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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
Q

barton fracture

A

intraarticular
subluxation of carpals dorsal or volar with displaced radius fragment

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26
Q

Chauffeurs fracture

A

oblique through base of radial styloid

27
Q

die punch fracture

A

depressed fracture fo artixular surface opposite of lunate/scaphoid

28
Q

subjective of radius fracture

A

acute pain
tenderness
sweling
deformity
N/T
Hx of FOOSH

29
Q

objective of radius fracture

A

swelling
deformity
discoloration
superficial injury
decreased sensation to median/radial/ulnar nerves
decreased circulation to hand

30
Q

interventions of distal radius fractures

A

while Fx heals: AROM shoulder, elbow, fingers all directions
after immobilization supination/pronation most limited in ROM, start PROM then AROM

31
Q

scaphoid fracture

A

most common carpal fracture
in both distal and proximal rows, vulnerable to FOOSH

32
Q

s/s of scaphoid fracture

A

local tenderness
pain over snuffbox
compress thumb, reproduce pain
traumatic Hx
could develop avascular necrosis

33
Q

subjective of scaphoid fracture

A

Hx of FOOSH
dorsal wrist pain
snuffbox tenderness

34
Q

objective of scaphoid fracture

A

palpation of snuffbox tender
decreased AROM of wrist by 50%
decreased grip strength
normal neuro

35
Q

scaphoid fracture intervention

A

immobilization in cast, position varies
AROM early, PROM after 2 weeks
gentle strengthening

36
Q

gamekeeper’s thumb

A

injury to UCL by injury or repeated use
instability at MCP joint

37
Q

subjective of gamekeeper’s thumb

A

pain and swelling along ulnar MCP joint
pain
weakness
loss of stability (chronic)

38
Q

objective of gamekeeper’s thumb

A

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
Q

special tests gamekeeper’s thumb

A

test MCP stability in full extension, 30 degrees flexion to stress accessory and ulnar collateral ligaments

40
Q

gamekeeper’s thumb interventions grades 1/2

A

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
Q

gamekeeper’s thumb interventions grade 3

A

surgery and immobilization
thumb spica cast x3 weeks + 2 weeks splinting
start AROM flexion/extension out of cast
same rehab progression

42
Q

thumb OA

A

40+ y/o
increased likelihood with hx of injury
increased ADL difficulty

43
Q

s/s of thumb OA

A

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
Q

surgical ligament reconstruction in thumb

A

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
Q

surgical ligament reconstruction and tendon interposition

A

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
Q

total joint arthoroplasty of thumb

A

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
Q

fusion of thumb arthorodesis

A

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
Q

flexor digitorum profundus avulsion

A

avulsion of FDP, most common in ring finger
from hyperextension stress to flexed finger
no characteristic deformity

49
Q

flexor digitorum profundus avulsion subjective

A

history of trauma to the digit

50
Q

flexor digitorum profundus avulsion objective

A

inability to flex dip when PIP held in extension
tenderness along flexor tendon sheath/palm

51
Q

flexor digitorum profundus avulsion intervention

A

surgical

52
Q

trigger finger

A

inflammation of flexor tendons
tendons thicken/narrow crossing MCP heads on palm, causing painful snapping
thumb/middle/ring fingers

53
Q

objective of trigger fingers

A

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
Q

trigger finger interventions

A

reduce swelling and inflammation
corticosteroid injections
often chronic/recurring

55
Q

mallet finger

A

finger deformity caused by damaged extensor tendon
DIP unable to extend

56
Q

mallet finger MOI

A

object strikes tip of finger
force damages tendon to straighten DIP

57
Q

mallet finger intervention

A

surgery to reattach tendon w splint 6-8 weeks
extension block k wire for 4 weeks
avoid all flexion to allow healing

58
Q

boutonniere deformity

A

injury to tendons straightening PIP of finger
flexion of PIP with hyperextension of DIP

59
Q

boutonniere deformity MOI

A

forceful blow to dorsal side of flexed PIP joint
or cut to top of finger severing tendon from attachment to bone
arthritis

60
Q

s/s of boutonniere deformity

A

finger can’t be straightened at PIP
DIP can’t be bent
swelling
pain top of middle joint of finger

61
Q

boutonniere deformity treatment

A

splint to straighten finger
join ends of tendon to allow healing

62
Q

swan neck deformity

A

PIP extended
DIP flexed

63
Q

swan neck MOI

A

weakness/tearing of ligament/tendon

64
Q

swan neck treatment

A

splint/brace
surgery
joint replacement

517 Ortho (11 decks)

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