger.
- Helps support middle joint of your finger and prevents it from being able to dislocate or over straighten.
What are the 3 main nerves in the hand
Ulnar nerve
Median nerve
Radial nerve
Key things about the median nerve
- Originates at shoulder,
- Controls the muscles we need to perform fine precision hand movements and pinching functions,
- Enters through carpal tunnel,
- controls sensation in the thumb, middle finger and one side of the ring finger.
Key things about ulnar nerve
- Runs Through the arm into the hand
- Largest unprotected nerve in the body,
- Connects little finger and adjacent side of the ring finger,
- Provides sensation to the palm side of the hand,
- Enables us to grasp objects
- Enters palm of the hand through Guyons canal
Key things about Radial nerve
- Nerve Runs through our arm and controls our ability to extend our wrist and control the position of our hand.
- Provides sensory feedback from the back of the little finger and adjacent side of the ring finger.
What does SOAP stand for
Subjective,
Objective,
Analysis,
Plan.
Things to include in an objective assessment
- Your observation,
- Patients wound and it’s condition,
- Patients scar and it’s condition,
- Palpation,
- Tendons,
- Oedema,
- ROM, Grip, Sensation.
Key things about mallet finger injuries
- It’s an injury to the end of your finger that causes it too bend inwards towards your palm.
- Will not be able to straighten the end of your finger because tendon connecting muscle to finger bone is stretched or torn.
- Finger will be painful and swollen.
- Extensor tendon is affected.
What are collateral ligament injuries also known as?
Joint sprains.
How is a collateral ligament injury graded?
Grade 1- Asymmetric swelling and tenderness,
Grade 2- Complete disruption of collateral ligament but Volar plate remains intact,
Grade 3- Total collateral ligament disruption and Volar plate rupture.
What are the 3 types of dorsal dislocation (hyper-extension injuries)?
Type 1 hyperextension,
Type 2 Dorsal dislocation,
Type 3 Fracture- dislocation
Why does a boutonierre deformity form?
- Rupture of the central slip,
- Lateral bands descend volarly around the PIPJ causing a flexion pull to the PIPJ and hyper-extension to the DIPJ.
- Oblique retinacular and transverse retinacular ligaments tighten.
- Triangular ligament tears,
- Intrinsic muscles tighten causing proximal migration of central slip.
What does the Elson’s test do?
It’s used for early detection of injuries to the central slip of the extensor tendon.
List the 10 common classifications of fracture
- Normal,
- Transverse,
- Open,
- Oblique,
- Commiuted/stress,
- Segmental,
- Avulsed,
- Oblique non-displaced,
- Taurus,
- Greenstick
What are the three stages of fracture healing.
Inflammatory phase,
Reparative (proliferative) phase,
Remodelling (maturation) phase.
How long does it typically take for a fracture to heal
4-6 weeks.
What are 5 common fracture fixations.
- K-wires,
- Lag screws,
- Circulage wires,
- plate/screw,
- Traction.
What is osteoarthritis?
- Where cartilage that cushions the ends of bones in your joints deteriorates.
- Causes joints to become painful and stiff it’s the most common type of arthritis.
What are the 4 stages of osteoarthritis
Stage 1- minor,
Stage 2 -mild,
Stage 3 -moderate,
Stage 4-Severe
What are the causes of osteoarthritis?
- Joint injury,
- Rheumatoid arthritis,
- age,
- family history,
- obese,
- being a woman
What are the clinical symptoms of osteoarthritis
- pain,
- stiffness,
- tenderness,
- swelling,
- bone spurs,
- grating sensation,
- loss of flexibility.
How is osteoarthritis diagnosed?
- Gp will ask questions about pain and examine joints affected,
- X-Rays to rule out other possible causes such as rheumatoid arthritis.
What are three deformities associated with osteoarthritis
- Heberdens nodes,
- Bouchards nodes,
- Z-Deformity.
What is Rheumatoid arthritis.
- It’s a long term condition that causes pain, swelling and stiffness in the joints,
- Caused by the immune system attacking healthy body tissue.
How stages of Rheumatoid arthritis is there?
4 Stages
What are the clinical symptoms of rheumatoid arthritis?
- Pain in the joints usually a throbbing and aching pain.
- Stiffness in the joints,
- Swelling, warmth and redness around the joints caused by inflammation.
How is Rheumatoid arthritis diagnosed?
- GP will do physical examination of joints to examine swelling will ask about symptoms,
- Blood tests,
- Joint scans such as x-ray,
- assessing physical activity.
- Rheumatoid factor and anti-ccp anti bodies.
What are the defomities associated with rheumatoid arthritis?
- Boutanierre,
- Swan neck,
- Ulnar drift,
- Z-Deformity.
What are the main principles for joint protection?
- Respect for pain,
- Balance activity and rest,
- Avoid activities which cannot be stopped,
- Use longer stringer joints for activities
What are the main principles of energy conservation?
- Pace,
- Plan,
- Prioritise.
What are 6 main principles of an exercise programme for a patient with with either type of arthritis?
1) Pain free movement,
2) Maintenance of joint range,
3) Protection of soft tissue structures,
4) Patient reproducibility,
5) Exercises that don’t reinforce patterns/positions of deformity,
6) Apprioate level of intensity to avoid flare ups and increased pain post excersise.
What are the main functions of splinting?
- Surgical protection,
- Support, position or rest,
- Immobilise a joint,
- Fracture alignment,
- Limit joint range of motion,
- Substitute impaired muscle function,
- Mobilise stiff joints,
- Maintain gains in ROM,
- Provide a prolonged stretch over soft tissue or adhesions,
- Prevent or correct abnormality or deformity,
- Control/modify scar formation.
Things to include in a subjective assessment?
- Patients medical history,
- Treatment now to then,
- How painful it is on scale 1-10,
- What caused the pain,
- What is their job and their leisure activities,
- How are they coping,
- If there anything they have tried before,
- What is there dominant hand,
- How do they deal with the pain,
- What causes the pain to worsen,
- what helps make the pain manageable.
What are the 8 principles of hand therapy assessment.
1) Time,
2) Assess appropriately,
3) Environment,
4) positioning,
5) Patient- put them at ease,
6) Explanations and instructions,
7) Equipment,
8) Prioritise.
What are the 6 pain assessment guidelines
1) Pain behaviour- type of pain,
2) Location of pain,
3) Irritability/alleviation,
4) Frequency,
5) Medication,
6) Quantitative assessment.
What is the acronym to remember the 8 Carpal bones?
So. = Scaphold Long = Lunate To = Triquetrum, Pinky = Pisiform, Here = Hamate Comes = Capitate The = Trapezoid Thumb = Trapezium.
