Wrist and hand

Question 1

Mallet finger

Answer 1

Rupture or avulsion of extensor tendon
Inability to extend DIP

Question 2

Sweater finger

Answer 2

Inability to flex DIP due to avulsion or rupture of FDP

Question 3

Trigger finger

Answer 3

Thickening of flexor tendon sheath, contributing to snapping with finger flexion/extension AROM

Question 4

Boutonniere deformity

Answer 4

Extension of MCP/DIP with flexion of PIP due to ruptured central tendon slip of extensor hood
(Unable to extend at PIP)

Question 5

Swan neck deformity

Answer 5

Flexion of MCP/DIP with (hyper)extension of PIP. Unable to actively flex PIP
Volar plate tear at PIP with intrinsic contracture

Question 6

Dupuytren’s contracture

Answer 6

Skin/fascia adherence, palmar fascia contracture, typical affecting digits 4 and/or 5
MCP and PIP flexion observed, difficulty extending

Question 7

Treatment for finger dysfunction

Answer 7

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

Question 8

Tfcc tear

Answer 8

MOI: FOOSH, axial loading with pronation, sometimes degenerative

Clinical findings:
ulnar fovea sign, + tfcc load test, piano keys test

Question 9

Wrist and hand OA
clinical findings

Answer 9

Pain with ROM, weak, capsular pattern, hard end-feel

Question 10

Lunotriqueteal instability

Answer 10

MOI: FOOSH or trauma

Clinical signs: reagans test, shuck test, Murphy sign

Question 11

Keinbock’s disease

Answer 11

AVN of lunate, often precipitated by trauma with pain -limited mobility

Clinical signs:
Shuck test and CT scan or MRI

Question 12

Static splint/orthosis

Answer 12

Immobilizes one or more joints in a rigid position

Question 13

Serial static

Answer 13

A static/rigid splint is worn for a time, removed and adjusted to new position, then worn for another period of time

Question 14

Static progressive

Answer 14

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

Question 15

Dynamic splint

Answer 15

Constant pull on joint but allows joint movement
Very important to have a 90deg angle of pull on joint

Question 16

Watson clunk test

Answer 16

Identifies scapholunate instability

Question 17

Shuck test

Answer 17

Lunotriquetral ballotement test for lunotriquetral instability

Question 18

Stener lesion

Answer 18

Complete distal tear of thumb ulnar collateral ligament, affecting aponeurosis of adductor pollicis

Question 19

Colles fracture

Answer 19

Extra-articular fracture of radius with dorsal displacement and angulation

Question 20

Barton’s fracture

Answer 20

Fracture of distal radius where radius displaces anteriorly into wrist joint

Question 21

Smith fracture
(Reverse Colles’ fracture)

Answer 21

Distal radius fracture resulting in volar displacement

Question 22

Median nerve common entrapment areas

Answer 22

Pronator Teres syndrome
Ligament of struthers
Anterior osseous syndrome.
Carpal tunnel

Special testing tends to be slightly more specific than sensitive

Question 23

Pronator teres syndrome
Clinical features

Answer 23

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

Question 24

Carpal tunnel syndrome CPR

Answer 24

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%

Question 25

Carpal tunnel syndrome
Clinical features

Answer 25

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

Question 26

Anterior interosseous syndrome
Clinical features

Answer 26

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