Wrist Flashcards
Carpal bones form what
Volar concave arch aka carpal tunnel
Ulnar nerve artery and vein cross over retinaculum but sometimes covered by fibrous band called….
Ulnar tunnel aka guyon canal
Forces and how they’re transmitted through wrist
Capitate, lunate and scaphoid on to distal radius
Force on radial side of wrist Mc lead to what when wrist in 95-100 degrees of extension
Scaphoid fractures
Carpal tunnel syndrome
Any process that causes increase in volume of carpal tunnel or decrease capacity that compress median nerve and 9 digital flexor tendons
S/s of carpal tunnel syndrome
Pain over median nerve distribution
- opposition of thumb disappears before sensory
- hypoesthesia/anesthesia
- motor nerves larger and damaged more than sensory
- pain may reach forearm/shoulder
- MC in Female
- more prominent at night
Causes of CTS
Repetitive hand movements HTN Thyroid dysfunction (retain fluids) Pregnancy Diabetes RA
Ulnar tunnel syndrome
Ulnar nerve compressed as travels through pisohamate canal (aka guyon canal)
Pisohamate canal aka and nerve that is compressed here
Guyon canal
Ulnar nerve
What may cause ulnar tunnel syndrome
Road cycling Crutches SOL Vascular lesion Fx of hook of hamate
Ulnar nerve gives off two sensory branches above wrist that supply what
Palmar and dorsal aspects of hand
Does not pass through guyon canal
If ulnar nerve compressed in canal what is affected
Only fingers show altered sensation
Fracture of pisiform/hamate may cause what
Ulnar tunnel syndrome
What covers the volar concave arch (aka carpal tunnel)
Flexor retinaculum
where does the median nerve lie at the wrist
Beneath fascia protected only my palmaris longus tendon
What is contained in carpal tunnel
Median nerve
Nine digital flexor tendons
What is median nerve compressed Mc by
Volar carpal ligament
Treatment for carpel tunnel syndrome
Wrist splint (cock-up splint) NSAIDS Steroids Surgery Adjust
If ulnar nerve is compressed at the elbow what are the findings
Altered sensation of entire ulnar distribution
Palmar and dorsal aspects of HAND and fingers
Findings if ulnar nerve compressed at wrist? Elbow?
Wrist: altered sensation of palmar/dorsal aspects of fingers
Elbow: palmar/dorsal aspects of fingers and hand (recall 2 sensory branches branch before wrist that supply these)
What motor loss is seen with ulnar tunnel syndrome
Motor loss of hypothecate eminence (flexor digiti minimi, abductor digiti minimi, opponens digiti minimi)
Adductor pollicis
Interosseous
Medial 2 lumbricals
Palmaris brevis
Aka for de Quervain disease
Hoffman disease
What is de Quervain disease/Hoffman disease
Stenosing Tenosynovitis of tendon sheath of abductor pollicis longus and extensors pollicis brevis
Dequervain/Hoffman affects who Mc
Women 30-60
What causes Hoffman/de Quervain
Repetitive thumb adduction or extension ulnar wrist deviation
What activities cause de Quervain/Hoffman
Keyboarding
Filing
Carpentry
Assembly-line worker
S/s of de Quervain/Hoffman
Pain, tenderness, swelling over first dorsal compartment (increased with thumb movement)
- swelling over styloid of radius
- palpable crepitus
- wrist use causes pain
- bilateral-30%
Dx with pain, tenderness, swelling over first dorsal compartment that increased with thumb motion. Swelling over styloid of radius and palpable crepitus
Dequervian/Hoffman
Trigger finger
Finger gets stuck in bent position
Inflammation narrows space within sheath surrounding tendon
S/s of trigger finger
Bent finger may bend/straighten with a snap
Swan neck deformity
Hyperextension of PIP
Flexion of DIP
RA
Alt: ehlers-Danilo’s, poorly healed fx
Boutonnière deformity
Flexion-PIP
Extension-DIP
RA
OA
Mallet finger
Rupture or avulsion of extensor tendon where it inserts into distal phalanx
Causes of mallet finger
Sports injuries
Especially catching a ball
Jersey finger
Tear of flexor tendons in finger
Causes of jersey finger
Contact sports: football/rugby
Gripping a jersey with fingers bent and opponent wrestles away causing forced extension.
Avulsion injury
Wrist ROM
Flexion: 90
Extension: 70
Ulnar deviation: 55
Radial deviation: 20
Tinel sign at the wrist-where
Over carpal tunnel and guyon canal
Phalen sign: for and what?
Back of palms upsidown praying pose for one minute.
+= tingling along median nerve distribution
CTS due to neural ischemia
Phalen sign indicates what
CTS due to neural ischemia
Reverse phalen sign: what? For?
Praying position one minute
+ tingling along median
CTS by neural stretch and compression
Reverse phalen indicates what
CTS by neural stretch and compression
Carpal compression test: what? For?
Compress carpal tunnel with patients wrist flexed
+ Paresthesia in median nerve distribution
CTS (if less than 15 seconds indicates more advanced)
Finkelstein test: what? For?
Fist with thumb inside and wrist ulnar deviated
+ over abductor pollicis longus and extensors pollicis brevis
Stenosing Tenosynovitis in tendons
What does + Finkelstein test indicate
Stenosing Tenosynovitis of AbPL and EPB
Bracelet test: what? For?
Distal radius/ulna squeezed while patient makes fist
+ pain over forearm, wrist, hand
= RA
What does bracelet test for?
RA
Bunnel- littler test: for? What?
Wrist extended and examiner extends MCP and flexes DIP/PIP.
+decreased flexion
= contracture of joint capsule or OA
+ bunnel-littler test?
Contracture of joint capsule
OA
Mannkopf sign
Pressure on pain and palpate heart rate
+ increase of 10BPM or more
= pain is organic
S/s of scaphoid fracture
Pain on thumb side of wrist and within snuffbox
Tests for scaphoid fracture
Axial compression Percussion on extended thumb Forced dorsiflexion Resisted pronation Max. Ulnar deviation (w/ pain in snuffbox)
