The Forearm, Wrist, Hand, and Fingers Flashcards
What is significant about the middle radioulnar joint?
Provides a surface for muscle attachments and there are opening for blood vessels at the upper and lower ends
The distal radioulnar joint is held together by?
The anterior and posterior radioulnar ligaments
Positioned anteriorly on the forearm are..?
Flexors and pronators
Positioned posteriorly on the forearm are..?
Extensors and supinators
Most of the flexor muscles of the fore arm are supplied with nerves by the..?
Median nerve
Most of the extensors are supplied with nerves by the..?
Radial nerve
Major blood supply for the forearm comes from..?
Stems from brachial into the radial and ulnar arteries
Which side of forearm is most likely to suffer from a contusion?
The ulnar side
The middle radioulnar joint is held together by?
An oblique ligamentous cord and the interosseous membrane.
How does one care for a contused arm?
The application RICE followed the next day by cryotherapy
Main symptom of forearm splints
Dull ache between extensor muscles, there also may be weakness and extreme pain during muscle contraction
Symptoms and signs of a forearm fracture?
An audible pop or crack followed by moderate to severe pain, swelling, and disability. There is localized tenderness, edema, and ecchymosis with possible crepitus
Management of a forearm fracture?
RICE followed by splinting until definited care is available. Definitive care consists of a long arm plaster or fiberglass cast followed by rehabilitation.
What kind of fore arm fracture is when the forearm fractures posteriorly? Anteriorly?
Colles fracture, Smiths fracture
Symptoms and signs of madelung deformity?
Wrist pain, loss of forearm rotation leading to decreased function of the wrist and hand
How to treat madelung deformity?
Treated with therapeutic modalities and nonsteroidal antiinflamitory medication for pain.
What should an ATC ask when assessing the wrist hand and fingers?
What was the mechanism of injury? What increases or decreases the pain? Has there been any trauma or overuse? What therapy, if any, has been given in the past?
What is the test for deQuervain’s syndrome?
Finkelstein’s test
How do you perform Finkelstein’s test?
Make fist with thumb tucked inside, then the wrist is deviated into ulnar flexion.
What can finkelstein’s test test for?
Stenosing tenosynovitis, and carpal tunnel syndrome
What does Tinel’s sign test for?
Carpal tunnel syndrome
How does one perform tinel’s sign test?
By tapping over the transverse carpal ligament if the carpal tunnel, which will cause tingling and paresthesia over the thumb, index, middle, and lateral half of the ring finger.
What is the purpose of Phalen’s test?
To test for carpal tunnel syndrome
How does one perform phalens test?
By flexing both wrists as far as possible and pressing them together. Position should be held for a minute. Pain will be priduced in the region of carpal tunnel if syndrome is present
What test is used to test for the instability of the lunotriquetral joint?
The lunotriquetral ballotment test
What is allens test used for?
To determine the function of the radial and ulnar arteries supplying the hand
What is the TFCC?
The Triangular Fibrocartilage Complex. Its a fibrous and cartilaginous structure that separates that radoiocarpal and inferior radioulnar joints of the wrist.
How does an athlete injure the TFCC?
Most often injured when swinging a bat or a racket that creates a violent twist, or torque of the wrist
Symptoms and signs of an injured TFCC?
Pain along the ulnar side of the wrist. Wrist extension is difficult and painful, especially on the ulnar side of the wrist. There is considerable swelling around the wrist.
How does one manage an TFCC injury?
Patient should be referred to a physician for treatment. If not properly managed permanent loss of motion and disability can occur. The wrist should be immobilized for 4 weeks followed by motion and strength exercises.
Wrist tenosynovitis occurs to which muscle?
the extensor carpi radialis longs or brevis
How does wrist tenosynovitis occur?
movements that require the patient to perform repetitive wrist acceleration and decelerations. The repetitive use and overuse of the wrist tendons and their sheaths.
symptoms and signs of wrist tenosynovitis?
pain with use or pain in passive stretching. There is tenderness and swelling over the tendon.
management of wrist tenosynovitis?
acute pain and inflammation are managed by ice massage for 10 minutes four times a day for the first 48 to 72 hours.
What is the primary cause of tendinitis?
overuse of the wrist.
What are the two most common nerve entrapments of the wrist?
the median nerve and the ulnar nerve
How does nerve palsy occur?
by direct trauma to a nerve
What nerves are most likely to exhibit nerve palsy?
the median and radial nerves
Benediction/Bishop’s deformity results from?
a damage to the ulnar nerve that affects the hypothenar and intrinsic muscles of the ring and little fingers.
How does drop wrist deformity occur?
A palsy of the radial nerve
How does Claw Hand deformity occur?
Compression of both the median and ulnar nerves
What is deQuervain’s syndrome?
A stenosing tenosynovitis in the thumb. Also called Hoffman’s disease.
Signs and symptoms of deQuervain’s syndrome?
A positive Finkelstein’s test. Point tenderness and weakness during thumb extension and abduction, and there may be a painful snapping and catching to the tendons during movement.
What is Kienbock’s disease?
a loss of blood supply to the lunate bone, eventually resulting in osteonecrosis. The cause of Kienbock’s disease is unknown. Patient thinks he or she has a sprained wrist
symptoms and signs of Kienbock’s disease?
as the disease progresses, the patient may develop a painful and sometimes swollen wrist, limited range of motion in the affected wrist, decreased grip strength in the hand, tenderness directly over the bone and pain or difficulty in turning the hand upward.
treatment of Kienbock’s disease?
usually immobilization with a cast and the use of NSAIDS.
What is the most frequently fractured of the carpal bones?
the scaphoid
how does scaphoid fracture occur?
usually by a force on the outstretched hand.
What is Preiser’s disease?
Avascular necrosis of the scaphoid bone due to the unhealing of a scaphoid fracture
signs and symptoms of Preiser’s disease?
Swelling in the area of the carpal bones, severe point tenderness of the scaphoid bone in the anatomical snuffbox. Absence of the ability to provoke pain by applying pressure in the anatomical snuffbox is perhaps the best way to distinguish a scaphoid fracture from a wrist sprain.
What is a wrist ganglion?
A synovial cyst often seen in sports.
symptoms and signs of a wrist ganglion?
Patient pains of occasional pain with a lump at the site. Pain increases with use. There is a cystic structure that may feel soft, rubbery, or very hard.
How does one treat a contusion of the finger?
cold and compression should be applied immediately until hemorrhage has ceased and is followed by gradual warming of the part in whirlpool or immersion baths.
What is a contusion of the fingernail called?
Subungual hematoma.
What is stenosing tenosynovitis in the finger or thumb called?
Trigger Finger/Thumb
What is the cause of Trigger Finger/Thumb
Nonspecific overuse
Another name for mallet finger
Baseball finger or basketball finger
What is the correct term for Mallet Finger?
Extensor Tendon Avulsion
What is Mallet Finger caused by?
A blow from an object that strikes the tip of the finger, jamming and avulsing the extensor tendon from its insertion, along with a piece of bone.
Signs and symptoms of Mallet Finger?
The patient is unable to extend the finger, carrying it at approximately a 30-degree angle.
What is Boutonniere Deformity?
A rupture of the extensor tendon dorsal to the middle phalanx.
Symptoms and signs of Boutonniere Deformity?
Patient complains of severe pain and an inability to extend the DIP joint. There is swelling, point tenderness and an obvious deformity.
Management of Boutonniere Deformity?
Cold application followed by splinting of the PIP joint in extension.
What is the correct term for Jersey finger?
Flexor Digitorum Profundus Rupture
What is the cause of Dupuytren’s contracture?
The cause is unknown. Nodules develop in the palmar aponeurosis that limit finger extension and eventually cause a flexion deformity.
Symptoms and signs of Dupuytren’s Contracture?
A flexion deformity most often develops in which the ring or little finger moves into the palm of the hand and cannot be extended.
What is Gamekeeper’s Thumb?
A sprain of the ulnar collateral ligament of the MCP joint of the thumb.
How does Gamekeeper’s Thumb occur?
A forceful abduction of the proximal phalanx, which is occasionally combined with hyperextension.
