MSK- Wrist And Hand Flashcards
Colles #
Distal radial fracture resulting in a dorsal displacement
Could compress medial nerve (present like carpal tunnel), CRPS, and arthritis
Colles # etiology
FOOSh
Dinner fork deformity
Colles #- look like a fork face down
Colles # interventions
Post-immobilization’s phase
- mobilization
Strengthening
CRPS- Complex regional pain syndrome
Chronic pain disorder caused by sympathetic nervous system (SNS) out of proportion of the original injury
Type 1- occurs after injury to tissue
Type 2- nerve injury
CRPS- S&S
Severe pain- burning
Allodynia or hyperalgesia
Abnormal blood flow, motor function (stiffness) or sweating
Trophies changes (colour, temp, edema, shiny tight skin, abnormal hair and nail growth)
CRPS- clinical course
Stage 1- acute/reversible stage (immediate)
Stage 2- dystrophic or vasoconstriction (ischemic) stage (3-6 mnths)
Stage 3 Atrophic stage (6 mnth-1yr +)
CRPS- interventions
Education
Mobility
Encourage ADLs
Compressive loading
Distraction
Desensitization
Edema control
Modalities
Mirror therapy
Aerobic activity
Immobilizations- warning signs
Increased pain- CRPS
Cast tightness- CRPS
Ct looseness
Changes in surrounding skin colour/ sensation
Increased swelling- CRPS
DOs and DONTS of immobilization
DOs
- maintain jts above and below
Skin integrity
Capillary refill
Reducing swelling
Education on warning signs
Remove tight jewelry
DONTS
Stick things inside the cast (ie to scratch)
Get the cast wet
Scaphoid #
Most commonly fractures carpal bone
Complications- avascular necrosis, nonunion of fracture, and arthritis
Young males are common (high risk activities)
Radial side pain, tenderness on anatomical snuff box, pain with longitudinal thumb compression
Scaphoid # interventions
Mobilization
Strengthening
De Quervains Tenosynovitis
Painful inflammation of the sheath surrounding tendons of the 1st dorsal compartment (abductor pollicis longus and extensor pollicis brevis)
Caused by overuse (repetitive thumb or wrist mvmts) or blunt trauma
De Qua- special tests
Finkelstein test
De quavers interventions
Activity mod
Cryotherapy
Splinting
Graduation stretching and strengthening (as tolerated)
Medical (NSAIDs, corticosteroid injections- super helpful, surgical release-rare)
TFCC tear
A tear in the ligament out and cartilaginous structures of the TFCC
- radius will bear more load than it should
Clicking- a hallmark sign
TFCC - special test
TFCC load test (Sharpey’s test)
Press test
TFCC interventions
Activity mod
Bracing (widget)
Cryotherapy
Progressive strengthening and mobility exercises when able to tolerate
Medical- NSAIDs, corticosteroid injection, surgery
Peripheral neuropathy- nerves and inervations
Radial- BEST (Brachioradialis, extensors, supinators, triceps and anconeus)
Median- 2LOAF (lumbrical 1/2, opponens pollicis brevis, flexor pollicis brevis)
Ulnar- (Lumbrical 3[4, hypothenar muscles, interosseim, adductor pollocis
PAD DAB
Palmar adducts
Dorsal abducts
Hand deformities due to nerve lesions
Median- ape hand, hand of benediction
Ulnar- claw hand
Radial- wrist drop
Carpal tunnel
Flexor reinaculum and carpal creates a tunnel containing:
- median nerve
- 9 total tendons
Carpal tunnel- etiology
Insidious
Repetitive hand mvmts
Vibrations
Associated conditions (RA, COlles, lunate subluxation, hypothyroidism, pregnancy, DM, obesity)
Carpal tunnel- S&S
Median nerve parenthesis- palmar 1, 2, 3, half of 4
Nocturnal pain
Relief with flicking
Weakness and clumsiness in hand (decreased grip strength)
Carpal tunnel special test
Tinels
Phalens
Reverse phalens
Carpal compression
Resisted APB
ULTT median nerve bias
Nerve conduction velocity test
Carpal tunnel interventions
Activity modifications
Splinting in neural
Nerve mobs
Medical- NSAID, corticosteroid, carpal release surgery
Double crush syndrome
Nerve compression at more than 1 site along nerve
Proximal compression or pathology of a nerve is suggested to increase vulnerability of a nerve at a distal point
Ulnar tunnel syndrome
Compression of ulnar nerve at Guyons canal syndrome
Caused from trauma, chronic pressure, space occupying lesions, extended use of crutches, higher risk amongst cyclist, baseball catchers, karate players and use of jack hammers
Ulnar tunnel S&S
Parenthesia and pain in ulnar nerve distribution of hand (5th and half of 4th)
Decreased muscle strength
Atrophy of muscle innervated by ulnar
Ulnar special test
Froment’s sign
Guy on canal compression test
Tinels test over Guyons canal
ULTT ulnar nerve bias
Nerve conduction velocity test
Ulnar tunnel interventions
Activity mods
Bracing- cockup splint
Ergo and padding equipment and tools
Frequent changes of hand positions
Nerve mods
Med- NSAIDS, corticosteroid injections, release surgery
Gameskeeper/ skiers thumb
Sprain of ulnar collateral lig of the thumb (MCP joint)
Valgus force on MCP joint
Commonly seen in games keeper, skiers, and volleyball players
Pain at base of thumb and with stretch
Worse with mvmt
Decrease pinch and gri
Gameskeeper test
Thumb UCL laxity or instability test
Gameskeeper interventions
Activity mod
Split MCP in slight flexion
Gentle ROM as tolerated
Strengthening (putty)
CMC OA
Most common OA of the hand
Repetitive mvmts and joint injury
Classic S&S of OA
CMC OA special test
Grind test
CMC OA- interventions
Activity mod
Splinting
Larger grip handles
AROM within tolerable limits
Strengthening
Finger deformities
Dupuytrens contracture
- fixed flexion deformity
- skin aherent to the fascia
Trigger
- thickening of the flexor tendon sheath (Notta’s nodule)
- results in the tendon sticking, catching, or locking when attempting to flex the affected finger
- often associated with RA
Mallet finger
- flexion of DIP at rest (splint and will be better in 6-8 wks) due to extensor tendon rupture
Bouchard node (PIP)
- OA
Heberden node (DIP)
- OA
Swan neck deformity
- RA
Boutonniere
- RA
Ulnar drift
- RA
