Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSPT > The Hand and Wrist > Flashcards

The Hand and Wrist Flashcards

1
Q

What 3 things should be examined at the hand/wrist aside from usual items during a PT observation?

A
  1. Heberden’s nodes on the posterior surface of the DIP joints, or Bouchard’s nodes in the posterior surface of the PIP joints
  2. Thenar or hypothenar eminence atrophy
  3. Clubbing on the distal aspects of the fingers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List 4 alignment impairments associated with RA.

A
  1. Swans Neck Hand
  2. Boutonniere’s Hand
  3. Thumb “Z” Hand
  4. Ulnar Drift
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is Swans Neck Hand? Cause?

A
  1. Manifested by excessive PIP extension and DIP flexion of digits 2-5.
  2. Caused by synovitis of the MCP joint resulting in intrinsic muscle spasm, or synovitis of the PIP joint, causing the lateral restraints of the PIP joint to migrate posteriorly.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is Boutonniere’s Hand? Cause?

A
  1. Manifested by excessive PIP flexion and DIP extension of digits 2-5.
  2. Caused by synovitis of the PIP joint resulting in erosion and volar displacement of the lateral restraints and/or extensor tendons of these joints. This causes PIP flexion and compensatory DIP hyperextension.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What position is the thumb in with a Thumb “Z” hand?

A

The thumb is positioned in MCP flexion and IP extension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the position of the MCP and wrist joints with an ulnar drift?

A
  1. MCP joints of digits 2 through 5 are positioned in ulnar deviation
  2. Wrist joint is positioned in radial deviation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List 4 alignment impairments associated with a peripheral nerve injury.

A
  1. Ape Hand
  2. Bishop’s/Benediction Hand
  3. Claw Hand
  4. Drop Wrist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is ape hand? Cause?

A
  1. Thumb metacarpal is positioned in the same plane as the metacarpals of digits 2-5, and is unable to move into opposition.
  2. Caused by a lesion in the median nerve at the wrist or proximal to the wrist, resulting in a loss of thumb CMC flexion and opposition.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What movement will a patient with Bishop’s/Benediction Hand be unable to perform? Cause?

A
  1. When asked to extend the fingers, the patient is unable to extend the IP joints of digits 4/5.
  2. Caused by a lesion in the ulnar nerve at the wrist or proximal to the wrist, resulting in a decreased strength in the two ulnar-most lumbricals.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is claw hand? Cause?

A
  1. The IP joints of all the digits are flexed and the MCP joints are hyperextended.
  2. Caused by a lesion in the median and ulnar nerves at the wrist, causing a loss of strength of the hand intrinsics, and contraction of the extrinsic musculature on the MCP joints.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is drop wrist? Cause?

A
  1. The wrist and fingers are positioned in flexion and cannot extend actively.
  2. Caused by a lesion in the radial nerve proximal to the wrist extensors and long finger extensors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What 2 areas should be examined for ROM in patients with hand/wrist pathologies?

A

Shoulder and Elbow

***Especially if pt. has been splinting the hand because of pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What tool is typically used to asses grip strength?

A

Hand Held Dynamometer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the normal grip strength for men and women?

A

Men: 102-113 kg

Women: 60-71 kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Most ADLs can be performed with ____ kg of grip strength.

A

3-5 kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

List 3 special tests performed at the hand/wrist and what they test for.

A
  1. Phalen’s Test (for Carpal Tunnel Syndrome)
  2. Tinel Sign (for Carpal Tunnel Syndrome)
  3. Finkelstein Test (for De Quervains Tenosynovitis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are 2 contractures than can affect the wrist/hand?

A
  1. Dupytren’s Contracture: Contracture of the palmar fascia. The areas most often affected are digits 4/5.
  2. Compartment Syndrome: Compression of the anterior compartment of the forearm, resulting in occlusion of the radial artery and subsequent contracture of the long flexor muscles of the wrist and hand. This contracture is called Volkmann’s Ischemic Contracture.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a key symptom of carpal tunnel syndrome?

A

Symptoms include numbness and tingling in the radial 3 digits that is usually worse at night.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

List 5 physical findings that are most useful in screening for wrist fracture.

A
  1. Pain with active motion (sensitivity 97%)
  2. Localized tenderness (94%)
  3. Pain with passive motion (94%)
  4. Pain with gripping (71%)
  5. Pain with supination (68%)

Bottom line: any one of the above findings associated with a history of trauma should be sent for radiographs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the MOI for a Colle’s fracture? What 2 populations is this commonly seen in?

A
  1. Caused by a fall on an outstretched arm, with the forearm in pronation and the wrist in extension
  2. Common among older adults, and among individuals with osteoporosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What happens to the carpal bones and radius with a Colle’s fracture?

A

Causes the carpal bones to jam against the distal end of the radius, which causes the distal radius to angulate posteriorly.

This posterior angulation of the radius causes the fracture to heal in a position of wrist extension, wrist radial deviation and forearm supination.

22
Q

True or False: It is not uncommon for patients to be lacking in range of motion into wrist flexion, wrist ulnar deviation and forearm pronation even after successfully completing a series of PT interventions after a Colle’s fracture.

A

TRUE

Bony angulation is responsible for a decrease in ROM

23
Q

What are 2 interventions used to treat Colle’s fracture?

A
  1. Post injury intervention consists of immobilization in a cast for ~ 6 weeks if angulation is not too severe, and surgery if angulation is severe enough to affect function
  2. Intervention usually entails procedures to address decreased wrist range of motion, decreased wrist accessory motion, decreased strength in wrist musculature, and wrist pain
24
Q

> ___% of all carpal fractures involve the scaphoid.

A

> 70%

25
Q

What is the common cause of scaphoid fractures?

A

Usually caused by a fall on an outstretched hand

26
Q

____ % of scaphoid fractures heal with early treatment.

A

90%

27
Q

What can happen if diagnosis of a scaphoid fracture is delayed? How can PTs prevent a delayed diagnosis?

A
  1. If diagnosis is delayed, there is a risk of malunion or nonunion, and avascular necrosis.
  2. Refer for X-rays if there is a history of trauma to the wrist
28
Q

What is the MOI for a triangular fibrocartilage complex (TFCC) tear? What population is this common in?

A
  1. Caused by a fall on a hyperextended wrist

2. Common among athletes

29
Q

What are 4 signs of symptoms of a TFCC tear?

A
  1. Characterized by ulnar wrist pain and clicking
  2. Wrist weakness
  3. lunotriquetrial tenderness
  4. Increased mobility with distal radioulnar joint mobilization glide
30
Q

How are TFCC tears typically diagnosed?

A

Diagnosed via MRI or arthrogram

31
Q

What are 2 immediate treatment options for a TFCC tear?

A
  1. Immobilization

2. Surgery

32
Q

What are 5 other names for complex regional pain syndrome affecting the wrist/hand?

A
  1. Reflex Sympathetic Dystrophy
  2. Shoulder Hand Syndrome
  3. Causalgia
  4. Post-traumatic Neuralgia
  5. Sudek’s Atrophy
33
Q

What is the cause of complex regional pain syndrome? When is it common? Men vs Women?

A
  1. Cause: Unknown
  2. Common following traumatic injury to extremity/Colle’s fracture
  3. 4x more common in women than in men
34
Q

What is the result of reflex sympathetic dystrophy?

A

Injury results in a disruption of the normal sympathetic activity in the extremity that is affected

35
Q

What are 4 characteristics of the acute stage of complex regional pain syndrome?

A
  1. Burning or aching pain in a stocking-glove distribution.
  2. Edema.
  3. Warm, dry and red skin.
  4. Hyperesthesia: sensitivity to touch, pressure, cold and/or mechanical stimuli.
36
Q

What are 5 characteristics of the dystrophic stage of complex regional pain syndrome?

A
  1. Continuous burning, aching or throbbing pain
  2. Edema
  3. Cool, gray and/or cyanotic skin
  4. Slowed growth of hair and nails
  5. Muscle wasting and joint stiffness
37
Q

What are 4 characteristics of the atrophic stage of complex regional pain syndrome?

A
  1. Pain
  2. Cool, thin skin
  3. Muscle atrophy and joint contractures
  4. Severe osteoporosis
38
Q

What are 3 ways to medically manage complex regional pain syndrome?

A
  1. Nerve blocks
  2. Sympathectomy
  3. Medication: including local anesthetics, narcotics, NSAID’s, corticosteroids and vasodilators
39
Q

True or False: There is no standard PT intervention to treat complex regional pain syndrome?

A

TRUE

Only thing we can really do it encourage the patient to perform strengthening and stretching exercise to the affected limb and to use the limb for functional activities as tolerated

40
Q

List 5 PT interventions that might be effective in treating complex regional pain syndrome.

A
  1. Scrub and Carry (Stress Loading) exercises
  2. Massage
  3. Limb Desensitization
  4. Compression garments
  5. Graded Motor Imagery
41
Q

What does the evidence say about graded motor imagery, mirror therapy, and overall PT/OT services in treating complex regional pain syndrome?

A
  1. Graded motor imagery may be effective for pain and function when compared with usual care;
  2. Mirror therapy may be effective for pain in post-stroke CRPS compared with a ’covered mirror’ control.
  3. ‘Low quality evidence suggests that PT/OT are associated with small positive effects that are unlikely to be clinically important at one year follow up when compared with a social work passive attention control.’
42
Q

List the 3 components of graded motor imagery.

A
  1. Laterality
  2. Imagery
  3. Mirror Therapy
43
Q

What is laterality? Why is it important?

A
  1. Imperative to teach the brain left versus right, so the image becomes clear in the homunculus
  2. Importance: The brain has difficulty determining which hand is which. This can lead to the spreading of CRPS to the opposite side.
44
Q

What is imagery?

A
  1. Clearing the painful image in the brain
  2. This begins with picturing the hand or foot, for example, in certain positions and progressing towards picturing active movements. In this step, the brain ‘clears up’ the painful image in the brain without having to move the body part.
45
Q

What is mirror therapy?

A
  1. A neuro-rehabilitation technique designed to remodulate cortical mechanisms by using vision to reprogram motor and sensory processes
  2. Pts perform movements using the unaffected limb while watching its mirror reflection superimposed over the (unseen) affected limb.
  3. Creates a visual illusion and provides positive feedback to the motor cortex that pain free movement of the affected limb has occurred.
46
Q

What is the cause of carpal tunnel syndrome? What is it attributed to?

A
  1. Etiology unknown.
  2. Often attributed to prolonged computer keyboard usage, and repetitive activities that involve wrist extension and finger flexion.
47
Q

What is carpal tunnel characterized by?

A

Characterized by numbness, tingling and motor loss in the areas innervated by the median nerve in the wrist

48
Q

What are 3 possible differential diagnoses for carpal tunnel?

A
  1. Tendinopathy of the long finger flexors
  2. Lesion in the median nerve proximal to the carpal tunnel
  3. Double-crush injury: two lesions in the median nerve, in this case, one at the carpal tunnel and another at a more proximal point along the median nerve
49
Q

How is carpal tunnel medically managed?

A

Surgical release of the carpal tunnel

50
Q

List 5 PT interventions used to treat carpal tunnel.

A
  1. Pt education to avoid positions that exacerbate the condition
  2. Instruction in exercises to stretch the wrist after it has been immobile for a period of time
  3. Nerve (median) and tendon (flexor) gliding exercises
  4. Wearing a splint at night that positions the wrist in neutral for a few weeks
  5. Impairment-based interventions

MSPT (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions