Hand/UE Disorders & Injuries Flashcards
Dupuytrens Disease
Disease of fascia of palm/digits where fascia becomes thick/contracted - develops cords/bands that extend into digits: Results in flex deformities of involved digits
*Surgical release required
Tx for Dupuytrens Disease
Wound care - dressing changes; Edema control - elevation; Extension splint - initially at all times; A/PROM and progress to strengthening; Scar mngt; Purposeful grip/release task
Skiers Thumb/Gamekeepers thumb
Rupture of ulnar collateral lig of MCP joint of thumb - most common is fall w ski pole in hand
TS for Skiers Thumb/Gamekeepers thumb
Thumb splint 4-6mo, AROM/Pinch strengthening for 6mo, Focus on ADL that req opposition/pinch strength, post-op tx: thumb splint for 6wx then AROM. PROM can begin at 8wk, strengthening at 10
Complex Regional Pain Syndrome (CRPS) {2 types}
Type I: formerly known as reflex sympathetic dystrophy (RSD); Type II: formerly known as causalgia
Vasomotor dysfx as a result of an abnormal reflex; Can be localized or spread
CRPS symptoms
Severe pain, edema, discoloration, osteoporosis, sudomotor changes, temp changes, trophic changes and vasomotor instability
Tx for CRPS
Modalities to decrease pain, edema mngt, AROM, ADL to encourage pain-free use, stress loading (wt bear/joint distraction activities like scrubbing/carrying), splinting to prevent contractures/enable ability, encourage self mngt, interventions to avoid/caution: PROM. pass stretch, joint mob, dynamic splinting/casting
Intraarticular vs Extraarticular fracture
Intra-articular fractures involve a joint space and are significantly more serious because they are associated with a much greater incidence of long-term complications; Extraarticulars do not extend into the joint
Closed vs Open fracture
An open fracture is an injury that not only damages the bone but will break the skin; Closed does not break skin
Dorsal vs Volar Displacement Fracture
A Colles’ fx: of the distal radius in the forearm w dorsal (posterior) and radial displacement - Sometimes referred to as a “dinner fork” or “bayonet”; Smiths fx: of the distal radius w volar displacement
A fracture with an offset of 2mm+ in any plane or 2mmm offset involving the articular surface is considered displaced.
Complete vs Incomplete Fracture
A complete fracture means that the fracture line goes completely across the bone — through the cortex
Simple vs Comminuted Fracture
A simple fracture is one where there are only 2 major bone fragments and one fracture line. A comminuted fracture is one where there are multiple bone fragments and multiple fracture lines.
Transverse Fracture
Fracture line is perpendicular to the long axis of the bone, caused by force in the direction of the fracture
Spiral Fracture
Fracture line is twisted and the fracture line is a twisting fracture caused by a twisting injury such as a break in your leg that happens when your foot is planted but your leg keeps turning
Oblique/Diagonal Fracture
Fracture line is on the diagonal and usually caused by force applied in the same direction as the long axis of the bone
Impacted, Compressed or Longitudinal Fracture
Fracture line and force is in the same direction as the long axis of the bone
Avulsion Fracture
Bone fracture which occurs when a fragment of bone tears away from the main bone mass as a result of physical trauma.
Types of Fx
Closed reduction: stabilization through short/long arm cast, splint, sling or fracture brace; ORIF: nails, screws, plates, wires; External Fixation; Arthodesis: fusion; Arthroplasty: joint replacement
Carpal Fx
Most common scaphoid fx (60%) - prox scaphoid has poor blood supply and may become necrotic
MC Fx
Classified by location; common complication is rotational deformities.
Boxers Fx
Fx of 5th MC; req ulnar gutter splint
Prox Phalanx Fx
Most common w thumb/index; common complication is loss of PIP A/PROM
Distal Phalanx Fx
Most common finger fx; May result in mallet finger which involves the terminal extensor tendon which straightens DIP
Humerus Fx of greater tuberosity could
Affect rotator cuff
Humerus Fx of radial shaft could
Injure radial nerve - wrist drop
Eval for Fx
Hx: w mechanism of injury/fx mngt; Results of special tests; Edema; Pain; AROM - not PROM until ordered by physician (ex humerus fx which usually begin with PROM); Sensation; Occ/roles/ADL/Activities
Tx for Fx - Immobilization Phase
Stabilization and healing goals - AROM of joints above/below stabilized part; Edema control: retrograde, elevation, compression garmets; Light ADL/role activities w no resistance - AT
Tx for Fx - Mobilization Phase
Edema control: elevation, retrograde, contrast baths, compression garmets; AROM: process to PROM when approved (4-8wks) - ex humerus fx; Light occ-based acts; Pain mngt: positioning & PAMs; Strengthening: isometrics to begin when approved
Cumulative Trauma Disorders (CTD) or Repetitive Strain Injuries (RSI) - Risk Factors
Overuse and/or MSD; repetition, static position, awkward postures, forceful exertion & vibration; Acute trauma, preg, DB, arthritis, wrist shape/size
de Quervains
Stenosing tenosynovitis of the abductor pollicus longus and extensor pollicus brevis, pain & swelling over radial styloid & positive finkelstiens - thumb in palm
Tx for de Quervains
Conservative tx: thumb spica splint w IP joint free, activity/work mod, ice massage over radial wrist, gentle AROM of wrist/thumb to prevent stiffness; Post-Op tx: thumb spica splint & gentle AROM 0-2wks, strengthening, ADL/Role activities 2-6wks; Unrestricted activity at 6wk
Lateral Epi or Tennis Elbow
Overuse of wrist extensors esp ECRB - degen of tendon origin
Medial Epi or Golfers Elbow
Overuse of wrist flexors - degen of tendon origin
Conservative tx for Lateral/Medial Epi
Elbow strap/wrist splint, ice/deep friction massage, stretching; act/work mod, as pain decreases add strengthening - progress to isotonic/eccentric
Trigger Finger
Tenosynovitis of finger flexors - most commonly A1 pulley
Conservative tx for Trigger Finger
Hand based trigger finger splint w MCP extended and IP free; Scar massage; Edema Control; Tendon gliding; Activity/Work mod - avoid rep gripping and tool w handles too far appart
