wrist

Question 1

wrist rom

Answer 1

flexion 80
extension 70
ulnar deviation 30
radial deviation 20

Question 2

radiocarpal open pack

Answer 2

neutral

Question 3

radiocarpal closed pack

Answer 3

full extension

radial deviation

Question 4

want to improve wrist extension in OKC

• what bones?
• what direction glide?

Answer 4

radius - scaphoid and lunate

OKC - roll post, glide ant

Question 5

what injury?

• “dinner fork” deformity on X-ray with dorsal displacement of the of the distal radius, wrist, and hand.
• “fall on an outstretched hand” (FOOSH) extension injury.
• The distal extremity may sustain a buckling or shearing wrist fracture during impact due to the combined forces of weight and momentum

Answer 5

Colles’ fracture, “dinner fork” or “bayonet” deformity

outward

Question 6

what injury?

• FOOSH flexion injury.
• “garden spade” deformity on x-ray with volar displacement of the distal radius, wrist, and hand

Answer 6

Smith’s fracture, reverse Colles’ fracture

inward

Question 7

what injury?

• isolated fracture of the radial styloid process.
• most commonly caused direct forcible blow to the wrist.
• names allude to the high incidence of this fracture type historically associated with hand crank starter mechanisms on antique automobiles.

Answer 7

Hutchinson’s fracture, “chauffeur’s fracture” or “backfire fracture”

Question 8

what injury?

• intra-articular fracture occurring at the base of the first metacarpal, which may also include subluxation.
• typically caused by axial loading of the metacarpal while the thumb is in a slightly flexed position.

Answer 8

Bennett’s fracture

Question 9

goniometer position for ulnar deviation?

Answer 9

sitting next to support surface, shoulder abduct 90deg, elbow flex 90deg
axis: dorsal aspect of the capitate
stationary: dorsal midline forearm, use humerus lateral epicondyle reference
moving arm: dorsal midline of the third metacarpal

Question 10

goniometer position for wrist flexion/extension?

Answer 10

sitting next to support surface, shoulder abduct 90deg, elbow flex 90deg

axis: triquetrum
stationary: lateral midline ulna using olecranon and ulnar styloid as reference
moving: lateral midline 5th metacarpal

Question 11

carpal tunnel CPR

Answer 11

4/5 items, + Likelihood Ratio: 4.3
Shaking hands to relieve symptoms
Wrist ratio >.67
Symptom Severity Scale > 1.9
Diminished sensation in median sensory field 1 (thumb) Age > 45 years old