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MSK > WRIST > Flashcards

WRIST Flashcards

1
Q

assessment for joint mobs (and the wrist joint mobs themselves) for the “true” wrist joint is done with palm how

A

palm down for all except for post glides it’s palm up

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2
Q

radial glide would mean pushing towards

A

radial side

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3
Q

skilled activity of the hand requires ___ degrees of wrist flexion and ___ degrees of wrist ext

A

10

30 -35

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4
Q

resting position of wrist is

A

10 degrees flexion with slight ulnar deviation

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5
Q

closed packed wrist is

A

extension and radial deviation

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6
Q

for all joint mobs of true wrist joint, your stabalization is where

A

AT STYLOIDS

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7
Q

post wrist glide helps with

A

flexion

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8
Q

ant wrist glide helps with

A

ext

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9
Q

radial glide of wrist helps with

A

ulnar dev

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10
Q

ulnar glide of wrist helps with

A

radial dev

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11
Q

all wrist mobs are done in palm down except

A

post is done palm up

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12
Q

radial and ulnar glides of the wrist are special with what motion

A

cresent shape

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13
Q

mid carpal joint mobs and assessment, which are palm up/down

A

for midcarpals, only post glide is palm up

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14
Q

where do you stabalize for mid carpal joint play

A

distal to the styloids

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15
Q

if there is an issue with wrist flexion, where will a lesion or malformity probably be found (which joint)

A

midcarpal

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16
Q

post glide of mid carpals helps with

A

flexion

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17
Q

ant glide of mid carpals helps with

A

ext

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18
Q

if you mob the pisiform for ulnar entrapment at guyon, mob it in what direction

A

proximally

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19
Q

what 2 muscles attach at pisiform

A

FCU

ABD DIG MINIMI

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20
Q

what direction does lunate usually dislocate

A

ant or volarly

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21
Q

the thumb CMC (or the trapezio MC joint) is a ___ joint

A

saddle

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22
Q

all thumb CMC mobs are done with palm

A

up

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23
Q

thumb CMC post glide helps with

A

abd

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24
Q

thumb CMC ant glide helps with

A

adduction

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25
Q

thumb CMC radial glide helps with

A

ext

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26
Q

thumb CMC ulnar glide helps with

A

flexion

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27
Q

explain inter MC joint mobs

A

like we did for toes, wiggle webbing

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28
Q

what movements would increase arch

A

post 3

ant 2, 4, 5

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29
Q

thumb mcp mobs are done palm

A

up

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30
Q

thumb mcp ant glide helps with

A

flexion

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31
Q

thumb mcp post glide helps with

A

ext

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32
Q

MCP of 2-5, mobs are done palm

A

up

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33
Q

MCP 2-5 post helps with

A

ext

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34
Q

MCP 2-5 ant glide helps with

A

flexion

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35
Q

MCP 2-5 radial glide helps with

A

abd for digit 2

add for 4 and 5

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36
Q

MCP 2-5 ulnar glide helps with

A

add for digit 2

abd for 4 and 5

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37
Q

IP post glides help with

A

ext

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38
Q

IP ant glides help with

A

flexion

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39
Q

so all CMC/IP are done

A

palm up

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40
Q

only specifics of palm up and palm down are done

A

wrist or carpals/midcarpals

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41
Q

px over radial styloid area with gripping activities or abd think what pathology

A

dequarvains

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42
Q

Insidious onset of numbness and tingling in 1st 3 fingers; may complain of worse pain at night…pathology

A

CTS

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43
Q

Paresthesias over dorsal aspect of ulnar border of hands and fingers 4-5…pathology

A

ulnar nerve compression at guyons

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44
Q

inability to extend MCP or IP joints…..pathologies

A

Dupuytren’s contracture, Trigger finger

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45
Q

palpable bony nodules on lateral and dorsal surfaces of DIPs (associated with OA)

A

Haberdans nodes (OA)

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46
Q

if the bony nodules are found on the PIP joints they are called

A

Bershards

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47
Q

list the arches of the wrist

A

long
transverse over MC
transverse over carpals

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48
Q

motor nerve to adductor pollicus

A

ulnar

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49
Q

first dorsal compartment tenderness, you need to rule out

A

dequarvains

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50
Q

what is full excursion

A

opposite of blocked measurement (allowing all joints to be in motion as you measure)

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51
Q

explain wrist length measurements (extensors)

A

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)

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52
Q

explain wrist length measurement for flexors

A

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)

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53
Q

lateral pinch tests what muscle and nerve

A

adductor pollicis/ulnar

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54
Q

what do you watch for with fromonts or lateral pinch

A

dont let them flex the thumb

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55
Q

3 special tests for scaphoid fracture

A

snuff box tenderness
compression test
supination with resisitance

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56
Q

explain supination with resistance test

A

pt is trying to pronate while you are trying to pull them into supination

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57
Q

phalans and reverse phalans you hold for ___ sec

A

60

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58
Q

what are the 4 tests for carpal tunnel

A

phalans
reverse phalans
tinnels
compression

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59
Q

how long do you hold the compression test for for carpal tunnel

A

30 sec (therapist uses both of their thumbs)

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60
Q

what is the watsons/scaphoid shift test

A

you start with wrist extension and ulnar deviation as you apply pressure on the scaphoid then quickly radial deviate and wrist flex

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61
Q

dequarvains is usually what tendons

A

abductor pollicis longus and extensor pollicis brevis

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62
Q

what 3 muscles make the snuff box

A

abductor polli longus and ext polli brevis

ext polli longus (one on more dorsal/top that is alone)

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63
Q

explain a pos bunnel littner test

A

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

64
Q

what is the cut off for “normal” for the volume test

A

10 mls

65
Q

oblique retinacular lig helps with ___ but helps prevent __

A

helps with DIP ext but prevents hyper ext

66
Q

explain how oblique retinaculum helps with extension

A

As PIP actively extends – it puts tension on oblique ret. Lig, which helps DIP ext

67
Q

what is the TFCC

A

Fibrocartilage disc b/t distal ulna and carpals in medial wrist
Contains Dorsal and volar radio-ulnar ligaments
Ulnar-carpal ligaments

68
Q

function of TFCC

A

Primary function is to enhance joint congruency and cushion against compressive forces

69
Q

what muscle attaches to the TFCC

A

ECU

70
Q

muscles connected to the extensor hood

A

ED
EDM
EI

71
Q

structures that go through the carpal tunnel

A

4 FDP tendons, 4 FDS tendons, Median N, FPL tendon

72
Q

funtional mvmts of wrist involve

A

extension, ulnar deviation

73
Q

open packed of distal RU joint

A

10 degrees sup

74
Q

where is the TFCC

A

btwn ulna and carpals

75
Q

midcarpal joint consists of

A

some lovers try

76
Q

radio carpal joint consists of

A

radius
tfcc
scaphoid

77
Q

MCPs resting position (other than thumb)

A

slight flexion

78
Q

what goes through the carpal tunnel

A

median N
FDS
FDP
FPL

then on top is the palmaris longus

79
Q

TFCC is on what side of wrist

A

medial

80
Q

only extrinsic forearm muscle to insert on a carpal bone

A

FCU

81
Q

tenodesis is what

A

floppy wrist makes motions

82
Q

tunnel of guyon is btwn

A

pisiform and hook of hammate

83
Q

serves as passage for ulnar N and ulnar A to get into hand

A

tunnel of guyon

84
Q

3 common deformaties seen in hands of pts with RA

A

boutoneirres
ulnar drift
swan

85
Q

to tx RA, what always is done

A

active and isometric ex for all motions

86
Q

ulnar drift (with RA) occurs bc of

A

damage to collateral lig and extensors

87
Q

with ulnar drift, there can be up to ___ degrees of lateral shift at the mcp

A

45 of mcp

88
Q

boutoneiires

A

flexion of PIP ext of DIP

89
Q

bouton deformity is dt what

A

damage to the slip

common ext tendon that inserts on the base of the middle phalanx is damaged

90
Q

boutonieres results in faulty

A

lateral bands in the extensor mech

lateral bands cause hyper ext of dip

91
Q

if there is 30 degrees of ext lag at the PIP suspect

A

boutonieres

92
Q

how to splint for boutoneires

A

just do the PIP in ext and keep others free

93
Q

with boutonieres, the lateral bands drift

A

forward

94
Q

with swan neck deformity, the lateral bands drift

A

dorsally

95
Q

Destruction of oblique retinacular ligament of the extensor mechanism leads to posterior displacement of the lateral bands

A

swan neck deformity

96
Q

what is swan neck deformity

A

ext of pip

flexion of dip

97
Q

FDP flexes

A

distal

98
Q

FDS flexes

A

proximal

99
Q

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)

A

TFCC

100
Q

TFCC has

A

clicking popping

101
Q

with TFCC you want to avoid what motions

A

pro and sup

102
Q

TFCC movement dx (one of 2)

A

wrist flexiion with pronation

wrist ext with pronation

103
Q

OA of hand is usually where

A

usually 1st CMC

104
Q

should you always trust plain film imaging if you suspect scaphoid fx

A

no - need a bone scan

105
Q

nodules in palmar hand
Higher incidence alcoholic, diabetic, epileptic, tobacco
Inability to straighten fingers, primarily 4th and 5th (cannot even PROM extend them)

A

dupytren contracture

106
Q

pain at ulnar side of 1st mcp (in the webspace) joint look into

A

game keepers thumb or UCL sprain

107
Q

tenosynovitis is

A

inflammation of the sheath (have had tendoitis for a period and it’s getting worse)

108
Q

dull ache radial side
Local swelling and tenderness in region radial styloid
can creak or have palpable lumpy feel

A

dequarvains

109
Q

with trigger finger, what can’t they do

A

you can PROM but they cannot AROM

110
Q

what is trigger finger

A

tendons get caught in the sheaths

111
Q

tendon gliding exersion exercises progression

A

Straight hand
Hook hand – greatest excursion between FDP and FDS
Full fist – full excursion FDP
Flat fist – full excursion FDS

112
Q

traumatic disruption of the terminal tendon (DIP ext)

jammed

A

mallet finger

113
Q

mallet finger can be ____ moved

A

passively (they just cant AROM)

114
Q

CTS sx are usually worse

A

at night

115
Q

claw hand (median N) effects what muscles

A

lumbricals (they arent working so the PIPs are in flexed contracture)

116
Q

ape hand is due to

A

median nerve palsy

117
Q

describe ape hand

A

Thumb doesn’t abduct/oppose bc you lose thenar muscle ability from median nerve

118
Q

wrist drop is due to ___ nerve

A

radial

119
Q

Compression of the superficial sensory radial nerve (between ECRL and brachioradialis tendons)
Pain, paresthesias, numbness on radial aspects of hand and wrist

A

Whartonburg syndrome

120
Q

claw hand for ulnar nerve effects which muscles

A

lumbricals

121
Q 
past trauma
hyperalgesia
edema
skin changes
all sound like
A

chronic regional px syndrome
or
reflex sympathetic dystrophy

122
Q

colles fx is a radial fx that displaces

A

post

123
Q

smith fx is a radial fx that displaces

A

ant

124
Q

boxers fx is of the

A

5th metacarpal (most common MC fx)

125
Q

Treat all wrist pain with swelling and pain in snuffbox as _____ until proven otherwise

A

scaphoid fx

126
Q

lunate usually disclocates

A

palmarly or ant

127
Q

dequarvains usually has

A

crepitus

128
Q

OA vs RA

A

OA is in one joint only

RA multiple joints both sides

129
Q

hook grip nerves

A

median and ulnar

130
Q

power grip nerves

A

median and ulnar

131
Q

lateral pinch uses what muscle and nerve

A

adductor poll

ulnar nerve

132
Q

precision pinch is what n

A

median

133
Q

cylindrical grip nerves

A

med
ulnar
rad

134
Q

numbness and tingling in palmar of hand think

A

CTS

135
Q

medial wrist px distal to the ulna, think

A

TFCC

136
Q

problems Writing, typing, using scissors, grasping objects

A

OA

RA

137
Q

inability to flex fingers/thumb or make a fist is what mvmt dx

A

insufficient flexion

138
Q

list the hand/wrist mvmt dx

A

insufficient flexion (finger or thumb)
insufficient ext (finger or thumb)
insufficient abd or opp of thumb
thumb cmc hypermobility

139
Q

explain thumb cmc hypermobility syndrome

A

px occurs at cmc but all thumb joints are effected

decreased pinch ocurs

140
Q

big difference btwn whartonburg and dequarvain

A

whartonburg is sensory only

dequarvain has both sensory and motor

141
Q

CTS mvmt dx

A

insufficient flexion

142
Q

need to do imaging

A

ok

143
Q

wrist joint (RC) and mid carpal joint play is

A

same

144
Q

what links the PIP and DIP motions

A

oblique lig

145
Q

the ext retinaculum and hood involve what muscles

A

ED
EI
EDM
then lumbricals and interossei

146
Q

how to immobilize if central slip is damaged

A

they end up with boutoniers, so you extend the pip and leave the others alone

147
Q

which hand pathology uses metal rings to correct

A

swan

148
Q

explain physiology of swan vs boutoneir

A

bouoneirs - damage to the slip pulls lat bands ant

swan -damage to the obliqe lig pulls the bands post

149
Q

FCU or abd dig minimi issues (motor) would make you think

A

ulnar nerve entrapment at guyons

150
Q

cant extend distal phalange

A

mallet

151
Q

how does the oblique ret lig help with extension of DIP

A

As PIP actively extends – it puts tension on oblique ret. Lig, which helps DIP ext

152
Q

claw hand effects what muscles

A

lumbricals (ulnar or median)

153
Q

wrist drop would be dt what

A

radial nerve issue

154
Q

when doing mobs for fingers or thumbs, palm is

A

palm up

155
Q

when doing mob assessment for wrist or mid carpals, their position is

A

all are palm down except post is palm up

MSK (10 decks)

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