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TRI 3 - MSK 2 > Wrist and hand > Flashcards

Wrist and hand Flashcards

1
Q

What is positive and negative ulnar variance

A

Positive - Ulna further than the radius

Negative - Ulna shorter than the radius

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2
Q

What is used to diagnose ulnar variance

A

X-ray

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3
Q

What population may develop ulnar variance and why

A

Child gymnasts

Due to chronic compressive loads closing distal radial physes

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4
Q

What does the ulna move distal naturally

A

Normal gripping and pronation

More positive with age

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5
Q

What are some injuries associated with ulnar variance

A

Lunotriquetral ligament tears
Scapulolunate instability
Ulnar impaction syndrome
TFCC tears

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6
Q

Describe negative ulnar variance

A

Increases risk for Kienbock’s disease

Osteochondrosis of the lunate

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7
Q

Describe the MOI for TFCC pathology

A

Fall on supinated outstretched wrist

Chronic repetitive rotational loading

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8
Q

What activities may aggravate TFCC pathology

A

Tennis
Golf
Occupational tasks

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9
Q

What is the clinical presentation of TFCC pathology

A

Medial wrist pain distal to ulna in dorsal anatomic depression
- increased with end-range PRO and SUP, forceful gripping
Painful click with wrist motions

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10
Q

Describe the eligibility for TFCC repair

A

The center is avascular and not amenable for repair

The outside is vascular and repairable

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11
Q

What special tests and imaging is used to determine TFCC pathology

A

TFCC stress test
TFCC compression test
MRI

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12
Q

Describe TFCC bracing for mild and unstable cases

A 
Mild - splint for ulnocarpal support
Unstable 
 - Long arm cast
 - elbow in 90
 - wrist in UD and EXT

While immobilized educate to avoid ulnar deviation or extension and radial deviation

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13
Q

After the cast is removed what is the progression of strengthening exercises for TFCC pathology

A

FLEX, EXT
PRO, SUP
UD, RD
2 weeks after cast is removed strengthen hand a wrist, avoid torsion loads

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14
Q

Describe ulnocarpal impingement syndrome

A

Cystic and erosive changes on the ulnar head and lunate
Caused by positive ulnar variance
Diagnosed with radiographs

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15
Q

Describe the presentation of DRUJ instabilities

A

AROM / PROM C - pain with pronation and supination
PROM A - pain with dorsal and volar glides
+DRUJ instability test

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16
Q

Describe DRUJ management

A 
Minimize mal alignment
External stabilization
 - taping, bracing
Internal stabilization
 - Therex for: Strengthening, proprioception, stabilization
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17
Q

Describe Static intercarpal instability

A

Involves a tear of a ligament or fracture

More severe

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18
Q

Describe dynamic Intercarpal instabilities

A

Occur when the wrist is stressed

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19
Q

What is the difference between dissociative and non-dissociative instabilities

A

diss - between carpal bones in the same row

non diss - carpal bones in different row

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20
Q

How do you manage intercarpal instabilities

A

Cast immobilization

Surgery for chronic cases

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21
Q

What is the most common tumor of the hand

A

Ganglia

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22
Q

Describe what a ganglia is and how it develops

A

Thin walled cysts containing hyaluronic acid
Spontaneously over joint capsule or sheath
Anterior and posterior wrist and fingers

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23
Q

Describe the clinical presentation of ganglia

A

May not cause pain
As they grow they may ache with flexion and extension
May compress median and ulnar nerve

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24
Q

Describe the physical properties of a ganglion

A

Smooth
Round
Multilobulated
Tender under pressure

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25
Q

Describe the management strategy for ganglion

A

Symptom relief
- splint immobilization, may shrunk ganglion
Needle aspiration
Surgical removal if necessary

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26
Q

What is the rehab protocol for ganglia at 2 weeks

A

Remove short term splint
AROM and AAROM wrist flexion and extension
Splint between exercise and at night

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27
Q

What is the rehab protocol for ganglia at 2-4 weeks

A

Resisted ROM and strengthening

Stop splinting at 4 weeks

28
Q

What is the rehab protocol for ganglia at 4-6 weeks

A

Allow normal activities to patient tolerance

29
Q

What is the rehab protocol for ganglia at 6 weeks

A

Allow full activity

30
Q

What are some activities associated with UCL sprain

A

“Game keeping”
Breakdancing
Skiing

31
Q

Briefly describe UCL sprains

A

Injuries to the MCP joint

Most common ligament injury of the hand

32
Q

What is the MOI for UCL sprains

A

Forceful abduction and hyperextension

33
Q

What is the clinical presentation of UCL sprain

A

Pain, swelling, tenderness on ulnar side of MCP
Weak pinch
Instability

34
Q

What classifies a UCL sprain for surgical intervention

A

Grade 1-2 sprain extension greater than 35-40 degrees compared to the other side

35
Q

How do you manage a grade 1-2 UCL sprain

A

6 weeks of immobilization followed by 2 weeks as necessary
AROM of flexion and extension to begin at 3 weeks
Strengthening to begin at 8 weeks

36
Q

What type of stress is to be avoided in the first 2-6 weeks of UCL management

A

abduction stress of the MCP

37
Q

What nerves are of concern during UCL sprain management

A

Superficial radial

Ulnar digital

38
Q

What is the medical management of a grade 3 UCL sprain

A

Thumb spica splint for 3-5 weeks, not worn during flexion and extension exercises
All other guidelines the same as 1-2 grade sprains

39
Q

Describe the arthrokinematics of thumb flexion and extension

A

Cave - metacarpal
Vex - trapezium
Flexion - ulnar glide
Extension - Radial glide

40
Q

Describe the arthrokinematics of thumb adduction and abduction

A

Cave - Trapezium
Vex - Metacarpal
Abduction - Dorsal glide
Adduction - Palmar glide

41
Q

Describe briefly mallet finger

A

Traumatic disruption of terminal tendon
Very common extensor tendon rupture
Baseball catcher, football receivers

42
Q

Describe the MOI for mallet finger

A

Longitudinal force to the tip of the finger producing sudden flexion of finger resulting in tendon rupture or fracture

43
Q

Describe the clinical presentation of mallet finger

A

Flexion deformity at the DIP

Can be extended passively but not actively

44
Q

What is the primary goal when treating mallet finger

A

maximize functional range of motion

45
Q

How do you manage a mallet finger with no fracture

A

8 week immobilization in slight hyperextension

46
Q

How do you manage mallet finger with a fracture

A

6 week immobilization in neutral extension
Exercise uninvolved side
Maintain extension force at DIP

47
Q

How do you progress mallet finger management

A 
AROM in 20-35 degrees after active extension is achieved
Splint between exercises
Progressive exercise at week 8
No more splinting at week 9
Unrestricted use at week 12
48
Q

Describe the longitudinal arch of the hand

A

Wrist to fingertips

Grasping

49
Q

Describe the proximal transverse row

A

Distal carpal row

stable gripping base

50
Q

Describe the distal transverse arch

A

Metacarpal shafts to heads

Allows hand to adapt to different shapes

51
Q

Describe this test

A

Watson / scaphoid shift test
Tests for dynamic stability of the wrist - scapholunate ligament
+ if clunk or pain in posterior wrist
(not very effective)

52
Q

Describe this test

A

Carpal compression test
Pressure over median nerve at carpal tunnel for 30 seconds
+ reproduces symptoms that subside in minutes after pressure is removed
indicates carpal tunnel syndrome
Flex wrist to 60 to make more sensitive

53
Q

Describe the UMT palmar glide

A

Assesses TFCC
+ is pain
Indicates TFCC pathology

54
Q

Describe Weber’s two pint discrimination

A

Finds threshold of discrimination

Less than 6mm is normal

55
Q

Describe the Digital blood flow test

A

Capillary refill test

Longer than 3 seconds indicates arterial insufficiency

56
Q

Describe this test

A

TFCC stress test/ compression test
+ is pain
Indicates TFCC pathology

57
Q

Describe the DRUJ instability test

A

Tests for DRUJ instability

Pain

58
Q

What is the pattern of loss in continuity

A

sensory more vulnerable than motor

Large touch cells more affected than thin pain cells

59
Q

Describe Vasomotor assessment

A

Blood vessels

Allen’s vascular test

60
Q

Describe Sudomotor assessment

A

Sweating response

61
Q

Describe Pilomotor assessment

A

Goose flesh response

62
Q

Describe Trophic assessment

A

Atrophy of tissue from skin to bone

63
Q

Describe a threshold test

A

Measure Intensity of the stimulus for depolarization

64
Q

Describe a functional test

A

How long to place items in a bin

65
Q

Describe objective tests

A

How quickly a nerve depolarizes

66
Q

Describe a Provocative test

A

Stressing a tissue for a response

67
Q

What are the two phases of sensory reeducation

A

Sensory preparation

Sensory reeducation

TRI 3 - MSK 2 (7 decks)

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