Wrist Flashcards
Wrist fractures must heal with ?
New bone, not a scare tissue
Bones are covered by a dense fibrous connective tissue membrane called?
Periosteum
How many layers does Periosteum has ?
Two layers
What are the two layers of periosteum ?
Vascular outer layer and cellular and delicate inner layer.
The initial inflammatory phase lasts?
1 to 7 days. Promotion on the hematoma. Provides early fracture stabilization.
Repair phase lasts ? and what goes on?
Hematoma is removed and replaced with callus bone. Can last up to 4 months but it usually is complete in 6 weeks.
Remodeling phase
Over months of time to years.
Secondary Healing phase?
An average of 7 weeks. An activation of AROM depending on the clients factor and fracture factor.
After 8 to 10 weeks after the injury client can begin?
Progressive resistive exercises
What is reduction ?
A physician uses various techniques to realign the fracture ends.
True or False. Early resumption of resistive or repetitive work, homemaking or vocational tasks, and /or premature introduction of progressive resistive exercises will likely result in pain and increased swelling and may compromise the integrity of the healing bone.
Ture
True or False. Encourage clients to use their involved hand early on for pain-free, light activities of daily living, work and or leisure interests. Client may need help in identification and grading these tasks appropriately so that they do not overuse the injured extremity
True
The 3 phases of soft tissue healing after reduction
Inflammatory phase lasts 1 to 5 days
The phase is from 2 to 6 weeks (forming of the scare tissue)
The last phase (maturation) scare tissue becomes more organized from 6 weeks up to 2 years. ROM can become resistive to change due to adhesions.
Extra-articular Fractures
Is non-displaced fracture. The fractured bone did not cross into the joint space. NO interruption of the cartilage at the end of the bone.
Intra-articular fractures
Fractured bone segment shifts and crosses into the joint space.
Reduction needed with the use of external and internal fixation.
True of False. This position can cause or aggravate carpal tunnel symptoms, because prolonged moderate wrist flexion will increase carpal tunnel pressure to potentially dangerous levels. It is therefore important to monitor the client’s sensory complains during the period of case immobilization and promptly report concerns to the physician.
Ture
Closed Reduction
Non invasive procedure to heal the bone/ Cast
Open Reduction
Invasive with ORIF in place for bone.
Carpals can be divided into two rows
Proximal = Scaphoid, lunate, triquetrum and pisiform Distal = trapezium, trapezoid, capitate and hamate.
Distal Radioulnar Joint
The ulnar notch of the radius rotates around the head of the ulna. This is a uniaxial pivot joint.
Moves pronation/supination along with the superior radioulnar joint.
Radiocarpal Joint
Articulation between Radius and the scaphoid, lunate, triquetrum.
MidCarpal Joint
Between two rows of carpal bones.
Little motion at the flex/ext, radial/ulnar deviation
What are the Intercarpal Joint?
Joints in between each individuals carpal bones.
They dont have joint capsule.
Motion of these bones is relative to eachother.
Where is Lister’s Tubercle and which muscle uses it as a pulley to wrap around?
In the center of posterior distal radius
Extensor Pollicis Longus
What is the significance of the “Poles” and “waist” of the Scaphoid?
The scaphoid is divided into three segments
- proximal pole nearest the radius
- the center is the waist
- distal pole nearest the thumb.
Where does blood enter in the scaphoid carpal bone
Blood enters at the distal pole so fractures nearer the proximal end have a worse prognosis for healing.
What is the significance of the palmar tilt of the radius?
allows the wrist more flexion than extension range of motion.
What is the significance of the ulnar tilt of the radius?
more ulnar deviation than radial deviation and radial deviation is also often a hard end feel.
Which row of carpals is more stable and which is more mobile?
The proximal row is more mobile since the distal row is well fastened to the metacarpal bones with multiple ligamentous structures.
Which of the carpal bones is most likely to sublux or dislocate?
The Lunate is the least stable in general.
Which of the carpal bones is a sesamoid bone?
The Pisiform as it is embedded in the tendon of the Flexor Carpi Ulnaris.
What travels under the hook of the hamate?
The Ulnar Nerve through Guyon’s Canal.
Which tendons and which nerve are contained within the carpal tunnel?
The Median Nerve, the four tendons for the FDS, four tendons of the FDP, and the tendon for the Flexor Pollicis Longus.
What are examples of extrinsic ligaments at the wrist versus intrinsic ligaments at the wrist?
Extrinsics like the dorsal radiocarpal ligament attach the radius or ulna to the carpal bones (outside carpal bones to inside)
Intrinsics like the scapholunate attach two carpal bones (within carpals).
What is the TFCC (Triangulofibrocartilage) and what is it’s function?
A disc of fibrocartilage that helps fill the gap between the ulna and the carpal bones to provide some cushioning and hold the distal radius and ulna together. It is important for weight bearing and strong gripping activities, and helps distribute weight between the radius and ulna. The usual distribution is 80% on the radius and 20% on the ulna, but if the TFCC is damaged the radius ends up accepting 95% of the weight.
You learned above that there is an articular disc at the wrist made of fibrocartilage. Can this disc heal? Why or why not?
No, it has very little to no blood supply and is made of cartilage which cannot regenerate.
Aside from the disc what is sometimes included when discussing the TFCC as the triangulofibrocartilage complex?
The palmar ulnocarpal ligament, ulnar collateral ligament, palmar and dorsal capsular ligaments, and the tendon for the extensor carpi ulnaris.
What symptoms will you see if a client has a TFCC tear?
Pain with weight bearing or strong gripping activities, clicking or grinding sensations with movement.
What is an external fixator?
Fixation for a fracture that resides outside of the body and is attached to the bones via pins that go through the skin.
What are some educational concepts that should be discussed with a client who has an external fixator?
Pin care and infection control.
What is a common way a client could sustain a distal radius fracture?
A FOOSH, fall on an outstretched hand.
What are the two types of distal radius fractures most commonly seen?
Colles and Smith’s
What is Colles fracture
distal radius fracture with dorsal displacement
What is Smith’s Fracture
distal radius fracture with palmar displacement.
How specifically are they sustained differently? Colle’s vs Smiths fracture
A Colles’ fracture or dorsal displacement is caused by a fall onto an extended wrist. A Smith’s fracture or volar displacement is caused by a fall onto a flexed wrist.
What is CRPS and how does it present?
Complex Regional Pain Syndrome, presents as an exaggerated pain response with edema, temperature changes, discoloration, and shiny skin. Similar to Cellulitis but without fever.
Where would a client have pain to palpation with a Scaphoid fracture?
The anatomical snuff box.
Where would a client have ulnar neuritis at the wrist?
At Guyon’s canal or the hook of the hamate.
What are the symptoms of Carpal Tunnel Syndrome?
Burning, numbness, tingling into the thenar eminence (thumb area) and digits 1-3, and eventually weakness of those intrinsic thumb muscles.
What is DeQuervain’s Tenosynovitis and where is pain felt with that diagnosis?
Inflammation of the synovial sheath surrounding the APL and EPB tendons in the first dorsal compartment. Pain is felt at the area of the radial styloid process, especially with ulnar deviation or thumb extension/abduction.
An intra-articular fracture at the radiocarpal joint would impact which bones? *
Radius, Scaphoid, Lunate
Which osteokinematic motions are possible at the DRUJ (distal radioulnar joint)?
Supination/Pronation
An injury to the TFCC at the wrist would result in which of the following symptoms? *
Pain with weight bearing activities and grip
Which of the following is an intrinsic ligament at the wrist? *
Scapholunate Ligament
Which of the following nerves travels through the carpal tunnel? *
Median Nerve
A wrist fracture that can result from a FOOSH with the wrist held in flexion is?
Smith’s Fracture
The carpal bone that can be palpated via the anatomical snuff box is the:
Scaphoid
If your client develops ongoing edema, skin redness and hypersensitivity, and pain that is inconsistent with the expected healing after a wrist fracture, he or she may be diagnosed with:
CRPS
Usual symptoms for Carpal Tunnel Syndrome are?
Wrist pain with numbness and tingling into the thumb and weakness of the thenar eminence
DeQuervain’s Tenosynovitis involves which two tendons in the first dorsal compartment at the wrist?
xtensor Pollicis Brevis and Abductor Pollicis Longus
A client who comes to see you after sustaining a wrist injury due to a motor vehicle accident, complains of pain with forceful gripping motions such as opening a jar of tomato sauce. This is most likely:
a TFCC tear
