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Sharlene and MB's PT party > MSK #10- Wrist and Hand conditions > Flashcards

MSK #10- Wrist and Hand conditions Flashcards

1
Q

Carpal Tunnel Syndrome: What is it

A
  • repetitive stress syndrome

- compression of the median nerve at the carpal tunnel due to inflammation of the flexor tendons and/or median nerve

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2
Q

Carpal Tunnel Syndrome: common causes

A
  • repetitive wrist motions or gripping
  • pregnancy
  • diabetes
  • RA
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3
Q

Carpal Tunnel Syndrome: special tests and diagnostic tests utilized

A
  • Phalen’s
  • Tinnel’s
  • electrodiagnostic tests
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4
Q

Carpal Tunnel Syndrome: what do you need to rule out

A
  • cervical spine dysfunction
  • thoracic outlet syndrome
  • peripheral nerve entrapment
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5
Q

Carpal Tunnel Syndrome: common s/s

A
  • 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
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6
Q

Carpal Tunnel Syndrome: meds

A
  • acetaminophen

- NSAIDs

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7
Q

Carpal Tunnel Syndrome: possible interventions

A
  • soft tissue and massage techniques
  • modalities
  • flexibility and strengthening exercises
  • joint mobilizations
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8
Q

De Quervain’s Tenosynovitis: what is it

A
  • 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
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9
Q

De Quervain’s Tenosynovitis: special tests and diagnostic tests

A
  • Finkelstein’s

- MRI, but usually not necessary

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10
Q

De Quervain’s Tenosynovitis: s/s

A
  • pain at anatomical snuffbox
  • swelling
  • decreased grip and pinch strength
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11
Q

De Quervain’s Tenosynovitis: meds

A
  • acetaminophen

- NSAIDs

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12
Q

De Quervain’s Tenosynovitis: possible interventions

A
  • soft tissue and massage techniques
  • modalities
  • flexibility and strengthening exercises
  • joint mobilizations
  • functional exercises
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13
Q

Colles’ Fracture: what is it

A
  • 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
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14
Q

Colles’ Fracture: special tests and diagnostic tests

A
  • no special test

- x-ray

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15
Q

Colles’ Fracture: possible complications from the fx

A
  • loss of motion
  • decreased grip strength
  • CRPS
  • carpal tunnel syndrome
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16
Q

Colles’ Fracture: meds

A
  • acetaminophen

- NSAIDs

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17
Q

Colles’ Fracture: possible interventions

A
  • 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

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18
Q

Smith’s Fracture: What is it

A
  • similar to Colles’ but distal fragment of radius dislocates in a volar direction
  • “garden spade” deformity
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19
Q

Smith’s Fracture: special tests and diagnostic tests

A
  • no special test

- x-ray

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20
Q

Smith’s Fracture: meds

A
  • acetaminophen

- NSAIDs

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21
Q

Smith’s Fracture: possible interventions

A
  • 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’

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22
Q

Dupuytren’s Contracture: what is it

A
  • observed as banding on palm and digit flexion contractures resulting from contracture of palmer fascia that adheres to skin
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23
Q

Dupuytren’s Contracture: who/what is affected

A
  • 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
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24
Q

Dupuytren’s Contracture: meds

A
  • acetaminophen

- NSAIDs

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25
Q

Dupuytren’s Contracture: possible interventions

A
  • 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
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26
Q

Boutonniere Deformity: what is it

A

results from rupture of central tendinous slip of extensor hood

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27
Q

Boutonniere Deformity: deformity observed

A
  • extension of MCP and DIP

- flexion of PIP

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28
Q

Boutonniere Deformity: common causes

A
  • trauma

- RA

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29
Q

Boutonniere Deformity: meds

A
  • acetaminophen

- NSAIDs

30
Q

Boutonniere Deformity: possible interventions

A
  • edema management
  • flexibility exercises of involved and uninvolved joints
  • splinting or taping
  • ther ex
31
Q

Swan Neck Deformity: what is it

A

results from contracture of intrinsic muscles w. dorsal subluxation of lateral extensor tendons

32
Q

Swan Neck Deformity: deformity observed

A
  • flexion of MCP and DIP

- extension of PIP

33
Q

Swan Neck Deformity: common causes

A
  • trauma

- RA

34
Q

Swan Neck Deformity: diagnostic tests and meds

A
  • x-ray, may not be necessary
  • acetaminophen
  • NSAIDs
35
Q

Swan Neck Deformity: possible interventions

A
  • edema management
  • flexibility exercises of involved and uninvolved joints
  • splinting or taping
  • ther ex
36
Q

Ape Hand Deformity: what is it

A
  • observed as thenar muscle wasting w/ 1st digit moving dorsally until it is line w/ 2nd digit
  • results from median nerve dysfunction
37
Q

Ape Hand Deformity: diagnostic tests

A

electrodiagnostic testing

38
Q

Ape Hand Deformity: meds

A
  • acetaminophen

- NSAIDs

39
Q

Ape Hand Deformity: possible interventions

A
  • edema management
  • flexibility exercises of involved and uninvolved joints
  • splinting or taping
  • ther ex
40
Q

Mallet Finger: what is it

A
  • rupture or avulsion of extensor tendon at its insertion into distal phalanx of digit
  • observed deformity is flexion of DIP
41
Q

Mallet Finger: common cause

A

usually occurs from trauma, forcing distal phalanx into a flexed position

42
Q

Mallet Finger: diagnostic tests and meds

A
  • possibly MRI
  • acetaminophen
  • NSAIDs
43
Q

Mallet Finger: possible interventions

A
  • edema management
  • flexibility exercises of involved and uninvolved joints
  • splinting or taping
  • ther ex
44
Q

Gamekeeper’s Thumb: what is it

A
  • a sprain/rupture of ulnar collateral ligament of MCP joint of 1st digit
  • results in medial instability of thumb
45
Q

Gamekeeper’s Thumb: common MOI

A

frequently occurs during a fall while skiing, when increasing forces are placed on thumb through ski pole

46
Q

Gamekeeper’s Thumb: diagnostic tests and meds

A
  • possibly MRI
  • acetaminophen
  • NSAIDs
47
Q

Gamekeeper’s Thumb: possible interventions

A
  • immobilized for 6 weeks
  • edema management
  • flexibility exercises of involved and uninvolved joints
  • splinting or taping
  • ther ex
48
Q

Boxer’s fracture: what is it

A

Fx of neck of 5th metacarpal

49
Q

Boxer’s fracture: common MOI

A

frequently sustained during a fight or from punching a wall in anger/frustration

50
Q

Boxer’s fracture: diagnostic tests and meds

A
  • x-ray
  • acetaminophen
  • NSAIDs
51
Q

Boxer’s fracture: possible interventions

A
  • 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
52
Q

Rheumatoid Arthritis: not straight up MSK or hand, but may come in for OP Ortho for hand issues so for review- What is it?

A
  • 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
53
Q

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?

A
  • clinical presentation of involved joints
  • presence of blood rheumatoid factor
  • radiographic changes
54
Q

Rheumatoid Arthritis: etiology

A
  • cause unknown
  • 1-2% US population is affected
  • women affect 3x more than men
  • common age of onset: 40-60
55
Q

Rheumatoid Arthritis: s/s

A
  • 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
56
Q

Rheumatoid Arthritis: meds

A

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

57
Q

Rheumatoid Arthritis: possible PT interventions

A
  • PROM/AROM
  • heating and cooling agents
  • splinting
  • pt.education: energy conservation, body mechanics, joint protection techniques
58
Q

Special Tests: test for ligamentous instability

A

ulnar collateral ligament instability test

59
Q

Special Tests: tests for vascular insufficiency

A

Allen Test

Capillary refill test

60
Q

Special Tests: tests for contracture/tightness

A

Bunnel-Littler test

Tight retinacular ligament test

61
Q

Special Tests: tests for neurological dysfunction

A

Froment’s sign
Phalen’s test
Tinel’s sign

62
Q

Special Tests: Miscellaneous tests to wrist and hand

A

Finkelstein test
Grind test
Murphy sign

63
Q

Describe ulnar collateral ligament instability test

A

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

64
Q

Describe Allen Test

A

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

65
Q

Describe Bunnel-Littler test

A

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

66
Q

Describe Tight retinacular ligament test

A

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

67
Q

Describe Froment’s sign

A

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
68
Q

Describe Phalen’s test

A

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

69
Q

Describe Tinel’s sign

A

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

70
Q

Describe Finkelstein test

A

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

71
Q

Describe Grind test

A

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

72
Q

Describe Murphy sign

A

Procedure: pt. asked to make a fist

Positive: pt.’s 3rd metacarpal is level w/ 2nd and 4th metacarpal
- indicative of dislocated lunate

Sharlene and MB's PT party (35 decks)

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