MSK #10- Wrist and Hand conditions Flashcards
Carpal Tunnel Syndrome: What is it
- repetitive stress syndrome
- compression of the median nerve at the carpal tunnel due to inflammation of the flexor tendons and/or median nerve
Carpal Tunnel Syndrome: common causes
- repetitive wrist motions or gripping
- pregnancy
- diabetes
- RA
Carpal Tunnel Syndrome: special tests and diagnostic tests utilized
- Phalen’s
- Tinnel’s
- electrodiagnostic tests
Carpal Tunnel Syndrome: what do you need to rule out
- cervical spine dysfunction
- thoracic outlet syndrome
- peripheral nerve entrapment
Carpal Tunnel Syndrome: common s/s
- burning
- tingling
- pins an needles
- numbness into median nerve distribution at night
- long term compression causes atrophy and weakness over thenar eminence and 2 lateral lumbricals
Carpal Tunnel Syndrome: meds
- acetaminophen
- NSAIDs
Carpal Tunnel Syndrome: possible interventions
- soft tissue and massage techniques
- modalities
- flexibility and strengthening exercises
- joint mobilizations
De Quervain’s Tenosynovitis: what is it
- inflammation of extensor pollicis brevis and adductor pollicis longus tendons at 1st dorsal compartment
- results from repetitive microtrauma or as a complication of swelling during pregnancy
De Quervain’s Tenosynovitis: special tests and diagnostic tests
- Finkelstein’s
- MRI, but usually not necessary
De Quervain’s Tenosynovitis: s/s
- pain at anatomical snuffbox
- swelling
- decreased grip and pinch strength
De Quervain’s Tenosynovitis: meds
- acetaminophen
- NSAIDs
De Quervain’s Tenosynovitis: possible interventions
- soft tissue and massage techniques
- modalities
- flexibility and strengthening exercises
- joint mobilizations
- functional exercises
Colles’ Fracture: what is it
- most common wrist fx resulting from FOOSH
- possible complication of median nerve compression from edema
- “dinner fork” deformity of wrist and hand from dorsal or posterior displacement of distal fragment of radius , w/ a radial shift of wrist and hand
Colles’ Fracture: special tests and diagnostic tests
- no special test
- x-ray
Colles’ Fracture: possible complications from the fx
- loss of motion
- decreased grip strength
- CRPS
- carpal tunnel syndrome
Colles’ Fracture: meds
- acetaminophen
- NSAIDs
Colles’ Fracture: possible interventions
- Fx is immobilized for 5-8 weeks
- early PT, very important to regain flexibility for functional mobility
- soft tissue and massage techniques
- modalities
- flexibility and strengthening exercises
- joint mobilizations
- functional exercises
**same as Smith’s
Smith’s Fracture: What is it
- similar to Colles’ but distal fragment of radius dislocates in a volar direction
- “garden spade” deformity
Smith’s Fracture: special tests and diagnostic tests
- no special test
- x-ray
Smith’s Fracture: meds
- acetaminophen
- NSAIDs
Smith’s Fracture: possible interventions
- Fx is immobilized for 5-8 weeks
- early PT, very important to regain flexibility for functional mobility
- soft tissue and massage techniques
- modalities
- flexibility and strengthening exercises
- joint mobilizations
- functional exercises
** same as Colles’
Dupuytren’s Contracture: what is it
- observed as banding on palm and digit flexion contractures resulting from contracture of palmer fascia that adheres to skin
Dupuytren’s Contracture: who/what is affected
- affects men more than women
- contracture usually affects the MCP and PIP joints of 4th and 5th digits in non-diabetic
- affects 3rd and 4th digits most often in diabetics
Dupuytren’s Contracture: meds
- acetaminophen
- NSAIDs
Dupuytren’s Contracture: possible interventions
- flexibility exercise to prevent further contracture
- possible splint to prevent further contracture
- once contracture is controlled, normal hand functional exercises
- if there is a surgical intervention, PTs may be involved in wound care, edema management, and progress to ther ex
Boutonniere Deformity: what is it
results from rupture of central tendinous slip of extensor hood
Boutonniere Deformity: deformity observed
- extension of MCP and DIP
- flexion of PIP
Boutonniere Deformity: common causes
- trauma
- RA
Boutonniere Deformity: meds
- acetaminophen
- NSAIDs
Boutonniere Deformity: possible interventions
- edema management
- flexibility exercises of involved and uninvolved joints
- splinting or taping
- ther ex
Swan Neck Deformity: what is it
results from contracture of intrinsic muscles w. dorsal subluxation of lateral extensor tendons
Swan Neck Deformity: deformity observed
- flexion of MCP and DIP
- extension of PIP
Swan Neck Deformity: common causes
- trauma
- RA
Swan Neck Deformity: diagnostic tests and meds
- x-ray, may not be necessary
- acetaminophen
- NSAIDs
Swan Neck Deformity: possible interventions
- edema management
- flexibility exercises of involved and uninvolved joints
- splinting or taping
- ther ex
Ape Hand Deformity: what is it
- observed as thenar muscle wasting w/ 1st digit moving dorsally until it is line w/ 2nd digit
- results from median nerve dysfunction
Ape Hand Deformity: diagnostic tests
electrodiagnostic testing
Ape Hand Deformity: meds
- acetaminophen
- NSAIDs
Ape Hand Deformity: possible interventions
- edema management
- flexibility exercises of involved and uninvolved joints
- splinting or taping
- ther ex
Mallet Finger: what is it
- rupture or avulsion of extensor tendon at its insertion into distal phalanx of digit
- observed deformity is flexion of DIP
Mallet Finger: common cause
usually occurs from trauma, forcing distal phalanx into a flexed position
Mallet Finger: diagnostic tests and meds
- possibly MRI
- acetaminophen
- NSAIDs
Mallet Finger: possible interventions
- edema management
- flexibility exercises of involved and uninvolved joints
- splinting or taping
- ther ex
Gamekeeper’s Thumb: what is it
- a sprain/rupture of ulnar collateral ligament of MCP joint of 1st digit
- results in medial instability of thumb
Gamekeeper’s Thumb: common MOI
frequently occurs during a fall while skiing, when increasing forces are placed on thumb through ski pole
Gamekeeper’s Thumb: diagnostic tests and meds
- possibly MRI
- acetaminophen
- NSAIDs
Gamekeeper’s Thumb: possible interventions
- immobilized for 6 weeks
- edema management
- flexibility exercises of involved and uninvolved joints
- splinting or taping
- ther ex
Boxer’s fracture: what is it
Fx of neck of 5th metacarpal
Boxer’s fracture: common MOI
frequently sustained during a fight or from punching a wall in anger/frustration
Boxer’s fracture: diagnostic tests and meds
- x-ray
- acetaminophen
- NSAIDs
Boxer’s fracture: possible interventions
- casted for 2-4 weeks
- edema management
- flexibility exercises initially with uninvolved joints, then w/ involved joints after sufficient healing
- splinting or taping
- ther ex
Rheumatoid Arthritis: not straight up MSK or hand, but may come in for OP Ortho for hand issues so for review- What is it?
- systemic autoimmune disorder
- chronic inflammation of synovial tissues
- results in erosion of cartilage and supporting structures w/in capsule
- onset typically in small joints: hand, foot, wrist, and ankle
- disease progression includes periods of remission and exacerbation
Rheumatoid Arthritis: not straight up MSK or hand, but may come in for OP Ortho for hand issues so for review- A few things used to diagnose it?
- clinical presentation of involved joints
- presence of blood rheumatoid factor
- radiographic changes
Rheumatoid Arthritis: etiology
- cause unknown
- 1-2% US population is affected
- women affect 3x more than men
- common age of onset: 40-60
Rheumatoid Arthritis: s/s
- onset may be gradual or immediate systemic involvement
- pain and tenderness at affected joint(s)
- morning stiffness
- warm joints
- decreased appetite
- malaise
- increased fatigue
- swan neck deformity
- boutonniere deformity
- low grade fever
Rheumatoid Arthritis: meds
NSAIDs for pain and inflammation
Corticosteroids for severe flare ups
Anti-rheumatoid meds: slow acting and takes weeks to months to be effective, but slow progression of disease
Rheumatoid Arthritis: possible PT interventions
- PROM/AROM
- heating and cooling agents
- splinting
- pt.education: energy conservation, body mechanics, joint protection techniques
Special Tests: test for ligamentous instability
ulnar collateral ligament instability test
Special Tests: tests for vascular insufficiency
Allen Test
Capillary refill test
Special Tests: tests for contracture/tightness
Bunnel-Littler test
Tight retinacular ligament test
Special Tests: tests for neurological dysfunction
Froment’s sign
Phalen’s test
Tinel’s sign
Special Tests: Miscellaneous tests to wrist and hand
Finkelstein test
Grind test
Murphy sign
Describe ulnar collateral ligament instability test
Procedure: PT holds pt. thumb in extension and applies valgus force to MCP joint of thumb
Positive: excessive valgus movement. May be indicative of ulnar collateral and accessory collateral ligaments.
**called gamekeeper’s or skier’s thumb
Describe Allen Test
Procedure: pt. asked to open/close hand several times, then maintain hand in closed position.
- PT compresses radial and ulnar arteries
- pt. told to relax
- PT releases pressure from one of the arteries while observing color of hand and fingers
Positive: delayed or absent flushing may indicate occlusion of artery
Describe Bunnel-Littler test
Procedure: pt. positioned w/ MCP joints held in slight extension
- PT attempts to move PIP joint into flexion
Positive: If PIP joint does not flex w/ MCP joint extend, there may be a tight intrinsic muscle or capsular tightness
- If PIP fully flexes w/ MCP in slight flexion, there may be a tight intrinsic muscle WITHOUT capsular tightness
Describe Tight retinacular ligament test
Procedure: PIP is held in neutral position while PT attempts to flex DIP
Positive: If PT is unable to flex flex DIP, the retinacular ligaments or capsule may be tight
- If DIP fully flexes w/ PIP in flexion, the retinacular ligaments may be tight WITHOUT capsular tightness
Describe Froment’s sign
Procedure: pt. asked to hold a piece of paper between thumb and index finger
- PT attempts to pull paper away from patient
Positive: pt.’s thumb flexing at distal phalanx due to adductor pollicis muscle paralysis
- If at same time thumb hyper extends at MCP, it is called Jeanne’s sign
- both implicate ulnar nerve compromise or paralysis
Describe Phalen’s test
Procedure: PT flexes pt.’s wrist maximally and asks pt. to hold position for 60 seconds
Positive: tingling in thumb, index finger, middle finger, and lateral half of ring finger
- implicated median nerve compression at carpal tunnel
Describe Tinel’s sign
Procedure: PT taps over volar aspect of the pt.’s wrist
Positive: tingling in thumb, index finger, middle finger, and lateral half of ring finger to contact site at wrist
- implicated median nerve compression at carpal tunnel
Describe Finkelstein test
Procedure: pt. asked ot make a fist w/ thumb tucked inside fingers
- PT stabilizes forearm and ulnarly deviates the wrist
Positive: pain over abductor pollicis longus and extenso pollicis brevis tendons at wrist
- indicative of tenosynovitis in thumb aka DeQuervain’s disease
Describe Grind test
Procedure: PT stabilizes pt.’s hand and grasps pt.’s thumb on metacarpal
- PT applies compression and rotation through metacarpal
Positive: pain
- may indicate DJD in CMC joint
Describe Murphy sign
Procedure: pt. asked to make a fist
Positive: pt.’s 3rd metacarpal is level w/ 2nd and 4th metacarpal
- indicative of dislocated lunate
