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Wrist > Pathology, Scanning, & Tests > Flashcards

Pathology, Scanning, & Tests Flashcards

1
Q

Pathology General Considerations: Visceral

A

Heart
Apical Lung
Bronchus Breast

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2
Q

Pathology General Considerations: Vascular

A

Scaphoid & Lunate vulnerable to AVN

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3
Q

Pathology General Considerations: Neurogenic

A

UMN
Tumors
Spinal Stenosis
Peripheral nerve: median, ulna

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4
Q

Pathology General Considerations: Spondylogenic

A 
C5-T2 Radiculopathy 
Referred pain & symptoms
Tumors
Fractures
Spinal Dysfunctions
Brachial Plexus Lesions
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5
Q

Pathology General Considerations: Systemic

A 
RA
AS
OA
Reiter's
Hemophilia
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6
Q

Pathology General Considerations: Other Joints

A 
Elbow
Shoulder
Shoulder girdle
C-spine
T-spine
Referred pain or signs
Facilitated segments
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7
Q

Pathology - Local MS Disorders: Bone

A

Fracture - scaphoid, lunate, radial/ulnar styloid, Colles Fx, Bennett fx, Diloc Tumor, deformity, dislocation

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8
Q

Pathology - MS Disorders: Articular

A

Capsular- traumatic arthritis, immobilization arthritis, OA, RA, AS, Reiter’s

Non-capsular- subluxation (carpals or TFCC), inferior R-U joint, dislocation, instability, loose body, scaphoid fx, lunate fx

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9
Q

Pathology - MS Disorders: Ligamentous

A

1st, 2nd, 3rd degree tears
Strains
Sprains

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10
Q

Pathology - MS Disorders: Muscular

A
  • Muscle tear
  • Tendon tear
  • Ruptures
  • Strains
  • Myositis Ossificans
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11
Q

Pathology - MS Disorders: Tendons

A
  • Tendinitis
  • Tendinosis
  • Tenosynovitis (DeQuervain’s)
  • Primary or Secondary
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12
Q

Pathology - MS Disorders: Soft Tissue

A
  • Contractures

- Trigger Points

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13
Q

Pathology - MS Disorders: Nerve

A
  • Neuritis
  • Impingement
  • Neuroma
  • Thoracic Outlet
  • Peripheral Neuropathy
  • Brachial Plexus Injury
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14
Q

Colle’s Fracture

A
  • Fx of distal radius with dorsal & radial displacement of wrist and hand
  • Dinner fork or Bayonet deformity
  • FOOSH with wrist extended
  • Dorsal angulation
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15
Q

Smith’s Fx (Reverse Colle’s)

A

Fx of distal radius with volar displacement

  • FOOSH with wrist flexed
  • Volar angulation
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16
Q

Monteggia Fx

A

Fx of proximal ulna with dislocation of radial head anteriorly

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17
Q

Galeazzi Fx

A

Fx of distal 1/3 of radius with dislocation of distal radioulnar joint

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18
Q

Bennett’s Fx

A

Fx of base of 1st metacarpal bone which extends into CMC joint

  • intra-articular fx; most common type of fx of thumb
  • instability of CMC joint accompanied by pain & weak pincer grasp
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19
Q

Most commonly fractured carpal bone: _______________

A

Scaphoid

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20
Q

Scanning Exam of Wrist

A
  • Hx: trauma vs insidious
  • Behavior of symptoms
  • Area of symptoms
  • PMHx
  • Special Q’s: imaging, meds, osteoporosis, systemic dx
  • Observation: posture, swelling, color, size, skin/nail condition
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21
Q

Plan of Wrist Exam

A
  • Scan: C-spine, T-spine, Shoulder-girdle complex, Elbow as indicated
  • Joint mobility: active, passive, resisted
  • Neurological conduction: LMN, UMN
  • Neurological Mobility Tests
  • Circulatory System
22
Q

Objective Wrist Tests - Observation

A
  • Temperature
  • Swelling
  • Moisture
  • Sensitivity to touch
  • +/- detailed sensation testing (2-pt discrimination)
23
Q

Objective Wrist Tests - ROM (active, passive, resisted)

A

Wrist: flex/ext, ulnar/radial deviation
Elbow: pronation/supination
Hand: cupping, flattening Palm
Thumb: 1st CMC - add/abd, flex/ext, oppos 1st MCP, IP-flex/ext
Fingers: MCP-flex/ext, abd/add, IP-flex/ext
Functional Motion: opposition- pad to pad mobility, Tips to MCP, Fist

24
Q

Objective Wrist Tests - Stress Tests

A
  • Ligamentous: ulnar/radial collateral, inferior radio-ulnar, specific for each carpus joint or finger joint
  • Articular: dorsal shear, ventral shear, specific for each carpus joint or finger joint
25
Q

Objective Wrist Tests - Palpation

A
  • Muscle
  • Tendon
  • Insertion
  • Ligaments
  • Capsules
  • Bones
26
Q

Radio-Carpal Joint Play - Radius

A
  • Radius - Scaphoid

- Radius - Lunate

27
Q

Radio-Carpal Joint Play - Triquetral

A
  • Triquetral-Ulna
  • Triquetral-Pisiform
  • Triquetral-Lunate
28
Q

Radio Carpal Joint Play - Scaphoid

A
  • Scaphoid-lunate
29
Q

Mid-Carpal Joint Play - Capitate

A
  • Capitate-Trapezoid
  • Capitate-Scaphoid
  • Capitate-Lunate
  • Capitate-Hamate
30
Q

Mid-Carpal Joint Play - Scaphoid

A
  • Scaphoid - Trapezii
31
Q

Mid-Carpal Joint Play - Trapezoid

A

Trapezoid-Trapezium

32
Q

Mid-Carpal Joint Play - Hamate

A

Hamate-Triquetral

33
Q

Special Test’s - Phalen’s

A

Forced flexion –> compression of median nerve

  • Exam: Pt elbows resting on table & asked to hold wrists in flexion for 30-60 sec
  • (+) = numbness/tingling into 1st - 3rd digits
  • CTS
  • SNout 77%, SPin 40%
34
Q

Special Test’s - Allen’s Test

A

Determine’s whether patency of radial or ulnar artery is normal

  • condition of being open/expanded or obstructed
  • Exam: pt opens/closes hands several times then asked to squeeze hand tightly. Examiner places thumbs over radial & ulnar arteries to compress them. Pt opens hand while pressure is maintained. Examiner releases pressure over 1 artery to see if hand flushes
  • 97%SPin, 73%SNout
  • Arterial blood flow, TOS
35
Q

Special Test’s - Finkelstein’s Test

A
  • Exam: Pt creates fist around them and ulnarly deviates hand
  • (+) = pain radiating up the inside of arm from the thumb
  • De Quevain’s
  • Reliability ??? Research limited
36
Q

Special Tests - Tinel’s Test

A
  • Exam: tapping on median nerve to elicit N/T sensation
  • (+) = when nerve is entrapped, will reproduce N/T
  • SNout 43%, SPin 56%
37
Q

Special Tests - Durkan’s Carpal Compression Test

A
  • Exam: examiner applies pressure directly over carpal tunnel
  • (+) = elicits typical CTS symptoms while pressure is applied
  • SNout 77%, SPin 18%
38
Q

TFCC Pathology

A
  • FOOSH–>tearing or displacement of ulnar meniscus
  • Light, but prolonged compression d/t adducted ulna–>tearing or displacement of ulnar meniscus
  • Commonly displaces DORSALLY–> springy block c ext/sup
  • S/S Tear = Painful loading of wrist (esp. with ulnar deviation), pain (+/-) extreme play at end of sup/pron
39
Q

Palmer Classification of TFCC Traumatic Lesions

A

1A: Central Perforation
1B: Ulnar Avulsion (with or without distal ulnar fx)
1C: Distal Avulsion
1D: Radial Avulsion (with or without sigmoid notch fx)
Traumatic tears can be repaired
- Class 2: Degenerative

40
Q

Carpal HVLAT - Indication

A
  • Subluxation carpus (anterior or posterior)
  • Chronic tightness secondary to adhesion
  • Unresponsive to mobilization
41
Q

Carpal HVLAT - Contraindications

A

General contraindications

  • unable to protect sensitive joints
  • cold/sweaty hand if other is warm
42
Q

Carpal HVLAT Technique

A

Patient: seated or supine, elbow, shoulder, neck protected
- wrist in slight Flexion
PT: 2 hands hold wrist
- stand in walk stance facing patient
- direction= in line of joint, fine tuned to plane where resistance or joint line is felt
- pre-manip hold: traction and glide to a larger amplitude than technique and hold
- HVLAT= rapid motion utilizing static rapid motion or flick (AVOID EXTENSION OF CARPUS)

43
Q

Trapezoid-Trapezium Manip

A

Planar joint
Pain in dorsum of hand, particularly during pinch or grip
Manip= stabilize trapezoid (base of 2nd metacarpal)
- grasp trapezium (base of 1st metacarpal)
- slightly flex
- thrust is PALMER on trapezium

44
Q

Scaphoid-Radius Dorsal Manip

A

Scaphoid often subluxes ventral & into IR

  • Stabilize scaphoid on palmar aspect
  • Thumbs over radius
  • Thrust= ventral on radius with the conjunct rotation joint plane
45
Q

Lunate-Radius: Ventral

A

Move Lunate VENTRAL

  • stabilize lunate on dorsal aspect with finger
  • thumbs over radius palmarly
  • wrist in slight Flexion
  • Thrust = on radius dorsally
46
Q

Lunate-Radius Dorsal

A

Move Lunate Dorsal

  • Stabilize lunate on palmar aspect with fingers
  • thumbs over radius dorsally
  • Thrust = on radius palmarly over a fixed lunate-relative dorsal lunate
47
Q

TFCC Manip - Dorsal/Ventral

A

Similar to Dorsal/Ventral Carpal Manips

  • Stabilize ulna
  • Move TFCC in direction to correct displacement
  • remember conjunct rotation with dorsal/ventral thrust
48
Q

TFCC Manip - Lateral Displacement

A
  • Ulnar deviation lost & springy end-feel; often palpable lateral subluxation present
  • Pt prone with arm OH and internally rotated (IR)
  • Plinth fixes radius/ulna
  • Wrist held in slight radial deviation
  • Thumbs over TFCC on ulnar aspect
  • Thrust = medial on TFCC
  • Retest mobility post & often needs to be stabilized (taped) and anti-inflammatory modalities (indicative of a tear)
  • Recheck stability & mobility of inferior radio-ulnar joint
49
Q

1st CMC Joint & Scapoid/Trapezium Manip

A
  • Proximal hand fixes Trapezium & induces traction
  • Distal hand grasps 1st CMC & induces traction/conjunct rot
  • Use hypo thenar over palmar aspect of trapezium/scaphoid & other hypothecate over 1st CMC
  • Apply circumduction moment to find barrier & apply short sharp squeeze
  • For Scapoid-Trapezium, thrust is similar, fixation is on correct bones
50
Q

MCP Manipulation

A
  • Stabilize MCP with proximal hand
  • Grasp phalanx with distal hand
  • Find barrier & thrust with distraction
51
Q

CMC Manipulation

A
  • Stabilize hand on table
  • Fingers in semi-Flexion
  • Fix proximal carpal
  • Distract metacarpal
52
Q

IP Joint Manip

A
  • Hold dorsum of pt hand against or towards therapist’s stomach or on table or on wedge
  • Thrust = distraction or medial/lateral gapping

Wrist (2 decks)

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