MSK- Wrist And Hand Flashcards by Sean Sawer

Colles #

Distal radial fracture resulting in a dorsal displacement
Could compress medial nerve (present like carpal tunnel), CRPS, and arthritis

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Colles # etiology

FOOSh

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Dinner fork deformity

Colles #- look like a fork face down

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Colles # interventions

Post-immobilization’s phase
- mobilization
Strengthening

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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

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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)

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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 +)

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CRPS- interventions

Education
Mobility
Encourage ADLs
Compressive loading
Distraction
Desensitization
Edema control
Modalities
Mirror therapy
Aerobic activity

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Immobilizations- warning signs

Increased pain- CRPS
Cast tightness- CRPS
Ct looseness
Changes in surrounding skin colour/ sensation
Increased swelling- CRPS

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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

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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

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Scaphoid # interventions

Mobilization
Strengthening

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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

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De Qua- special tests

Finkelstein test

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De quavers interventions

Activity mod
Cryotherapy
Splinting
Graduation stretching and strengthening (as tolerated)

Medical (NSAIDs, corticosteroid injections- super helpful, surgical release-rare)

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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