Wrist and hand Flashcards
Mallet finger
Rupture or avulsion of extensor tendon
Inability to extend DIP
Sweater finger
Inability to flex DIP due to avulsion or rupture of FDP
Trigger finger
Thickening of flexor tendon sheath, contributing to snapping with finger flexion/extension AROM
Boutonniere deformity
Extension of MCP/DIP with flexion of PIP due to ruptured central tendon slip of extensor hood
(Unable to extend at PIP)
Swan neck deformity
Flexion of MCP/DIP with (hyper)extension of PIP. Unable to actively flex PIP
Volar plate tear at PIP with intrinsic contracture
Dupuytren’s contracture
Skin/fascia adherence, palmar fascia contracture, typical affecting digits 4 and/or 5
MCP and PIP flexion observed, difficulty extending
Treatment for finger dysfunction
Mallet finger, sweater finger, swan neck, boutonnière: manual therapy and splinting
Trigger finger: splinting, corticosteroid injection, surgery
Dupuytren’s: surgery, post-op splinting, hand therapy
Tfcc tear
MOI: FOOSH, axial loading with pronation, sometimes degenerative
Clinical findings:
ulnar fovea sign, + tfcc load test, piano keys test
Wrist and hand OA
clinical findings
Pain with ROM, weak, capsular pattern, hard end-feel
Lunotriqueteal instability
MOI: FOOSH or trauma
Clinical signs: reagans test, shuck test, Murphy sign
Keinbock’s disease
AVN of lunate, often precipitated by trauma with pain -limited mobility
Clinical signs:
Shuck test and CT scan or MRI
Static splint/orthosis
Immobilizes one or more joints in a rigid position
Serial static
A static/rigid splint is worn for a time, removed and adjusted to new position, then worn for another period of time
Static progressive
Joint is positioned at endrange for a period of time, then adjusted when tissue response allows reposition to a new lengthened position
Ie: trying to gain elbow extension
Dynamic splint
Constant pull on joint but allows joint movement
Very important to have a 90deg angle of pull on joint
Watson clunk test
Identifies scapholunate instability
Shuck test
Lunotriquetral ballotement test for lunotriquetral instability
Stener lesion
Complete distal tear of thumb ulnar collateral ligament, affecting aponeurosis of adductor pollicis
Colles fracture
Extra-articular fracture of radius with dorsal displacement and angulation
Barton’s fracture
Fracture of distal radius where radius displaces anteriorly into wrist joint
Smith fracture
(Reverse Colles’ fracture)
Distal radius fracture resulting in volar displacement
Median nerve common entrapment areas
Pronator Teres syndrome
Ligament of struthers
Anterior osseous syndrome.
Carpal tunnel
Special testing tends to be slightly more specific than sensitive
Pronator teres syndrome
Clinical features
Relatively rare peripheral entrapment. Maybe related to trauma.
Sensory changes of palm at thenar eminence, digits 1-3, 1/2 digit 4
Motor weakness: abductor pollicis brevis, OP, 1/2 FPB, FDP, FPL, pronator quadratus
Pronator teres may be spared. FCR, PL, FDS spared
Carpal tunnel syndrome CPR
Age > 45
Wrist ratio index > 0.67 (rounder wrists)
Symptom severity score > 1.9
Decreased sensation median sensory field one (thumb)
Handshaking improves symptoms
If 4/5, 70% post test probability
If 5/5, 90%
Carpal tunnel syndrome
Clinical features
Sensory sparing at thenar eminence, diminished sensation at palmar digits 1-3, 1/2 digit 4, distal dorsal tips of digits 1-3
Motor weakness thenar eminence (OP, APB) with possible atrophy
Anterior interosseous syndrome
Clinical features
No sensory deficits, but may have aching/forearm pain
Motor weakness FDP digits 1-2, FPL, pronator quadratus
Kiloh-nevin sign: cannot make “Ok” sign- will see digit 1&2 DIP extension
