wirst and hand patho Flashcards
Pathologies of the hand and wrist (6)
De Quervain’s Tenosynovitis
Trigger fingers
Dupuytren’s contracture
OA
CTS
Fractures
Classification of hand and wrist disorders (4)
soft tissue
fracture
joint
nerve entrapment
CTS: entrapment neuropathy of the ____ N within carpal tunnel
Median
CTS: __ flexors puls___ N
9 flexors, median N
CTS: anything that ____ space within carpal tunnel
reduces
CTS: F >/< M? Ratio
F>M; 3:1
CTS: age?
45-54
CTS: risk factors (5)
F,
45-54 y/o
obesity
occupation
pregnancy
CTS: presentation (7)
Paraesthesia/____
_______symptoms
AGGs: ______ positions
_____ relieves
wasting of _____ muscles
+ve ____&____test
_____if diagnostic uncertainty
numbness
nocturnal - irritate cuz hand flexion
prolonged
shaking
thenar
phalen, Tinels
NCS = Nerve conduction study
CTS tx (6)
splinting
Ex (mobilizing N and tendons, proximal mobilisation)
Ergonomics (task breaks, posture)
MT
Injection
Decompression Surgery (if any motor weakness, affecting QOL, transverse carpal ligament release)
DQT full name
De Quervain’s Tenosynoitis
DQT: Affects tendons of the ______ and ______ in the first dorsal compartment
ABDuctor pollicis longus (APL)
Extensor pollicis brevis
DQT: tendons and sheath become ______
thickened
DQT gender ratio
F>M; 4:1
DQT risk factors (5)
F>M
pregnancy/post partum. Hormonal changes?
OA
May follow traumatic incident or cumulative micro-trauma
Occupation/Repetitive activity
DQT presentation (4)
tenderness over ____ +/-___
pain on ____/____, _____, ____sign
may get _____
+ve____ Test
Radial styloid; Swelling
Gripping, UD, scissors (radial N), hitchhiker sign
Crepitus
Finkelsteins’ test
DQT Tx (8)
Activity mod
Splinting regime - gradual return to load
Reduce inflammation (ice/NSAIDs)
Mobilization (dart throwers position)
Gradual re-loading (grip and hold>add weigth>add mvmt)
Consider higher up the chain (elbow and shoulder)
Steroid injection
Decompression surgery
Trigger finger:
commonly at the tunnel b//w __ and ___ pulley.
____ of the tendon OR _____ of the sheath
May form a ____
Metacarpal and A1.
Thickening; Tightening
Nodule
Trigger finger:
commonly ___, ____ and ____ finger affected
thumb, middle, Ring
1, 3, 4th
Trigger finger risk factor:
F>/< M
Repetitive ___ or direct ____ from tool use
F>M
gripping; compression
Trigger finger Presentation Grade 1: ____ and point ___
2: demonstrable ____ but ___ ROM
3: demonstrable ____ required passive ______
4: locked in a ____ position
Pain, point tenderness.
Catching but Full ROM.
Catching; passive extension.
Flexed position
Trigger finger Tx (7)
_____ modification
Night extension ____; ___wks
Reduce _____ (i.e.___&___)
Tendon ____ Ex (FDS and FDP)
Gradual ____
____ Injection
____ Surgery
Activity
Splinting; 3-6 wks
Inflammation (ice/NSAIDs)
Tendon Gliding
Gradual reloading
Steroid
Decompression
Trigger finger decompression surgery only when ____
nodule is palpable and affective ADLs and painful and struggling (grade 4)
Trigger finger: Splint ___ and or ____, ___ joint into extension? gradual reloading; ____ mvmt into ___ mvmt? work on ____ grip?
MCP, DIP, PIP; smaller into bigger; HOOK
Dupuytren’s contracture:
Benign ___ of the palm’s deep ______ (fascia)
thickening; deep connective tissue
Dupuytren’s contracture: cause?
Unknown cause. Genetic w env factor
Dupuytren’s contracture:______ but functionally disruptive
non-painful
Dupuytren’s contracture risk factors: (4)
Gender; Earlier onset for__
Age
predominantly __ and __ digits
can be ____ to other conditions (e.g. __&__)
M>F; 2:1 ratio. Men
Prevalence increases w AGE
4th and 5th fingers
2nd; diabetes and alcoholism
Dupuytren’s contracture Presentation (2)
palpable____
_____ restriction
palpable nodules/cords
functional restriction
Dupuytren’s contracture Tx (4)
___ = gold standard
____ post surgery
___management and ____ important
_____ aponeurectomy
_____ injection
fascietomy.
splinting.
wound; Ex.
Needle.
Collagenase
Dupuytren’s contracture: Why Most ppl don’t need intervention
it resolves naturally
Distal Radius Fractures: most common types?
Colles, Smith’s
Colles fracture is ?
FOOSH
Smiths fracture is?
fall on the dorsal side of hand with a flexed wrist
most common fracture site of hand
distal 3rd radius
Colles fracture:
classic ____ deformity
F ? M
Common to get ___ pain
___ & ____ usually most restricted
dinner fork
F>M
ulnar side
Ext & sup
Colles fracture complications (4)
nerve.
CRPS.
healing?
rupture?
Nerve injury: commonly median N (CTS)
complex regional pain syndrome (risk following Hand / Foot injury)
Malunion
Rupture EPL - check with thumb lift
Colles management
___ if displaced
_____ cast - leave ___ free
___ wks immobilization
if unable to reduce or unstable ->?
physio rehab to regain ____
MUA = Manipulation under anaesthesia
short arm cast; MCP
4-6 wks
ORIF
regain function
fracture: how physio regain function (7)
reassurance/advise/education
reduce swelling
ROM
re-educate sensory input
strength
proprioception (inc WB)
Function (individualize)
OA mechanical; common sites (3)
DIP Heberden’s nodes
PIP Bouchard’s nodes
Thumb bsae (1st CMC or STT)
where is Heberden’s nodes
DIP
where is Bouchard’s nodes
PIP
what is STT joint
joint involving the scaphoid, trapezium, trapezoid
OA risk factors (6)
age >40
F
family history
occupation
obesity
previous joint injury
OA presentation (7)
pain typically around ____
____mins morning stiffness
pain with _____ mvmt (very disabling)
_____ around CMC joint
_____ deformity - CMC joint collapses ____
Stiffness (loss of ____)
+ve ____ test
base of thumb (C-sign)
<30 mins
gripping, twisting, lifting
swelling
Zig Zag; inwards
opposition
Grind test
OA management (8)
Ex
ROM
strengthening/inc load tolerance
proprioception
MT
splinting
injection
surgery - trapeziumectomy
Joint protection (5)
____over several joints
use _____ to help w momentum w lifting
try _____ position
use ____ rather than one
_____ load when possible
spread load
wider kinetic chain
alternative grip
2 hands
break up
dynamometers:
useful for ___
diff >?% considered clinically sig
best of ?# efforts
setup doesn’t matter so long as it _____
____ usually most powerful
also have one for ___ grip
obj measurement of grip strength
>10%
3 efforts
remains consistent
held at side in standing
key/pinch grip
