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1022 THEORY > Week 9 Wrist > Flashcards

Week 9 Wrist Flashcards

1
Q

function of the wrist complex

wrist - allow 2 degrees of freedom

A
  • positioning of the hand
  • stability for WB
  • maintaining optimal length for the muscles responsible for grasp
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2
Q

radiocarpal joint

proximally, distally

A

proximally:
concave surface of radius, TFCC

distally:
convex surface of scaphoid, lunate and triquetrum

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3
Q

function of triangular fibrocartilage complex (TFCC)

A
  • stabiliser of the ulnar carpal bones and distal radioulnar joint
  • provides cushion/ load-bearing surface at the wrist joint during WB on hands or pushing
  • WB: radius -80%, ulna -20%
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4
Q

role of wrist ligaments

A
  • provide stability
  • transfer forces through and across the carpal bones
  • limit unwanted movements
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4
Q

describe midcarpal joint

A
  • proximal row jointed losely, distal row is bound tightly by strong ligaments
  • functional joint
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4
Q

wrist complex: midcarpal joint

A
  • *lunate is the most commonly dislocated carpal bone *
  • important role of scaphoid and proximal carpal row: acts as an ‘intercarpal bridge’
  • implication: without the scaphoid and the central radio-luno-capitate link, the wrist would be unstable under compression loads
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4
Q

extrinsic wrist ligaments

A
  1. dorsal radiocarpal ligament
  2. palmar radiocarpal ligament
  3. radial collateral ligament
  4. ulnar collateral ligament
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5
Q

intrinsic wrist ligaments

A
  1. palmar ligaments
  2. dorsal intercarpal ligaments
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6
Q

wrist movement

A
  • motion occurs simultaneously at radiocarpal and midcarpal joints
  • this allows greater total ROM and more stable arc of motion in all planes
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7
Q

wrist complex AROM

degrees of wrist F, E, radial and ulnar deviation

A

wrist flexion: 65-80 degrees
wrist extension: 55-70 degrees
radial deviation: 15 degrees
ulnar deviation: 30 degrees

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8
Q

wrist extension movement

A
  • proximal carpal bones slides anteriorly and roll posteriorly
  • limit to extension: *palmar radiocarpal ligament *, dorsal lip of radius impinges on carpus
  • close packed position
  • as the palmar radiocarpal ligaments tighten, creating a sling across the scaphoid/ lunate, causing *proximal and distal rows to rotate together *
  • damange to scapholunate/ lunotriquetral ligamnets = instability and decreased range and function at wrist
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9
Q

wrist flexion movement

A
  • slides posteriorly and rolls anteriorly
  • limit to flexion: tension dorsal radiocarpal ligaments, posterior capsule
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10
Q

wrist movement: radial deviation

A
  • roll radially and slide in ulnar direction (in both distal and proximal carpal rows)
  • also moves anteriorly in proximal carpal row
  • anterior movement of proximal row occurs due to ‘pushing’ forces of contacting articular surfaces and ‘pulling’ forces sue to ligament tension
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11
Q

wrist movementL ulnar deviation

A
  • roll ulnar side and slide in radial side (in both the distal and proximal carpal bones)
  • also moves posteriorly in proximal carpal row
  • palmar ligaments play large role in guiding carpal movement
  • highly variable and complex
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12
Q

if wrist extension was limited by stiffness, which accessory movement of the radiocarpal joint might you consider for mobilisation treatment?

A

PA glide extension

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13
Q

wrist musculature 手腕肌肉組織

A

wrist complex provides
- stable base for hand
- optimmal length-tension ratio of long finger muscles

14
Q

wrist musculature: flexors

A
  • 6 main muscles
  • much stronger than extensors
  • flexor retinaculum
    ~~~
  • force in dependent on wrist extension
  • finger flexion is modified by intrinsic muscles of the hand
    ~~~
15
Q

why are extensors so important?`

A
  • stabilise and position the wrist for effective use of long finger flexors
  • contraction of long finger flexors causing wrist flexion torque at the same time = active insufficiency
  • wrist extends as fingers flex to maintain length tension
16
Q

functional position of the wrist

A
  • **15-20 degrees extension and 10 degrees ulnar deviation **
  • implications: stiff, painful, weak/ unstable wrist often assumes a posture that interferes 干擾 with the optimal length of finger muscles –> limits effectie hand function
  • position for surgical fusion/ immobilisation due to injury
17
Q

common mechanisms of wrist injury

A
  1. impact
  2. weight bearing
  3. twisting
  4. throwing
18
Q

colles’ fracture

mechanism, diagnosis, management

A
  • mechanism: fall on outstretched hand (extension)
  • dinner fork deformity
  • diagnosis: pain, swelling, restricted wrist ROM
  • management:
    1. GAMP (general anesthetic manipulation or gap)
  • non-displaced 無移位 or minimally displaced fractures with only monir comminution 粉碎性骨折, casted for 6/52 until bony union
    1. ORIF
  • plate or pin fixation
  • shorter period of immobilisation
  • 3-4/52
  • potential consequences 潛在後果:
  • radial shortening –> wrist to OA and stiffness

epiphyseal fractures are common in children 6-10 years.

19
Q

position of safe immobilisation

POSI of colles’ fracture

A

- wrist 20-30 degrees extension and slight ulnar deviation
- MCP joints: 45-70 degrees flexion
- IP joints: extension volar plate taut
- flexion for prolonged period = contractures of volar plate
**- thumb: 45 degrees abduction **

20
Q

opposite to colles’ fracture

smith’s fracture

A
  • mechanism: backward fall on the palm of an outstrected hand (flexion)
  • classification:
  • type I: extra articular
  • type II: crosses into the dorsal articular surface
  • type III: enters radiocarpal joint
21
Q

scaphoid fracture

A
  • mechanism: fall on outstretched hand (wrist extension and radial deviation)
  • diagnosis: pain on wrist and thumb movement (tender snuffbox palpation)
  • can be missed on x-ray in early stages - may not show for 10-14 days (need to repeat X-rays or CT scans)
  • management: cast including thumb for 6-12 weeks (unstable fractureL internal fixation)
  • complications: non union 骨折不癒合, avascular necrosis 缺血性壞死 due to poor blood supply, wrist instability
  • physio aims: same as colles
22
Q

gaining ROM post fracture

A
  • focus on AROM
  • **no overpressure **
  • be very **wary 警惕 of pain at # site **
  • **be careful of added resistance **
  • no strength testing/ strength exercises until # union
23
Q

lunate fractures

A
  • mechanism: wrist hyperextension
  • surgery required
24
Q

ligament injuries of the wrist

A
  • scapholunate ligament tear –> results in ‘Terry Thomas sign’
  • Watson’s test –> positive if pain
  • conservative or surgical management –> decrease ROM wrist complex

conservative management: eg: muscular strengthening, proprioceptive training, and coordination training

25
Q

triangular fibro-cartilage complex (TFCC)

A
  • *major stabiliser of ulna and carpus and distal R-U joint *
    -** common site of ulnar wrist pain **
  • mechanism: high compressive loads with ulnar deviation
  • MRI
  • surgery: shorten ulna
26
Q

**carpal tunnel syndrome (CTS) **

causes, sings and symptoms, special tests, management

A
  • neuropathy due to compression of median nerve in carpal tunnel
  • common causes: gripping, overuse of wrist/ finger flexors (typing)
  • conditions with increased fluid retention eg: pregnancy, lymphoedema
  • signs and symptoms: numbness and pain in palmar aspect lateral 3.5 fingers, wrist and hand weakness - thumb (median nerve), worse through night and in morning, eased with activity, wasting of thenar muscles (thumb)
  • special tests: Tinel’s sign, Phalen’s sign (wrist in full flexion for 30-60 seconds), nerve conduction tests of medial nerve
  • management: convervative (RICE, NSAIDS), surgical (decompression of carpal tunnel)

more common in women 40-60 years old

27
Q

6 steps that causes CTS

A

step 1: increase pressure in carpal tunnel
step 2: reduce blood to median nerve
step 3: reduce oxygen to nerve
step 4: inflammation of perinurium
step 5: blocking of neural transmission/ axoplasmic transport
step 6: atrophy of median nerve

28
Q

De Quervain’s Tenosynovitis

signs and symptoms, diagnosis, management, complications

A
  • **tendinopathy of ther APL and EPB tendons **
  • signs and symptoms: pain, swelling, history of repetitive forceful gripping coupled with ulna deviation - most cases
  • diagnosis: Finkelstein’s test (ulnar deviation of the wrist with the fist closed over the flexed thumb, positive if pain)
  • management: decrease pain/ inflammation, increase flexibility EPB/ APL (massage and stretch), increase strength EPB/ APL (use eccentric and concentric with caution)
  • complications: painful scars, tendon adhesions, subluxation of tendons

corticosteroid injections are often required, if these treatments fail, surgical release maybe necessary

29
Q

wrist injuries - aims of physio management

A
  • increase/ restore joint ROM
  • increase/ restore muscle length, strength
  • increase/ resotre function (gross motor and fine motor)
  • proprioceptive retraining
  • decrease pain/ swelling

1022 THEORY (11 decks)

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