Quiz I

Question 1

treatment for scaphoid-lunate and lunate-triquetral injuries

Answer 1

Grade I sprain: follow stages of soft tissue healing, immobilization, proliferation/remodeling, strengthening with emphasis on dart throwers
Surgical ligament reconstruction: no forceful load for 6mo post op

Question 2

common wrist injuries - radial dorsal zone

Answer 2

• de quervains
• thumb CMC osteoarthritis
• thumb MP (gatekeeper’s thumb)
• scaphoid fracture (S-L and L-T)
• distal radius fracture

Question 3

common wrist injuries - radial volar zone

Answer 3

• carpal tunnel
• scaphoid fracture
• distal radius fracture
• ganglion cysts

Question 4

common wrist injuries - ulnar dorsal zone

Answer 4

• lunotriquetral instability
• TFCC
• ECU tenditnits
• distal radioulnar joint instability

Question 5

common wrist injuries - ulnar volar zone

Answer 5

• guyons canal
• hamate fracture
• FCU tenditnits
• ganglion cysts
• distal radioulnar joint instability

Question 6

common wrist injuries - central dorsal zone

Answer 6

• scaphoid lunate instability
• capitate fracture
• ganglion cysts

Question 7

ulnar + and -

Answer 7

Ulnar +: distal ulnar longer than radius causing ulnar sided pain
Ulnar -: distal ulnar shorter than radius causing radial sided pain

Question 8

sagittal/frontal planes of ulnar and radius

Answer 8

Sagittal plane: 11 degree palmar tilt

Frontal plane: radial inclination 23 degrees

Question 9

Distinguish between the forces that are placed on the radial and ulnar wrist with grip activities.

Answer 9

Radiocarpal joint: 80% → (radioscaphoid 45% and radiolunate 35%)

Ulnocarpal joint: 20% → (ulnolunate 14% and ulnotriquetral 8%)

Question 10

general treatment rehabilitation progressions

Answer 10

Joint mobilization (orthosis)
Edema control
Pain management
Guarding
A/PROM
Soft tissue: acupressure, mobilizations, resistance/positional stretching
Limited strength: immobilization then strengthening, functional activities, exercise

Question 11

clinical test for scaphoid lunate and lunate triquetrum instabilities

Answer 11

Watson’s test: positive test is scaphoid shifts/jumps

Lunotriquetral ballottement test (Regan Shuck): positive result is laxity, pain, or crepitus

Question 12

heat - superficial and deep

Answer 12

Superficial agents: hot packs, paraffin, infrared lamp

Deep agents: ultrasound, phonophoreisis, short wave diathermy

Question 13

heat - conduction vs convection

Answer 13

conduction - hot packs, paraffin

convection - whirlpool, fluidotherapy

Question 14

cold - conduction vs convection

Answer 14

conduction - cold packs, ice massage, ice towels

convection - cold water baths, cold whirlpools

Question 15

72 hour rule

Answer 15

First 72 hours - ice

After 72 hours - heat

Question 16

RICE

Answer 16

rest ice compression elevation

*not effective where the cause of edema is from immobility or poor circulation

Question 17

CBAN

Answer 17

Normal patient sequence of sensation with ice massage: 
C - intense cold 1-3 min
B - burning 3-5 min
A - aching 5-7 min
N - numbness - 7+ min

Question 18

contraindications

Answer 18

pregnancy
pacemaker
cardiac, communication, sensory impairments
open wound/other skin

Question 19

Triangular Fibrocartilage Complex (TFCC)

Answer 19

stabilizer for forearm rotation, supports ulnar carpal column, cushions ulnar wrist, provides gliding surface for carpal movement

Question 20

NMES

Answer 20

intensity/amplitude: strong enough
frequency: fast enough
duration: long enough
waveform: asymmetrical for small mx, symmetrical for large mx
duty cycle: 1:4
ramp: 2 secs

Question 21

mechanisms of wound healing

Answer 21

tissue regeneration: primary intention/closure; wound edges are close with little/no tissue loss (sutures)
tissue repair: secondary intention/closure; wound is beyond superficial layer

Question 22

Overlapping phases of wound healing

Answer 22

1. Hemostasis: immediate, lasts a few minutes, clotting cascade occurs
2. Inflammatory: 1-6 days, edema and pain, vasodilation, neutrophils and macrophages
3. Proliferative: 3-20 days
   filling the wound, contraction of wound margins, epithelialization
4. Remodeling/maturation: 14 days-1 year, max strength is limited to ~80% of pre-injured strength

Question 23

cellular events of wound healing

Answer 23

• initiated by tissue and platelet disruption
• each phase is characterized by changes in cellularity as different cell types (neutrophils, monocytes, macrophages, fibroblasts, endothelial) migrate into and out of wound bed
• regulated by phagocytosis etc

Question 24

appropriate therapy interventions based on the specific phase of wound healing

Answer 24

When wounds won’t heal: grafts (skin/tendon/bone), flaps (share blood supply)
Factors that influence wound healing: humidity/temp, infection, edema, hematoma, depressed immune system, nutrition, smokers
Therapist goals:
protect wounds, prevent infection with cleaning and dressing, keep moist
inflammatory: immobilize, RICE, cardinal signs (redness, warmth, swelling, pain, LOF)
monitor for infection and discharge
maturation: scar management, PROM, pressure, stretch, massage (to restore fx)
keloids: scars that extend beyond the wound

Question 25

wound colors and treatments

Answer 25

red: healthy - protect, keep moist
yellow: clean, light whirlpool, remove necrotic tissue, absorb drainage, antibiotics
black: decried wound with whirlpools, wound dressing, mechanical debridement