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2 Therapeutic Exercise > Lecture 12, Wrist and Hand > Flashcards

Lecture 12, Wrist and Hand Flashcards

1
Q

The wrist has both ____ and ______ segments

A

fixed/stable
mobile

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2
Q

Fixed segment consists of

A

distal row of carpal bones
2nd and 3rd MC

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3
Q

Why is having fixed and mobile segments important?

A

stability without rigidity
enables the hand to move more discretely
enhances function of digits

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4
Q

Mobile segment makeup

A

5 phalanges
1st, 4th, 5th MC

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5
Q

Contributions of arches

A

enable hand to grasp objeects
direct motor skill of fingers and control power of grasp
intrinsic muscles maintain arches

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6
Q

Proximal transverse arch

A

at distal row of carpals. rigid, very little movement

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7
Q

Distal transverse arch

A

heads of MC, mobile, allows the palm to flatten & cup

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8
Q

Longitudinal arch

A

rigid proximally @ CMC and mobile distally for fingers

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9
Q

Conjunct rotation

A

can be tested by folding and fanning the hand

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10
Q

Tenodesis

A

passive changes in finger posture

passive finger exntesion occurs when wrist is flexed
finger flexion occurs when wrist is extended

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11
Q

Wrist tenodesis reflects _____ length tension relationships

A

passive

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12
Q

Active extensor mechanism

A

stabilization during grip

As the fingers and thumb flex, wrist extensors stabilize the wrist to prevent flexor digitorum superficialis from flexing wrist at the same time

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13
Q

Active flexor mechanism

A

stabilization during release of grip

During finger and thumb extension, wrist flexors stabilize so that EDC, ext indicus & others can function more efficiently

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14
Q

Key features of thumb

A

60% of hand function
mobility and force

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15
Q

Index finger features

A

strength and its interaction with thumb
loss = pinch and power grip

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16
Q

Middle finger

A

strongest in flexion
important for precision and power grips

17
Q

Ring finger

A

least functional role in hand

18
Q

Little finger

A

enhances power grips, holds objects, affects capacity of hand

19
Q

Power grip types

A

hook
cylinder
fist
spherical

20
Q

What is a power grip?

A

clamping object against palm of hand w/partially flexed fingers and adducted thumb

isometric muscle action, fingers are flexed, ER, ulnar deviation

21
Q

Precision patterns

A

involve manipulating object that is not in contact with palm
fingers and thumb work in opposition to hold object
input from sensory surfaces, help with fine adjustments
small objects are manipulated btwn index and thumb

22
Q

Types of precision patterns

A

pap to pad (holding pencil)
tip to tip (pinch)
pad to lateral prehension (keys)

23
Q

Combined grips

A

include pinch where index or middle and thumb hold isometrically and 3-5 supplement with power

24
Q

What structural and functional impairments would you expect to see related to finger joint hypomobility?

A

decreased ROM
weakness
adherent tendon sheath
effusion

25
Q

What would you expect to detect with PROM?

A

hard end feel, pain with overpressure

caused by tendon adhesion from inflammation

26
Q

What would you expect to detect with RROM?

A

decreased muscle performance

27
Q

OA and post-trauma arthrosis

A

OA most commonly involves CMC of thumb, DIPs
trauma can occur at any joint
PIP joint common articular fracture site resulting in degeneration

be mindful of fractures that might not appear on x-ray

28
Q

Ulnar drift

A

rupture of collateral ligaments at MCP resulting bowstringing of tendons
caused by subluxation of proximal phalanges

29
Q

Swan neck deformity

A

hyperextension of PIP and flexion of DIP

30
Q

Boutonniere deformity

A

PIP flexion and DIP extension

31
Q

Z deformity of thumb

A

MCP dislocation of thumb with swan or boutonniere deformity

32
Q

What is the diagnostic gold standard for RA?

A

lab tests for inflammatory markers
medical treatment to slow deformity
Work with CHT to provide splinting for joint protection

33
Q

Acute stage of Finger hypomobility

A

control pain and protect joints

patient education (joint protection)
pain management (gd 1 distractions)
splinting
conserve energy (w/RA)

34
Q

Goals of acute phase

A

maintain joint and tendon mobility and muscle integrity

35
Q

Interventions for finger hypomobility, post trauma

A

passive, assistive, active ROM
tendon-gliding exercises to prevent adhesions
multiple angle muscle setting exercises

36
Q

Return to function phases interventions

A

increase joint play and accessory motions –> joint mob
improve joint tracking and pain free motion –> MWM, tendon blocking
progressive strengthening –> putty, rubber bands

37
Q

Zone 2

A

FDP and FDS share the same tendon sheath up to this point

2 Therapeutic Exercise (14 decks)

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