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Musculoskeletal Physiotherapy 2 > Week 7 Wrist > Flashcards

Week 7 Wrist Flashcards

1
Q

Joints of the wrist

A 
radiocarpal 
pisiform joint
intercarpal joint (mid-carpal)
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2
Q

Why put patients into resting position

A

to reduce pain (when they’re injured)

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3
Q

Zero starting position for the wrist joint complex

A

longitudinal axes through the radius and third metacarpal bone are in a straight line

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4
Q

Resting position of the wrist joint complex

A

zero starting position with a little ulnar flexion

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5
Q

Close packed position

A

wrist in maximal dorsal flexion (extension)

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6
Q

Capsular pattern

A

restricted equally in all directions

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7
Q

Characteristics of the radiocarpal joint

A

-mechanically simple, biaxial
-distal convex surface;
scaphoid, lunate, triquetrum
-proximal concave surface;
radius and articular disc

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8
Q

Intercarpal joint characteristics

A 
-mechanically compound,
anatomically simple
- convex scaphoid articulates
with the two trapezii
- scaphoid and lunate form a
concave surface for
articulation with the convex
capitate
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9
Q

Pisiform joint characteristics

A 
-anatomically simple, plane
gliding joint
-sesamoid bone in the
insertion of flexor carpi
ulnaris; origin of abductor
digiti minimi
-contraction of these two
muscles will stabilise
pisiform
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10
Q

Wrist joint complex

A

all bones can be moved individually in relation to each other

the two most important carpal bones regard loss of range of motion with pathology are scaphoid and lunate

functional movement does not occur in one plane, all muscles cross the wrist obliquely so movement is radiodorsal & ulnarvolar

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11
Q

Flexion =

Extension =

A

Flexion = partly radiocarpal, mostly midcarpal

Extension = radiocarpal then midcarpal

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12
Q

What is radial deviation

A

proximal row of carpals
and midcarpals slide into dorsal and ulna
glide

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13
Q

What is ulnar deviation

A

proximal row moves into

a palmar and radial glide

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14
Q

Tendon lesions

A

ECR
ECU
FCU
FCR

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15
Q

MCP joint

A

simple biaxial joints

  • convex proximal, concave distal
  • Active movements = flex, ext, abd, add ; passive rotation

Joint stability is maintained by capsule and collateral ligaments as the joint surfaces are incongruent

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16
Q

The hand & fingers

A

PIP & DIP joints are hinge joints
Convex head of proximal phalanx articulates with the concave base of the middle phalanx
Movements of flexion and extension

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17
Q

Classification of MSK disorders

A

soft tissue lesions
joint diseases
bone disorders
nerve entrapments

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18
Q

What is De Quervain’s

A

APL & EPB

stenosing tendovaginitis of the First Dorsal Retinaculum

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19
Q

Intersection syndrome

A

APL/EPB & ECR

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20
Q

Ligament sprains - subluxation/ instability

A

Ulnar collateral ligt 1st MCP

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21
Q

Dupuytren’s contracture

A

pg.. 18

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22
Q

ganglion

A

pg. 19

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23
Q

TFCC (triangular fibro-cartilage complex

A

pg.20

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24
Q

Lacerations

A

pg. 21

25
Q

Tendon avulsion

A

Mallet finger

jersey finger

26
Q

Joint diseases

A

degeneration

27
Q

Rheumatoid arthritis

A

pg. 24

28
Q

distal radius and ulna “Colles”

A

pg. 25

29
Q

Scaphoid fracture

A

pg. 26

30
Q

Scapholunate dissociation

A

pg. 27

31
Q

hook of hamate

A

pg. 28

32
Q

metacarpal, phalanx

A

pg. 29

33
Q

Dislocation PIP

A

pg. 30

34
Q

Bennett’s fracture

A

pg. 31

35
Q

Impingement syndromes

A

pg. 32

36
Q

Kienbocks disease

A

pg. 33

37
Q

Nerve entrapments

A

median nerve
-carpal tunnel syndrome

Ulnar nerve
-guyon’s tunnel (karate & cyclists)

38
Q

Phalen’s test

A

pg 36

39
Q

Instability

A

wrist instability?
carpal instability
carpal malalignment
carpal dysfunction

40
Q

Carpal instability

A

Inability to bear physiological loads with an associated loss of normal carpal alignment

41
Q

Carpal malalignment

A 
dynamic instability (CIND)
Static instability (CID)
42
Q

Carpal dysfunction

A

in a normal wrist there is the ability to transfer loads without sudden changes of stress on the articular cartilage(normal kinetics)
-and the capacity to move throughout the normal range without sudden alterations of intercarpal alignment (normal kinematics

43
Q

Classifications of carpal dysfunction

A

dissociative carpal instability (CID)
Non - dissociative carpal instability (CIND)
Complex carpal instability (CIC)
Adaptive carpal instability (CIA)

44
Q

Dissociative carpal instability

A

dysfunction between bones of the same carpal row (usually proximal)

  • scapholunate, lunotriquentral
  • fracture or ligament disruption
45
Q

Non-dissociative carpal instability (CIND)

A

dysfunction between bones of the different carpal row

  • triquetralcapitate
  • radioulnate
  • radiocapitate
46
Q

Complex carpal instability *+(CIC)

A

when CID and CIND are found together

e.g. perilunate dislocations

47
Q

Adaptive carpal instability (CIA)

A

origin of the carpal dysfunction proximal or distal to wrist

carpals adapt to an extrinsic pathology
-eg. distal radial fracture

48
Q

Dissociative carpal instability (CID)

A

CID-DISI Dorsal intercalated segment instability

CID-VISI Volar intercalated segment instability

49
Q

CID- DISI

A

Scapholunate dissociation
Lunate (intercalated segment) is abnormally extended relative to its proximal and distal links
due to extension moment transmitted by triquetrum

50
Q

CID - VISI

A

Lunotriquetral dissociation

Scaphoid forces unrestrained lunate into palmar flexion

51
Q

Treatment carpal instability

A

there is no single treatment for carpal instability. the intervention is primarily surgical and six criteria must be considered

52
Q

Trangular Fibrocartilage complex (TFCC)

A

pg. 51

53
Q

TFCC injuries

A

mechanism of injury
-compression of lunate and the head of the ulna (e.g. fall on outstretched hand)
Rotational forces (throwing/ racquet sports)
Degenerative lesions

54
Q

TFCC contributing factors

A

positive ulnar variance

  • increased load bearing ulnar side of wrist
  • 18% to 42% with 2.5mm +variance
  • Decreased thickness of TFC
55
Q

TFCC symptoms

A 
ulnar side wrist pain
swelling
loss of grip strength
inability to perform manual activity 
'click' with active ulnar deviation
56
Q

TFCC signs

A 
point tenderness distal to the ulnar styloid 
Pain with passive pronation/supination/ulnar deviation 
important to assess stability of DRUJ
-piano key test (PA ulna in pronation)
Shuck test (AP radius)
57
Q

TFCC confirmation

A 
plain view radiology 
-determine ulnar variance 
Wrist arthrography 
MRI 
Arthroscopy
58
Q

TFCC treatment

A

TFCC injury without DRUJ instability

  • immobilisation 4/52 (Sl. flexion/ulnar dev)
  • injection local anesthetic/corticosteroid

TFCC injury with DRUJ instability
-surgical reconstruction

Musculoskeletal Physiotherapy 2 (10 decks)

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