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(2) Evaluation & Intervention of MSK Conditions 💪 > S2_L3: Wrist & Hand > Flashcards

S2_L3: Wrist & Hand Flashcards

1
Q

Type of prehension pattern where the thumb is NOT necessarily active:

A. Cylindrical grasp
B. Spherical Grasp
C. Hook Grasp
D. None of These

A

C. Hook Grasp

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2
Q

Synergistic actions of the wrist muscles are noted in the following:

A. When the thumb is extended, the extensor carpi ulnaris contracts to prevent radial abduction of the wrist by the abductor pollicis longus
B. When the thumb is flexed, the palmaris longus aids the movement by tensing the fascia of the palm; to prevent flexion of the wrist, the extensor digitorum contracts
C. When the 5th finger is abducted, the flexor carpi ulnaris furnishes countertraction on the pisiform; to prevent wrist ulnar deviation, the flexor carpi radialis contracts
D. All of these

A

A. When the thumb is extended, the extensor carpi ulnaris contracts to prevent radial abduction of the wrist by the abductor pollicis longus

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3
Q

Which of the following is NOT considered precision handling?

A. Lateral prehension
B. Pad-to-pad prehension
C. Tip-to-tip prehension
D. Pad-to-side prehension

A

A. Lateral prehension

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4
Q

Which of the following carpal bones DOES NOT form part of the radiocarpal joint?

A. Trapezoid
B. Scaphoid
C. Lunate
D. Triquetrum

A

A. Trapezoid

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5
Q

The flexor digitorum profundus muscles insert into the?

A. Base of the metacarpals
B. Metacarpal heads
C. Base of distal phalanges
D. Base of the proximal phalanges

A

C. Base of distal phalanges

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6
Q

Determine where the following zones can be seen or attached to.

  1. MCP
  2. Carpal tunnel
  3. Midcarpal Joint
  4. Insertion of FDP & FDS
  5. PIP

A. Finger Flexor Zone 1
B. Finger Flexor Zone 4
C. Thumb Extensor Zone 3
D. Finger Extensor Zone 3
E. Finger Extensor Zone 7

A
  1. C
  2. B
  3. E
  4. A
  5. D
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7
Q

Determine which description is seen on the kind of tendon laceration.

  1. Prone to adhesions
  2. Retract when ruptured
  3. More common laceration
  4. Most difficult to treat when zone III & VII is affected
  5. Most difficult to treat when zone II is affected

A. FLEXOR Tendon Laceration
B. EXTENSOR Tendon Laceration

A
  1. B
  2. A
  3. B
  4. B
  5. A
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8
Q

Determine the position of immobilization of the following zones.

  1. 10-45° wrist and 40-70° MCP Flexion with PIP & DIP extension
  2. PIP & DIP extension
  3. 30° wrist extension and 30-45° MCP flexion

A. Flexor zone 1-3
B. Flexor zone 4
C. Flexion zone 5
D. Extensor zone 3-4
E. Extension zone 5-6

A
  1. A
  2. D
  3. E
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9
Q

Determine which fracture is describe in the following descriptions

  1. Fracture at the neck of the 5th metacarpal bone
  2. Fracture of the distal end of the radius resulting to
    dinner fork deformity
  3. Fracture of the distal end of the radius accompanied by fracture of the ulnar styloid process
  4. Fracture of the distal end of the radius involving the intra-articular joint of the radius and its adjoining carpal bones
  5. An avulsion fracture of the distal end of the radial styloid process

A. Barton’s Fracture
B. Boxer’s Fracture
C. Chauffeur’s Fracture
D. Colle’s Fracture
E. Smith’s Fracture

A
  1. B
  2. D
  3. E
  4. A
  5. C
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10
Q

TRUE OR FALSE: In DIP or PIP Arthroplasty, the goal of the PT is to restore 70° PIP flexion and full extension.

A

True

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11
Q

TRUE OR FALSE: Finkelstein test usually presents as (+) in most people.

A

True

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12
Q

Differentiate tenosynovitis from tenovaginitis.

A

Tenosynovitis - inflammation of the synovial membrane covering the tendon

Tenovaginitis - inflammation with thickening of a tendon sheath

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13
Q

TRUE OR FALSE: In sensory re-education, a PT must determine the most irritating sensory stimulus then re-introduce it first to help pt adapt to it faster.

A

False.

Start with least irritating as to not discourage the pt then progress to the most irritating sensory stimulus.

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14
Q

TRUE OR FALSE: The ulnar nerve enters the hand through a trough formed by the pisiform bone & hook of the hamate bone.

A

True

Then, the volar carpal ligament and palmaris brevis muscle covers the ulnar nerve, forming the tunnel of Guyon.

Source: Kisner 7th ed, page 387

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15
Q

TRUE OR FALSE: The most common finger affected in trigger finger is the 3rd & 4th finger, but mostly on the 4th finger.

A

True

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16
Q

Determine which description corresponds to what timing of repair

  1. A repair done in the first 24 hours after surgery
  2. A repair done 10 days to 3 weeks after injury
  3. Surgery performed well beyond 3-4 weeks
  4. Multiple separate surgeries performed over a period
    of weeks or months
  5. A repair performed up to 10 days after injury

A. Immediate Primary Repair
B. Delayed Primary Repair
C. Secondary Repair
D. Late Reconstruction
E. Staged Reconstruction

A
  1. A
  2. C
  3. D
  4. E
  5. B
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17
Q

The most common site for compression of the median nerve is in the (1)____, while the most common site for compression of the ulnar nerve is in the (2)___.

A
  1. Carpal tunnel
  2. Ulnar tunnel/ Canal of Guyon

Source: Kisner & Colby 7th ed., page 663

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18
Q

Determine whether the descriptions listed are seen in OA or in RA.

  1. Present systemic signs
  2. Morning stiffness <30 mins
  3. Cartilage degeneration
  4. Unilateral
  5. Inflammatory synovitis

A. OA
B. RA

A
  1. B
  2. A
  3. A
  4. A
  5. B
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19
Q

Differentiate central slip-splitting & central -slip sparring. Which technique needs more time of immobilization?

A

Slip-sparring - moving the tendon to the side
Slip-splitting - splitting the tendon in half

central slip-splitting needs more days of immobilization (3-5 days) post-op & will produce slower ROM.

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20
Q

What muscle is used for tendon grafts?

A

Palmaris Longus

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21
Q

This is considered the most complex joint of the body

A

Wrist joint

Source: Kisner & Colby 7th ed., page 657

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22
Q

TRUE OR FALSE: The structure and biomechanics of the wrist as well as the hand vary significantly from person to person

A

True

Source: Kisner & Colby 7th ed., page 657

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23
Q

TRUE OR FALSE: The distal radioulnar (RU) joint is considered part of the wrist joint

A

False

Source: Kisner & Colby 7th ed., page 658

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24
Q

Most activities are carried out with an oblique wrist motion from extension with radial deviation to flexion with ulnar deviation. This oblique plane of motions is referred to as the ____

A

“dart thrower’s motion” (DRT)

Source: Kisner & Colby 7th ed., page 658

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25
Q

This carpal bone functions as a sesamoid bone in the flexor carpi ulnaris tendon.

A

Pisiform

Source: Kisner & Colby 7th ed., page 658

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26
Q

TRUE OR FALSE: With flexion and extension, as well as radial and ulnar deviation, the distal component of the ulnar compartment (capitate and hamate) slides opposite the physiological motion.

A

True

Source: Kisner & Colby 7th ed., page 658

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27
Q

The fourth and fifth metacarpal joints are able to “fold” or rotate toward the center of the hand, deepening the palmar concavity. This motion occurs by flexion and internal rotation of the fourth and fifth metacarpals moving toward the third digit and is often referred to as _____.

A

“cupping” of the hand

Source: Kisner & Colby 7th ed., page 659

28
Q

The CMC joint of the thumb is a (1)____ joint between the (2)____ and base of the (3)____.

A
  1. saddle-shaped (sellar)
  2. trapezium
  3. first metacarpal

Source: Kisner & Colby 7th ed., page 659

29
Q

An isolated contraction of the (1)____ produces MP joint hyperextension with IP joint flexion. The IP joint flexion is produced from passive pull of the extrinsic flexor tendons. This position is called the (2)____.

A
  1. extensor digitorum
  2. clawing or hook position

Source: Kisner & Colby 7th ed., page 662

30
Q

TRUE OR FALSE: PIP and DIP extension is interdependent.

A

True

Source: Kisner & Colby 7th ed., page 662

31
Q

This muscle acts as a “brake” at the MP joints, allowing for more refined and controlled motion at the IP joints.

A

extensor digitorum

Source: Kisner & Colby 7th ed., page 662

32
Q

TRUE OR FALSE: Power grips are primarily isometric functions

A

True

Source: Kisner & Colby 7th ed., page 663

33
Q

Maximum grip force occurs with the wrist positioned in
slight ____ & ____.

A

extension and ulnar deviation

Source: Kisner & Colby 7th ed., page 663

34
Q

To successfully perform a precision pattern, hand muscles should primarily function ____

A

isotonically

Source: Kisner & Colby 7th ed., page 663

35
Q

TRUE OR FALSE: For treatment of nerve disorder to be effective, it must be directed to the source of the problem, not to the site where the patient perceives the pain or sensory changes.

A

True

Source: Kisner & Colby 7th ed., page 663

36
Q

These 2 common hand or finger deformities may be seen in the advanced stages of RA.

A

Swan-neck deformity & Boutonnière deformity

A zigzag deformity of the thumb may also occur.

37
Q

In the fingers, this joint is a common site of articular fracture and subsequent joint degeneration.

38
Q

How do you perform MWM of the wrist?

A
  1. With the pt seated, elbow must be flexed & FA must be supinated.
  2. PT stabilizes distal radius & ulna with one hand, while the other applies a gentle radial glide using the web space of PT’s hand.
  3. Instruct pt to perform active wrist flexion & extension to the end of the available range and, with his or her free hand, apply gentle overpressure at the end of the pain-free.
39
Q

How do you perform MWM of the MP & IP joints of the digits?

A

Gently apply a radial or ulnar glide the involved phalanx in a painless direction, then have the patient actively flex or extend the finger and apply a pain-free, end-range stretch

40
Q

What zone is considered as the “No Man’s Land”?

A

Flexor Tendon Zone II

41
Q

TRUE OR FALSE: A late reconstruction timing of repair necessitates a tendon graft.

A

True.

If a repair must be delayed for more than 3 to 4 weeks, a direct repair is no longer possible, which necessitates a tendon graft.

Source: Kisner & Colby 7th ed., page 688

42
Q

Most common zone affected in the extensor tendon lacerations?

A

zone V

Injuries to zone V frequently happen as a result of a punch to another’s mouth, called a fight bite.

Source: Kisner & Colby 7th ed., page 696

43
Q

In canal of Guyon syndrome, where do PTs notice muscle weakness?

A

hypothenar area

44
Q

A ___ splint may be used as a non-operative management for canal of Guyon syndrome

45
Q

What kind of nerve mobilization should a PT use on a patient diagnosed with carpal tunnel syndrome?

46
Q

TRUE OR FALSE: In CTS, the palm’s sensations are also affected.

47
Q

What muscles are affected in Stenosing Tenovaginitis?

A

Abductor Pollicis Longus and Extensor Pollicis Brevis (Anatomical Snuffbox)

48
Q

In stretching the 1st CMC after arthroplasty, apply force on the (1)____ and not on the (2)____.

A
  1. 1st metacarpal
  2. phalanx
49
Q

In MCP Arthroplasty, a PT’s goal must be to achieve full active MCP extension and (1)____ of flexion of the index & middle fingers and (2)____ flexion of the ring & little fingers.

A
  1. 45-60°
  2. 70°
50
Q

What are the joint protection principles?

A
  1. Respect pain
  2. Maintain functional ROM, strength, endurance
  3. Balance activity level and rest
  4. Use stronger, larger muscles whenever possible
  5. Avoid deforming postures
  6. Use appropriate adaptive equipment
51
Q

Joint hypomobility of the wrist & hand may be due to:

A

● Rheumatoid Arthritis
● Osteoarthritis
● Acute Joint Trauma
● Immobilization

52
Q

In tendon blocking exercises, isolated MCP flexion of 1 digit targets what muscles?

A

Lumbricals and palmar interossei

53
Q

Determine which muscles are acting for each tendon gliding position.

  1. Maximum gliding of the superficialis tendon occurs with respect to the flexor sheath and bone
  2. Maximum gliding of the profundus tendon with respect to the sheath and bone as well as over the superficialis tendon occurs
  3. Maximum gliding occurs between the interossei & lumbricals
  4. Maximum gliding occurs between the profundus and superficialis tendons, between the profundus tendon and the bone, and gliding of the extensor digitorum tendons

A. Full fist
B. Hook (Claw) fist
C. Straight fist
D. Tabletop (intrinsic plus)

A
  1. C
  2. A
  3. D
  4. B

Source: Kisner & Colby 7th ed., page 702

54
Q

TRUE OR FALSE: In power grips, the extrinsic finger flexors, especially the flexor digitorum profundus muscles of the fourth and fifth digits, provide the major gripping force.

A

True

Source: Kisner & Colby 7th ed., page 663

55
Q

TRUE OR FALSE: With the exception of the fourth lumbrical, lumbricals do not participate in the power grip.

A

True

Source: Kisner & Colby 7th ed., page 663

56
Q

TRUE OR FALSE: Combined grips involve digits 1 and 2 (and sometimes 3) performing precision activities, whereas digits 3 through 5 supplement with power.

A

True

Source: Kisner & Colby 7th ed., page 663

57
Q

TRUE OR FALSE: DJD, or osteoarthritis (OA), most commonly involves the CMC joint of the thumb and DIP joints of the digits.

A

True

Source: Kisner & Colby 7th ed., page 665

58
Q

TRUE OR FALSE: The axis of rotation for the wrist lies at the proximal third of the capitate

A

True

Source: Kisner & Colby 7th ed., page 669

59
Q

TRUE OR FALSE: A straight laceration usually lends itself well to a direct (end-to-end) repair, whereas a jagged laceration that frays the tendon may require a tendon graft

A

True

Source: Kisner & Colby 7th ed., page 687

60
Q

Determine which description corresponds to what management of repair

  1. Simple, clean, acute laceration of a tendon without
    associated injuries of the hand
  2. Wound is not clean
  3. Multiple injuries, such as extensive skin loss, fractures that cannot be stabilized immediately, or long-standing scarring and contractures.

A. Direct Primary Repair
B. Delayed Primary Repair
C. Secondary Repair
D. Late Reconstruction
E. C, D

61
Q

A closed or open injury to the extensor mechanism over what zone may injure the central slip, the lateral bands, or both?

A

zone III

This can result in a PIP joint extensor lag and DIP joint hyperextension - boutonniere deformity.

Source: Kisner & Colby 7th ed., page 697

62
Q

What is the term for when full passive range of extension is available but the person cannot actively move the joint through the full range of extension?

A

Extensor lag

An extensor lag can occur as the result of weakness but is frequently caused by adhesions that prevent gliding of the tendons when the muscles contract

Source: Kisner & Colby 7th ed., page 703

63
Q

TRUE OE FALSE: In RA, joint mobilization is usually a contraindication, especially in the acute phase.

A

True.

Source: Kisner & Colby

64
Q

TRUE OR FALSE: In OA and RA patients, full ROM is not the aim.

A

True.

The aim is functional ROM.

65
Q

Both boutonniere and swan neck deformity necessitates a central-slip ___ approach

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