lecture 13: wrist and hand Flashcards
what are some examples of how hand and wrist play an intergral role in ADL
- Gripping
- Fine motor control
- End of kinetic chain
what is the main joint of the hand/wrist
radiocarpal joint
what are the most commonly injured carpal bone
scaphoid and lunar
what does the dorsal radiocarpal lg resist
flexion
what does the palmar radiocarpal ligament resist
hyperextension
where does the ulnar nerve pass through
pisiform and hook iof the hammate
what does the median nerve pass
carpal tunnel
where does the radial nerve pass
posterio half of the dorsal aspect
what is the common MOI of colles fracture
foosh
what is the position of the radius in a colles fracture
distal radius is driven dorsally
who is the vulnerable population for colles fracture
vulnerable children/adolescence
whtat are the SS of colles fracture
• S/S- pain with movement,
decreased grip strength, swelling,
deformity, sharp pain, feel of
cracking sensation
what is the treatment for colles fracture
splint it
if there is obvious deformity in a colles fracture do you do a tap test
no
what is considered a reverse colles frcature
smoth fracture
what is the positionn of the radius in a smith fractuere/reverse colles
the radius gets driven palmarly
what is the MOI for smith fracture/reverse colles
falling with wrist flexed
ex: runnning back lands in flexed postion
what are the SS of Smith fracute
S/S: pain with movement, decrease grip strength, swelling, deformity,
sharp pain, cracking sensation
smith fracture is a reverse BLANK
reverse colles fracture
true or false: manteggia fracture is considered a fracture dislocattion
true
explain why monteggia frcature is considered a fracture dislocation
Fracture of proximal 3rd of ulna
• Dislocation of radial head
what is the MOI for monteggia fracture
FOOSh
what is the big danger of a menteggia fracture
might lead to a compartment synfrome (because of the hemmoraging/swelling which compresses the structures)
what are the SS of monteggia fracture
Rapid swelling, protective spasm, discoloration, unwillingness to
move
what is the treatment for monteggia fracture
splint and check PMSX
if you fracture the ulna what nerve is affected
ulnar
if you fracture the radius, what nerve is affect
radial
a fracture of the ulna and dislocation of the radius togethere is what type of fracture
monteggia
true or false: galeazzi fracture is not considered a fracture discloation
false, it is
explain why galeazzi fracture is considered a fracture dislocation
Fracture of distal 1/3 of the radius
• Dislocation of the distal ulna
fracutre of the radius and dislocation of the ulna is what fracture
galeazzi fracture
what is the MOI for galeazzi
FOOSH `
what is the SS of galaezzi fracture
Rapid swelling, protective spasm, unwilling to move, discoloration
wht is the most common mass or lump in the hand./wrist
ganglion cyst
what is a ganglion cyst
non cancerous anf fluid filled cyst
what do ganglion cysts arrise from
the ligaments
- joint lining
- tendon sheaths when irritated or inflamed (friction)
true or false: ganglion cysts are permanent
false, thy can disapear or change quickly
what is the treatment if the ganglion is nonn painful
no treatment
what is the treatment if the ganglion is painful
surgical removal
what percentage of carpal fractures involve the scapohid
70%
70% of carpal fractures involve what bone
scaphoid
what do 70% of carpal fractures involve scapohid
because of its roll in bonny block limiting wrist extensionn
what is the MOI for scaphoid
FOOSH
what carpal bonen has the largest articulation with the wrist
scaphoid
true or false: scaphoid bones heal very good
false, usually dont because there is not good supply
what part of the scaphoid heals better and why
the distal part ebcaue there is more blood supply
there is high incidence of what inn the scaphoid fracuetre
High incidence of non union
fractures and malunion
fractures compromise blood supply to the proximal or distal end of the scapohid
proximal end
scaphoid gets blood supply from what artery
radial
true or false: scapohid does not often show up on the 1st xray
true
a fractured scaphoid can lead to instability of what
proximal row
unresolved fractures or impaired circulation of the scaphoid can lead to what disease
preiser disease
what is preisers disease
avascular necrossi of the scaphoid
what are the SS of scaphoid fractures
Point tenderness in anatomical snuffbox
• Swelling
• Pain with thumb extension and abduction and wrist extension and radial
deviation
• Decrease grip strength
hook of the hammate fracture is common in what sprots
where gripping and vibration occur (batting and cycling)
what are the SS of hook of the hammate fracture
Pt tender on palmar aspect
• Potentially ulnar nerve
involvement
- Pain with wrist flexion
- Pain with opposition
- Pain with gripping
what nerve runs near the hook of the hammate
ulnar nerve
what nerve is potentially involved in hook of the hammate fracture
ulnar
in what anatomical location will there be pain for scaphoid
in anatomical snuffbox
what is a boxers fracture
Fracture to the neck of the 5th metacarpal (sometimes the 4th)
what is the MOI for boxers fracture
axial loading at metacarpal
what are the SS of boxers fracture
Depression where knuckle should be
- Swelling over the knuckle
- Decreased ability to make a fist
what fracture is assocaited with depression where the knuckles should be
boxers fracture
Lunate dislocation occurs when BLANK
he lunate dissociates from the connecting carpals
in a lunate dislocation does the lunate displace forward (palmar) or dorssal
forward
perilunate dislocations occur when…
the proximal row of carpals is
being stripped from the lunate
in a periluante dislocation, the capals displace where
dorsally compred to the lunate
what is the MOI for lunate dislocationn
Forced hyperextension of the wrist
ex: gymast
true or false: in a lunate dislocation, the lunate can only dislocate dorsally
false, also palmarly
in a lunate dislocation, what ligaments are ruptured
rupturing of the palmar itnerosses ligaments
what ligamnets connect scapohid to lunate
palmar interosseous ligaments
what is the MOI for perilunate discloation
forced hyperextension of the wrist (ex: blockin)
what is the displacement of the pernilucate dislocationn
Displacement of the carpals
DORSALLY compared to the
lunate
what ae the SS of perilunate and lunate
Obvious deformity
- Swelling
- Complaining of a sprained wrist
- Median nerve irritation
- Limited wrist extension
- Point tenderness over the lunate
- Pain increases with gripping
where will thre be pain in a perilunate and lunate dislocation
point tenderness over lunate
what nerve might be irritated in perilunate/lunate dislocation
median nerve
in a wrist sprain, where is the most common ligamentous instability
between the scaphoid and lunate
what are the SS of wrist sprain
Complain of pain and instability in
the wrist
• Weakness in the wrist during
functional tasks
what is keinblocks disease
avascular necrosis of the lunate bone
what is avascular necrosis of the lunate bone called
keinbocks disease
true or false: keinbocks comes primarely or secodnary to dislocation
secondary
true or false: keinbocks disease pain is acute
false, gradual onset
what are the SS of keinbocks disease
Chronic wrist ache
• Pain over lunate
• Pain when tapping 3rd metacarpal
• Decrease ROM, decrease grip strength
in a keinbocks disease ther would be pain when tapping where
onn the 3rd metacarpal
what does TFCC stand for
Triangular Fibrocartilaginous Complex Injury
TFCC
what is Triangular Fibrocartilaginous Complex Injury
TFCC
rotational stress to the distal radioulnar joint that forces ulnar deviation with rotation
what is the MOI of Triangular Fibrocartilaginous Complex Injury
(TFCC)
Fall onto pronated hyperextended wrist (FOOSH)
• Distraction applied to forearm/wrist
what are the SS of TFCC injury
Painful grinding or clicking with wrist ROM
• Especially extension and ulnar deviation (Active and passive)
- Weakness in RROM especially in extension and ulnar deviation
- Maybe okay if in neutral position
- Pain pushing up from a chair or weight bearing
- Ulnar deviation causes clicking and wrist pain
• Point tenderness distal to the ulna along the medial one half of the wrist joint
line
where will there be point tenderness for a TFCC innjury
Point tenderness distal to the ulna along the medial one half of the wrist joint
line
what is the function of the ulnar and radial collateral ligaments
help to stabilizr the radiocarpal joitn
how can the ulnar/radial collateral ligaments be injuryed
through repetitive ulnar and radial deviateion
what are the SS of ulnar/radial. collateral ligaments sprain in wrist
Pain with valgus and varus stress tests
- Pain with ulnar and radial deviation (stretching of ligament)
- Feeling of instability of the wrist
where are the locations that ulnar nevre compression can occur
happen at the elbow and the wrist
ulnar nerve runs through the tunnel of ///
guyon
what can mimic ulnar nerve entrapment
cyclist palsy
true or false; cyclist palsy usually resolves after the ride
true
ehat are the SS of ulnar nerve compression
Burning or numbness in 4&5th finger
- Atrophy of the hypothenar eminence
- Decrease grip strength
atrophy os the hypothenar eminence is assocaited to what condition
ulnar nerve compression
what is carpal tunnel syndrom
compression of the median nerve throug hthe carpal tunnel
what is the MOI for carpal tunnel
Overuse- typing, repetitive flexion/extension
- Fluid retention- pregnant women
- Secondary to trauma- swelling
what are the SS of carpal tunnel syndrome
Tinel’s sign positive • Numbness and tingling • Progressive weakness of the thenar muscles • Maybe TOS! ( taping over nerd thoracic outlet syndrome
what is tinels sign
tapping over nerve
gymnasts wrist usually occurs in whta population
young gymnasts
what is the MOI for gymnasts wrist
repetitive extension of the wrist
what is a gymnasts wrists
Dorsal Radio carpal
Impingement Syndrome/Distal
Radial Epiphyseal Plate Fracture
what are the SS of gymnasts wrist
Activity related pain at dorsum of the wrist (in ext)
- Point tender along dorsum of radio carpal joint
- Sharp pain with abrupt extension of the wrist
- Swelling
gymnasts wrist gets sharp pain in what motion of the wrist
abrupt extension of the wrist
what is another name for an ulnar collateral ligament sprin (MCP)
game keeper thumb
true or false: game keepers thumb is both acute and chronic
true
what is the MOI for game keepers thumb
Hyperextension or hyper abduction
of the first MCP joint
what are the SS of UCL sprain of 1ts MCP joint
- Pain along ulnar aspect of 1st MCP
- Localized swelling
- Loss of grip strength
- Possible ecchymosis
• Pain during active extension,
abduction and opposition
- Weakness in MCP flexion and adduction, pinch grip decreased
- Passive pain with thumb extension and abduction
what is dequervain;s tenosynovitis
Tenosynovitis of the extensor pollucis brevis and abductor pollucis longus tendons
• First extensor compartment
what is the MOI for dequervain tenosynovitis
Repetitive radial deviation
(New moms)
- Pregnancy- fluid retention
- Maybe associated with inflammatory arthritis
what is finkelsteins test
hich you bend your thumb across the palm of your hand and bend your fingers down over your thumb. Then you bend your wrist toward your little finger
what atre the SS of dequervainns syndrome
Swelling over styloid process of radius
• Pain over styloid process of radius and dorsum of thumb
• Radial and ulnar deviation of the wrist is painful
(As well as flexion, extension, abduction of the thumb)
where will there be pain in dequervainns (bone)
over the styloid process of radius
what is bennets fracure
fracture of the base of the 1st metacarpal (ex: jamming ur finger)
what frscture is simular to a bennetts fracture
scaphoid
what is the MOI for bennetts fractuere
Axial compression of the metacarpal
- Direct trauma
- Hyperextension of the thumb
what is the MOI for collateral ligamnent injuries of the finter
Stress applied to extended finger
• Valgus and varus stress
what are the SS for collateral ligament injuries of the finger
Pain with active and passive motions
• Swelling, ecchymosis
figner dislocation is common inn what finger joints
Can occur to PIP, DIP or MCP joints
whta is treament for fingner dislocation
splint
as an AT should you reduce a fingner dislocation
no , not legally permitted
what is a boutonnieres deformity
A rupture of the central extensor tendon causes the lateral bands to slip
palmarly on each side of the PIP joint
• Changes line of pull on this joint from an extensor to a flexor
•
what is the position ofnthe finger in boutonniere deformity
Resulting in extension of DIP and MCP and flexion of the
mallet finger is the avulsion/rupture of what tendon
an extension tendon (distally)
mallet finger results in the inability to do wht
fully extend the distal phalanx
what is the MOI for mallet finger
dDIP forced into flexion
ex: finger struck by ball
rupture of distal exttensor tenden of the finger leads to what
mallet finger
jersey finger is the avulsion what what
Avulsion of the flexor digitorum profundus tendon off the palmar
aspect of the DIP join
jersey fingrs causes the inability to flex what joint
DIP
what is the MOI for jersey finer
finger forced into hyperexension (grabbing another jersey)
what are the SS for jersey finger
On observation looks normal • Finger painful • Possible swelling • Fingers appear to flex and extend normal
Isolation of DIP joint- patient is
unable to actively flex
what is the only injury that on observation it looks normal
jersey finger
how do you treat jersey finget?
splint
what is swam neck deformity
Hyperextended PIP joint and
flexed DIP joint
which two conditions/deformities are the opposites of eacb other
swan neck deformity and boutonnniere
what are some conditions that loosen structures aroung PIP joint that cause hyperextension
Weaken volar plate
• Rheumatoid arthritis
• Chronic inflammation
what is trigger finger
snapping flexor tendons
wht is the MOI for triigger finger
trauma to palmar aspect of
hand, or repetitive clenching of
fingers (ex: lifting)
what is the result of a trigger finger
Thickening of the tendon sheath
• Prevents tendon from sliding in
annular ligaments
• nodule
what posistion if your finger locked in on trigger finger
locked in flexion
