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Interventions II > Lecture 15: Wrist & Hand Conditions > Flashcards

Lecture 15: Wrist & Hand Conditions Flashcards

1
Q

Colles fracture

A
  • fracture of distal end of radius with dorsal displacement

- +/- ulnar fracture

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2
Q

Etiology of Colles fracture

A
  • older adults
  • female > male
  • FOOSH (Fall on outstretched hand)
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3
Q

Colles fracture and lunate

A
  • lunate acts as a wedge to sheer the distal 2cm of the radius
  • body momentum causes the fragment to displace radially and posteriorly
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4
Q

Colles Fracture Exam findings

A
  • general loss of A/PROM from immobilization; capsular pattern (equal limitations in flexion and extension)
  • may lose some shoulder ROM
  • rarely heals without some malalignment – loss of full ROM (flexion, UD, pronation)
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5
Q

Ulnar variance

A

relative lengths of the distal articular surfaces of the radius on the ulna

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6
Q

Positive ulnar variance

A

“longer” ulna

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7
Q

Negative Ulnar variance

A

“shorter” ulna

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8
Q

Colles Fracture - Rx implications

A
  • consider ROM goals - inquire about alignment
  • ROM/accessory motion restrictions - 2deg immobilization
  • strengthening
  • functional activities
  • look for median nerve compression, vascular disturbances, or other complications
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9
Q

smith fracture

A

-distal radial fracture with volar/palmar displacement of fragment

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10
Q

Rx implications of smith fracture

A

similar to colles fracture

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11
Q

Scaphoid fractures/lunate dislocations etiology

A
  • similar mechanism to colles fracture

- 20-30y.o male

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12
Q

If the radius is strong, a fall tends to fracture the: s

A

scaphoid or dislocate the lunate

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13
Q

What to note for a scaphoid fracture

A

-poor blood supply to the scaphoid

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14
Q

Common presenting symptoms for scaphoid fracture

A
  1. pain
  2. localized tenderness in anatomical snuff box
  3. loss of thumb function
  4. palpation changes of lunate
  5. mm spasm with PROM
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15
Q

Treat implications for scaphoid fracture

A
  1. Rx swelling agressively
  2. watch for healing regularly
  3. A/PROM (after immobilization)
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16
Q

Hand Fractures

A
  • Bennett’s Fracture (2deg ABD)

- Boxer’s fracture (metacarpal fracture of 4th metacarpal)

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17
Q

Ulnar collateraal ligament tear AKA

A
  1. Skier’s thumb

2. Gamekeeper’s thumb

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18
Q

Other ligamentous injuries of the hand

A

PIP and DIP collateral ligaments

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19
Q

Ligamentous injury treatment considerations

A
  • joint protection/rest (splinting/buddy taping)
  • minimize stress to tissues
  • Progress Rx through stages of healing as appropriate
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20
Q

Tendinopathy etiology

A
  • repetitive use or eccentric strain of wrist/forearm mm
  • results in micro-damange, usually at musculo-tendon junction
  • tissue response to stress/fatigue
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21
Q

common tendinopathy impairments

A
  • pain when involved mm is stretched or contracted v resistance
  • increased pain after exercise activity of wrist/hand
  • decreased strength, endurance
  • decreased grip strength
  • tenderness to palpation
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22
Q

DeQuervain’s syndrome Tenosynovitis etiology

A

inflammation and swelling of the synovial lining of the common sheath of the APL and the EPB in the first dorsal compartment

often insidious; may be due to trauma or reptitive irritation

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23
Q

DeQuervain’s syndrome presenting symptoms

A
  • tenderness over radial styloid

- pain with thumb movements (grasping, writing)

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24
Q

DeQuervain’s syndrome pertinent exam findings

A
  • pain with resisted thumb extension and abduction
  • mild swelling
  • tenderness over anatomical snuff box
  • (+) Finkelstein’s
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25
Q

DeQuervain’s syndrome Treatment implications

A
  • conservative vs. surgical
  • splinting
  • AROM - gentle resisted motion
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26
Q

Pronator teres syndrome

A
  • compression of the median nerve between heads of the pronator teres (or fib. arch of FDS)
  • wrist/finger flexor weakness
  • hand symptoms (CTS)
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27
Q

Carpal tunnel syndrome pertinent exam findings

A 
(+) Tinel's Sign 
(+) Phalens
(+) EMG 
Median. N tension sign 
Thenar mm. atrophy 
Lumbrical weakness
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28
Q

carpal tunnel etiology

A

-increased pressure in the tunnel

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28
Q

carpal tunnel etiology

A
  • increased pressure in the tunnel
    • trauma
    • pregnancy
  • unknown causes
    • collagen disease
    • Hereditary
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29
Q

Carpal tunnel syndrome common presenting findings

A
  • pain/numbness radial sign of hand
  • sensory changes with prolonged use
  • worse at night (position)
  • decreased prehension/clumsiness
30
Q

Ulnar nerve compression

A

-compression of the ulnar nerve within Guyon’s tunnel
-parasthesia of ulnar 1 1/2 fingers
-weakness of muscles innervated by ulnar nerve
-may lead to deformities of the hand in chronic cases
Rx: similar to CTS

31
Q

Osteoarthritis onset

A

later decades

32
Q

Osteoarthritis symptoms

A
  • pain with nodular swelling of distal fingers (H nodes)

- joint instability

33
Q

Most common place for osteoarthritis

A

1st CMC. DIPs

34
Q

Rheumatoid Arthritis etiology

A

age 20-40
female> male
+RA factor

35
Q

RA presentation

A
  • involvement of synovial membrane
  • multiple joints with exacerbations and remissions
  • deformities 2deg instability and muscle imbalance
36
Q

RA classic hand signs

A
  • ulnar deviation
  • Boutonniere deformity
  • Swan Neck deformity
  • Z shaped thumb
  • MCP subluxation
37
Q

Common sites for RA

A
  • MCP
  • PIP
  • wrist
38
Q

Bacterial Arthritis

A

occurs after bites, wounds, septicemia

  • pain exacerbated by movement
  • local pain and swelling
39
Q

bacterial arthritis RX

A
  • antibiotics

- joint aspirations

40
Q

Raynaud’s Disease

A
  • idiopathic vascular disorder
  • intermittment pallor or cyanosis
  • cold, mottled, painful hand
  • dont tolerate temp changes
41
Q

Raynaud’s disease implications

A
  • don’t rx with cold
  • check vascularization (allen’s test)
  • facilitate increased blood flow with muscle pumping exercises
42
Q

complex regional pain syndrome (CRPS)
Reflex Sympathetic Dystrophy (RSD)
Etiology

A
  • exact mechanism is poorly understood
  • usually a preceding event like a: fracture, trauma to nerve, prolonged edema, and immobilization
    • alteration cutaneous innervation following injury
    • peripheral - increased substance P and bradykinin
    • central - increased substance P, bradykinin, glutamate in SC
  • females > males (2-4:1)
  • all ages, peak 50-70
43
Q

CRPS (Stamp)

A
  1. sensory: allodynia, hypo/hyperalgesia, hypo-hyperesthesis
  2. trophic: hair, nails, skin changes
  3. autonomic: swelling, sweating, edema
  4. motor: weakaness, contractures, atrophy
  5. Pain
44
Q

CRPS characteristics

A
  • usually starts distally and spreads proximally
  • intense prolonged pain
  • disproprtionate to inciting event
  • vasomotor disturbances (bluish skin color or shiny red discoloration)
45
Q

CRPS treatment implications

A
  • whatever it takes (trial and error)
  • distraction and weight bearing
  • desensitization (rubbing affected limb gently with cloth)
  • early active mobilization
  • functional and fine motor exercises
  • adapt to severity of disease
  • below pain threshold

sympathetic block
spinal cord stimulator
medications: steroid, pain patch, opioids

46
Q

Ganglion cysts

A
  • after trauma to wrist joint capsule, the synovium may herniate to form a ganglion cyst
  • greatest pain with extension
  • tenderness over scapho-lunate intervala
47
Q

Swan-neck deformity

A
  • hyper-extension of the PIP
  • flexion of the DIP
  • 2deg contraction of intrinsic muscles & laxity of PIP joint
  • common with RA or after trauma
48
Q

Boutonniere Deformity

A
  • MCP and DIP extension
  • PIP flexion
  • rupture of the central tendinous slip of extensor hood
  • common with RA
49
Q

Claw fingers/hand

A
  • MCPs are hyperextended and PIP/DIP are flexed

- loss of intrinsic muscle action (ulnar nerve)

50
Q

Ape hand deformity

A

-thumb falls back in line with fingers
Pt unable to flex thumb
wasting of thenar eminence 2deg median and ulnar nerve palsy

51
Q

Ulnar drift

A
  • ulnar deviation of the digits due to weakening of the capsular/ligamentous structures of the MCP joints
  • common with RA
52
Q

Mallet finger

A
  • ruptrue or avulsion of the extensor tendon where it inserts in the distal phalynx
  • distal phalanx rests in flexion

splint in extension

53
Q

Trigger finger

A
  • thickening of tendon flexor sheath causes “sticking” of tendon as pt. attempts to flex finger
  • usually occurs in 2nd adn 3rd digits
54
Q

Dupuytren’s Contracture

A

-contracture of palmar fascia
-flexion of MCP and PIP joint
-usually ring or middle finger
-men>women
-40/70 yo
-increased in ppl with epilepsy alcholism or gout
painless

55
Q

Flexion
(Capitate and Hamate)
(Trapezium & Trapezoid)

A

(Capitate and Hamate): dorsal

(Trapezium & Trapezoid): volar

56
Q

Extension
(Capitate and Hamate)
(Trapezium & Trapezoid)

A

(Capitate and Hamate): volar

(Trapezium & Trapezoid): dorsal

57
Q

Radial Deviation
(Capitate and Hamate)
(Trapezium & Trapezoid)

A

(Capitate and Hamate): ulnar

(Trapezium & Trapezoid): dorsal

58
Q

Ulnar deviation
(Capitate and Hamate)
(Trapezium & Trapezoid)

A

(Capitate and Hamate): radial

(Trapezium & Trapezoid): volar

59
Q

treat the capitate and hamte as

A

convex (gliding on concave surfaces of portions of the scaphoid, lunate, and triquetrum)

60
Q

Treat trapezium & trapezoid as

A

concave (gliding on convex distal surface of scaphoid)

61
Q

Distal radioular dorsal glide

A

supination

62
Q

distal radioulnar volar glide

A

pronation

63
Q

radiocarpal dorsal glide

A

flexion

64
Q

radiocarpal volar glide

A

extension

65
Q

radiocarpal ulnar glide

A

radial deviation

66
Q

radiocarpal radial glide

A

ulnar deviation

67
Q

1st cmc dorsal glide

A

abduction

68
Q

1st cmc volar glide

A

adduction

69
Q

1st cmc ulnar glide

A

flexion

70
Q

1st cmc radial glide

A

extension

71
Q

MCP, PIP, DIP dorsal glide

A

extension

72
Q

MCP, PIP, DIP volar glide

A

flexion

Interventions II (11 decks)

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