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COMP ORTHO > Wrist > Flashcards

Wrist Flashcards

1
Q

Proximal joint surface

A

Biconcave

Radius and radioulnar disc

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2
Q

Distal joint surface

A

Convex

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3
Q

Open chain

A

Convex carpals on concave radius

VEX on CAVE = OPP

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4
Q

Closed chain

A

Concave on convex

SAME

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5
Q

Ligaments - Volar (palmar) radiocarpal

A

From radius to carpal bones
Limit extension
Prevents carpal separation

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6
Q

Ligaments - Volar (palmar) radiocarpal - radiocapitate

A

Stabilizes lunate when tight
Pulls capitate towards radius
Traps scaphoid

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7
Q

Ligaments - Volar (palmar) radiocarpal - radiotriquetral

A

Stabilizes lunate by pulling obliquely

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8
Q

Ligaments - Volar (palmar) ulnocarpal

A

Stabilize midcarpal joint
Limit ext
Prevent carpal separation

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9
Q

Ligaments - Dorsal radiocarpal

A

From radial styloid to lunate and triquetrum

Limits flex and prevents carpal separation

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10
Q

Ligaments - Ulnar collateral

A

From ulna to pisiform and triquetrum

Limits radial deviation

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11
Q

Ligaments - Radial collateral

A

From radius to scaphoid, trapezium, and 1st MC

Limits ulnar deviation

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12
Q

Close packed (radiocarpal and midcarpal)

A

Radiocarpal in full ext and RD

Midcarpal in full ext

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13
Q

Open packed (radiocarpal and midcarpal)

A

Radiocarpal in neutral with slight UD

Midcarpal in slight flex with UD

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14
Q

Flex to ext Sequence

A

distal row initiates - distal glides on proximal row
volar radioscaphoid and radiocapitate lig tighten and pull distal row into close packed
at 45 ext, volar radioscaphoid and lunat tighten and pull lunate into close packed on scaphoid

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15
Q

Radial deviation sequence

A

Distal carpal row initiates mvmnt and moves toward radius
Ulnar lig tighten, prox row moves in ulnar direction
Scaphoid and trapezium approach radial styloid
Scaphoid forced into flex - ligament btw scaph and lunate pulls lunate into flex
Radial dev continues with prox row ulnar glide

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16
Q

Carpal tunnel

A

upside down arch/bridge
proximal part is more narrow than distal part
If you extend the wrist, the area gets tighter

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17
Q

Carpal tunnel is maintained by

A

the flexor retinaculum and transverse intercarpal ligaments

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18
Q

Carpal tunnel contains

A

Flexor digitorum superficialis/profundus
Flexor pollicis longus
flexor carpi radialis
median nerve

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19
Q

Longitudinal arch

A

From carpal bones to tip of phalanges
centered around 3rd digit
relatively stable

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20
Q

Transverse arch

A

Proximal through distal row of carpals
Distal through heads of MCs
Mobility of wrist/fingers

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21
Q

Oblique arch

A

digits move obliquely to thumb/carpals

thumb opposition to fingers

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22
Q

Carpometacarpal joints (CMC) motion increases from

A

radial to ulnar

2nd and 3rd are immobile

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23
Q

CMC Thumb opposition includes

A

flex
abd
IR

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24
Q

Metacarpophalangeal joints (MCP) (2nd to 5th) close packed

A

full flexion

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25
Q

Interphalangeal joints (IP) close packed

A

full ext

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26
Q

Thenar mm

A

Abductor pollicis brevis
Opponens pollicis
Flexor pollicis brevis
Adductor pollicis

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27
Q

Hypothenar mm

A

Abductor digiti minimi
Flexor digiti minimi
Opponens digiti minimi

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28
Q

Prehension

A

act of gripping something with the hand

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29
Q

Prehension - Precision grip

A

For fine movements
great strength not available
mainly index and thumb

30
Q

Prehension - preciision grip - which has the most strength

A

Pad to side

31
Q

Prehension - power grip

A

Used when strength is needed
fine movement not available
mainly flexion of all fingers

32
Q

Prehension power grip - palmar grip

A

gives more dexterity, can have full fist without ulnar deviation

33
Q

Prehension power grip - hook grip

A

gives more strength

thumb does not carry weight but locking mechanism stabilizes

34
Q

Collies fracture

A

Fracture of the distal radius in an extended position

Most common

35
Q

Smith fracture

A

Fracture of the radius in a wrist flexion position

36
Q

Scaphoid fracture

A

worry about necrosis

37
Q

Bennetts fracture

A

metacarpal fracture

38
Q

Gamekeepers thumb

A

Ulnar collateral ligament sprain

Forceful radial deviation of thumb

39
Q

Dequervains tenosynovitis

A

Irritation of the tendons and tendon sheath

Abd pollicis longus and ext pollicis brevis

40
Q

Trigger finger

A

pulleys not working
stretched out and ruptured
finger stuck in flexion
might have to pull it back with other hand

41
Q

Dupuytrens contracture

A

proliferation of palmar fascia
adheres to itself as it grows
usually affects 4th and 5th digits
get finger flex contracture

42
Q

Volkmanns ischemic contracture

A

Obstruction of blood supply to forearm mm typically due to cast being too tight
mm necrose and fibrose in as little as 6 hours
flexor mm contracture results

43
Q

Mallet fingers

A

Disruption to profundus tendon from OA
Avulsion of extensor tendon at DIP
hangs down in flexion and they will have trouble extending fingers

44
Q

Heberdens nodes

A

At DIP joints typically on dorsal aspect
have ext limitations
might also present with stiffness in hands - OA might be starting

45
Q

RA - ulnar drift often seen at

A

MCPs

46
Q

RA - Swan neck deformity

A

PIP hyperextension
DIP flex
Rupture of volar plate

47
Q

RA - Boutonniere deformity

A

PIP flex
DIP ext
rupture of extensor mechanism

48
Q

RA - Bouchards nodes

A

at PIP joints

49
Q

Wrist drop

A

radial nerve compromise

can;t actively extend wrist but they can passively

50
Q

Claw hand

A

intrinsic minus hand
interossei and lumbricals
occurs due to median and ulnar compromise

51
Q

Ape hand

A

medain nerve compromise
involvement of 1st and 2nd and 3rd digits
get recessed thumb and MCP extension
indicative of progressive, long term carpal tunnel syndrome

52
Q

Bishops deformity

A

Ulnar compromise, flexed fingers

53
Q

Complex regional pain syndrome

A

sympathetic dysfunction of unknown origin

hypovascularity to a portion of body due to abnormal sympathetic activity

54
Q

Raynauds syndrome

A

Vasospasm of small cutaneous and subcutaneous arteries and arterioles
idiopathic
usually B

55
Q

Manual dexterity - Jebsen taylor

A 
writing 
card turning
picking up small objects
stacking
picking up large light and heavy objects
56
Q

Manual dexterity - Minnesota rate of manupulation tets

A

wood cutouts, blocks with diff colors

placing, turning, displacing, one hand turning and placing, two hands

57
Q

Manual dexterity - Purdue pegboard

A 
fine motor
assembly
place in in holes 
washer on top of pin
then another washer 
timed test
58
Q

Manual dexterity - Nine hole peg

A

time it

59
Q

Murphys sign

A

for dislocated lunate
have pt make fist
pos if 3rd MC level with 2nd and 4th

60
Q

Ulnar snuff box test

A

for triquetrum integirty

palpate snuff box - pos if pain (compressing triqutrum into disc)

61
Q

Watsons sign

A

Scaphoid shift
Scapholunate ligament stability
palpate scaphoid
passively move pt wrist from ulnar dev and ext to rad dev and flex

62
Q

Finkelstein

A

for dequervains

63
Q

trigger finger test

A

palpate volar surface of PIP
pt flex and extend PIP
pos if snapping

64
Q

Phalen

A

Median nerve
B flex elbows at 90
fully flex wrists for 60 sec

65
Q

Pinch test

A

median nerve

pt tries tip to tip pinch btw thumb and 2nd

66
Q

Fromets

A

Ulnar

Pt hold piece of paper try to pull away

67
Q

Wartenbergs sign

A

Ulnar

therapist passively spreads fingers apart and if pt can’t adduct 5th digit is pos

68
Q

Allens

A

Radial and ulna rarterial supply
pt amke fist and relax repetitively
squeeze hand tightly and then PT compress both radial and ulnar for 10-20 sec
pt open hand and PT release pressure over one artery - watch for refill
should have rapid refill within 3 sec

69
Q

Digital blood flow

A

Compress nailbed and note time to return

avg is 3 sec

70
Q

Contraindications for neural provocation tests

A 
Irritable and inflammatory conditions
Spinal cord lesions
Nerve root compression
Malignancy
Complex regional pain syndrome
Suspicion that distal sympts are result of spinal segment issues

COMP ORTHO (11 decks)

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