msk conditions of wrist and hand

Question 1

dupuytrens contracture

Answer 1

palmar fascia dimpling puckering the skin

visible raised cords or nodules along the flexor tendons

progresses to causing flexion contractures

occasionally present in the plantar fascia and penis

Question 2

clinical assessment for dupuytrens

Answer 2

palpation to cords or nodules for pain assessment

AROM/PROM measurements to assess contracture vs lag

sensory testing- digital nerve involvement

Question 3

treatment options for dupuytrens

Answer 3

surgical dermofascietomy and soft tissue mobilization and stretching

xiaflex injection and night resting orthoses

needle aponeurotomy and post op care, wound, orthosis, movement

Question 4

trigger finger

Answer 4

2-3% of population

stenosing flexor tendosynovitis

flexor tendon enlarged at A1 pulley

locking or popping occurs upon finger flexion/extension

Question 5

trigger finger assessment

Answer 5

palpation to flexor tendon at A1 pulley

AROM PROM of finger

functional limitations

Question 6

treatment for trigger finger

Answer 6

orthosis- single joint immobilization, MPjt PIPjt
full time use for 6 wks up to 12 wks (81-88% favorable)
night time use only (53% favorable)

movement- stretching, AROM, and tendon gliding

medical intervention- injection and or surgical release

Question 7

thumb ulnar collateral lig injury

Answer 7

gamekeepers thumb; skiers thumb

injury to UCL at MPjt

instability at MPjt upon lateral stress

associated trauma- stener lesion and avulsion fx

Question 8

assessment of UCL

Answer 8

palpation
tip pinch strength and integrity
MRI, diagnostic US, radiographs

ucl stress test- complete tear indicated…
valgus motion > 35 or 15> contralateral side
absence of a firm endpoint with valgus testing

Question 9

treatment for UCL

Answer 9

conservative care
week 0-4 immobilization
wk 4 AROM of MPjt
wk 6 light use without orthosis
wk 10-12 no forceful pinching
wk 12 begin heavy use

Question 10

base of thumb OA

Answer 10

basal joint oa
degenerative
women > men
pinching is painful
ligament laxity
deformity
pain at base of thumb

Question 11

assessment of base of thumb oa

Answer 11

palpation- volar and dorsal CMCjt

AROM of thumb

pinch- lateral and tip pinch

observation and movement
radiographs do not correlate with pain

Question 12

treatment for base of thumb oa

Answer 12

orthosis- stabilization
splint effectiveness
3-12 mo, splints promote moderate to large pain reduction
3-12 mo, splints contribute to small to moderate improvement in function

stabilization exercises
restore motion
adaptive devices and joint protection

Question 13

de Quervains tenosynovitis

Answer 13

stenosis of EPB and APL at the first dorsal compartment

moi- maintaining static ulnar deviation while engaging thumb extrinsic tendons
repetitive thumb CMCjt flexion and extension or wrist radial and ulnar deviation

Question 14

assessment de quervains tenosynovitis

Answer 14

TTP at 1st dorsal compartment

wrist RD/UD AROM limitations
thumb flex/ext AROM limitations

localized inflammation
radial nerve mobility

finkelsteins test
eichhoffs test

Question 15

treatment for de quervains

Answer 15

thumb spica orthosis
activity analysis and modification
manual therapy techniques
AROM, PROM, resistance
modalities for pain and edema

medical- cortisone injection
surgical- release of 1st dorsal compartment

Question 16

triangular fibrocartilage complex (TFCC) injury

Answer 16

TFCC is comprised of ligaments, articular disc at the end of the ulna, and ECU tendon sheath

common injury with distal radius fx

type 1- injury from trauma, FOOSH
type 2- repetitive, wear and tear

Question 17

TFCC assessment

Answer 17

localized lain complains to ulnar side of wrist
ulnar deviation provokes symptoms
assess integrity of DRUJ
TFCC compression test
weight bearing test

Question 18

TFCC injury treatment

Answer 18

Rigid orthosis to restrict wrist and forearm

Rest rest for 4-6 then begin AROM

Strengthen at 8 weeks

Wrist widget

surgical intervention- arthroscopy, debridement

Question 19

scapholunate dissociation

Answer 19

ligamentous injury between the scaphoid and the lunate

Acute FOOSH injury

Degenerative OA

Imaging shows a gap at the SL ligament

Question 20

scapholunate dissociation assessment

Answer 20

palpation of the ligament
Wrist AROM
grip strength
Reproducible click in the wrist

Symptoms increase with pushing off of the palm

Positive shift test pain with the scaphoid shift is significant to diagnose scaphoid instability

Question 21

scapholunate dissociation treatment

Answer 21

partial tears with conservative treat
Immobilization
FCR isometrics
Delay grip strengthening
regain AROM with dart throwers motion
Proprioception

Complete tears and surgical intervention
Repair of SL ligament
Reconstruction