Wrist and Hand Flashcards
Distal Radius Fracture
Break at distal end of radius.
FOOSH
Colles Fracture
distal radius fracture with dorsal angulation
FOOSH with wrist extension
Smith fracture
distal radius fracture with wrist flexion
FOOSH with wrist flexion
Barton’s fracture
radius fracture with dislocation of radio-carpal joint
FOOSH
Distal ulna fracture
break at distal ulna
Impact
Scaphoid fracture
fracture at scaphoid
FOOSH or rapid radial deviation of wrist
Chauffeur Fracture
fracture at radial styloid
FOOSH with wrist extension
Greenstick fracture
only in children, mainly in long bones
Ulnar styloid Fracture
associated with distal radius fracture or rapid ulnar deviation of wrist
Benediction Sign
ulnar neuropathy, hypothenar wasting
Ape hand
median neuropathy, thenar wasting
Wrist drop
Radial neuropathy
Froment’s sign
can’t pinch, ulnar neuropathy
Anterior interosseous nerve palsy
can’t do “OK” sign
Wartenberg’s syndrome
numbness radial side of dorsum of hand, NO motor loss
Boxer fracture
fracture in neck of 5th met
Bennet Fracture
partial intra-articular fx of thumb
Rolando fracture
complete intra-articular fx of thumb
Kienbock’s Disease
AVN lunate
Preiser’s Disease
AVN scaphoid
Claw fingers
MCP ext, IP flex, increased exterinsic ext tone.
Median and Ulnar nerve palsies
Scapohid instability testing
Scaphoid shift test
Watson catch up clunk
Scaphoid ballottment test
TFCC testing
pain with compression and pronation Limited wrist ext>flex Ulnomeniscotriquetral doral glide ulnar fovea sign piano keys test TFCC toad test ulnar compression test
Golfer’s fracture
hook of hamate fracture
Trigger finger
thickened flexor tendon sheath
3rd and 4th digits
Sweater finger
rupture avulsion of flexor tendon
inability to flex distal phalanx
Mallet finger
rupture avulsion of ext tendon
inability to extend distal phalanx
Swan neck deformity
Volar plate tear at PIP jt
MCP flex, PIP ext, DIP flex
Boutonniere Deformity
rupture of central tendon slip of extensor hood
MCP ext, PIP flex, DIP ext
Dupuytren’s Contracture
contracted palmar fascia
MCP/PIP flex in 4th and 5th digits
Contents of carpal tunnel
Median nerve, FDS, FDPS, FPL
Carpal Tunnel CPG: Diagnosis
A level:
2.83 or 3.22 monofilament threshold for normal light touch and static 2-pt discrimination on middle finger.
More severe use 3.22
B: Katz hand diagram, phalen test, tinel sign, carpal compression test
CPR: age >45 shaking hands relieves symptoms sensory loss in thumb wrist ratio index >0.67 Boston Carpal tunnel Q >1.9
Carpal Tunnel CPG: Outcome measures - activity limitations/self reported measures
B:
CTQ-SSS for symptoms and non surgical management
Boston Carpal Tunnel Questionnaire Funcitonal Scale (CTQ-FS)
DASH
Carpal Tunnel CPG: how to measure activity limitations/performance (dexterity)
C:
quantify dexterity:
Purde pegboard (PPB)
Dellon-modified Moberg pick-up test (DMPUT)
After CTR:
do not use PPB, jebsen taylor hand function test, 9-hole peg test
DO USE DMPUT following surgery
Carpal Tunnel CPG: how to measure activity limitations/physical impairment measures: Strength measures
A: do NOT use lateral pinch strength
B: do NOT use grip strength for assessing short term changes after CTR surgery
C: assess grip strength and 3-pt or tip pinch strength
D: conflicting evidence tip and 3-pt pinch strength and abd pollicis brevis m strength testing following CTR surgery
Carpal Tunnel CPG: how to measure activity limitations/physical impairment measures: sensory and provocative measures
C: do NOT use thershold or vibration testing for non-surgical pts.
C: may use phalen test for long term followup after CTR surgery
D: conflicting evidence for use of sensory measures including 2pt discrimination and threshold testing to assess change overtime following surgery
Carpal Tunnel CPG: interventions - assistive technology
C: pt ed on effects of mouse use on carpal tunnel pressure, teach them alternatives: arrow keys, touch screens, alternating mouse hand. Can reccomend keyborads with reduced strike force for pts with pain with keyboard use
Carpal Tunnel CPG: Interventions: orthoses
B: neutral-positioned wrist orthosis worn at night for short-term symptom relief and functional improvement
C: If night use ineffective, try including day time, symptomatic, or full time use.
Can add MCP jt immobilization or modify wrist jt position.
Pt ed on pathology, risk ID, symptom self management, postures/activities that aggravate symptoms
Carpal Tunnel CPG: Interventions: biophysical agents
C: trial of superficial heat for short term relief
C: microwave or shortwave diathermy for short term pain relief
C: trial of interferential current for short term pain relief
B: DO NOT use low level laser
C: DO NOT use thermal US
D: conflicting evidence for nonthermal US
B: do NOT use iontophoresis
C: phonophoresis could work
B: do NOT use magnets
Carpal Tunnel CPG: Interventions: manual therapy
C: may perform manual directed at c/s and UE
D: conflicting evidence on neurodynamic mobs
Carpal Tunnel CPG: interventinos: therex
C: may use combined orthotic/stretching program for pts without thenar atrophy and who have normal 2pt discrimination.
