WRIST Flashcards
assessment for joint mobs (and the wrist joint mobs themselves) for the “true” wrist joint is done with palm how
palm down for all except for post glides it’s palm up
radial glide would mean pushing towards
radial side
skilled activity of the hand requires ___ degrees of wrist flexion and ___ degrees of wrist ext
10
30 -35
resting position of wrist is
10 degrees flexion with slight ulnar deviation
closed packed wrist is
extension and radial deviation
for all joint mobs of true wrist joint, your stabalization is where
AT STYLOIDS
post wrist glide helps with
flexion
ant wrist glide helps with
ext
radial glide of wrist helps with
ulnar dev
ulnar glide of wrist helps with
radial dev
all wrist mobs are done in palm down except
post is done palm up
radial and ulnar glides of the wrist are special with what motion
cresent shape
mid carpal joint mobs and assessment, which are palm up/down
for midcarpals, only post glide is palm up
where do you stabalize for mid carpal joint play
distal to the styloids
if there is an issue with wrist flexion, where will a lesion or malformity probably be found (which joint)
midcarpal
post glide of mid carpals helps with
flexion
ant glide of mid carpals helps with
ext
if you mob the pisiform for ulnar entrapment at guyon, mob it in what direction
proximally
what 2 muscles attach at pisiform
FCU
ABD DIG MINIMI
what direction does lunate usually dislocate
ant or volarly
the thumb CMC (or the trapezio MC joint) is a ___ joint
saddle
all thumb CMC mobs are done with palm
up
thumb CMC post glide helps with
abd
thumb CMC ant glide helps with
adduction
thumb CMC radial glide helps with
ext
thumb CMC ulnar glide helps with
flexion
explain inter MC joint mobs
like we did for toes, wiggle webbing
what movements would increase arch
post 3
ant 2, 4, 5
thumb mcp mobs are done palm
up
thumb mcp ant glide helps with
flexion
thumb mcp post glide helps with
ext
MCP of 2-5, mobs are done palm
up
MCP 2-5 post helps with
ext
MCP 2-5 ant glide helps with
flexion
MCP 2-5 radial glide helps with
abd for digit 2
add for 4 and 5
MCP 2-5 ulnar glide helps with
add for digit 2
abd for 4 and 5
IP post glides help with
ext
IP ant glides help with
flexion
so all CMC/IP are done
palm up
only specifics of palm up and palm down are done
wrist or carpals/midcarpals
px over radial styloid area with gripping activities or abd think what pathology
dequarvains
Insidious onset of numbness and tingling in 1st 3 fingers; may complain of worse pain at night…pathology
CTS
Paresthesias over dorsal aspect of ulnar border of hands and fingers 4-5…pathology
ulnar nerve compression at guyons
inability to extend MCP or IP joints…..pathologies
Dupuytren’s contracture, Trigger finger
palpable bony nodules on lateral and dorsal surfaces of DIPs (associated with OA)
Haberdans nodes (OA)
if the bony nodules are found on the PIP joints they are called
Bershards
list the arches of the wrist
long
transverse over MC
transverse over carpals
motor nerve to adductor pollicus
ulnar
first dorsal compartment tenderness, you need to rule out
dequarvains
what is full excursion
opposite of blocked measurement (allowing all joints to be in motion as you measure)
explain wrist length measurements (extensors)
ELBOW FLEXED FIRST THEN ELBOW EXTENDED AND YOU MEASURE WRIST FLEXION, IF SECOND IS SMALLER THEN THEY ARE TIGHT
extensors are short if wrist flexion with the elbow extended is less than wrist flexion with elbow flexed (short if second is less than first)
explain wrist length measurement for flexors
ELBOW FLEXED FIRST THEN ELBOW EXTENDED AND YOU MEASURE WRIST EXT. IF SECOND MEASUREMENT IS SMALLER THAN THE FIRST THEY ARE TIGHT.
if wrist extension with elbow extended is less than with elbow flexed they are tight (if second is smaller than first)
lateral pinch tests what muscle and nerve
adductor pollicis/ulnar
what do you watch for with fromonts or lateral pinch
dont let them flex the thumb
3 special tests for scaphoid fracture
snuff box tenderness
compression test
supination with resisitance
explain supination with resistance test
pt is trying to pronate while you are trying to pull them into supination
phalans and reverse phalans you hold for ___ sec
60
what are the 4 tests for carpal tunnel
phalans
reverse phalans
tinnels
compression
how long do you hold the compression test for for carpal tunnel
30 sec (therapist uses both of their thumbs)
what is the watsons/scaphoid shift test
you start with wrist extension and ulnar deviation as you apply pressure on the scaphoid then quickly radial deviate and wrist flex
dequarvains is usually what tendons
abductor pollicis longus and extensor pollicis brevis
what 3 muscles make the snuff box
abductor polli longus and ext polli brevis
ext polli longus (one on more dorsal/top that is alone)
explain a pos bunnel littner test
you measure the PIP of finger with MCP in neutral first, then you put MCP in flexion and PIP flexed (measure PIP) and if the PIP moves into more flexion with the MCP flexed= tight intrinsic muscles
what is the cut off for “normal” for the volume test
10 mls
oblique retinacular lig helps with ___ but helps prevent __
helps with DIP ext but prevents hyper ext
explain how oblique retinaculum helps with extension
As PIP actively extends – it puts tension on oblique ret. Lig, which helps DIP ext
what is the TFCC
Fibrocartilage disc b/t distal ulna and carpals in medial wrist
Contains Dorsal and volar radio-ulnar ligaments
Ulnar-carpal ligaments
function of TFCC
Primary function is to enhance joint congruency and cushion against compressive forces
what muscle attaches to the TFCC
ECU
muscles connected to the extensor hood
ED
EDM
EI
structures that go through the carpal tunnel
4 FDP tendons, 4 FDS tendons, Median N, FPL tendon
funtional mvmts of wrist involve
extension, ulnar deviation
open packed of distal RU joint
10 degrees sup
where is the TFCC
btwn ulna and carpals
midcarpal joint consists of
some lovers try
radio carpal joint consists of
radius
tfcc
scaphoid
MCPs resting position (other than thumb)
slight flexion
what goes through the carpal tunnel
median N
FDS
FDP
FPL
then on top is the palmaris longus
TFCC is on what side of wrist
medial
only extrinsic forearm muscle to insert on a carpal bone
FCU
tenodesis is what
floppy wrist makes motions
tunnel of guyon is btwn
pisiform and hook of hammate
serves as passage for ulnar N and ulnar A to get into hand
tunnel of guyon
3 common deformaties seen in hands of pts with RA
boutoneirres
ulnar drift
swan
to tx RA, what always is done
active and isometric ex for all motions
ulnar drift (with RA) occurs bc of
damage to collateral lig and extensors
with ulnar drift, there can be up to ___ degrees of lateral shift at the mcp
45 of mcp
boutoneiires
flexion of PIP ext of DIP
bouton deformity is dt what
damage to the slip
common ext tendon that inserts on the base of the middle phalanx is damaged
boutonieres results in faulty
lateral bands in the extensor mech
lateral bands cause hyper ext of dip
if there is 30 degrees of ext lag at the PIP suspect
boutonieres
how to splint for boutoneires
just do the PIP in ext and keep others free
with boutonieres, the lateral bands drift
forward
with swan neck deformity, the lateral bands drift
dorsally
Destruction of oblique retinacular ligament of the extensor mechanism leads to posterior displacement of the lateral bands
swan neck deformity
what is swan neck deformity
ext of pip
flexion of dip
FDP flexes
distal
FDS flexes
proximal
Medial wrist pain distal to the ulna, increased with end-range forearm pronation/supination and forced gripping
Painful click during wrist motions
Tenderness localized to distal to ulnar head
Pain with ulnar (compression) and radial deviation (stretch)
TFCC
TFCC has
clicking popping
with TFCC you want to avoid what motions
pro and sup
TFCC movement dx (one of 2)
wrist flexiion with pronation
wrist ext with pronation
OA of hand is usually where
usually 1st CMC
should you always trust plain film imaging if you suspect scaphoid fx
no - need a bone scan
nodules in palmar hand
Higher incidence alcoholic, diabetic, epileptic, tobacco
Inability to straighten fingers, primarily 4th and 5th (cannot even PROM extend them)
dupytren contracture
pain at ulnar side of 1st mcp (in the webspace) joint look into
game keepers thumb or UCL sprain
tenosynovitis is
inflammation of the sheath (have had tendoitis for a period and it’s getting worse)
dull ache radial side
Local swelling and tenderness in region radial styloid
can creak or have palpable lumpy feel
dequarvains
with trigger finger, what can’t they do
you can PROM but they cannot AROM
what is trigger finger
tendons get caught in the sheaths
tendon gliding exersion exercises progression
Straight hand
Hook hand – greatest excursion between FDP and FDS
Full fist – full excursion FDP
Flat fist – full excursion FDS
traumatic disruption of the terminal tendon (DIP ext)
jammed
mallet finger
mallet finger can be ____ moved
passively (they just cant AROM)
CTS sx are usually worse
at night
claw hand (median N) effects what muscles
lumbricals (they arent working so the PIPs are in flexed contracture)
ape hand is due to
median nerve palsy
describe ape hand
Thumb doesn’t abduct/oppose bc you lose thenar muscle ability from median nerve
wrist drop is due to ___ nerve
radial
Compression of the superficial sensory radial nerve (between ECRL and brachioradialis tendons)
Pain, paresthesias, numbness on radial aspects of hand and wrist
Whartonburg syndrome
claw hand for ulnar nerve effects which muscles
lumbricals
past trauma hyperalgesia edema skin changes all sound like
chronic regional px syndrome
or
reflex sympathetic dystrophy
colles fx is a radial fx that displaces
post
smith fx is a radial fx that displaces
ant
boxers fx is of the
5th metacarpal (most common MC fx)
Treat all wrist pain with swelling and pain in snuffbox as _____ until proven otherwise
scaphoid fx
lunate usually disclocates
palmarly or ant
dequarvains usually has
crepitus
OA vs RA
OA is in one joint only
RA multiple joints both sides
hook grip nerves
median and ulnar
power grip nerves
median and ulnar
lateral pinch uses what muscle and nerve
adductor poll
ulnar nerve
precision pinch is what n
median
cylindrical grip nerves
med
ulnar
rad
numbness and tingling in palmar of hand think
CTS
medial wrist px distal to the ulna, think
TFCC
problems Writing, typing, using scissors, grasping objects
OA
RA
inability to flex fingers/thumb or make a fist is what mvmt dx
insufficient flexion
list the hand/wrist mvmt dx
insufficient flexion (finger or thumb)
insufficient ext (finger or thumb)
insufficient abd or opp of thumb
thumb cmc hypermobility
explain thumb cmc hypermobility syndrome
px occurs at cmc but all thumb joints are effected
decreased pinch ocurs
big difference btwn whartonburg and dequarvain
whartonburg is sensory only
dequarvain has both sensory and motor
CTS mvmt dx
insufficient flexion
need to do imaging
ok
wrist joint (RC) and mid carpal joint play is
same
what links the PIP and DIP motions
oblique lig
the ext retinaculum and hood involve what muscles
ED
EI
EDM
then lumbricals and interossei
how to immobilize if central slip is damaged
they end up with boutoniers, so you extend the pip and leave the others alone
which hand pathology uses metal rings to correct
swan
explain physiology of swan vs boutoneir
bouoneirs - damage to the slip pulls lat bands ant
swan -damage to the obliqe lig pulls the bands post
FCU or abd dig minimi issues (motor) would make you think
ulnar nerve entrapment at guyons
cant extend distal phalange
mallet
how does the oblique ret lig help with extension of DIP
As PIP actively extends – it puts tension on oblique ret. Lig, which helps DIP ext
claw hand effects what muscles
lumbricals (ulnar or median)
wrist drop would be dt what
radial nerve issue
when doing mobs for fingers or thumbs, palm is
palm up
when doing mob assessment for wrist or mid carpals, their position is
all are palm down except post is palm up
