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USAHS Ortho Practical- Hands > Hands > Flashcards

Hands Flashcards

1
Q

Carpal Tunnel: Symptoms

A

-Pain at polar wrist breast
-Paresthesia/numbness in the thumb, index, middle, and radial half of the ring fingers
-Atrophy of the thenar eminence (especially the median nerve head of the adductor)

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2
Q

Carpal Tunnel: Common Causes

A

-Repetitive Grasp
-Repetitive finger moving
-Sustained wrist flexion
-Pregnancy
-Obesity
-Age (>55)
-Inflammatory conditions (RA)

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3
Q

Carpal Tunnel: Assessments

A

-Semmes Weinstein/2pt discrimination
-9 Hole Peg/Purdue Pegboard
-AROM of wrist/digits
-Screening for the elbow/forearm AND SHOULDER
-Posture screening
-Dynamometer
-Pinch Strength (Lateral, Tip-to-tip, Tripod
-DASH/QuickDASH
-Boston Carpal Tunnel Questionnaire

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4
Q

Carpal Tunnel: Special Tests

A

-Tinels Sign at wrist crease
-Phalens Test (or reverse Phalen if needed)

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5
Q

Carpal Tunnel: Interventions

A

-Treat: Pain in wrist, stiffness in wrist, paresthesia of skin, lesion of median n.
-Use wrist cock-up splint for night and avoid sustained wrist flexion
-Positioning: Neutral wrist (min pressure)
-AT: Built up handles (avoid sustained grip/pinch)
-Education for workplace ergonomics
-Tendon gliding
-Median nerve gliding (mobilize, not stretch)
-Lumbrical stretching
-Transverse Carpal Ligament Stretching
-Coordination training
-Strengthening as tolerated (pending goals)
-Education for self-management techniques
-Education for decreased sensation

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6
Q

Post-OP Carpal Tunnel: Intervention

A

-Tendon gliding
-Nerve gliding
-Coordination training
-Scar management (after skin closes, approx. 2-4wks)
-Strengthening after skar is closed (approx. 2-4wks)
-Edema control
(Rate of healing: 1mm/day)

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7
Q

Carpal Tunnel: Explanation

A

“You have a nerve that runs through structures within your wrist. Imagine a water hose with water running through it, the water is your nerve. When the water hose is squeezed or compressed, the water cannot flow through it. Just like the water hose, your nerve is being squeezed between structures in the wrist and causing numbness. The nerve helps the muscles that bend your wrist and allows you to feel things with your first 3 fingers and half of your ring dinger which is why you are feeling numbness/tingling. It is important to protect this N.

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8
Q

DeQuervains

A

(Mommys Thumb)
-Tendon injury

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9
Q

DeQuervains: Symptoms

A

-Radial wrist pain
-Inflammation/overuse of the EPB and APL
-Pain when performing ulnar deviation
-Irritation of 1st dorsal compartment
-Pain/burning with resisted thumb extension or abduction
-Swelling over palpable area (radial base of thumb)
-Fibrotic, thickened tissue with hyper vascular changes and tendon degeneration
-Can be caused by forceful, repetitive, or sustained thumb abduction with ulnar deviation of the wrist

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10
Q

DeQuervains: Buzz Words

A

Occassional squeaking or snapping with motion at the base of the radial thumb

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11
Q

DeQuervains: Common Causes

A

-Repetitive abduction of thumb (picking up baby)
-Repetitive thumb motion while in ulnar deviation (writing on board)
-Pregnancy
-Inflammatory conditions (RA)
-Obesity
-Age (>55)
-More common in females
-Diabetes

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12
Q

DeQuervains: Assessments

A

-9-hole peg/ Purdue Pegboard
-AROM of wrist and thumb
-Screening for the elbow/forearm and shoulder
-Body mechanics screening
-Dynamometer
-Pinch test (Lateral, Tip-to-tip, Tripod)
-QuickDash
-Functional Test

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13
Q

DeQuervains: Special Tests

A

-Finkelstein
-Differential diagnosis

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14
Q

DeQuervains: Intervention

A

-1st Dorsal comparment tendon gliding (opposition)
-ROM of wrist and thumb
-Screening for elbow/forearm and shoulder
-Body mechanics screening (education for alternative grasp patterns)
-Power grasp strengthening
-Pinch strengthening (lateral, tip-to-tip, tripod)
-Soft tissue mobilization APL/EPB
-Coordination training

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15
Q

DeQuervains: TIPS

A

-Moving your wrist from side to side (demonstrate radial and ulnar deviation) with thumb held straight or bent is likely to cause pain. Try to keep wrist straight so the long finger is in line with the middle of your forearm. From this position, you may be able to perform light pink and grip tasks without pain
-Avoid symptom proving motions of radial and ulnar deviation and thumb composite flexion/extension should be avoided until it can be performed without pain

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16
Q

Trigger Finger: Symptoms

A

-Pain in hand (metacarpal heads palmately)
-Pain in digit
-Stiffness in hand
-Localized edema
-Sensation of snapping or popping during AROM
-Digits “stuck” in flexion upon waking
-Palpable nodule during AROM of digit

17
Q

Trigger Finger: Buzz Words

A

-Sensation of snapping or popping during AROM
-Locking, Clicking, Snapping, Catching

18
Q

Trigger Finger: Explanation

A

-Catching or locking of the flexor tendon at the A1 pulley which leads to the inability to perform smooth digital flexion and extension
-A1 pulley
-Mostly affects index, thumb, & middle finger
-Pain in flexion
-Overuse injury
-Thickening of tendon

19
Q

Trigger Finger: Common Causes

A

-Edema/nodule formation in flexor tendons of digit/thumb
-Sustained grasp (holding steering wheel, gardening equipment) with pressure on metacarpals
-Pregnancy
-Inflammation conditions (RA)
-Most common in females
-Diabetes

20
Q

Trigger Finger: Assessments

A

-AROM measurement
-Edema measurement
-Palapation of nodule during AROM
-Obsevation of popping/snapping during AROM
-Medical history/patient report of symptoms (injection, surgery)
-Work/hbby assessment
-DASH
-Review physician protocol (fabrication of orthosis)
(commonly seen conservatively or post-op)

21
Q

Trigger Finger: Intervention

A

-Tendon gliding: Caution w straight fisting as FDS is commonly affected and will reproduce symptoms if conservatively treated
-Screening for elbow/forearm/shoulder
-Orthosis fabrication (usually relative motion orthosis to limit MCP flexion to limit triggering if conservative)
-Strengthening as appropriate
-Coordination training
-Education for self-management
-ADL/IADL/wor simulated training to prevent recurrence

22
Q

Post-Op Trigger Finger: Intervention

A

-Wound care (if post surgery)
-Scar management

23
Q

Distal Radius Fracture (Smith/Colles)

A

-Colles: More common
-Smiths: More complex

24
Q

Distal Radius Fracture (Smith/Colles): Symptoms

A

-Pain in wrist
-Stiffness in wrist/hand/elbow
-Edema
-Often with a specific diagnosis on MD orders
-Ulnar wrist pain (TFCC injury)

25
Q

Distal Radius Fracture (Smith/Colles): Common Causes

A

Falls
-Osteoporisis/Osteopenia
-MVA
-Trauma

USAHS Ortho Practical- Hands (1 decks)

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