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Exam Prep > UE and Hand > Flashcards

UE and Hand Flashcards

1
Q

Lateral epicondyle tendons

A

Extensors (anconeus, supinator, ECRL, ECRB, ECU, ED, EDM)

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2
Q

Medial epicondyle tendons

A

Flexors (pronator teres, FCR, FCU, PL, FDS)

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3
Q

UE blood supply

A

Aortic arch - brachiocephalic - subclavian (2) - axillary (2) - brachial (2) - ulnar/radial (2) - digital arteries

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4
Q

Extensor zone I

A

DIP

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5
Q

Extensor zone II

A

Middle phalanx

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6
Q

Extensor zone III

A

PIP

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7
Q

Extensor zone IV

A

Proximal phalanx

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8
Q

Extensor zone V

A

MP

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9
Q

Extensor zone VI

A

Metacarpal

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10
Q

Extensor zone VII

A

Carpal bones/wrist

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11
Q

Extensor zone VIII

A

Forearm

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12
Q

Extensor thumb zone I

A

IP

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13
Q

Extensor thumb zone II

A

Proximal phalanx

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14
Q

Extensor thumb zone III

A

MCP

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15
Q

Extensor thumb zone IV

A

Metacarpal

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16
Q

Extensor thumb zone V

A

Wrist

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17
Q

Flexor zone I

A

Fingertip to center of middle phalanx

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18
Q

Flexor zone II

A

Center of middle phalanx to distal palmar crease “no mans land”

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19
Q

Flexor zone III

A

Distal palmar crease to transverse carpal ligament

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20
Q

Flexor zone IV

A

Overlies transverse carpal ligameent

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21
Q

Flexor zone V

A

Proximal to wrist

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22
Q

Distal row of carpal bones (radial to ulnar)

A

trapezium, trapezoid, capitate, hamate

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23
Q

Proximal row of carpal bones (radial to ulnar

A

Scaphoid, lunate, triquetrum, Pisiform

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24
Q

Main blood supply of the hand

A

Ulnar and radial arteries

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25
Q

Boxer fracture

A

Finger metacarpal fractures most common in 4th and 5th digits (shaft, neck, head)

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26
Q

Bennett’s fracture

A

Thumb fracture (shaft, neck)

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27
Q

Skier’s thumb

A

Injury to thumb ulnar collateral ligament

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28
Q

Avulsion injury

A

When terminal tendon separates from the bone and insertion and removed bone material with the tendon

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29
Q

Types of avulsion injuries

A

Mallet finger, boutonniere deformity, swan neck deformity

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30
Q

Mallet finger

A

Avulsion of terminal tendon resulting in flexed DIP requiring continuous extension splint for 6 weeks, typically not painful but impacts function

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31
Q

Boutonniere deformity

A

Disruption of central slop of extensor tendon causing PIP flexion and DIP hyperextension requiring continuous PIP extension splint for 6 weeks and DIP free for isolated flexion exercises

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32
Q

Injury to extensor zones 5-7 splint

A

Volar wrist splint in 30-30 degrees extension and 0-10 degrees MCP flexion

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33
Q

Swan neck deformity

A

Injury to MCP, PIP or DIP joint resulting in PIP hyperextension and DIP flexion requiring continuous PIP slight flexion splint for 6 weeks

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34
Q

3 Phases of fx healing

A

Inflammation: cellular activity for healing
Repair: forms callus for stabilization
Remodeling: deposits bone

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35
Q

General timeframe for AROM post fracture

A

3-6 weeks if fixation is stable

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36
Q

Colles fracture

A

Distal radius fracture with dorsal displacement (most common)

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37
Q

Smiths fracture

A

Distal radius fracture with palmar displacement

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38
Q

Most common carpal bone fracture

A

Scaphoid

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39
Q

What disease in lunate fracture associated with

A

Kienbock’s disease (causes block of blood supply)

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40
Q

Most severe complication of fracture

A

CRPS

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41
Q

Mechanism of injury for radial head fractures (forearm)

A

FOOSH

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42
Q

Types of radial head fracture

A

Type I: non-displaced treated with long arm sling
Type II: displaced with single fragment treated non operatively with immobilization for 2-3 weeks and then early motion
Type III: comminuted treated operatively with immobilization and early motion within first week post-op and use of long arm sling for 3-4 weeks

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43
Q

Most common fracture of upper arm

A

Proximal humeral fractures

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44
Q

Treatment for nonoperative humeral fracture

A

Sling to immobilize fracture with ROM as early as 2 weeks and stretching 4-6 weeks after fracture

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45
Q

CRPS

A

Pain disproportion to an injury

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46
Q

Type 1 CRPS

A

Develops after noxious event

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47
Q

Type 2 CRPS

A

Develops after nerve injury

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48
Q

Common symptoms of CRPS

A

Allodynia, hyperalgia, hyperpathia, edema, contractures , shiny skin, abnormal sweating, abnormal hair growth, low activity tolerance, decreased strength, muscle spasm

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49
Q

Treatment for CRPS

A

Gentle and pain from AROM (NO PROM)
Stress loading exercises (scrubbing and carrying)
TENS/splinting for pain mgmt
Edema control with elevation, massage, compression, contrast bath
Desensitization with fluidotherapy
Tendon gliding
Joint protection technique

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50
Q

Cumulative trauma injuries (CTD)

A

AKA overuse syndrome or repetitive strain (deQuerevains, CTS, tendinitis, rotator cuff tear)

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51
Q

Grade 1 CTD

A

Pain after activity that resolved quickly

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52
Q

Grade 2 CTD

A

Pain during activity that resolved when activity is stopped

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53
Q

Grade III CTD

A

Pain persists after activity and affects work productivity including objective weakness and sensory loss

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54
Q

Grade IV CTD

A

Use of extremity results in pain up to 75% of time and work is limited

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55
Q

Grade V CTD

A

Unrelenting pain and unable to work

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56
Q

Acute phase of CTD Tx (1)

A

Reduction of inflammation and pain with static splint, ice, contrast bath, ultrasound, iontophoresis

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57
Q

Subacute phase of CTD Tx (2)

A

Slow stretch, myofascial release, progressive resistance exercise as tolerated, body mechanic and trigger identification education, static splint during painful activity, return to acute phase treatment with flareups

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58
Q

Return to work phase of CTD tx (3)

A

Assessment of job site, tools, body positioning
Work simulator and functional activities
Strengthening
(4) Functional capacity evaluation (capacity to perform work activities related participation in employment)
(5) Work hardening (tasks around your specific requirements for returning to work)

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59
Q

Role of tendon glides in flexor/extensor rehab

A

Promote excursion and prevent tendon/scar adhesion

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60
Q

Initiation of strengthening in flexor/extensor rehab

A

Week 8

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61
Q

Discontinuation of splints in flexor/extensor rehab

A

Week 6

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62
Q

When is a tendon repair the weakest

A

10 -12 days post-op during fibroplasia phase in which collagen is being to be laid down and original strength of suture is gone

63
Q

Why is early mobilization important in flexor/extensor rehab

A

Prevents adhesion formation

64
Q

Splint for flexor tendon

A

Dorsal block splint to prevent patient moving into full extension to prevent tendon rupture

65
Q

Dorsal block splint positioning

A

20-30 wrist extension
50-70 MCP flexion
IP extension

66
Q

Early mobilization protocols for flexor tendon rehab

A
  1. Duran protocol
  2. Kleinert protocol
67
Q

Duran protocol

A

0-4 weeks: passive flexion/active extension using dorsal block splint
4-6 weeks: tendon gliding exercises and place/hold into light fist
6-8 weeks: light occupation based activities
8-12 weeks: strengthening
12 weeks: resume normal activities

68
Q

Kleinert protocol

A

Passive flexion/extension with active extension via rubber band traction with similar timeframe as Duran protocol

69
Q

Immobilization protocol

A

Complete immobilization in cast used for patient unable to care for self or with low cognitive capacity (always for children under 12) to ensure safety and prevent rupture

70
Q

Purpose of heat with tendon injury

A

Prepare tissues for motion

71
Q

Purpose of NMES with tendon injury

A

Promote excursion and activation of tendons

72
Q

Sequence of tendon glides

A

Straight
MCP flexion “table top”
Hook fist (MCP straight)
Straight fist
Full fist

73
Q

Common complications of flexor tendon injuries

A
  1. Nerve involvement - laceration due to mechanism of tendon injury
  2. Edema/stiffness
  3. Pain
74
Q

Median nerve distribution

A

Brachial plexus, moves through anterior arm and ends in palmar surface of digits 1-3

75
Q

Common signs of median nerve injury

A

Thenar atrophy, weakness of 1st and 2nd lumbricals, pain/paresthesia/sensory loss, in digits 1-3, difficulty with thumb opposition and AB, decreased pronation, loss of tip pinch

76
Q

Common median nerve injury

A

Carpal tunnel syndrome

77
Q

Ape hand

A

Hand deformity due to median nerve damage resulting in atrophy of thenar eminence and inability to oppose thumb

78
Q

Sign of benediction

A

Hand deformity due to median nerve damage that prevents patient from being able to make full fist with digits 1-3 remaining in full extension

79
Q

Muscles innervated by median nerve

A

Pronator teres, FCR, PL, FDS

80
Q

Ulnar nerve distribution

A

originates from brachial plexus, moves through anterior/lateral arm and ends in palmar/dorsal surfaces of digits 4-5

81
Q

Common ulnar nerve injury

A

Fracture to medial epicondyle of humerus, cubital tunnel syndrome, Guyon’s canal

82
Q

Common signs of ulnar nerve injury

A

Hypothenar atrophy, sensory loss in digits 4-5, weakness in digits 4-5, poor opposition in 5th digit, weakness with thumb AD and AB/AD of digits 2-5

83
Q

Claw hand

A

Hand deformity due to ulnar nerve damage resulting in paralysis of medical two lumbricals causing MCP digits 4-5 to remain extended at rest with flexed IP joints, pinch strength loss, sensory loss digits 4 and 5 (dorsal hand if injury proximal to Guyon’s canal)

84
Q

Jeanne’s sign

A

Hyperextension of thumb MCP and sign

85
Q

Muscles innervated by ulnar nerve

A

FCU, FDP, palmaris brevis, lumbricals, hypothenar and interossei muscles.

86
Q

Radial nerve distribution

A

Originates from brachial plexus, moves through posterior arm and ends in dorsal surface of digits 1-3

87
Q

Radial tunnel syndrome

A

Compression of radial nerve in proximal forearm resulting in dull ache and burning sensation along lateral forearm from radial head to supinator muscle

88
Q

Common radial nerve injury

A

Midshaft fracture of humerus, radial tunnel syndrome

89
Q

Common signs of radial nerve injury

A

Weakness of supinator and extensor muscles, sensory loss of dorsal hand

90
Q

Wrist drop

A

Hand deformity due to radial nerve damage resulting in weakness of finger extensors and unopposed action of wrist and finger flexors causing resting flexion

91
Q

Saturday night palsy

A

Compression of radial nerve at brachial plexus resulting in paralysis of triceps and loss of elbow/wrist/finger extension

92
Q

Muscles innervated by radial nerve

A

Triceps, brachialis, brachioradialis, anconeus, extrinsic/intrinsic extensors, supinator

93
Q

Conservative treatment for radial nerve injury

A

Cock-up splint with or without dynamic extension assist, PROM/AROM, isotonic strengthening post re innervation

94
Q

Operative treatment for radial tunnel syndrome

A

Long arm splint with elbow in flexion, forearm in supination and wrist in neutral followed by wrist cock-up splint for 2 more weeks, PROM/AROM pronation/supination, hand strengthening (3 week) and resistive exercises (6 weeks)

95
Q

Nonoperative treatment for radial tunnel syndrome

A

Long arm splint with elbow in flexion, forearm in supination and wrist in neutral, TENS for pain mgmt, pain-free ROM, nerve glides, avoidance of forceful wrist extension and supination

96
Q

Splinting for median nerve compression to facilitate functional pinch

A

Thumb splinted in opposition and palmar AB

97
Q

Benefits of contrast bath

A

Reduced edema and inflammation by providing alternating vasoconstriction and vasodilation to increase circulation

98
Q

Keys for brachial plexus injury

A

No shoulder AROM above 90 degrees
Reduce overhead activities

99
Q

Deformity due to high level ulnar nerve injury

A

MCP hyperextension fingers 4 and 5 due to loss of extension controlling forces in 3rd and 4th lumbricals

100
Q

Splinting for lateral/medial epicondylitis

A

Wear counterforce braces during any activity that provokes pain to rest muscles/tendons and protect against pain with activity

101
Q

Use of Iontophoresis

A

Decreased inflammation using low electrical current and dexamethasone (anti-inflammatory)

102
Q

Use of phonophoresis

A

Decrease inflammation using ultrasound with hydrocortisone (steroid)

103
Q

Radial tunnel syndrome

A

Compression of radial nerve in proximal forearm resulting in dull ache and burning sensation along lateral forearm from radial head to supinator muscle

104
Q

Line of pull for dynamic MCP flexion splint

A

90 degrees

105
Q

Trigger finger

A

locking of finger into flexion due to inflammation and thickening of flexor tendon sheath

106
Q

Trigger finger treatment

A

MCP extension blocking splint with gentle PIP/DIP AROM with splint ON

107
Q

Anterior interosseous syndrome

A

Compression of anterior interosseous nerve resulting in motor loss with FPL, FDP, and pronator quadratus

108
Q

Pronator Teres Syndrome

A

Entrapment of proximal median nerve between heads of pronator muscle causing deep pain in proximal forearm

109
Q

Nonoperative treatment for pronator syndrome

A

Splint with elbow in 90 degrees flexion and forearm neutral, TENS for pain, gentle stretch into supination, avoid repetitive forearm rotation with resistance and prolonged elbow flexion

110
Q

Operative treatment for pronator syndrome

A

Half cast with AROM of UE joints while wearing cast, muscle strengthening in 1 week with full AROM by 8 weeks

111
Q

Nonoperative median nerve splint

A

Static thenar web spacer splint

112
Q

Operative treatment median nerve injury

A

Dorsal wrist blocking splint 4-6 weeks, AROM/PROM in splint , tendon gliding exercises, scar massage

113
Q

Most common nerve compression of UE

A

Carpal tunnel (median nerve)

114
Q

Impairment due to median nerve injury

A

Numbness/tingling digits 1-3, diminished FMC, atrophy

115
Q

Evaluation for carpal tunnel

A

Tinel’s test (tap median nerve to elicit symptoms)
Phalen’s test (hold wrist in full flexion for 1 min)
Moberg pick-up
Semmes Weinstein

116
Q

Nonoperative treatment carpal tunnel

A

wrist cock-up splint 10 degrees wrist extension to relieve pressure on median nerve, tendon/nerve gliding exercises, activity modification and client education

117
Q

Operative treatment carpal tunnel

A

Surgical open carpal tunnel release surgery or endoscopic release, pain mgmt with gel pads, splinting for sleep if needed and clients who engage in too much activity, AROM wrist, thumb fingers and nerve/tendon gliding (1-2 days post-op, strengthening (3-6 weeks post-op)

118
Q

Pillar pain

A

pain on either side of surgical release for carpal tunnel

119
Q

Cubital tunnel syndrome

A

Ulnar nerve compression at the elbow between medial epicondyle and olecranon process

120
Q

Impairments due to cubital tunnel syndrome

A

Decreased sensation in 4-5th digits, decreased grip strength, decreased lateral pinch due to weak interossei and FCU

121
Q

Evaluation for cubital tunnel syndrome

A

Tinels (tap over cubital tunnel)
Froment’s sign
Wartenberg’s sign
Elbow flexion test

122
Q

Froment’s sign

A

Flexion of thumb IP when a lateral pinch is attempted (ulnar nerve)

123
Q

Wartenberg’s sign

A

5th digit held in abduction from the e4th digit (ulnar nerve)

124
Q

Elbow flexion test

A

Holding elbow in flexion for 5 minutes with the wrist neutral to elicit symptoms of ulnar nerve injury

125
Q

Nonoperative splint for cubital tunnel syndrome

A

Elbow splint positioned in 30-60 degrees flexion for 3 weeks

126
Q

Operative treatment for cubital tunnel syndrome in protection phase (1 day - 3 weeks)

A

Elbow splint in 70-90 degrees flexion, wound care, edema mgmt, pain mgmt, AROM uninvolved joints, one-handed ADL technique

127
Q

Operative treatment for cubital tunnel syndrome in active phase (3+ weeks)

A

Discontinue elbow splint, add elbow AROM in pronation first and then progress to in supination, start with wrist AROM with elbow flexed and progress to elbow extended, ulnar nerve gliding and desensitization technique

128
Q

Nonoperative splint for claw hand

A

Ulnar nerve palsy or anti-claw splint with or without dynamic PIP extension assist if PIP flexion contractures are noted

129
Q

Operative Claw hand tx

A
  • Bulk dressing (3-10 days)
  • Dorsal blocking splint wrist 20 degrees flexion and MCP block 45 degrees flexion
  • Adjust splint at 3-6 weeks to neutral wrist
  • Discontinue splint 6 weeks
  • Wound care/scar mobilization
  • Sensory desensitization when would is healed
  • AROM wrist/hand 6 weeks
  • Sensory reeducation once protective sensation has returned (10-12 weeks)
130
Q

Double crush syndrome

A

Peripheral nerve is entrapped in more than one location causing paresthesia and pain with specific posturing

131
Q

DeQuervain syndrome

A

Tenosynovitis to APL and EPB in the first dorsal compartment of the wrist due to repetitive thumb AB with ulnar deviation

132
Q

DeQuervain syndrome splint

A

Forearm-based thumb spica splint with wrist in neutral (20 degrees if surgical release performed) and thumb radially AB for 3 weeks

133
Q

Protective reeducation

A

Educated to visually compensate for sensory loss

134
Q

Discriminative reeducation

A

Repetition of tactile identification of variety of objects with and without vision

135
Q

Properties of thermoplastic splints

A

Elasticity, memory, bonding, durability, rigidity, perforations

136
Q

Resting hand splint

A

Wrist 20 degrees extension
Thumb 45 degrees palmar AB
MCP 35 degrees flexion
PIP/DIP slight flexion

137
Q

Intrinsic plus position (anti-deformity)

A

Wrist 30 degrees extension
Thumb 45 degrees palmar AB
MCP 70 degrees flexion
PIP/DIP full extension

138
Q

Wrist cock-up splints (volar or dorsal) allow for full

A

Thumb ROM and MCP flexion

139
Q

Carpal tunnel splint

A

Cock-up neutral to 10 degrees extension

140
Q

Ulnar nerve wrist splint

A

Block digits 4 and 5 50 30 degrees flexion to prevent hyperextension

141
Q

Radial nerve splint

A

Cock-up splint with dynamic finger extension assist optional

142
Q

Pronator syndrome splint

A

Forearm and wrist in neutral with 90 degrees elbow flexion

143
Q

Anterior interosseous splint

A

Forearm neutral with elbow in 90 degree flexion

144
Q

Radial tunnel syndrome splint

A

Wrist in 30 degrees extension, forearm supinated and elbow in 90 degree flexion

145
Q

Purpose of dynamic splinting

A

Correct contracture, increase PROM, substitute for active motion, protect post surgery

146
Q

Finger pull for dynamic splinting

A

90 degrees

147
Q

Stages of wound healing

A
  1. Inflammatory
  2. Proliferative
  3. Remodeling
148
Q

Inflammatory phase of wound healing

A

(4-6 days) clot formation, vasoconstriction, change in skin color, temp, edema, pain, healing process triggered, WBC initiate debridement and attack bacteria

149
Q

Proliferation phase of wound healing

A

(4-21 days) tissue granulation, fibroblasts lay down collagen for wound contraction and tensile strength, scab formation, beginning of scar formation, revascularization and re-epithelialization

150
Q

Remodeling phase of wound healing

A

(21 days – 2 years) collagen remodeling, scar matures and tissue soften while tensile strength increases, strengthening, erythema lessens

151
Q

How to document wound

A

Anatomical location
Length/depth/width/shape
Color and presence of Necrotic tissue
Wound exudate
Granulation
Surrounding intact skin

152
Q

Systemic factors impacting wound healing

A

Diabetes mellitus, nutrition deficiency, atherosclerosis, HIV/AIDS, aging, radiation

153
Q

Allodynia

A

Pain due to a stimulus that does not normally provoke pain.

154
Q

Hyperalgia

A

Increased sensitivity to feeling pain and an extreme response to pain

Exam Prep (19 decks)

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