Uppers Wrist Flashcards by James Miller

structures affected

distal radius and ulna
carpal bones
collateral, palmar, dorsal ligaments
traingular fibrocartilage comples (TFCC)
neurvascular structures

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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

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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

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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

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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

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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

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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

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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

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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)

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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

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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

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reverse Colles’ fracture

other name
what

Smith’s Fracture
distal radius fracture occurring with wrist flexion
palmar displacement

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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

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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

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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

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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

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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

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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

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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

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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
-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
-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