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5 Ortho > L7 Hand/Elbow > Flashcards

L7 Hand/Elbow Flashcards

1
Q

Proximal Radial Ulnar Joint

A

Radial head rotates in radial notch of ULNA

radius rotates around the ulna to create forearm rotation

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2
Q

Ligaments of Proximal radioulnar joint

A

annular ligament
interosseous membrane

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3
Q

Radial Head Fx

A

can be displaced or non displaced

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4
Q

Non-displaced radial fx treatment

A

edema control
pain control
early AROM of elbow and forearm

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5
Q

Displaced radial head fx treatment

A

Follow MD order
edema and pain control
will need hinged elbow orthosis

can start elbow motion, but need to limit forearm motion

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6
Q

Anterior Joint Capsule of Elbow

A

the anterior joint capsule is often the cause of elbow flexion contractures due to its tendency to thicken and become fibrotic

there’s a capular redundancy in flexion

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7
Q

Interosseous Membrane

A

Very dense
can be a restricting structure for forearm rotation after immobilization or scarring

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8
Q

IM Treatment

A

responds well to low load long duration stretch. Mobilization can be used as long as both distal and proximal joints are stable

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9
Q

Treatment progression of wrist instability

A

Education
Edema Control
Pain Control
Begin with AROM
Progress AA/PROM
Isometrics
Proprioception
Functional Strengthening

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10
Q

Manual Edema Mobilization

A
  1. Rub armpit 10 firm circles
  2. Rub inside of elbow 10 firm circles
  3. With flat hand, start on back of hand and gently draw the hand up to inside of elbow to armpit onto chest 5 times
  4. End with arm overhead and do 10 fists
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11
Q

AROM that you should begin with hand issues

A

Fingers out straight, make hook fist, make table top, make straight fist, make full fist, repeat

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12
Q

Isometrics for hands

A

Goal is to learn motor control

Wrist Extension
Wrist Flexion
Ulnar Deviation
Radial Deviation

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13
Q

Triangular Fibrocartilage Complex

A

load bearing structure between lunate, triquetrum, ulnar head

stabilizes the distal radoiulnar joint

known as the meniscus of the wrist

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14
Q

TFCC makeup

A

ulnocarpal ligament

articular disc

dorso and volar radioulnar ligament

ECU sub sheath

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15
Q

Load across the distal radioulnar joint

A

causes stress to TFCC

normal: ulnar should be slightly shorter than the radius so that more force goes through the radius

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16
Q

Causes of ulnar neutral or positive variance

A

genetics
DR fracture
DRUJ injury

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17
Q

How to find DRUJ

A

find lister’s tubercle and slide ulnarly but medial to ulnar styloid

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18
Q

How to find TFCC

A

pronation palpate between FCU, ulnar styloid, pisiform

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19
Q

Injury Types of TFCC

A

peripheral and central

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20
Q

Central TFCC Injury

A

Wear and tear or ulna hitting against carpal bones

this injury is does not destabilize the joint, associated with positive ulnar variance, has poor vascularization, cannot be repaired only debrided

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21
Q

Peripheral TFCC Injury

A

FOOSH especially with rotational component

has better vasularity, destabilizes the joint, but can be surgically repaired

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22
Q

S/S of TFCC

A
  1. pain w/palpation over ulnar fovea
  2. popping or clicking in forearm rotation
  3. decreased grip strength
  4. edema at ulnar fovea
  5. pain at ulnar side with forearm rotation
  6. pain with weight bearing
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23
Q

Press test

A

seated pt pushes up to stand on arms of chair, positive w/pain

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24
Q

Ulnar impingement sign

A

elbow on table, in UD there is clicking

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25
Q

Ulnar compression Test

A

load wrist in ulnar deviation, positive is clicking

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26
Q

Destabilizing TFCC injury tx

A

if acute, refer to hand surgeon

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27
Q

Peripheral TFCC injury tx

A

if it is in a vascularized area and NOT displaced, can be treated while limiting forearm/wrist motion for 6-8 weeks

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28
Q

Chronic TFCC injury tx

A

use immobilization with orthosis
modalities to decrease pain/inflammation
avoid weightbearing
isometrics
proprioceptive exercises

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29
Q

Structures involved in forearm rotation

A

PRUJ and ligaments
interosseous membrane
DRUJ and ligaments
biceps, supinator, anconeus, pronator teres, pronator quadratus

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30
Q

Regaining forearm rotation following TFCC injury

A

avoid carpal torque when placing load in hand
compensate with shoulder abduction
orthoses, practice swinging a hammer

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31
Q

Scaphoid Anatomy

A

volar tubercle is in proximal thenars, dorsal in snuff box

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32
Q

Hamate is commonly

A

tender with palpation

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33
Q

Intrinsic ligaments of the wrist

A

very important and commonly injured

scapholunate ligament
lunotriquetral ligament

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34
Q

Carpal Instability Dissociative

A

occurs within same carpal row

involves the scapulunate ligament and lunotriquetral ligament

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35
Q

Scapholunate ligament injury

A

scaphoid palmar flexes while lunate and triquetrum dorsiflex

occurs with wrist hyperextension and ulnar deviation

the scapholunate angle ends up being greater than 60°

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36
Q

Lunotriquetral ligament injury

A

lunate palmar flexes and scaphoid and triquetrum stay vertical

angle between lunate and scaphoid is <30°

occurs from wrist hyperextension and radial deviation

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37
Q

Radial sided wrist pain can be due to

A

scaphoid fracture
scapholunate ligament injury
thumb OA
thumb arthritis
dorsal ganglion

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38
Q

Scaphoid fracture

A

MOI: FOOSH

S/S: pain at radiodorsal, may improve with time. Pain with bearing weight, pain with palpation of snuff box

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39
Q

Tx of scaphoid fracture

A

refer to hand surgeon
commonly requires surgery because the scaphoid can die

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40
Q

Scapholunate Ligament Injury

A

Hx: FOOSH

S/S: pain at dorsoradial wrist, pain with weightbearing, decreased grip, popping or clunking

41
Q

Watson’s shift test

A

testing for scapholunate ligament injury

thumb holds palmar scaphoid, index finger holds radial tubercle dorsally. Wrist should be in ulnar deviation.

push the hand into radial deviation. Positive if proximal pole of ligament will jump over dorsal lip of radius with a clunk, the scaphoid is dorsiflexing.

42
Q

Rehab of scapulolunate

A

dart thrower’s motion
wrist proprioception
stability vs mobility
immobilization 3-8 weeks in thumb spica orthosis
AROM
weightbearing in neutral

43
Q

LT Ligament Rehab

A

immobilization 3-8 weeks in wrist orthosis or cast
AROM
proprioceptive
strengthening
weight bearing in neutral

44
Q

Dart thrower’s motion

A

indicate fro patients who will benefit from midcarpal mobility and have instability in the proximal row

45
Q

1st CMC Joint

A

saddle joint that permits a wide range of motion and is largely responsible for the characteristic dexterity of human prehension

46
Q

What stabilizes the metacarpal trapezial joint?

A

ligaments
muscles

47
Q

1st CMC OA

A

most common in women over 50

MOI: wear and tear from overuse, laxity, previous injury

S/S: pain at base of thumb and into thenars, weakness in grip/punch, shoulder sign, loss of web space

48
Q

Treatment of 1st CMC OA

A

Orthotics (can be custom)
Joint Protection
Adaptive equipment (increase handle size, increase leverage, decrease demand)

49
Q

Adaptations for ADLs for 1st CMC OA

A

can opener, gripping water bottle from bottom, peelers

50
Q

Dynamic thumb stabilization

A

helps to strengthen the muscles that stabilize the base of the thumb

Performed as so:
1. Web space massage
2. APB
3. OP
4. 1st DI
5. EPB
6. Resistance for all

51
Q

When conservative management fails for thumb OA

A

injection with corticosteroid
surgery
remove the trapezium
ligament reconstruction
prevent caving
arthroplasty

52
Q

Metacarpal phalangeal joint

A

is a hinge joint

has collateral ligaments that are tight in flexion, loose in extension, and prevent lateral deviation

has a joint capsule that prevents hyperextension

53
Q

MCP joint sprain

A

often neglected by patient, and misdiagnosed or mistreated

MOI; history of impact with fist or forced abduction

S/S: edema between MC heads, tender to palpation at collateral ligament, pain with fisting

54
Q

Tx of MCP joint sprain

A

buddy tape to off load injured side

custom orthosis to block MCP flexion to allow collateral ligament to heal in shortened position and take tension off

55
Q

MC Fractures

A

can occur at base, shaft, neck, or head.

ulnar usually can tolerate more foce and health with immobilization

most common is a boxers fx/5th metacarpal fx

56
Q

Non operative Treatment of MC fx

A

immobilization in ulnar gutter in safe position

forearm based cast in safe position which is wrist in DF, MP in flexion, IP in extension for 4-6 weeks

57
Q

Operative MC Fx treatment

A

ORIF if greater than 60°

pinning
plating usually dorsal
tendon adherence with edema, start tendon gliding

58
Q

Safe position for immobilization of the hand

A

edema of the hand pools dorsally due to laxity of skin. This will pull MCPS into hyperextension, which flexes the IP joints

Safely position by controlling edema and MCP flexed at 70° and IPs extended

59
Q

Proximal IP

A

hinge joints

ligaments are TIGHT in extension and LOOSE in flexion

volar plate prevents hyperextension

60
Q

Proximal IP Sprain

A

MOI: lateral stress to tip of finger

S/S: redness, edema at PIP

61
Q

Tx of proximal IP sprain

A

edema control
early motion with finger buddy taped to decrease stress on injured ligament

use of orthosis to limit lateral stress

62
Q

Distal IP Joint

A

hinge joint
ligaments prevent lateral deviation

volar plate prevents hyperextension

63
Q

Distal IP Joint Injury

A

MOI: hyperextension for dorsal injury, forced flexion for volar

typically does well with immobilization fro 4-6 weeks

(pictured is dorsal dislocation)

64
Q

Mallet finger

A

MOI: axial loading of DIP jt when in extension or forceful DIP flexion that overpowers the weaker extension system

S/S: loss of DIP extension

can be tendinous or bony

65
Q

Bony mallet finger

A

tendon pulls a small dorsal piece of dorsal distal phalanx with it

6 weeks of immobilization, heals faster vs tendinous

66
Q

Tendinous mallet finger

A

tendon tears and bone remains intact

requires min of 8 weeks of immobilization

67
Q

Treatment of Mallet finger

A

immobilization of DIP in slight HE
encourage FDS gliding
gradual mobilization
watch for burning pain
change orthosis to prevent skin breakdown

68
Q

After immobilization

A

check tendon integrity
wean off immobilization gradually
no flexion
no grip strengthening

there will be an imbalance between flexor and extensor systems

69
Q

Injuries to Radial nerve

A

Saturday night palsy, honeymoon palsy, crutch palsy. Humerus fx, compression between supinator, post interosseous nerve injury

70
Q

Radial nerve injury due to humerus fx

A

loss of wrist and digit extension and lack of sensation

71
Q

Arcade of Frohse

A

compression of radial nerve between heads of supinator

72
Q

Post Interosseous Nerve Injury

A

wrist function and sensation are preserved

73
Q

Tx for radial nerve injuries

A

orthotics to provide function of muscles that are impaired

PROM to prevent contracture

AROM and strengthening once return begins

74
Q

High median nerve injury

A

occurs proximal to ant interosseous nerve origin

loss of sensation in lateral forearm and radial hand

loss of function of pronator, radial wrist flexors, thenar muscles, extrinsic thumb, IF/MF

75
Q

Low median nerve

A

helps the function of wrist and pronator

76
Q

Anterior interosseous nerve injury

A

loss of FPL and FDP to IF

77
Q

Tx of Median Nerve injuries

A

orthotics to retain mobility and function
PROM to prevent contracture
AROM and strengthening once motor return occurs

78
Q

High ulnar nerve at elbow

A

loss of FCU, RF/SF FDP, ulnar lumbricals, dorsal interossei

clawhand, fromet’s sign, wartenburg sign

79
Q

Lower ulnar nerve injury

A

loss of ulnar limbricals, dorsal interossei. Loss of sensation in ulnar RF (1/2) and SF

80
Q

Treatment of lower ulnar injury

A

orthotics to replace function and prevent contracture

adaptive equipment for handwriting, fine prehension

81
Q

deQuervain’s tenosynovitis

A

MOI: inflammation of EPB and ABPL within tendon sheath as it passes through extensor retinaculum

disease of new mothers

82
Q

Tests for dequervain’s tenosynovitis

A

finkelsteins test
resisted thumb extension

83
Q

Tx for de Quervain’s Tenosynovitis

A

rest/immobilization in forearm based thumb spica

ice, k tape, iontophoresis

gentle low rep tendon gliding, activity modificaiton, injection, surgery

84
Q

Boutonniere Deformity

A

disruption of central bands leads to volar displacement of lateral bands then the lateral bands become PIP flexors, putting more tension on the tendon, causing DIP hyperextension

85
Q

MOI of Boutonniere Deformity

A

rupture of central slip
PIP joint flexion contracture often post PIP sprain

86
Q

Elson test

A

examiner passively flexes the PIP joint ot 90° over edge of table and asks pt to perform extension while examiner resists

a rupture would produce no extensor force at PIP, and extension at DIP

87
Q

Tx of Boutonniere Deformity

A

correct any contracture with serial casting

acute requires 6 weeks of immobilization

perform oblique retinacular stretches, helps lateral band to go dorsally

Gradual mobilization

88
Q

Jersey Finger

A

avulsion of the flexor digitorium profundus tendon (FDP) from its distal insertion on the distal phalanx

89
Q

FPL can be

A

weak post ORIF for distal radius fracture

90
Q

Hook fist works

A

interossei

91
Q

Tabletop hand works

A

lumbricals

92
Q

Hook and full fist work

A

FDS and FDP

93
Q

The pulley system of FDS/FDP prevents

A

bowstringing
places important role in flexion

94
Q

Trigger Finger

A

inflammation of flexor tendon at the pulley results in catching or locking as the nodule enters or exits the pulley system

95
Q

Treatment for Trigger Finger

A

Rest
Anti inflammatory drugs
teach PROM to prevent contracture
refer to surgeon if locking
Orthotics

96
Q

Pulley Injury

A

rupture of A2 pulley, usually occurs in rock climbers

97
Q

Treatment for Pulley injury

A

pulley ring
progress to H taping
surgery requires reconstruction

98
Q

Dorsal Dermis of Hand

A

loose and mobile
needed to make fists

99
Q

Volar dermis of hand

A

more attachement and stability
needed for secure grasp

5 Ortho (14 decks)

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