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KINE 3575 > The Wrist & Hand > Flashcards

The Wrist & Hand Flashcards

1
Q

Introduction

Why are the wrist and hand vulnerable?

A

The wrist and hand are vulnerable to injury because of the intricate movements they require

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2
Q

Introduction

How many bones?

A

There are 28 bones, and numerous articulations in the thumb, carpal, metacarpal and phalangeal regions

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3
Q

Introduction

Injuries to wrist and hand are common in?

A

Injuries to the wrist and hand are common in sports such as:
* Basketball
* Volleyball
* Hockey
* Skiing
* Baseball
* Martial Arts

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4
Q

Introduction

Injuries that can occur in this region?

A

Injuries are classified as:
* Traumatic
* Overuse
* Neurological
* Vascular

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5
Q

Introduction

Traumatic Injuries?

A
  • Sprains - carpal, thumb, MCP/PIP, DIP ligaments
  • Strains - dorsal/palmar musculature
  • Fractures
  • Dislocations, volar plate injury
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6
Q

Introduction

Overuse injuries?

A
  • Tendonitis
  • Tenosynovitis
  • Synovitis
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7
Q

Introduction

Vascular injuries?

A

Avascular necrosis - scaphoid/lunate

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8
Q

Anatomy

Bones of wrist - regions?

A

The bones of the wrist can be broken down into three bony regions:
* Carpals
* Metacarpals
* Phalanges

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9
Q

Anatomy

Two rows of carpal bones?

A

There are two rows of carpal bones which articulate as synovial joints

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10
Q

Anatomy

Sesamoid bones?

A

There are two sesamoid bones in the thumb and the pisiform is also considered a sesamoid bone

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11
Q

Anatomy

Proximal row of carpal bones includes?

A

The proximal row of carpal bones includes the:
* Scaphoid
* Lunate
* Triquetrum
* Pisiform

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12
Q

Anatomy

Distal row of carpal bones includes?

A

The distal row of carpal bones includes the:
* Trapezium
* Trapezoid
* Capitate
* Hamate

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13
Q

Scaphoid Bone

Found in?

A

The scaphoid bone is found in the anatomical “Snuff Box”

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14
Q

Scaphoid Bone

Recipient of?

A

It is the recipient of forces which are transferred through the radius which makes it one of the most commonly fractured carpal bones

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15
Q

Scaphoid Bone

Major concern with fracture?

A

The major concern with a fracture in this area is an “Avascular Necrosis”

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16
Q

Scaphoid Bone

What indicates a fracture?

A

Tenderness and swelling in the anatomical snuff box may indicate a fracture of the scaphoid bone

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17
Q

Scaphoid Bone

Where do most fractures occur? Blood supply?

A

Most fractures occur in the mid portion of this bone and a large segment of the population only has blood supply to one end of this bone

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18
Q

Scaphoid Bone

Blood supply complications?

A

This may lead to an avascular necrosis of the scaphoid bone known as “Preiser Disease”

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19
Q

Lunate Bone

Where is it found?

A

The lunate is found in the proximal row, sitting next to the scaphoid

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20
Q

Lunate Bone

Why is it the most commonly dislocated of all the carpal bones?

A

Due to its location and shape, the lunate is the most commonly dislocated of all the carpal bones

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21
Q

Lunate Bone

What is the mechanism of injury?

A

The mechanism of injury is forced wrist extension

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22
Q

Lunate Bone

What happens with lunate dislocation?

A

With a lunate dislocation, this bone will migrate into the carpal tunnel, compressing the medial nerve

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23
Q

Lunate Bone

What can this dislocation cause?

A

This is one of the potential causes of Carpal Tunnel Syndrome

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24
Q

Lunate Bone

What is Murphy’s Sign

A

With a lunate dislocation, observations will reveal swelling on the dorsum of the wrist and a depressed second “knuckle” joint

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25
Q

Lunate Bone

Bone may also be? What does this lead to?

A

The lunate may also be fractured, leading to an avascular necrosis known as Keinbock’s Disease

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26
Q

The Pisiform

What is it?

A

The pisiform is the smallest carpal bone

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27
Q

The Pisiform

Where is it?

A

It is in the proximal row of carpal bones, where the wrist joins the ulna

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28
Q

The Pisiform

What type of bone?

A

The pisiform is a sesamoid bone, lying within flexor carpi ulnaris

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29
Q

The Pisiform

Where are the attachments? What does it make up?

A

There are attachments from the pisiform to the hook of the hamate (Pisohamate Ligament). This makes up the Tunnel of Guyon

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30
Q

The Pisiform

What does the Tunnel of Guyon contain?

A

The Tunnel of Guyon contains the ulnar nerve and artery

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31
Q

The Pisiform

Pisiform Injury

A
  • Handle bars - compression of the ulnar nerve
  • Loss of sensation in half of 4th digit and 5th digit
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32
Q

Hamate Bone

Why is it unique?

A

The hamate bone is unique as it has a hook on it

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33
Q

Hamate Bone

What is it joined to? What does it form?

A

Is joined to the pisiform by the pisohamate ligament, forming the roof of the Tunnel of Guyon

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34
Q

Hamate Bone

Region can be compressed by?

A
  • This region can be compressed by fracture, swelling, or by compression by leaning on the ulnar portion of the wrist
  • Handlebar/Cyclist’s Palsy
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35
Q

The Capitate

What is it? What does it articulate with?

A
  • The capitate is the largest of the carpal bones
  • Articulating with seven other bones
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36
Q

The Capitate

What radiates from this bone?

A

Many ligaments in the wrist region radiate from this bone

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37
Q

The Capitate

What is the most common injury?

A

Fractures are the most common injury

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38
Q

The Triangular Fibrocartilage

Where is it located?

A

The Triangular Fibrocartilage Complex (TFCC) of the wrist is located between the distal ulna and first row of carpal bones

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39
Q

The Triangular Fibrocartilage

How is this structure injured?

A

This structure is injured through a fall on the hand and wrist, with the wrist in a hyperextended position

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40
Q

The Triangular Fibrocartilage

Injury symptoms?

A

There is pain and swelling on the ulnar aspect of the wrist and the motion of wrist extension is usually painful and limited

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41
Q

The Triangular Fibrocartilage

Injury - when is there pain?

A

Pain is elicited with palpation as well as ulnar compression, which is the same premise as the meniscal tests in the knee

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42
Q

Ligament Injury

What is a common occurrence in sport?

A

Ligament injury of the wrist, finger joints (MCP, PIP & DIP collateral ligaments) as well the thumb (UCL/RCL) are a common occurrence in sport

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43
Q

Ligament Injury

How are these ligaments injured?

A

These ligaments are usually injured by a traumatic mechanism

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44
Q

Ligament Injury

What are these ligaments tested for?

A

These ligaments are tested for pain, laxity and end feel

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45
Q

Ligament Injury

How are the ligaments of the wrist assessed?

A

The ligaments of the wrist (carpal region) are assessed by stabilizing one bone and testing the surrounding ligaments to the adjacent bones

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46
Q

Ligament Injury

How are the ligaments of the fingers and thumb tested?

A

The ligaments of the various joints of the fingers and thumb are tested by a valgus and varus stress

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47
Q

Ligament Injury of the Thumb

What is ulnar collateral sprain of the thumb also known as?

A

The ulnar collateral sprain of the thumb is also known as “Skier’s Thumb” or “Gamekeeper’s Thumb”

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48
Q

Ligament Injury of the Thumb

How does this injury occur?

A

This injury occurs because of a forced abduction, and/or hyperextension mechanism, tearing the medial ulnar collateral ligament

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49
Q

Ligament Injury of the Thumb

Signs and symptoms?

A

There is swelling and ecchymosis, pain upon movement and palpation as well as laxity with the “Abduction Test”

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50
Q

Ligament Injury of the Thumb

How is this injury classified?

A

This injury is classified as 1st - 3rd degree

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51
Q

Range of Motion

Range of motion for the wrist?

A

Range of motion for the wrist occurs at the midcarpal (flexion) and radiocarpal (extension) joints and radial and ulnar deviation

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52
Q

Range of Motion

Movements at the fingers?

A

Movement at the fingers include:
* Flexion
* Extension
* Abduction
* Adduction
* Thumb also has opposition

53
Q

Range of Motion

What causes these movements?

A

There are numerous muscle groups which cause these movements

54
Q

Circulation

What terminates in the wrist and hand?

A

The ulnar and radial arteries terminate in the wrist and hand

55
Q

Circulation

What is used to assess circulation?

A
  • Capillary refill
  • The “Allen Test”
56
Q

Circulation

How is the “Allen Test” performed?

A
  • The patient is asked to quickly open and close the hand several times and then squeeze it shut
  • The examiner then places his/her thumb and index finger over the radial and ulnar arteries temporarily occluding blood flow
  • The patient then opens their hand and the examiner can test each artery by releasing the pressure and seeing if the hand “flushes”
57
Q

Flexor Tendon Injury

Where do flexor tendons originate?

A

The flexor tendons originate on the medial epicondyle

58
Q

Flexor Tendon Injury

Where do they pass under?

A

The flexor tendons pass underneath the flexor retinaculum and into the hand

59
Q

Flexor Tendon Injury

What do these tendons do?

A

These tendons flex and pronate the wrist and elbow

60
Q

Flexor Tendon Injury

What are these tendons involved in?

A

The flexor tendons are involved in a number of injuries as they pass into the wrist and hand

61
Q

Flexor Tendon Injury

What do some of the injuries include?

A
  • Tendonitis/strains
  • Carpal tunnel syndrome
  • Palmaris Longus (Dupuytren’s Contracture)
  • Flexor Tendon Injury (Sweater Finger)
  • Swan Neck deformity
62
Q

Carpal Tunnel Syndrome

What is it?

A

Carpal Tunnel Syndrome is a compression of the median nerve as it passes beneath the flexor retinaculum at the wrist

63
Q

Carpal Tunnel Syndrome

What is the Carpal Tunnel?

A

The Carpal Tunnel is an enclosed space

64
Q

Carpal Tunnel Syndrome

What can space occupying lesion lead to?

A

Any space occupying lesion can lead to compression of the nine flexor tendons and median nerve

65
Q

Carpal Tunnel Syndrome

Where is it seen?

A

Carpal Tunnel Syndrome is seen in sports involved with wrist flexion, such as:
* Bowling
* Rock climbing
* Wheel chair sports
* Gripping and throwing sports mechanics

66
Q

Carpal Tunnel Syndrome

Why may it develop?

A

Carpal Tunnel Syndrome (CTS) mau develop due to:
* Overuse (tendonitis)
* Peripheral edema (pregnancy)
* Anatomical anomalies
* Trauma, such as a Colle’s fracture or lunate dislocation

67
Q

Carpal Tunnel Syndrome

Tests?

A

Tests include:
* The Tinel’s Tap Test
* Phallen’s
* Carpal Compression Tests

68
Q

Palmaris Longus (Dupuytren’s Contracture)

What is it?

A

The Palmaris Longus tendon is a flexor tendon

69
Q

Palmaris Longus (Dupuytren’s Contracture)

Where does it insert?

A

The Palmaris Longus tendon inserts into the palmar fascia of the hand

70
Q

Palmaris Longus (Dupuytren’s Contracture)

Dupuytren’s Contracture - what is it?

A

Named after the French surgeon, Dupuytren’s Contracture is a progressive and painless thickening of the subcutaneous tissue of the palm primarily affecting the ring and little fingers

71
Q

Palmaris Longus (Dupuytren’s Contracture)

Cause?

A

Even though not everyone has a Palmaris Longus Tendon (only 14% of the population), the cause of this condition is still unknown

72
Q

Palmaris Longus (Dupuytren’s Contracture)

Condition frequently seen in?

A

This condition is frequently seen in women between the ages of 50-70

73
Q

Jersey/Sweater Finger

What is it?

A

Sweater or Jersey finger is a tear or avulsion of the distal flexor digitorum profundus tendon

74
Q

Jersey/Sweater Finger

Occurs most frequently to?

A

This injury occurs most frequently to the ring finger

75
Q

Jersey/Sweater Finger

Commonly seen when?

A

Commonly seen when an athlete tries to grab an opponents sweater

76
Q

Jersey/Sweater Finger

What happens?

A

There is an inability to flex the distal (DIP) joint where the FDP attaches and the finger is stuck in an extended position

77
Q

Jersey/Sweater Finger

“Sweater Finger Sign” Evident when?

A

The “Sweater Finger Sign” is evident when the distal phalanx of the involved finger does not flex

78
Q

Jersey/Sweater Finger

Tendon can be assessed?

A

The tendon can be assessed for strength with a partial tear

79
Q

Swan Neck Deformity

Characterized by?

A

Swan Neck Deformity is charcaterized by hyperextension of the PIP joint and flexion of the DIP joint

80
Q

Swan Neck Deformity

Caused by?

A

It is caused by:
* Trauma/force
* Damage to the volar plate
* Rheumatoid arthritis which can damage the joint

81
Q

Swan Neck Deformity

Plates in human hand? Found in?

A
  • The human hand has both palmar and volar plates (also called volar ligaments)
  • These are found at the various joints where they serve to reinforce the joint capsules and limit hyperextension/flexion
82
Q

Swan Neck Deformity

Injury treated with?

A

This injury is usually treated with:
* Splinting
* Therapy
* Surgery is sometimes required

83
Q

Extensor Tendon Injury

Where do the extensor tendons originate?

A

The extensor tendons originate on the lateral epicondyle

84
Q

Extensor Tendon Injury

What is the function of the extensor tendons?

A

They extend and supinate the wrist and elbow

85
Q

Extensor Tendon Injury

Involved in?

A

These tendons are involved in a number of injuries as they pass into the wrist and hand

86
Q

Extensor Tendon Injury

Injuries include?

A

Some of these injuries include:
* Tendonitis/strains
* Dequervain’s Disease
* Mallet/Frisbee Finger
* Boutonniere Deformity

87
Q

Extensor Tendon Injury

How many tunnels? Where do they cross?

A

There are six extensor tunnels which cross the dorsal region of the wrist

88
Q

Extensor Tendon Injury

Tunnels present with?

A

Each of the tunnels may present with certain pathology either alone, or in combination with other tunnels

89
Q

Extensor Tendon Injury

Tunnel 1

A

Abductor Pollicis Longus/Extensor Pollicis Brevis

90
Q

Extensor Tendon Injury

Tunnel 2

A

Extensor Carpi Radialis Longus and Brevis

91
Q

Extensor Tendon Injury

Tunnel 3

A

Extensor Pollicis Longus

92
Q

Extensor Tendon Injury

Tunnel 4

A

Extensor Digitorum Communis and Indicis

93
Q

Extensor Tendon Injury

Tunnel 5

A

Extensor Digiti Minimi

94
Q

Extensor Tendon Injury

Tunnel 6

A

Extensor Carpi Ulnaris

95
Q

Dequervain’s Disease (Tunnels 1 and 3)

What do tunnels 1 and 3 make up?

A

Tunnels 1 and 3 make up the boundaries of the anatomical snuff box which is found on the radial aspect of the wrist

96
Q

Dequervain’s Disease (Tunnels 1 and 3)

What can occur in this region?

A

A common tendonitis or Stenosing Tenosynovitis, can occur in this region known as “Dequervain’s Disease”

97
Q

Dequervain’s Disease (Tunnels 1 and 3)

What is it?

A

This is an overuse injury

98
Q

Dequervain’s Disease (Tunnels 1 and 3)

How can it occur?

A

This condition can occur during pregnancy due to peripheral water retention

99
Q

Dequervain’s Disease (Tunnels 1 and 3)

Assessed by?

A

This condition is assessed by:
* Palpating for pain and crepitus
* “Finkelstein Test”

100
Q

Dequervain’s Disease (Tunnels 1 and 3)

What does it affect?

A

Dequervain’s Disease affects dorsal tunnels 1 (abductor pollicis longus/extensor pollicis brevis) and 3 (extensor pollicis longus)

101
Q

Dequervain’s Disease (Tunnels 1 and 3)

Finkelstein’s Test

A
  • Stretches the tendons of the first dorsal compartment
  • (Fist closed, hand pulled down)
102
Q

Extensor Tunnels

What does tunnel 2 contain? What is it involved in?

A
  • Tunnel 2 contains the extensor carpi radialis longus and brevis
  • Both of which are involved in lateral epicondylitis
103
Q

Extensor Tunnels

Where do these tendons (extensor carpi radialis longus and brevis) insert?

A

These tendons insert onto the lateral dorsal surface of the base of the 3rd metacarpal bone with a few fibers inserting onto the second as well

104
Q

Extensor Tunnels

How can these tendons (extensor carpi radialis longus and brevis) be palpaed?

A

They can be palpated with a clenched fist

105
Q

Extensor Tunnels

What does tunnel 6 contain?

A

Tunnel 6 contains the extensor carpi ulnaris which is found on the ulnar aspect of the wrist

106
Q

Extensor Tunnels

What is tunnel 6 a common site for?

A

Tunnel 6 is a common site for tendonitis

107
Q

Extensor Tunnels

What facilitates palpation of the extensor carpi ulnaris?

A

Ulnar deviation of the wrist facilitates palpation of this tendon

108
Q

Mallet Finger

What is it?

Injury to what?

A

A mallet (baseball, frisbee, or basketball) fingers is an injury to the terminal slip (DIP joint) of the extensor tendon

109
Q

Mallet Finger

Caused by?

A

It is caused by a sudden forceful flexion of the distal phalanx, such as catching the ball on the end of the finger-tip

110
Q

Mallet Finger

Extensor tendon can suffer from?

A

The extensor tendon can suffer a variety of injuries such as:
* Stretching the tendon
* Tearing the tendon
* Avulsion
* Epiphyseal fracture

111
Q

Mallet Finger

Injury evident upon?

A

This injury is evident upon observation by its appearance

112
Q

Mallet Finger

How is this injury treated? In some cases?

A
  • This injury is treated non-operatively and requires immobilization (splinting)
  • In some cases, a large flake of bone (avulsion fracture) may need to be surgically fixated
113
Q

Boutonniere Deformity

Caused by?

A

The Boutonniere or “button-hole” deformity is cuased by a rupture of the extensor tendon at the proximal inter-phalangeal joint (PIP)

114
Q

Boutonniere Deformity

Region known as?

A

This region is known as the central extensor hood, or slip

115
Q

Boutonniere Deformity

Mechanism of injury

A

The mechanism of this injury is trauma to the tip of the finger forcing the DIP joint into extension and the PIP into flexion, injuring the extensor tendon at the PIP joint and leading to the inability to extend the PIP joint

116
Q

Boutonniere Deformity

How is this injury treated?

A

This injury is often treated non-operatively and splinting/bracing is usually required

117
Q

Ganglion Cyst

What are they?

A

Ganglion cysts (also called “bible bumps”) are the most common mass or lump in the hand

118
Q

Ganglion Cyst

Where do they occur?

A

Occur in various locations, mostly developing on the dorsum of the hand

119
Q

Ganglion Cyst

Harm?

A

They are not cancerous and, in msot cases are harmless

120
Q

Ganglion Cyst

How do they develop?

A

These fluid-filled cysts can quickly appear, disappear, and change size

121
Q

Ganglion Cyst

Treatment?

A

Many ganglion cysts do not require treatment, but if they are painful, or interfere with hand function, there is a surgical option

122
Q

Ganglion Cyst

What triggers the formation?

A

It is not known what triggers the formation of ganglion cyst

123
Q

Colle’s Fracture

What is it?

A

Colle’s fractures are one of the most common types of forearm fractures

124
Q

Colle’s Fracture

Mechanism?

A

FOOSH - occurs from a fall on an outstretched extended hand

125
Q

Colle’s Fracture

Also called a?

A

“Dinner or Silver Fork” deformity due to its appearance

126
Q

Colle’s Fracture

Commonly seen in?

A

This is a common fracture seen in the elderly as well as athletes

127
Q

Colle’s Fracture

What is involved?

A

The distal radius, and to a lesser degree the ulna are usually involved

128
Q

Smith’s Fracture

What is it?

A

The opposite displacement of a Colle’s fracture is known as a Smith’s fracture

129
Q

Smith’s Fracture

What causes it?

A

This fracture is caused by falling on a flexed wrist

KINE 3575 (7 decks)

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