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Musculoskeletal Upper Limb > Wrist and hand > Flashcards

Wrist and hand Flashcards

1
Q

Distal Radius Fracture - Clinical presentation (demographic, MOI, symptoms)

A
  • all age groups, especially young and old
  • FOOSH
  • pain, swelling, bruising and tenderness all local to distal radius; focal bony tenderness over the distal raidus
  • deformity? (dinner fork?)
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2
Q

Distal Radius Fracture - Acute Management

A

Apply makeshift splint and sent to ED

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3
Q

Distal Radius Fracture - Rehab

A
  • From day 1 maintain finger, thumb, elbow and shoulder ROM
  • light upper limb strength ex. as soon as tolerated
  • 5-6 weeks: wrist AROM
  • 7-8 weeks: PROM, gentle grip/wrist strength
  • 8-9 weeks: weight-bearing on hand
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4
Q

Scaphoid Fracture - Clinical presentation (demographic, MOI, symptoms)

A
  • teens/young adults
  • FOOSH
  • pain in radial wrist near base of thumb
  • clamp sign
  • local swelling - obscures contour of snuff box
  • tenderness on scaphoid tubercle
  • pain with longitudinal thumb compression
  • pain with ulnar deviation in pronation
  • pain with resisted supination
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5
Q

Scaphoid fracture - Acute management

A

Refer to ED

MRI

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6
Q

Scaphoid fracture - Rehab

A

From day 1: maintain finger, thumb, elbow and shoulder ROM
Light upper limb strength ex’s as soon as tolerated
6-9 weeks: AROM *depends on specialist advice
10-12 weeks: PROM, gentle grip/wrist strength ex
12+ weeks: weight-bearing ex’s

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7
Q

De Quervain’s Tenosynovitis - Clinical presentation (demographic, MOI, subjective and physical features

A

MOI: repetitive loading/overuse
Presentation:
- insidious, increasing, radial-sided wrist pain during activity

  • thumb extension: passive no pain; active some pain; resisted some pain
  • pain with tendon tension - wrist UD + thumb flexion/opp (Finkelstein)
  • pain with retinacular loading
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8
Q

De Quervain’s Tenosynovitis - management/rehab

A

break the cycle!

  1. reduce pain/irritation
    • education, activity modification, taping, splinting
  2. reduce inflammation
    • time without irritation -> splint ~4 weeks
    • > cortisone injections
  3. reduce thickening
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9
Q

Scapholunate ligament injury - Clinical presentation (demographic, MOI, subjective and objective features)

A 
MOI: FOOSH or high-energy impact
demo: younger, active patients
Clinical findings:
- radial/dorsal wrist pain
- Xray: S-L widening, carpal instability
- focal tenderness over dorsal scapholunate joint
- Watson's test +ve
-> MRI to confirm
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10
Q

Scapholunate ligament injury - management/rehab for acute injury

A

Acute:
surgical repair within 3 months of injury
rehab -> hand specialist

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11
Q

Scapholunate ligament injury - management/rehab for chronic injury

A 
Education
settle it down
gentle rehab only
cortisone inj. for temporary relief
partial or complete wrist fusion will be required (via splint or surgery)
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12
Q

ECU Tenosynovitis - Clinical presentation (demographic, MOI, symptoms)

A

MOI: repetitive loading/overuse - grip-load-twist-repeat
demo: young, active patient - sports injury
presentation:
- ulnar sided wrist pain
- ‘popping’ of the wrist
findings:
- focal tenderness over ECU groove in ulnar head
- pain with stress loading of ECU (active supination + extension + ulnar deviation)

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13
Q

ECU Tenosynovitis - Management/Rehab

A

break the cycle

  • taping or splinting to limit wrist movement inc. supination
  • cortisone inj
  • surgery for stabilisation
  • sport-specific rehab
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14
Q

TRIANGULAR FIBRO-CARTILAGE COMPLEX (TFCC) - Clinical presentation (symptoms)

A
  • ulnar sided wrist pain
  • TOP of TFCC
  • TFCC stress test
  • supination lift test (TFCC disruption)
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15
Q

TRIANGULAR FIBRO-CARTILAGE COMPLEX - Management

A
  1. settle it down - rest, taping, compressive support, brace/splint
  2. build it up - target rehab to limited/painful activities, graduated loading
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16
Q

Carpal Tunnel Syndrome - Clinical presentation (demographic, cause, symptoms)

A

demo: any age
Typical presentation: intermittent P+N in thumb, Index finger and middle finger, worst at night
presentation varies greatly

Cause: anything that causes compression in the carpal tunnel

17
Q

Carpal Tunnel Syndrome - Special tests

A
  • phalens + reverse phalens
  • tinels
  • carpal compression
18
Q

Carpal Tunnel Syndrome - Management

A

Consider the cause:
o Inflammation – try splint/rest, maybe cortisone injection
o Oedema – try elevation, drainage massage, AROM exs
o Wrist position – try splint, especially when sleeping
o Gripping/lumbricals – try activity/grip modification, keep fingertips away from palm

Educate, load manage, tape/support, isometric strength/control

19
Q

THUMB MCP ULNAR COLLATERAL LIGAMENT INJURY (SKIER’S THUMB) - Clinical presentation (demographic, MOI, symptoms)

A

Demo: young, active population - sporting injury
MOI: impact against thumb
Symptoms:
- pain, swelling, bruising around the whole MCP joint
- focal tenderness over ulnar aspect of joint
- resting position - may be in radial deviation
- Skiers thumb test +ve

20
Q

THUMB MCP ULNAR COLLATERAL LIGAMENT INJURY (SKIER’S THUMB) - management

A
  1. get diagnostic clarity
    • US / surgical opinion
    • splint thumb whilst awaiting US results
  2. protect
    • 4-6 weeks in splint full time then phase out
  3. rehab
    • start early with gentle AROM out of splint
    • warm water exercises
    • add light resistance e.g. sponge @ 3-4 weeks
    • PROM only if MCP stiffness
21
Q

MALLET FINGER - Clinical presentation (demographic, MOI, symptoms)

A

Demo: all ages
MOI: forced flexion of the fingertip/DIP joint
Clinical findings:
- terminal phalanx resting in flexion
- mallet finger test
- often no pain, swelling or bruising
- extensor mechanism disrupted -> no active extension

22
Q

MALLET FINGER - management

A
  1. Xray
  2. Splint full-time 6-8 weeks: DIP in full ext. PIP free.
  3. Rehab
    • gentle splint wearing
    • gentle AROM only - PROM almost never needed
23
Q

Jersey Finger - Clinical presentation (demographic, MOI, symptoms)

A

Demo: sporting
MOI: simultaneous maximal grip/effort with FDP muscle, and passive extension of digit

clinical findings:

  • pain, swelling and bruising of whole finger
  • general loss of ROM
  • specific loss of active DIP flexion (rupture/avulsion of FDP)
  • unable to flex DIP with the examiner holding the PIP in ext.
  • make a fist and check if the DIP flexes

Special tests:

  • test for flexor integrity passive) - FDP and FDS
  • palpation: check for retracted tendon in palm -> surgery
24
Q

Jersey Finger - management

A
  • refer to ED!

post-op care:

  • 6 weeks in dorsal blocking splint
  • specific post-op management in care of hand therapy clinic
25
Q

FINGER JOINT INJURIES (PIP) - Clinical presentation ( MOI, symptoms)

A

MOI: impact/jarring, ball vs. fingertip, hyperextension

presentation:

  • fusiform swelling around injured joint, local bruising
  • MCP’s may rest in hyperext; IP joints in flex
  • check for ulnar/radial deviation at rest
  • loss of full AROM
26
Q

FINGER JOINT INJURIES (PIP) - Management

A
  1. Xray!
    - volar plate avulsion -> hand therapy
    - dislocation -> ED
    - fracture -> ED
  2. once xray clear
    - test volar plate
    - test for tendons integrity (passive) radial collateral and ulnar collateral lig -> soft x 3, med x 3, firm x 3
    - test major ligaments for stability (sprain vs. rupture)
  3. hand therapy
    - protect from re-injury
    - regain full finger flexion
    - regain strength/function
    - prevent/treat PIP flexion contracture

Musculoskeletal Upper Limb (5 decks)

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