Uppers Wrist Flashcards
structures affected
distal radius and ulna carpal bones collateral, palmar, dorsal ligaments traingular fibrocartilage comples (TFCC) neurvascular structures
wrist joint sprains
- can be…
- where
- MOI
- S/S
- when to be concerned
common can be an exclusion Dx distal radioulnar joint and carpal bones MOI -hyperextension -hyperflexion -FOOSH -"jamming" the wrist S/S -swelling -point tenderness -pain with active and passive ROM -possible weakness when you have a wrist sprain with S/S lasting 2+ weeks, there could be a problem
scapholunate instability
- most…
- S/S
- can lead to…
most common sprain of the carpals S/S -pain and swelling over the joint line -hypermobility at scapholunate articulation -decreased ROM and grip strength -+ Watson's test can lead to surgical repair
Gamekeeper’s Thumb
- AKA
- where
- MOI
- S/S
- > /
AKA Skiier's Thumb ulnar/medial collateral ligament, 1st MCP joint MOI -typerextension or hyperabduction S/S -pain -point tenderness over the medial MCP -swelling in the thenar eminence -varying degrees of instability 30 degrees requires surgical repair
flexor tendon avulsion
- another name
- MOI
- S/S
- complete rupture S//s
- splint how
"Jersey Finger" MOI -forceful extension when the finger is flexed S/S -immediate pain -swelling -point tenderness at attachment site -"Jersey finger sing" complete rupture = inability to flex DIP splint DIP in flexion
extensor tendon avulsion
- other name
- MOI
- S/S
- splint in…
"Mallet Finger" MOI -extended distal phalanx is suddenly and forcefully flxed S/S -pain -point tenderness over distal attachment -"Mallet finger sign" splint DIP in extension
extensor tendor rupture
- other name
- S/S
- what happens
Boutonniere Deformity S/S -flexion of the PIP -hyperextension of the DIP -pain at the PIP -swelling -weakness with PIP extension rupture of the extensor digitorum tendon
wrist ganglion
- what
- MOI
- more common…
- S/S
- high rate
synovial cyst herniation of synovial fluid through the joint capsule may result from sprains/strains more common dorsally S/S -observable and palpable mass -discomfort with wrist extension high rate of reoccurrence unless surgically removed
De Quervain’s Disease
- what
- most common…
- MOI
- S/S
- Tx
tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons most common in women 20-40 MOI -repetitive stress (radial deviation) S/S -TTP over APL and EPB, thenar eminence, radial styloid -pain with radial deviation -+ Finkelstein's test Tx -conservative -corticosteroids --sometimes the first line of defense -positive results with releasing the tendon sheath (surgery)
trigger finger -what most common in... -MOI -S/S
tenosynovitis of the flexor tendons thickening of the synovial sheath most common on the 3rd/4th digits MOI -repetitive trauma S/S -finger appears "stuck" in a flexed position -"snap" with active flexion
Colles’ fracture
- what
- displacement
- MOI
- S/S
- possible…
- surgery determined by…
distal radius/ulna fracture dorsal displacement MOI -FOOSH with wrist extension S/S -immediate pain -rapid swelling -tenderness -deformity possible median nerve involvement surgery determined by degree of displacement and if it affects the joint
reverse Colles’ fracture
- other name
- what
Smith’s Fracture
distal radius fracture occurring with wrist flexion
palmar displacement
scaphoid fracture
- common in…
- MOI
- S/S
- Tx
- other
most common wrist Fx common in younger athletes MOI -FOOSH or forced hyperextension S/S -vague symptoms -lateral wrist pain -snuffbox pain and swelling -pain with thumb motion Tx -immobilization --distal and nondisplaced -surgery --proximal Fx -quick RTP poor vascular supply the more distal the fracture, the better the blood supply
hamate fracture
- MOI
- S/S
- 5th finger movement
- Tunnel of Guyon
- Tx
MOI -fall on the hand -direct blow -axial load to the 4th/5th MC -trauma while gripping --baseball/golf S/S -swelling in the hypothenar eminence -TTP pain with 5th finger movement -active adduction/abduction -resisted flexion and abduction -passive extension Tunnel of Guyon -where the ulnar nerve runs through the carpal bones -between the pisiform and hamate Tx -immobilize in slight flexion -take out hook of the hamate
Bennett’s Fracture
- what
- APL tendon
- MOI
- S/S
base of the 1st metacarpal APL tendon will likely cuse displacement MOI -axial load S/S -immediate pain -rapid swelling -tenderness and crepitus at the MCP joint -loss of function
metacarpal fracture
- MOI
- S/S
- 5th metacarpal name
- Tx
MOI -axial load -direct trauma S/S -pain -diffuse swelling (dorsal) -TTP over MC -fingernail rotation -depressed MC head (4th/5th) -increased pain with longitudinal stress and/or percussion -possible crepitus 5th met - Boxer's Fracture Tx -surgical with displacement > 35 degrees -up to 70 degrees with the 5th met -surgical fixation with rotational fracture
phalanx fracture
- commonly seen…
- MOI
- S/S
- splint…
commonly seen as a secondary injury to a sprain/dislocation MOI -axial load -torsion -indirect trauma -direct trauma S/S -pain -swelling -point tenderness -loss of function -deformity -crepitus -+ long bone compression or percussion splint in the position found can see lots of deformity
MCP/IP dislocation
- direction depends on…
- associated with…
- S/S
- check for
direction of the dislocation depends on the force associated with 3rd degree ligament/capsule sprain S/S -obvious deformity -pain -rapid swelling -loss of function check for capillary refill
carpal tunnel syndrome
- what
- who
- predisposing factors
- S/S
- Tx
compression of the median nerve as it passes through the carpal tunnel multiple factors older adults predisposing factors -age -bony structure -posture --typing - wrist flexion S/S -pain -tenderness over palmar aspect of the wrist -sensory changes -motor weakness -+ Tinel's sign -+ Phalen's Tx -can do a surgical release
ulnar nerve compression
- other name
- MOI
- S/S
- Tx
"Cycler's Palsy" MOI -repetition --ulnar nerve palsy: cycling -trauma S/S -pain -tingling -numbness radiating into ulnar distribution -Bishop's Deformity Tx -decrease whatever is causing the compression
lunate dislocation
- MOI
- S/S
MOI -high velocity hyperextension S/S -lateral wrist/hand pain -palpable bulge -flat 3rd MC head -malalignment of other carpals -limited ROM, especially extension
perilunate dislocation
-what
where the lunate remains in place but other carpals dislocate around it
-particularly the capitate
TFCC
- what
- function
- ulnar variance
articular disk dorsal and palmar radioulnar ligaments ulnar collateral ligament meniscus homolog function -dissipates force ulnar variance -ulna is longer than medial radius -predisposes to TFCC injury because it becomes compressed
TFCC injury
- MOI
- S/S
- Tx
MOI -acute -chronic --most common --gymnasts S/S -pain with weightbearing -TTP over ulnar styloid -limited ROM -pain with ulnar deviation -possible + valgus stress test Tx -surgical intervention
past history
rheumatoid arthritis
PVD (peripheral vascular disease)
Raynaus’s phenomenon
general inspection
palmar creases
lacerations or scars
posturings
Ape Hand Bishop's Deformity Claw Hand Swan Neck Deformity Dupuytern's Contracture Volkmann's Ischemic Contraction Jersey Finger Mallet Finger Boutonniere Deformity
Ape Hand
due to medial nerve neuropathy
weakness of thenar eminence
extensors become overactive and pull the thumb into extension and slight adduction
Bishop’s Deformity
flexion of all MCP, PIP, and DIP joints, specifically at the 4th and 5th digits
typically due to ulnar nerve pathology
-leads to weakness in the interossei, hypothenar muscles, and medial two lumbricles
Claw Hand
extension at MCP and flexion at PIP and DIP
results from median nerve neuropathy, and occasionally ulnar
results in weakness of the intrinsic muscles
Swan Neck Deformity
extension of the PIP and flexion of the DIP
- usually accompanied by flexion at the MCP
- most commonly due to damage to the volar plate (anterior portion of the PIP joint)
Dupuytern’s Contraction
flexion contracture of the MCP and PIP
most common at 4th and 5th digits
most common due to shortening of the palmar fascia
strong hereditary component
Volkmann’s Ischemic Contraction
result of decreased blood flow
hyperextension of MCP joints and flexion of PIP joints
jersey finger
unable to actively flex DIP
Mallet finger
unable to extend DIP
Boutonniere Deformity
PIP in flexion, DIP in extension
how to check alignment of MCP joints
flex fingers
wrist and hand inspection
posture of wrist and hand
ganglion cyst
thumb and finger inspection
subungual hematoma felon -infection or abscess of the distal phalanx paronychia -infection around the fingernail alignment of fingernails -hands open and closed -with some fractures you may see rotation of the fingernail muscle contour -thenar and hypothenar eminence
wrist ROM
flexion - 90
extension - 45
radial deviation - 20
ulnar deviation - 35
thumb ROM
CMC flexion (make a four)/extension - 60 CMC abduction - 70-80
finger and hand
MCP flexion - 90
MCP extension - 45
PIP flexion - 100
DIP flexion - 90
wrist strength assessment
flexion flexion w/ radial deviation flexion/ ulnar deviation extension extension w/ radial deviation extension w/ ulnar deviation radial deviation ulnar deviation
thumb strength assessment
flexion
extension
abduction
adduction
hand and fingers
MCP abduction and adduction
PIP flexion
DIP flexion
special tests
grip dynamometry
RCL and UCL stress test
valgus and varus testing of IP joints
test for laxity of the thumb MCP collateral ligaments
Finkelstein’s Test for De Quervain’s Syndrome
Watson’s Test for Scapholunate Instability
Phalen’s Test for Carpal Tunnel Syndrome
Finkelstein’s Test
tuck thumb under fingers by making a fist
ulnarly deviate the wrist
Watson’s Test
apply dorsal pressure to the distal side of the scaphoid and move wrist from ulnar to radial deviation
look for pain and a clunk
Phalen’s Test
apply over-pressure during passive wrist flexion and hold for 1 minute
tingling develops or increases in the distribution of the medial nerve distal to the carpal tunnel
