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Ortho LE and UE > the wrist and hand > Flashcards

the wrist and hand Flashcards

1
Q

what capsule is tight in the radio-ulnar ligament in supination

A

anterior capsule

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2
Q

what capsule is tight in the radio-ulnar ligament in pronation

A

posterior capsule

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3
Q

radio collateral attachments

A

styloid and scaphoid

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4
Q

ulnar collateral ligament attachments

A

styloid to pisiform and triqutral

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5
Q

what does the carpal tunnel attach to

A

scaphoid, trapezium, capitate, hook of the hammate, pisiform

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6
Q

open pack of the distal radio ulnar joint

A

10 degrees of supination

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7
Q

closed pack of the distal radio ulnar joint

A

full extension and radio deviation

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8
Q

degree of freedom of the distal radio ulnar joint

A

1 (pronation and supination) concave radius on convex ulnar and TFCC

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9
Q

open packed of the radio carpal joint

A

nautral and slight ulnar deviation

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10
Q

closed packed of the radio carpal joint

A

full extension with radio deviation

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11
Q

degrees of freedom of the radio carpal joint

A

2 (sagittal and frontal) convex distally concave proximally

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12
Q

radial pain

A
  • traumatic suggest scaphoid fx
  • non traumatic suggest de quervain tenosynovitis
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13
Q

posterior pain

A
  • generalized might be associated with arthritis
  • defined mass indicate a ganglion cyst
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14
Q

ulnar pain

A

traumatic can suggest a tear of the fibrocartilage complex (TFCC)

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15
Q

anterior pain

A

think carpal tunnel, ganglion cyst formation and tenosynovitis

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16
Q

law of repetitive motion

A

I=NF/AR

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17
Q

what is carpal tunnel syndrome

A

compression neuropathy of the median nerve that occurs under the transverse carpal ligament of the wrist

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18
Q

subjective of carpal tunnel syndrome

A
  • numbness and tingling of the median nerve
  • pain in forearm and wrist
  • pain awake the pt at night
  • pain with activities involving wrist flexion
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19
Q

objective of carpal tunnel

A
  • thenar atrophy in late stage
  • positive phalen, tinel, carpal compression
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20
Q

intervention for carpal tunnel

A

splinting

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21
Q

what is de quervains tenosynovitis

A

inflammation of the extensor and abductor pollicis caused by repeative use of the thumb

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22
Q

subjective of de quevains tenosynovitis

A
  • pain on the radial side of the hand
  • difficulty with grasping or gripping
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23
Q

objective of de quervains tenosynovitis

A
  • swelling at radio styloid process
  • palpation elicits pain at the site of the retinaculum at the radial styloid process
  • positive finkelsteins, WHAT, and eichoffs
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24
Q

prognosis for de quervains tenosynovitis

A

good if seek treatment within first 6 mo of symptoms

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25
what is duprytrens
fibroproliferation disease of the palmar fascia that is genetic and environmental - refer out for CCH injections
26
what is the most common wrist injury for all age groups
fx of the distal radius
27
colles fx
distal radius tilted upward (dorsally); typical foosh
28
smith fx
distal radius tilted palmerly; foosh with wrist in extension
29
barton fx
intra articular fx associated with subluxation of the carpus (dorsally or volarly) along the displaced articular fragment of the radius
30
chauffeurs fx
oblique fx through the base of the radial styloid
31
Die-punch fx
depressed fx of the articular surface opposite the lunate or the scaphoid boone
32
subjective of the distal radius fx
acute pain, tenderness, swelling, and deformity of the wrist, FOOSH
33
objective of the distal radius fx
- swelling deformity and discoloration around the wrsit and distal radius - may have associated skin injury and bleeding - may have decreased sensation of the median, radial, or ulnar nerve distribution - may have decreased circulation in the hand
34
what motions are going to be limited post immobilization of a fx of the distal radius
extension and supination commonly limited and need to be mobilized
35
fx of the scaphoid
dx is often delayed or missed vulnerable to a FOOSH
36
fx of scaphoid subjective
- hx fo foosh - dorsal wrist pains and with grippind - tenderness over the anatomic snuff box
37
objective findings for fx of scaphoid
- tender anatomic snuff box - decrease AROM of the wrist (by 50%) - decrease grip strength - normal neuro exam - pain with axial compression of the thumb
38
time line for fx of the scaphoid
after splint removal - initiate AROM 2 weeks PROM and gental stretching
39
what is the discription of gamekeepers thumb or skier thumb
injury to the ulnar collateral ligament of the thumb leading to instability of the MCP joint
40
subjective of gamekeepers thumb/ skiiers thumb
- pain and swelling along the ulnar side of the MCP joint (acute) - complaints of pain, weakness or loss of stability (chronic)
40
intervention for gamekeepers thumb both post op and non surgical
immobilization for 3 weeks, with additional splinting for 2 weeks - AROM at 3 weeks - strengthening at 8 weeks - no abduction stress for first 2-6 weeks
40
objective of gamekeepers thumb
- local tenderness and swelling with palpation along the ulnar side of the MCP joint - pain or laxity with valgus stress testing - impaired MCP joint flexion and extension - decreased pinching strength and opposition - valgus at extension and 30 degrees of flexion
41
OA of the thumb symptoms
- pain with activities such as turning a key, opening a door, or snapping your fingers - swelling at the base of the thumb - aching discomfort after prolonged use - out of joint appearance - development of bony prominence
41
how long do you have to wear a thumb cast with LRTI
4 weeks
41
what are the different surgical options for thumb OA
1) ligament reconstruction-use wrist flexor tendon 2) ligament reconstruction and tendon interposition (LRTI)-remove trapezium 3) total joint replacement 4) fusion
42
flexor digitorum profundus avulsion MOI
hypextension stress applied to a flexed finger most often misdx as a jammed finger most common in the ring finger
43
subjective of flexor digitorum profundus alvulsion
- hx of trauma involving the digit
44
objective for flexor digitorum profundus alvulsion
- testing of the isolated DIP joint flexion in all digits reveals effected digit - inability to flex the DIP - tenderness along the flexor tendon sheath or in the palm
45
tx for flexor digitorum profundus avulsion
refer out for surgery
46
trigger finger MOI
inflammation of the 2 flexor tendons of the tinger which become thickened and narrowed as the cross the MC head and palm causing painful snapping
47
trigger finger subjective
complaints of painful finger loss of smooth motion (catching) with gripping or pinching - painful nodule in the distal palm
48
trigger finger objective
- tenderness with palpation - crepitus or moving nodular mass - pain aggravated by stretching the tendon into extension or resisted flexion - clicking or locking - full flexion might not be possible
49
trigger finger tx
reduce inflammation and steroid injections
50
Mallet finger/ baseball finger
DIP is unable to extend/ is locked in flexion
51
MOI of mallet finger/baseball finger
ball strikes the tip of the finger damaging the extensor
52
tx for mallet finger
mallet splint for 6-8 weeks extension block k-wire for 4 weeks DO NOT LET THR FINGER BEND
53
boutonniere deformity
injury to the PIP extensors. PIP locked in flexion
54
MOI of boutonniere deformity
forceful blow to the top (dorsal) side of a bent (flexed) PIP, or cutting the top of the hand, or athritis
55
how long to wear a splint for boutonniere deformity
6 weeks for young pt; 3 weeks for elderly pt
56
swan neck deformity
PIP is extendend and DIP is flexed
57
what is swan neck deformity caused by
weakness or tearing of the tigament and tendon

Ortho LE and UE (7 decks)

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