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MSK 1 > Hand/Wrist > Flashcards

Hand/Wrist Flashcards

1
Q

The hand accounts for __ of upper limb function.

A

90%

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2
Q

The thumb is involved in __ of hand function.

A

40-50%

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3
Q

What is the functional range of motion of the wrist?

A

10 degrees extension

30 degrees flexion

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4
Q

The __ is convex and the __ is concave in the distal radioulnar joint?

A

Ulnar head

Ulnar notch of the radius

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5
Q

What does the distal radioulnar joint join together?

A

Distal radius
Ulna
TFCC (articular disc)

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6
Q

What is the open packed position of the distal radioulnar joint?

A

10 degrees supination

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7
Q

What is the close packed position of the distal radioulnar joint?

A

5 degrees supination

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8
Q

What is the capsular pattern of the distal radioulnar joint?

A

Pronation = supination

Pain at extremes of pronation/supination

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9
Q

What is the TFCC?

A

Triangular Fibrocartilage Complex

Fibrocartilage disc between the distal ulna and carpals in the medial wrist

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10
Q

What is the primary function of the TFCC?

A

Enhances joint congruity and cushion against compressive forces
Transmits ~20% of axial load from the hand to forearm

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11
Q

What does the radio carpal joint join together?

A

Radius
Scaphoid
Lunate
TFCC

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12
Q

What does the open packed position of the radio carpal joint?

A

10 degrees wrist flexion

Slight ulnar deviation

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13
Q

What does the close packed position of the radiocarpal joint?

A

Full extension with radial deviation

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14
Q

What is the capsular pattern of the radiocarpal joint?

A

Equal limitation all directions

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15
Q

What is the proximal part of the midcarpal joint made up of?

A

Scaphoid
Lunate
Triquetrum

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16
Q

What is the distal part of the midcarpal joint made up of?

A

Trapezium
Trapezoid
Capitate
Hamate

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17
Q

What does the open packed position of the midcarpal joint?

A

Neutral or slight flexion with ulnar deviation

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18
Q

What does the close packed position of the midcarpal joint?

A

Extension with ulnar deviation

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19
Q

What does the capsular pattern of the midcarpal joint?

A

Equal limitation in all directions

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20
Q

What is the articulation of the first CMC joint?

A

1st metacarpal and trapezium

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21
Q

The trapezium is concave in the __ direction and convex in the __ direction.

A

Concave: anterior/posterior
Convex: medial/lateral

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22
Q

The 1st MCP is concave in the __ direction and convex in the __ direction.

A

Concave: medial/lateral
Convex: anterior/posterior

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23
Q

What is the open packed position of the first CMC joint?

A

Midabduction and adduction in mid flexion and extension

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24
Q

What is the close packed position of the first CMC joint?

A

Full opposition

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25
What is the capsular pattern of the first CMC joint?
Abduction most limited | Followed by extension
26
What is the open packed position of the 2-5 CMC joint?
Neutral position of the wrist
27
What is the close packed position of the 2-5 CMC joint?
Not described
28
What is the capsular pattern of the 2-5 CMC joint?
Equal limitation in all directions
29
What is the open packed position of the MCP joint of the 1st digit?
Slight flexion
30
What is the close packed position of the MCP joint of the 1st digit?
Maximal opposition
31
What is the capsular pattern of the MCP joint of the 1st digit?
Greater limitation in flexion than extension
32
What is the open packed position of the MCP joint of the 2-5 digits?
Slight flexion
33
What is the close packed position of the MCP joint of the 2-5 digits?
Full extension
34
What is the capsular pattern of the MCP joint of the 2-5 digits?
Equal restriction in all directions
35
What is the open packed position of the PIP joint of the 2-5 digits?
Slight flexion
36
What is the close packed position of the PIP joint of the 2-5 digits?
Full extension
37
What is the capsular pattern of the PIP joint of the 2-5 digits?
Greater limitation in flexion than extension
38
What is the open packed position of the DIP joint of the 2-5 digits?
Slight flexion
39
What is the close packed position of the DIP joint of the 2-5 digits?
Full extension
40
What is the capsular pattern of the DIP joint of the 2-5 digits?
Greater limitation in flexion than extension
41
Extensor retinaculum
Prevents tendons from "bowstringing" | Forms 6 compartments
42
Extensor hood
Complex tendon covering posterior aspect of the digits ED, EI, EDM Distal portion of hood receives tendons of lumbricals and interossei over prox phalanx Between MCP and PIP, complete tendon splits into 3 parts: central slip and 2 lat bands Arrangement creates cable system for extending MCP and IP joints
43
Compartment 1
Extensor pollicis brevis | Abductor pollicis
44
Compartment 2
Extensor carpi radialis brevis | Extensor carpi radialis longus
45
Compartment 3
Extensor pollicis longus
46
Compartment 4
Extensor digitorum | Extensor indicis
47
Compartment 5
Extensor digiti minimi
48
Compartment 6
Extensor carpi ulnaris
49
What is contained underneath the flexor retinaculum? (4)
Flexor digitorum profundus Flexor digitorum superficialis Median N Flexor pollicis longus
50
What is the function of the volar plates/palmar ligaments at the IP joints?
Help prevent hyperextension of the IP joints
51
Oblique retinacular ligament
Helps the PIP/DIP move together | As the PIP extends through the central slip, tension is put not he oblique reticular ligament which then extends the DIP
52
Where is the flexor retinaculum located?
Spans area between pisiform, hamate, scaphoid and trapezium
53
What are the 2 functions of the flexor retinaculum?
Prevents bowstringing of flexor tendons | Protects the median N
54
What are the flexor pulleys?
Annular and cruciate connective tissues restrain flexor tendons to metacarpals and phalanges Contributes to tunnels through which the tendons travel
55
Carpal Tunnel
Median N | 9 flexor tendons: FDS, FDP, FPL
56
Tunnel of Guyon
Between the hook of the hamate and the pisiform | Passageway fro ulnar N and artery in hand
57
What is a double crush injury?
Nerve symptoms may start distally then move proximally OR Nerve symptoms may start proximally and move distally
58
What 2 muscles attach to the pisiform?
Flexor carpi ulnaris | Abductor digiti minimi
59
Pathology of Rhuematoid Arthritis
Systemic disease Cycle of stretching, healing and scarring that occurs as a result of the inflammatory process Significant damage to soft tissues and periarticular structures Can lead to pain, stiffness, joint damage, instability, deformity
60
Name the 3 common deformities associated with RA
Ulnar drift Boutonniere deformity Swan-neck deformity
61
Intervention for RA
``` Control inflammation Focus on joint systems vs isolated joints Exercises Joint protection/energy conservation Splinting Pain management ```
62
Ulnar Drift
Result of interaction forces and damage to collateral ligaments and extensor mechanisms Pulls the finger into ulnar deviation, pronation, anterior subluxation Up to 45 degrees of lateral deviation can occur at the MCP joint
63
Boutonniere Deformity Description
Extension of MCP/DIP | Flexion of PIP
64
Boutonniere Deformity Mechanism
Common extensor tendon that inserts on the base of the middle phalanx is damaged Damage to central slip insertion requires extra effort to extend joint, causing hyperextension at DIP Lateral bands drift forward past axis of rotation of PIP and act as flexors while hyperextending DIP
65
Causes of a Boutonniere Deformity
Division, rupture, avulsion, closed trauma to common extensor tendon RA
66
Boutonniere Deformity Examination
If more than 30 degree extension lag is present at PIP
67
Boutonniere Deformity Intervention
Immobilize PIP full extension with MCP/DIP free 6-8 weeks
68
Swan Neck Deformity Description
Flexion of DIP | Hyperextension of PIP
69
Swan Neck Deformity Mechanism
Destruction of oblique reticular ligament of the extensor mechanism leads to posterior displacement of lateral bands resulting in hyperextension of PIP Pull on FDP tendon causes flexion of DIP
70
Swan Neck Deformity Intervention
Silver ring splint
71
TFCC Lesions
Disruption of articular disc | Following fall on supinated outstretched wrist or chronic repetitive rotational loading
72
TFCC Lesion History/Examination
Medial wrist pain distal to the ulna, increased with end-range forearm pronation/supination and forced gripping Painful click during wrist motions Tenderness localized distal to ulnar head
73
TFCC Lesion Intervention
Joint distraction, wrist strengthening | Long arm cast or splint 6 weeks
74
Primary Osteoarthritis
Commonly involves 1st CMC joint or scaphotrapeziotrapezoid joint
75
Secondary Osteroarthritis
Old trauma or infection
76
1st CMC Osteoarthritis
``` Women > men >45 years old Joint pain at the base of thumb which increases with use Restricted ROM in capsular pattern Joint crepitus ```
77
Osteroarthritis Intervention
Splinting Thermal modalities Education
78
Dupuytren Contracture
``` Active cellular process in the fascia of the hand, characterized by nodules in palmar and digital fascia Tendon-like cords Contractures at MCP and PIP Little finger in 70% Usually bilateral ```
79
Dupuytren Contracture Examination
Caucasian men, later in life Higher incidence with alcoholic, diabetic, epileptic, tobacco Inability to straighten fingers, primarily 4th/5th
80
Dupuytren Contracture Intervention
Stretching initially Surgery Postoperative scar management and splinting
81
UCL sprain of the thumb
Gamekeeper's or skier's thumb Injury to MCP of the thumb Most common ligament injury
82
UCL sprain of the thumb Examination
Pain/tenderness on ulnar aspect of MCP | Direct force causing hyperextension and abduction of MCP joint or repeated trauma
83
UCL sprain of the thumb Intervention
Splinting Strengthening Taping
84
Ganglia
Thin-walled cysts containing hyaluronic acid that develop spontaneously over a joint capsule or tendon sheath Common sites: anterior or posterior surfaces of the wrist and fingers
85
Ganglia Examination
May not cause pain As grows: aching increased with flexion/extension Tender with applied pressure
86
Ganglia Intervention
Needle aspiration or surgical excision
87
Tendonitis
Inflammation of the tendon or tendon-muscle attachment Overuse Abductor pollicis longus Extensor pollicis brevis
88
Tenosynovitis
Inflammation of the tendon sheath | Rheumatic disease, DM, hypothyroid
89
DeQuervain Disease
Progressive tenosynovitis involving sheaths of first posterior compartment of wrist (APL and EPB) Thickening of extensor retinaculum, stenosing of fibro-osseus canal and eventual entrapment and compression of tendons
90
DeQuervain Disease Examination
Gradual and insidious onset Dull ache over radial aspect of the wrist "Creak" in wrist as tendons move Severe pain with wrist ulnar deviation and thumb flexion/adduction Localized swelling and tenderness in region of radial styloid process Loss of abduction of CMC joint
91
DeQuervain Disease Intervention
``` Rest Activity modification Splinting NSAIDs Manual therapy ```
92
Trigger Finger
Painful snapping/triggering of the fingers due to disproportion between the flexor tendon and its tendon sheath More common in thumb, ring and middle fingers Most common in diabetics, young children, menopausal women, RA
93
Trigger Finger Examination
Limited finger motion (esp PIP) Crepitus or moving nodular mass near A1 pulley with finger movement Swelling
94
Trigger Finger Intervention
Splinting, immobilization MCP joint Activity modifications Steroid injections or surgical release
95
Tendon rupture
Common flexor pollicis longus and flexor digitorum profundus to index finger
96
Tendon rupture with repair postoperative
Early protected mobilization Know number of strands of suturing used: 2 strands-may be limited to PROM; 4-6 strands-may be able to work tendons actively Prevent adhesions that limit excursion
97
Mallet Finger Deformity
Traumatic disruption of the terminal tendon from DIP
98
Mallet Finger Deformity Examination
Loss of active extension of the DIP joint, can be extended passively Flexion deformity of DIP
99
Mallet Finger Deformity Intervention
Immobilization/splinting of DIP in extension Allow PIP movement Unrestricted use after 12 weeks
100
Carpal Tunnel Syndrome
Ischemic compression of the median nerve at the wrist as it passes through the carpal tunnel Compounded by increase in synovial fluid pressure and tendon tension
101
Carpal Tunnel Syndrome Examination
Intermittent pain and paresthesia in median nerve distribution of hand, progressively becomes more persistent Symptoms typically worse at night Phalen tests and Tinel sign
102
Carpal Tunnel Syndrome Intervention
Splints, ergonomics Activity modification Diuretics and NSAIDs Isolated tendon excursion exercises and nerve glides
103
Radial Nerve Entrapment Examination
Weak wrist and finger extension | Hand grip weakened as a result: decreased stabilization
104
Wartenberg Syndrome
Compression of the superficial sensory radial nerve | Pain, paresthesias, numbness on radial aspects of hand and wrist
105
Radial Nerve Entrapment Intervention
Activity modification | Manual therapy
106
Chronic Regional Pain Syndrome Examination | Reflex sympathetic dystrophy (RSD)
``` Past event of trauma Persistent pain Edema: pitting or nonpitting Stiffness Skin temperature changes, sweating Hyperalgesia Allodynia ```
107
Chronic Regional Pain Syndrome Intervention | Reflex sympathetic dystrophy (RSD)
Team approach Minimize pain while doing PT Slow/gentle progression of strengthening, AAROM, AROM, weight-bearing exercises Mirror therapy
108
Colles Fracture
Complete fracture of distal radius with posterior displacement of the distal fragment FOOSH
109
Smith Fracture
Complete fracture of distal radius with anterior displacement of the distal fragment Fall on back of a flexed hand
110
Scaphoid Fracture
Most commonly fractured carpal bone | FOOSH with wrist pronated
111
Scaphoid Fracture Examination
Posterior radial-sided wrist pain Tenderness over anatomic snuffbox Swelling in anatomic snuffbox
112
All wrist pain with swelling and pain in the snuffbox should be treated as ___ until ruled out because __.
Scaphoid fracture | Delayed diagnosis can result in long-term pain, loss of mobility and/or loss of function
113
Kienbock Disease
Aseptic necrosis or osteonecrosis of lunate Pain over lunate FOOSH Decreased grip strength Surgery vs immobilization with splint followed by exercise
114
Lunate Dislocation
``` Dislocation of the lunate volarly FOOSH or hit by outside force Pain over lunate Deformity Inability to move wrist Median neuropathy ```
115
Lunate Dislocation Intervention
Reduction Immobilization No extension for 5-6 weeks
116
Raynaud's Phenomenon
Vasospasm of the distal vessels of the hands and toes Decreased circulation distal UE Diffuse pain in hand Pale fingers Cold may trigger Allen's test (+) Blanching of fingers followed by reddening
117
Boxer's Fracture
Fracture of the 5th metacarpal
118
Hook Grip Innervation
Median N | Ulnar N
119
Power Grip Innervation
Ulnar N | Maybe median N
120
Lateral Pinch Innervation
Ulnar N
121
Precision Pinch Innervation
Median N
122
Cylindrical Grip Innervation
Radial N | Median N

MSK 1 (15 decks)

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