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517 Ortho > Wrist > Flashcards

Wrist Flashcards

1
Q

ligaments of the wrist

A

radioulnar: strengthens capsule ant/post
radiocarpal ligaments:
- palmar: radius to proximal carpals
- dorsal: same attachments, weaker
radial collateral: styloid to scaphoid
ulnar collateral: styloid to pisiform/triquetrium

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2
Q

radiocarpal joint open pack

A

neutral, slight ulnar deviation

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3
Q

radiocarpal joint closed pack

A

full extension with radial deviation

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4
Q

tfcc
name and function

A

triangular fibrocartilage complex
functions as disc to transfer load from hand to forearm

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5
Q

radial pain indicates

A

fracture of scaphoid if post traumatic
nontraumatic, deQuervain’s tenosynovitis

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6
Q

ulnar pain indicates

A

trauma: tear of TFCC

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7
Q

anterior wrist pain indicates

A

carpal tunnel, ganglion cyst, tenosynovitis

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8
Q

law of repetitive motion

A

I=NF/AR
I = insult
N = number of reps
F = force of each rep
A = amplitude of rep
R = relaxation btwn reps
insult greater with greater reps and force and smaller amplitude with less relaxation

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9
Q

carpal tunnel definition

A

median nerve compression/neuropathy under the transverse carpal ligament of the wrist

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10
Q

associations with carpal tunnel

A

pregnancy
diabetes
tumors

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11
Q

boundaries of the carpal tunnel

A

palmar aspect
scaphoid, trapezium, capitate, hook of hamate, pisiform, transverse carpal ligament

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12
Q

carpal tunnel subjective

A

numbness, median nerve distribution esp tips of first 3 fingers
forearm/wrist pain
waking up from sleep due to pain
discomfort with wrist flexion in activity

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13
Q

carpal tunnel objective

A

thenar atrophy
median n distribution numbness/parasthesia

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14
Q

carpal tunnel special tests

A

Phalen
Tinel
Carpal compression test

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15
Q

de Quervain’s tenosynovitis

A

inflammation of extensor/abductor tendons of thumb

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16
Q

cause of de Quervain’s tenosynovitis

A

repetitive or unaccustomed use of thumb

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17
Q

subjective of de Quervain’s tenosynovitis

A

wrist pain, radial side along line of tendon
difficulty grasping/gripping

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18
Q

objective of de Quervain’s tenosynovitis

A

radial nerve parasthesia if swelling at radial styloid process
PTP at radial styloid

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19
Q

special tests de Quervain’s tenosynovitis

A

finkelstein’s
WHATs
Eichoff

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20
Q

de Quervain’s tenosynovitis interventions

A

reduce inflammation w: splinting, steroid injection, thermal modalities
start w gentle AROM -> isometrics -> concentrics

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21
Q

deprytrens disease

A

fibroproliferation of palmar fascia creating contracture
often not treated by PT

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22
Q

distal radius fracture types

A

colles
smith
barton
chauffeurs
die punch

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23
Q

colles fracture

A

most common
distal radius fracture fragment tipped dorsally
MOI: FOOSH

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24
Q

smith fracture

A

distal radius fracture fragment tipped palmarly
MOI: fall on back of hand

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25
barton fracture
intraarticular subluxation of carpals dorsal or volar with displaced radius fragment
26
Chauffeurs fracture
oblique through base of radial styloid
27
die punch fracture
depressed fracture fo artixular surface opposite of lunate/scaphoid
28
subjective of radius fracture
acute pain tenderness sweling deformity N/T Hx of FOOSH
29
objective of radius fracture
swelling deformity discoloration superficial injury decreased sensation to median/radial/ulnar nerves decreased circulation to hand
30
interventions of distal radius fractures
while Fx heals: AROM shoulder, elbow, fingers all directions after immobilization supination/pronation most limited in ROM, start PROM then AROM
31
scaphoid fracture
most common carpal fracture in both distal and proximal rows, vulnerable to FOOSH
32
s/s of scaphoid fracture
local tenderness pain over snuffbox compress thumb, reproduce pain traumatic Hx could develop avascular necrosis
33
subjective of scaphoid fracture
Hx of FOOSH dorsal wrist pain snuffbox tenderness
34
objective of scaphoid fracture
palpation of snuffbox tender decreased AROM of wrist by 50% decreased grip strength normal neuro
35
scaphoid fracture intervention
immobilization in cast, position varies AROM early, PROM after 2 weeks gentle strengthening
36
gamekeeper's thumb
injury to UCL by injury or repeated use instability at MCP joint
37
subjective of gamekeeper's thumb
pain and swelling along ulnar MCP joint pain weakness loss of stability (chronic)
38
objective of gamekeeper's thumb
local tenderness and swelling to palpation along ulnar MCP pain/excess motion with valgus stress test to UCL impaired MCP flexion/ext decreased pinching strength
39
special tests gamekeeper's thumb
test MCP stability in full extension, 30 degrees flexion to stress accessory and ulnar collateral ligaments
40
gamekeeper's thumb interventions grades 1/2
immobilize 1 and 2 grade tears with spica cast 2-3 weeks, splint 2 weeks start AROM flexion/extension at 2 weeks, strengthen at 8 weeks avoid abduction stress for 2-6 weeks
41
gamekeeper's thumb interventions grade 3
surgery and immobilization thumb spica cast x3 weeks + 2 weeks splinting start AROM flexion/extension out of cast same rehab progression
42
thumb OA
40+ y/o increased likelihood with hx of injury increased ADL difficulty
43
s/s of thumb OA
pain w ADLs including gripping, turning key, opening door, snapping fingers, opening containers swelling/tenderness at base of thumb aching after use loss of strength out of joint appearance bump over joint limited motion all directions
44
surgical ligament reconstruction in thumb
procedure to stabilize CMC using wrist flexor tendon to replace damaged ligament improves joint with laxity pain relief with early arthritis, but repair doesn't repair damaged cartilage
45
surgical ligament reconstruction and tendon interposition
ligament repair with wrist flexor as well as using a piece of tendon as a meniscus to keep bones separated also remove most of the trapezium improves arthritis by removing damaged joint surface long rehab process and immobilization
46
total joint arthoroplasty of thumb
remove damaged portions of thumb to replace with artificial part less invasive than repair bc no graft higher complications with spacers for high level of bone damage
47
fusion of thumb arthorodesis
fuse bones to reduce pain shape metacarpal and trapezium to fit together hold with metal pin used for traumatic injuries/arthritis, RA, second line treatment stable and pain free but decreases CMC mobility
48
flexor digitorum profundus avulsion
avulsion of FDP, most common in ring finger from hyperextension stress to flexed finger no characteristic deformity
49
flexor digitorum profundus avulsion subjective
history of trauma to the digit
50
flexor digitorum profundus avulsion objective
inability to flex dip when PIP held in extension tenderness along flexor tendon sheath/palm
51
flexor digitorum profundus avulsion intervention
surgical
52
trigger finger
inflammation of flexor tendons tendons thicken/narrow crossing MCP heads on palm, causing painful snapping thumb/middle/ring fingers
53
objective of trigger fingers
local PTP at base of finger crepitus moving nodular mass pain worse with stretch into extension or isometric flexion click/lock with active flexion lacking full finger flexion
54
trigger finger interventions
reduce swelling and inflammation corticosteroid injections often chronic/recurring
55
mallet finger
finger deformity caused by damaged extensor tendon DIP unable to extend
56
mallet finger MOI
object strikes tip of finger force damages tendon to straighten DIP
57
mallet finger intervention
surgery to reattach tendon w splint 6-8 weeks extension block k wire for 4 weeks avoid all flexion to allow healing
58
boutonniere deformity
injury to tendons straightening PIP of finger flexion of PIP with hyperextension of DIP
59
boutonniere deformity MOI
forceful blow to dorsal side of flexed PIP joint or cut to top of finger severing tendon from attachment to bone arthritis
60
s/s of boutonniere deformity
finger can't be straightened at PIP DIP can't be bent swelling pain top of middle joint of finger
61
boutonniere deformity treatment
splint to straighten finger join ends of tendon to allow healing
62
swan neck deformity
PIP extended DIP flexed
63
swan neck MOI
weakness/tearing of ligament/tendon
64
swan neck treatment
splint/brace surgery joint replacement

517 Ortho (11 decks)

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