Week 6 Flashcards
What is Flexor Tendon Injury of the finger?
Presents with DIP flexion loss
What is another name for flexor tendon injury of the finger?
Jersey finger
What does flexor tendon injury of the finger result from?
A forceful hyperextension of the DIP joint with the FDP in maximal contraction
Example jersey ripped out of tackler’s grip
Which is the primary flexor of the index, middle, ring and small finger?
Flexor digitorum profundus
Where does the flexor digitorum profundus insert?
Distal phalanx
Where does the flexor tendon injury usually rupture?
Tendon rupture occurs at the bony insertion site
What is the orthotic treatment for Jersey finger?
Buddy system
WHO-only use when buddy system flexion is painful
What are other names for ulnar collateral ligament injury?
gamekeeper’s thumb
skier’s thumb
What does the ulnar collateral ligament do?
Supplies structural lateral support of the thumb for fine motor functional activities and weight bearing tasks
What is the common cause of ulnar collateral ligament injury?
A severe, sudden valgus force placed on the already abducted thumb
What is ulnar collateral ligament injury?
Ulnar collateral ligament ruptures at its distal insertion site into the base of the proximal phalanx
What are the common sports associated with ulnar collateral ligament injury?
Football
Wrestling
Skiing
What is the orthotic treatment of ulnar collateral ligament injury?
Thumb spica orthosis that encases the IP and MP joints with the thumb in slight adduction
How long does the patient immobilize the ulnar collateral ligament injury?
6-10 weeks
What treatment occurs after 8-12 weeks of ulnar collateral ligament injury?
Physical therapy with progression into lateral pinch strengthening and oppositional strengthening
What makes up the traingular fibrocartilage complex?
Ulnotriquetral ligament ulnolunate ligament plamar radioulnar ligament articular disc dorsal radioulnar ligament (Triangular fibrocartilage, palmar and dorsal radioulnar ligaments, and the ulnar carpal ligaments)
What does TFCC stand for?
Triangular fibrocartilage complex
What is the centerpiece of the trianguar fibrocatilage complex?
The articular disc
How common is TFCC injury?
Not common-1 every few years
What is TFCC injury?
TFCC avulsion from distal sigmoid notch
Where does the disc originate and insert for the TFCC?
Originates from the sigmoid notch of the distal radius
Inserts into the fovea at the base of the ulnar stylod process
What merges to create the TFCC?
Volar fibers of the articular disc
ulnolunate ligament
ulnotriquetral ligament
What is the TFCC critical in supporting?
The ulnar carpus (Carpal bones that articulate with the ulna)
What does the TFCC act as?
A decelerator and shock absorber when conducting the radial and ulnar deviation activities
How is the TFCC injured?
Distal radius fractures and wrist sprains.
What is the orthotic treatment for TFCC?
Antiinflammatory medication and a resting splint to limit pronation, supination and joint loading activities
How long is the orthosis worn for TFCC?
4-6 weeks
What is another orthotic treatment option for TFCC after 4-6 weeks?
A custom fitted long arm splint with 90 degrees elbow flexion, forearm neutral, and wrist 10-20 degrees extension
What orthotic treatment can be used for metacarpal fractures?
“buddy system” hand orthosis-stabilizes whole hand or just the last two fingers
Partial WHO-maintain and stabilizes the arch with palmar extension
Palm splint-allows 1 and 2 to move
What is a 5th metacarpal fracture also called?
Boxer’s fracture
How does boxer’s fracture occur?
When people are upset and punch wall, locker, equipment, person causing a fracture of the 5th metacarpal
What is the orthotic treatment for boxer’s fracture?
MP flexed with HO or WHO
How do wrist fracture occur?
Fall or MVA or any strong force on the hand
A sudden force pushing the hand backwards
What is another name for a distal radius fracture?
Colles fracture
How does a Colles fracture occur?
When the broken fragment of the radius tilts upward
What is another name for smith’s fracture?
Reverse colles fracture
How does a smith’s fracture occur?
A backward fall on the palm of an outstretched hand causing pronation of upper extremity while the hand is fixed to the ground
What is a Chauffer’s fracture?
Fracture to the styloid process of the radial joint
What is another name for a chauffer’s fracture?
Hutchinson fracture
Where does a chauffer’s fracture often begin?
At the junction of the lunate and scaphoid fossae on the radial artuclar surface and extends laterally
What is Barton’s fracture?
Dislocation of the radiocarpal joint
How is barton’s fracture characterized?
Shear type fractures of the distal articular surface of the radius with translation of the distal radial fragment and the carpus
What are the different areas of the scaphoid bone?
Distal pole
Waist
Proximal pole
What are the different types of fractures to the scaphoid bone?
Tubercle fracture
Transverse
Horizontal oblique
vertical oblique
What is the most commonly fractured bone of the carpus?
Scaphoid
What are the signs that the scaphoid bone is fractured?
Complaint of pain and discomfort at the anatomical snuffbox
How does a scaphoid fracture usually occur?
On an outstretched hand
What is important to consider for scaphoid fractures?
The poor blood supply to the scaphoid
What are acute fracture of the scaphoid?
less than 6 weeks distal oblique waist proximal pole fracture dislocation
What are non-unions of the scaphoid?
greater than 6 weeks fibrous union pseudarthrosis sclerotic pseudarthrosis avascular necrosis
What often occurs to scaphoid fractures?
Mistaken for wrist sprain and immobilization is not carried out
What is the orthotic treatment option considerations for scaphoid fractures?
Depends on severity
Usually also involves ligamentous injuries affecting wrist stability, and functionality.
What are the orthotic treatment options for scaphoid fractures?
Non-displaced fractures are typically in a thumb spica orthosis (custom fab or fit)
Fractures of the proximal 2/3 require long arm splinting with distal humerus to prevent forearm rotation and restrict thumb motion
Where is the elbow positioned for scaphoid fracture treatment?
70 degrees of flexion
Forearm and wrist neutral
What tests are used to diagnosis CTS?
Phalen’s test
Reverse phalan’s test
What is phalan’s test?
Wrist flexion with hand together. Tingling is a positive CTS
If the arm cannot reach 90 degrees of flexion for the phalan’s test what should you do?
Let the arm drop as far as possible without added force
Who is Jules Tinel?
Studied wartime nerve injuries in France
What is the Tinel’s sign?
Tapping (percussion) over the areas of the hand of the injured nerve to determine the progress of nerve regrowth
What can the injured nerve eventually do?
Grow along the old course and re-connect to the original target tissue
What is froments sign?
The practitioner asks the patient to grip a piece of paper between the thumb and index finger. The flexion of the thumb with resistance indicates adductor pollicis weakness
What is Wartenberg’s sign?
The little finger lies abducted due to ulnar nerve involvement and the unopposed action of the extensor digitorum
