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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
Q

What is the capsular pattern of the first CMC joint?

A

Abduction most limited

Followed by extension

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26
Q

What is the open packed position of the 2-5 CMC joint?

A

Neutral position of the wrist

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27
Q

What is the close packed position of the 2-5 CMC joint?

A

Not described

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28
Q

What is the capsular pattern of the 2-5 CMC joint?

A

Equal limitation in all directions

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29
Q

What is the open packed position of the MCP joint of the 1st digit?

A

Slight flexion

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30
Q

What is the close packed position of the MCP joint of the 1st digit?

A

Maximal opposition

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31
Q

What is the capsular pattern of the MCP joint of the 1st digit?

A

Greater limitation in flexion than extension

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32
Q

What is the open packed position of the MCP joint of the 2-5 digits?

A

Slight flexion

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33
Q

What is the close packed position of the MCP joint of the 2-5 digits?

A

Full extension

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34
Q

What is the capsular pattern of the MCP joint of the 2-5 digits?

A

Equal restriction in all directions

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35
Q

What is the open packed position of the PIP joint of the 2-5 digits?

A

Slight flexion

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36
Q

What is the close packed position of the PIP joint of the 2-5 digits?

A

Full extension

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37
Q

What is the capsular pattern of the PIP joint of the 2-5 digits?

A

Greater limitation in flexion than extension

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38
Q

What is the open packed position of the DIP joint of the 2-5 digits?

A

Slight flexion

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39
Q

What is the close packed position of the DIP joint of the 2-5 digits?

A

Full extension

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40
Q

What is the capsular pattern of the DIP joint of the 2-5 digits?

A

Greater limitation in flexion than extension

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41
Q

Extensor retinaculum

A

Prevents tendons from “bowstringing”

Forms 6 compartments

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42
Q

Extensor hood

A

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

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43
Q

Compartment 1

A

Extensor pollicis brevis

Abductor pollicis

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44
Q

Compartment 2

A

Extensor carpi radialis brevis

Extensor carpi radialis longus

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45
Q

Compartment 3

A

Extensor pollicis longus

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46
Q

Compartment 4

A

Extensor digitorum

Extensor indicis

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47
Q

Compartment 5

A

Extensor digiti minimi

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48
Q

Compartment 6

A

Extensor carpi ulnaris

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49
Q

What is contained underneath the flexor retinaculum? (4)

A

Flexor digitorum profundus
Flexor digitorum superficialis
Median N
Flexor pollicis longus

50
Q

What is the function of the volar plates/palmar ligaments at the IP joints?

A

Help prevent hyperextension of the IP joints

51
Q

Oblique retinacular ligament

A

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
Q

Where is the flexor retinaculum located?

A

Spans area between pisiform, hamate, scaphoid and trapezium

53
Q

What are the 2 functions of the flexor retinaculum?

A

Prevents bowstringing of flexor tendons

Protects the median N

54
Q

What are the flexor pulleys?

A

Annular and cruciate connective tissues restrain flexor tendons to metacarpals and phalanges
Contributes to tunnels through which the tendons travel

55
Q

Carpal Tunnel

A

Median N

9 flexor tendons: FDS, FDP, FPL

56
Q

Tunnel of Guyon

A

Between the hook of the hamate and the pisiform

Passageway fro ulnar N and artery in hand

57
Q

What is a double crush injury?

A

Nerve symptoms may start distally then move proximally
OR
Nerve symptoms may start proximally and move distally

58
Q

What 2 muscles attach to the pisiform?

A

Flexor carpi ulnaris

Abductor digiti minimi

59
Q

Pathology of Rhuematoid Arthritis

A

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
Q

Name the 3 common deformities associated with RA

A

Ulnar drift
Boutonniere deformity
Swan-neck deformity

61
Q

Intervention for RA

A 
Control inflammation
Focus on joint systems vs isolated joints
Exercises
Joint protection/energy conservation
Splinting
Pain management
62
Q

Ulnar Drift

A

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
Q

Boutonniere Deformity Description

A

Extension of MCP/DIP

Flexion of PIP

64
Q

Boutonniere Deformity Mechanism

A

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
Q

Causes of a Boutonniere Deformity

A

Division, rupture, avulsion, closed trauma to common extensor tendon
RA

66
Q

Boutonniere Deformity Examination

A

If more than 30 degree extension lag is present at PIP

67
Q

Boutonniere Deformity Intervention

A

Immobilize PIP full extension with MCP/DIP free 6-8 weeks

68
Q

Swan Neck Deformity Description

A

Flexion of DIP

Hyperextension of PIP

69
Q

Swan Neck Deformity Mechanism

A

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
Q

Swan Neck Deformity Intervention

A

Silver ring splint

71
Q

TFCC Lesions

A

Disruption of articular disc

Following fall on supinated outstretched wrist or chronic repetitive rotational loading

72
Q

TFCC Lesion History/Examination

A

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
Q

TFCC Lesion Intervention

A

Joint distraction, wrist strengthening

Long arm cast or splint 6 weeks

74
Q

Primary Osteoarthritis

A

Commonly involves 1st CMC joint or scaphotrapeziotrapezoid joint

75
Q

Secondary Osteroarthritis

A

Old trauma or infection

76
Q

1st CMC Osteoarthritis

A 
Women > men
>45 years old
Joint pain at the base of thumb which increases with use
Restricted ROM in capsular pattern
Joint crepitus
77
Q

Osteroarthritis Intervention

A

Splinting
Thermal modalities
Education

78
Q

Dupuytren Contracture

A 
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
Q

Dupuytren Contracture Examination

A

Caucasian men, later in life
Higher incidence with alcoholic, diabetic, epileptic, tobacco
Inability to straighten fingers, primarily 4th/5th

80
Q

Dupuytren Contracture Intervention

A

Stretching initially
Surgery
Postoperative scar management and splinting

81
Q

UCL sprain of the thumb

A

Gamekeeper’s or skier’s thumb
Injury to MCP of the thumb
Most common ligament injury

82
Q

UCL sprain of the thumb Examination

A

Pain/tenderness on ulnar aspect of MCP

Direct force causing hyperextension and abduction of MCP joint or repeated trauma

83
Q

UCL sprain of the thumb Intervention

A

Splinting
Strengthening
Taping

84
Q

Ganglia

A

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
Q

Ganglia Examination

A

May not cause pain
As grows: aching increased with flexion/extension
Tender with applied pressure

86
Q

Ganglia Intervention

A

Needle aspiration or surgical excision

87
Q

Tendonitis

A

Inflammation of the tendon or tendon-muscle attachment
Overuse
Abductor pollicis longus
Extensor pollicis brevis

88
Q

Tenosynovitis

A

Inflammation of the tendon sheath

Rheumatic disease, DM, hypothyroid

89
Q

DeQuervain Disease

A

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
Q

DeQuervain Disease Examination

A

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
Q

DeQuervain Disease Intervention

A 
Rest
Activity modification
Splinting
NSAIDs
Manual therapy
92
Q

Trigger Finger

A

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
Q

Trigger Finger Examination

A

Limited finger motion (esp PIP)
Crepitus or moving nodular mass near A1 pulley with finger movement
Swelling

94
Q

Trigger Finger Intervention

A

Splinting, immobilization MCP joint
Activity modifications
Steroid injections or surgical release

95
Q

Tendon rupture

A

Common flexor pollicis longus and flexor digitorum profundus to index finger

96
Q

Tendon rupture with repair postoperative

A

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
Q

Mallet Finger Deformity

A

Traumatic disruption of the terminal tendon from DIP

98
Q

Mallet Finger Deformity Examination

A

Loss of active extension of the DIP joint, can be extended passively
Flexion deformity of DIP

99
Q

Mallet Finger Deformity Intervention

A

Immobilization/splinting of DIP in extension
Allow PIP movement
Unrestricted use after 12 weeks

100
Q

Carpal Tunnel Syndrome

A

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
Q

Carpal Tunnel Syndrome Examination

A

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
Q

Carpal Tunnel Syndrome Intervention

A

Splints, ergonomics
Activity modification
Diuretics and NSAIDs
Isolated tendon excursion exercises and nerve glides

103
Q

Radial Nerve Entrapment Examination

A

Weak wrist and finger extension

Hand grip weakened as a result: decreased stabilization

104
Q

Wartenberg Syndrome

A

Compression of the superficial sensory radial nerve

Pain, paresthesias, numbness on radial aspects of hand and wrist

105
Q

Radial Nerve Entrapment Intervention

A

Activity modification

Manual therapy

106
Q

Chronic Regional Pain Syndrome Examination

Reflex sympathetic dystrophy (RSD)

A 
Past event of trauma 
Persistent pain
Edema: pitting or nonpitting
Stiffness
Skin temperature changes, sweating
Hyperalgesia
Allodynia
107
Q

Chronic Regional Pain Syndrome Intervention

Reflex sympathetic dystrophy (RSD)

A

Team approach
Minimize pain while doing PT
Slow/gentle progression of strengthening, AAROM, AROM, weight-bearing exercises
Mirror therapy

108
Q

Colles Fracture

A

Complete fracture of distal radius with posterior displacement of the distal fragment
FOOSH

109
Q

Smith Fracture

A

Complete fracture of distal radius with anterior displacement of the distal fragment
Fall on back of a flexed hand

110
Q

Scaphoid Fracture

A

Most commonly fractured carpal bone

FOOSH with wrist pronated

111
Q

Scaphoid Fracture Examination

A

Posterior radial-sided wrist pain
Tenderness over anatomic snuffbox
Swelling in anatomic snuffbox

112
Q

All wrist pain with swelling and pain in the snuffbox should be treated as ___ until ruled out because __.

A

Scaphoid fracture

Delayed diagnosis can result in long-term pain, loss of mobility and/or loss of function

113
Q

Kienbock Disease

A

Aseptic necrosis or osteonecrosis of lunate
Pain over lunate
FOOSH
Decreased grip strength
Surgery vs immobilization with splint followed by exercise

114
Q

Lunate Dislocation

A 
Dislocation of the lunate volarly
FOOSH or hit by outside force
Pain over lunate
Deformity
Inability to move wrist
Median neuropathy
115
Q

Lunate Dislocation Intervention

A

Reduction
Immobilization
No extension for 5-6 weeks

116
Q

Raynaud’s Phenomenon

A

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
Q

Boxer’s Fracture

A

Fracture of the 5th metacarpal

118
Q

Hook Grip Innervation

A

Median N

Ulnar N

119
Q

Power Grip Innervation

A

Ulnar N

Maybe median N

120
Q

Lateral Pinch Innervation

A

Ulnar N

121
Q

Precision Pinch Innervation

A

Median N

122
Q

Cylindrical Grip Innervation

A

Radial N

Median N

MSK 1 (15 decks)

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