Week 11 Hand and fingers Flashcards

1
Q

function of CMC joints: fingers

A
  • allow small amounts of flexion coupled with slight rotation (10-20 degrees)
  • enhances 增強 opposition of ulnar side of hand for power grip 以獲得力量握力
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2
Q

movement of CMC joint thumb

A

1. flexion/ extension, abduction/ adduction
conjunct rotation:
flexion accompanied by medial rotation
extension accompanied by lateral rotation

2. opposition
- metacarpal abducts, then flexes and adducts
- muscular and ligamentous forces help to guide metacarpal
- conjunct medial rotation (at least 45-60 degrees)

full opposition/ abduction = close packed position

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3
Q

bone stability of MCP joints

A
  • poor stability, good movement (large convex MC head 180 degrees, shallow concave surface of proximal phalanx 20 degrees)
  • MCPs form distal transverse arch of the hand

stability is vital to hand function

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4
Q

movements of MCP joint

A
  1. flexion
    - approx 90 degrees
    - range increases towards the ulnar side of hand
    - concave phalanx on convex MC hand = rolls and slides in same direction
  2. extension
    - variable, around 0 degrees
    - significance of hyperextension
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5
Q

ligaments of MCP joints

A
  1. collateral ligaments
    - proper: cord-like 繩狀
    - accessory: fan shape
    - tension in collateral ligaments increases with F due to curvature 彎曲 of metacarpal head
    - flexion: prevents unwanted abduction of fingers during gripping
    - extension: collateral ligs are lax –> permit abduction of fingers by interossei
  2. volar plate
    - fibrocartilage
    - blends with capsule
    - increases congruency 一致性
    - prevents hyperextension
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6
Q

why IP joints are more stability than MCP joints

A
  1. due to congruent articular surface - median ridge
  2. strong three ligaments system: proper collateral ligaments, accessory collateral ligaments, volar plate
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7
Q

ROM of IP joints

A
  1. flexion
    - 0-130 degrees flexion (PIPs)
    - 70-90 degrees flexion (DIPs)
    - flexion ROM increases toward ulnar side
  2. extension
    - volar plate and accessory ligaments are taut - prevent hyperextension
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8
Q

position of safe immobilisation (POSI)

A

wrist 0-30 degrees E
MCP joint 70-90 degrees F
IP joints 0 degrees E = full extension

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9
Q

extrinsic muscles: flexors

A
  • powerful ‘motors’ of the fingers & thumb (FDS, FDP, FPL)
    **- dependent on:
  • wrist extensors (length/ tension)
  • intrinsic muscles of hand (modify finger F)
  • intact flexor gliding mechanism**
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10
Q

flexor gliding mechanism

A
  1. retinaculae - anchor long flexor tendons to the hand (將long flexor tendons固定在手上)
  2. bursae - friction free excursion 遊覽 between tendon and retinaculum
  3. fibro-osseous tunnels; pulleys
  4. digital tendon sheaths - reduce friction
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11
Q

what are the functions of digital synovial sheaths

A
  • reduce friction
  • nutritional support to tendon

implications: 影響
may heal with adhesions –> therefore, inhibit free gliding of tendon within sheath 可能會因沾黏而癒合 –> 因此,抑制腱鞘內肌腱的自由滑動

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12
Q

extrinsic muscles: extensors

A
  • no digital sheath or pulley system
  • extensor expansion: central band, lateral bands: insets into base of sdistal phalanx
  • actions: MCP extension
  • intrinsics:
    lumbricals; IP E > MCP F
    interossei; MCP F > IP E
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13
Q

intrinsic and extrinsic interaction 內在和外在的相互作用

A

allow fine motor function

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14
Q

two types of prehension
抓握力

A

1. power grip
- cylindrical: handles of tools, racquets (most common)
- spherical: gripping around door knobs
- hook grip: shopping bags, holding cases (thumb not invloved)
- lateral prehension: cigarette (static hold of object between fingers)

2. precision handling
- an object is held between the pads of the thumb and fingers, such as pen, needle and fork
- pad-to-pad, tip-to-tip, pad-to-side

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15
Q

management of skier’s thumb

A

grade 1 and 2 tears:
- immobilise in thermoplastic splint in slight MCP flexion for 6/52
- physiotherapy: increase ROM and strength
- protective splinting for RTS

grade 3: surgery
- immobilisation for 1/12

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16
Q

signs and symptoms, diagnosis of thumb MCP hyperextension

A
  • common in** AFL, football, netball, basketball**
  • injury to volar plate, anterior capsule, thenar muscles and FPL
  • signs and symptoms:
  • pain on hyperextension thumb
  • swelling
  • tenderness palpation MCP joint
  • diagnosis:
  • radial stress test (ulnar collaterall ligament)
  • X-ray: # joint surface
  • splint: IP joint to base of MC, 1st MCP in 20 degrees flexion
17
Q

boxer’s fracture

A
  • fracture of the 4th/ 5th metacarpal
  • most common mechanism of injury - direct punch - ‘wall punchers’
18
Q

management of phalangeal fractures

A

buddy taping

19
Q

mallet finger

signs, management

A
  • rupture/ avulsion fracture 斷裂/撕脫骨折 of extensor tendon at the DIP joint
  • 45 degrees bend finger but cannot back into extension

management:
- **conservative: **
- splinted in DIP extension for 6-8/52 – cont splinting 6-8/52 RTS
- physio: restore ROM and strength
- surgical:
- ORIF with K-wire
- joint splinted in extension for 6/52
- K-wired removed
- mobilisation and strengthening

20
Q

signs and symptoms of complex regional pain syndrome (CRPS)

A
  • increase in odema
  • burning pain
  • red and shiny skin
  • increased sweating
  • can be localised 可侷限於 to wrist/hand/fingers or affect whole UL
21
Q

rheumatoid arthritis vs osteoarthritis

A

RA:
- immune system attack the joint (autoimmune)
- morning stiffness >30 mins
- flu-like symptoms: eg: fatigue, fever
- often bilateral

OA
- degeneration
- morning stiffness < 30 mins
- unilateral

management: medication, exercise (strengthening muscles)

22
Q

basal thumb osteoarthritis

A
  • most common: 1st CMC joint
  • middle-aged plus
  • forceful gripping (FPL)

management:
- education
- splinting
- AROM and strengthening to maintain joint range

23
Q

Dupuytren’s contracture

A

wasting of intrinsic muscles (flexion contracture)

24
Q

position of safe immobilisation (POSI)

A

wrist extension 20-30 degrees
MCP joint flexion 45-70 degrees
IP joint extension
thumb 45 degrees abduction

25
Q

effects of immobilisation

A

positive:
- capsule and ligaments become tightened and fibrosed
- muscle immobilised in lengthened position - gain in sacromeres

negative:
- decrease in bone density
- muscle atrophy 肌肉萎縮 = decrease muscle strength
- muscle immobilised in shortened position - loss of sacromeres

26
Q

scar management in the hand

A
  • massage
  • vitamin E cream