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ANATOMY > WRIST AND HAND > Flashcards

WRIST AND HAND Flashcards

1
Q

WRIST AND HAND - ROM - DISTAL RADIOULNAR

A
  • Supination - 85-90
  • Pronation - 85-90
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2
Q

WRIST AND HAND - ROM - WRIST

A
  • Flexion - 80
  • Extension - 70
  • Ulnar flexion - 30
  • Radial flexion - 20
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3
Q

WRIST AND HAND - ROM - FINGERS

A
  • Flexion (MP) - 90
  • Extension (MP) - 40
  • Abduction - 20
  • Adduction - 20
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4
Q

WRIST AND HAND - ROM - PIP JOINT

A
  • Flexion - 70
  • Extension - 0
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5
Q

WRIST AND HAND - ROM - DIP JOINT

A
  • Flexion - 80
  • Extension - 20
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6
Q

WRIST AND HAND - MYOTOMES

A
  • Brachioradialis - C5, C6 - radial
  • Biceps - C5, C6 - musculocutaneous
  • Triceps - C6, C7, C8, T1 - radial
  • Wrist extensors - C6, C7, C8 - radial
  • Wrist flexors - C6, C7 - median/ulnar
  • Finger flexors - C7, C8, T1 - ulnar/median
  • Interossei - C7, C8, T1 - ulnar
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7
Q

WRIST AND HAND - ORTHO TESTS - CARPAL TUNNEL

A
  • CARPAL TUNNEL SYNDROME - Phalen’s, Reverse phalen’s, Tinel’s, Median nerve compression test
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8
Q

WRIST AND HAND - ORTHO TESTS - ULNAR NEUROPATHY

A
  • ULNAR NERUOPATHY - Tinel’s at wrist and elbow
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9
Q

WRIST AND HAND - ORTHO TEST - VASCULAR DISORDER

A
  • VASCULAR DISORDER - Allen’s test
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10
Q

WRIST AND HAND - ORTHO TEST - TENOSYNOVITIS

A
  • TENOSYNOVITIS - Finkelstein’s test
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11
Q

WRIST AND HAND - ORTHO TEST - INSTABILITY

A
  • INSTABILITY - Valgus/varus stress test, Watson’s test
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12
Q

WRIST AND HAND - ORTHO TEST - TFCC TEAR

A
  • TFCC tear - TFCC dorsal glide
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13
Q

WRIST AND HAND - JOINT TYPE

A
  • Gliding - intercarpal
  • Ellipsoid - radiocarpal and ulnocarpal
  • Pivot - distal radioulnar
  • Saddle - trapeziometacarpal
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14
Q

WRIST AND HAND - MAIN MUSCLE ACTIONS - WRIST FLEXION

A
  • WRIST FLEXION - flexor carpi radialis and flexor carpi lunaris, palmares longus
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15
Q

WRIST AND HAND - MAIN MUSCLE ACTIONS - WRIST EXTENSION

A
  • WRIST EXTENSION - extensor carpi radialis longus and brevis, extensor carpi ulnaris, extensor digitorum
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16
Q

WRIST AND HAND - MAIN MUSCLE ACTIONS -RADIAL FLEXION

A
  • RADIAL FLEXION (ABDUCTION) - extensor carpi radialis longus/brevis, flexor carpi radialis
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17
Q

WRIST AND HAND - MAIN MUSCLE ACTIONS - ULNAR FLEXION

A
  • ULNAR FLEXION (ADDUCTION) - flexor and extensor carpi ulnaris
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18
Q

WRIST AND HAND - MAIN MUSCLE ACTIONS - FINGER FLEXION

A
  • FINGER FLEXION - flexor digitorum profundus, superficialis, lumbricals
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19
Q

WRIST AND HAND - MAIN MUSCLE ACTIONS - THUMB FLEXION

A
  • THUMB FLEXION - flexor pollicis longus and brevis
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20
Q

WRIST AND HAND - MAIN MUSCLE ACTIONS - FINGER EXTENSION

A
  • FINGER EXTENSION - extensor digitorum
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21
Q

WRIST AND HAND - MAIN MUSCLE ACTIONS - THUMB EXTENSION

A
  • THUMB EXTENSION - extensor pollicis longus and brevis
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22
Q

WRIST AND HAND - MAIN MUSCLE ACTIONS - ADDUCTION

A
  • ADDUCTION - palmar interossei
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23
Q

WRIST AND HAND - MAIN MUSCLE ACTIONS - ABDUCTION

A
  • ABDUCTION - dorsal interossei
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24
Q

WRIST AND HAND - NORMAL END FEEL

A

RADIOCARPAL FLEXION/EXTENSION - firm ligamentous

RADIOCARPAL ADDUCTION/ABDUCTION - bony

CMC THUMB - elastic

MCP EXTENSION - elastic/ligamentous

MCP FLEXION - ligamentous/firm

MCP THUMB - firm/bony

PIP FLEXION - firm/bony

PIP EXTENSION - firm/ligamentous

DIP FLEXION - firm/ligamentous/elastic

DIP EXTENSION - firm/ligamentous/elastic

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25
Q

WRIST AND HAND - CONDITIONS - CARPAL TINNEL SYNDROME

A

Hx - insidious onset, paraesthesia into hand, loss of digital dexterity
S&S - +ve Tinel’s and Phalen’s test, decreased sensation over median nerve distribution of the hand
DDx - pronator teres syndrome, TOS, C6-C7 radiculopathy

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26
Q

WRIST AND HAND - CONDITIONS - DE QUERVAIN’S TENOSYNOVITIS

A

Hx - aching pain above radial styloid, worse with wrist and thumb movements
S&S - +ve Finkelstein’s test, audible squeeking sound with wrist movement
DDx - scaphoid fracture, osteoarthritis

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27
Q

WRIST AND HAND - CONDITIONS - GAME KEEPERS THUMB

A

Hx - traumatic extension or abduction of thumb, pain over ulnar side of MCP joint
S&S - +ve thumb abduction test, UCL instability
DDx - scaphoid fracture, Bennett fracture, osteoarthritis

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28
Q

WRIST AND HAND - CONDITIONS - WRIST SPRAIN

A

Hx - traumatic extension or flexion of wrist (FOOSH)
S&S - palpable tenderness over ligaments, limited AROM and PROM, +ve Bracelet test
DDx - scaphoid fracture, TFCC tear, rheumatoid or septic arthritis

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29
Q

WRIST AND HAND - CONDITIONS - GANGLION CYST

A

Hx - painfull or painless lump or mass on wrist, weight bearing aggravates (push-up)
S&S - palpable solid mass, may be tender to palpation
DDx - infection

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30
Q

WRIST AND HAND - CONDITIONS - LUNATE DISLOCATION

A

Hx - FOOSH or impact trauma to hand
S&S - tenderness in wrist in line with 3rd metacarpal, visible on x-ray
DDx - lunate or scaphoid fracture, osteoarthrosis

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31
Q

WRIST AND HAND - CONDITIONS - SCAPHOID FRACTURE

A

Hx - FOOSH or impact trauma to hand
S&S - pain in anatomical snuff box with radial flexion, +ve scaphoid fracture test
DDx - lunate dislocation, osteoarthrosis

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32
Q

WRIST AND HAND - CONDTIONS - TFCC TEAR

A

Hx - FOOSH or impact trauma to hand with twisting
S&S - local pain with ROM, possible decrease in ROM and grip strength, +ve TFCC dorsal glide
DDx - lunate dislocation, ulnar styloid fracture, osteoarthrosis

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33
Q

WRIST AND HAND - ORTHO TESTS - ALLEN’S TEST - POSITIVE TEST

A

Artery stenosis or occlusion (peripheral vascular disease)

  • Skin remains balanced for more than 5 seconds
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34
Q

WRIST AND HAND - ORTHO TESTS - ALLEN’S TEST

A
  • Pt seated
  • Instruct pt to make a fist to remove blood from the hands
  • Examiner then compresses the ulnar and radial arteries
  • Ask the pt to pump fist again to remove and excess blood
  • Examiner then releases one artery
  • Repeat test releasing the other artery
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35
Q

WRIST AND HAND - ORTHO TEST - BRACELET TEST

A
  • Pt seated or standing
  • Examiner applies lateral compressive force around the distal radius & ulna
  • (around the location of a bracelet)
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36
Q

WRIST AND HAND - ORTHO TEST - BRACELET TEST - POSITIVE TEST

A

Rheumatoid arthritis, OA/DJD at the wrist

  • Forearm, wrist or hand pain

Ligament laxity, instability

  • Abnormal ROM
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37
Q

WRIST AND HAND - ORTHO TEST - FINKLESTEIN’S TEST

A
  • Pt seated or standing
  • Pt makes fist with thumb inside fingers
  • Pt ulnar deviates the wrist
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38
Q

WRIST AND HAND - ORTHO TEST - FINKLESTEIN’S TEST - POSITIVE TEST

A

de Quervain’s disease

  • Pain on lateral wrist
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39
Q

WRIST AND HAND - ORTHO TEST - FINKLESTEIN’S TEST - SN & SP

A

SN: 81

SP: 50

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40
Q

WRIST AND HAND - ORTHO TEST - MEDIAN NERVE COMPRESSION TEST

A
  • Pt seated or standing
  • Examiner places thumbs over median nerve as it passes through the carpal tunnel
  • Examiner applies pressure for 30-60 seconds
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41
Q

WRIST AND HAND - ORTHO TEST - MEDIAN NERVE COMPRESSION TEST - POSITIVE TEST

A

Carpal tunnel syndrome

  • Pain, numbness or tingling distal to compression site
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42
Q

WRIST AND HAND - ORTHO TEST - MEDIAN NERVE COMPRESSION TEST - SN & SP

A

SN: 42-100

SP: 92-100

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43
Q

WRIST AND HAND - ORTHO TEST - PHALEN’S TEST

A
  • Pt seated
  • Pt has wrists maximally flexed
  • Back of pt hands tigether in front of body so wrists are fully flexed
  • Maintain position for up to one minute
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44
Q

WRIST AND HAND - ORTHO TEST - PHALEN’S TEST - POSITIVE TEST

A

Carpal tunnel syndrome

  • Numbness or tingling over the distribution of the median nerve
  • Increased anterior wrist pain
  • Subsequent weakness of thumb opposition
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45
Q

WRIST AND HAND - ORTHO TEST - PHALEN’S TEST - SN & SP

A

SN: 10-88

SP: 33-100

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46
Q

WRIST AND HAND - ORTHO TEST - REVERSE PHALEN’S

A
  • Pt seated
  • Pt wrists extended
  • Pt places palms of hands together in front of body so both wrists are extended (praying position)
  • Maintains position position for up to a minute
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47
Q

WRIST AND HAND - ORTHO TEST - REVERSE PHALEN’S - POSITIVE TEST

A

Carpal tunnel syndrome, MFTP referral from forearm flexors

  • Numbness or tingling over the distribution of the median nerve
  • Increased anterior wrist pain
  • Subsequent weakness of thumb opposition
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48
Q

WRIST AND HAND - ORTHO TEST - REVERSE PHALEN’S TEST - SN & SP

A

SN: 45-75

SP: 55-96

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49
Q

WRIST AND HAND - ORTHO TEST - TFCC DORSAL GLIDE

A
  • Pt seated or standing
  • Examiner places thenar eminence over posterior distal ulna and thumb over anterior pisiform/triquetrum
  • Examiner then pushes the pisiform/triquetrum posteriorly and anteriorly
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50
Q

WRIST AND HAND - ORTHO TEST - TFCC DORSAL GLIDE - POSITIVE TEST

A

Triangular fibrocartilage tear or triquetral instability

  • Pain or laxity in lateral ulnocarpal joint
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51
Q

WRIST AND HAND - ORTHO TEST - TFCC DORSAL GLIDE - SN & SP

A

SN: 66

SP: 64

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52
Q

WRIST AND HAND - ORTHO TEST - THUMB GRIND TEST

A
  • Pt seated
  • Examiner grips and stabilises pt wrist and thumb
  • Then examiner applies long axis compression while circumducting the thumb
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53
Q

WRIST AND HAND - ORTHO TEST - THUMB GRIND TEST - POSITIVE TEST

A

Trapeziometacarpal arthritis or DJD scaphoid fracture

  • Pain or crepitus
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54
Q

WRIST AND HAND - ORTHO TEST - TINEL’S SIGN AT WRIST

A
  • Pt seated
  • Examiner gently taps over the carpal tunnel and ulnar tunnel with fingertips or reflex hammer
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55
Q

WRIST AND HAND - ORTHO TEST - TINEL’S SIGN AT WRIST - POSITIVE TEST

A

Median neuropathy

  • Paraesthesia (numbness, tingling, shooting electrical pain) along the median nerve distribution

Ulnar neuropathy

  • Paraesthesia (numbness, tingling, shooting electrical pain) along the ulnar nerve distribution
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56
Q

WRIST AND HAND - ORTHO TEST - TINEL’S SIGN AT WRIST - SN & SP

A

SN: 23-97

SP: 53-100

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57
Q

WRIST AND HAND - WRIST DEFORMITIES

A

Congenital variations

  • Embryonic abnormalities of the upper limb are likely to affect the one segment (or the whole) of the limb
    • Congenital conditions often appear together in the forearm, wrist and hand
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58
Q

WRIST AND HAND - WRIST DEFORMITIES - RISK FACTORS

A
  • Congenital
    • Birth defects - Club foot, Cleft lip, Cleft palette
    • Acquired - Trauma, Rheumatoid arthritis, Cerebral palsy
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59
Q

WRIST AND HAND - WRIST DEFORMITIES - POPULATION AFFECTED

A
  • Congenital
    • There at birth
    • Sometimes not seen till after
      • Not seen before 10 years in Madelung’s deformity
  • Acquired
    • Older people
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60
Q

WRIST AND HAND - WRIST DEFORMITIES - CLINICAL PRESENTATION - CONGENITAL

A

Congenital variations

  • Radial dysplasia
    • Infant is born with the wrist in marked radial deviation
    • There is absence of the whole or part of the radius, and usually also the thumb
  • Madelung’s deformity
    • The lower radius curves forwards (ventrally) carrying the carpus and hand with it but leaving the distal end of the ulna projecting on the back of the wrist
    • Although the abnormality is present at birth the deformity is rarely seen before the age of 10
    • Function is usually undisturbed
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61
Q

WRIST AND HAND - WRIST DEFORMITIES - CLINICAL PRESENTATION - ACQUIRED

A

Acquired deformities

  • Physical injuries can result in malunited fractures or subluxation of the distal radioulnar joint
  • Non-traumatic deformities are seen typically in rheumatoid arthritis and cerebral palsy
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62
Q

WRIST AND HAND - WRIST DEFORMITIES - PROGNOSIS - CONGENITAL

A

Congenital variations

  • Radial dysplasia
    • Treatment in the neonate consists of gentle stretching and splinting
    • Serious cases can be treated by distraction prior to a tension-free soft tissue correction which has less effect on growth of the carpus and distal ulna
    • Prolonged splintage is still needed to avoid recurrence of the deformity
  • Madelung’s deformity
    • Treatment may be unnecessary
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63
Q

WRIST AND HAND - WRIST DEFORMITIES - PROGNOSIS - ACQUIRED

A

Acquired deformities

  • Physical injuries
    • Osteotomy of the radius or stabilisation of the ulna may be needed
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64
Q

WRIST AND HAND - TUBERCULOSIS

A
  • Quite rare in the wrist
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65
Q

WRIST AND HAND - TUBERCULOSIS - RISK FACTORS

A
  • No vaccination
  • Trauma
  • Immunodeficiency
  • Low socioeconomic status
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66
Q

WRIST AND HAND - TUBERCULOSIS - POPULATION AFFECTED

A
  • Middle age
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67
Q

WRIST AND HAND - TUBERCULOSIS - CLINICAL PRESENTATION

A
  • Pain and stiffness come on gradually
  • The hand feels weak
  • Forearm looks wasted
  • Wrist is swollen and feels warm
    • Involvement of the flexor tendon compartment may give rise to a large fluctuant swelling that crossed the wrist into the palm
    • Movements are restricted and painful
    • X-ray examination shows localised osteoporosis and irregularity of the radiocarpal and intercarpal joints and sometimes bone erosion
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68
Q

WRIST AND HAND - TUBERCULOSIS - PROGNOSIS

A
  • Antituberculosis drugs are given
  • Wrist is splinted
  • If an abscess forms, it must be drained
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69
Q

WRIST AND HAND - RHEUMATOID ARTHRITIS

A
  • Rheumatoid arthritis is an inflammatory condition that affects the peripheral joints symmetrically
  • After the metacarpophalangeal joints, the wrist is the most common site of rheumatoid arthritis
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70
Q

WRIST AND HAND - RHEUMATOID ARTHRITIS - RISK FACTORS

A
  • Age - Likelihood increases with age
  • Sex - Women affected more than men
  • Genetics
  • Smoking
  • Obesity
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71
Q

WRIST AND HAND - RHEUMATOID ARTHRITIS - POPULATION AFFECTED

A
  • 30 – 50
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72
Q

WRIST AND HAND - RHEUMATOID ARTHRITIS - CLINICAL PRESENTATION

A
  • Pain, swelling and tenderness may at first be localised to the radioulnar joint, or to one of the tendon sheaths
  • Sooner or later the whole wrist becomes involved, and tenderness is much more ill defined
  • In late cases the wrist is deformed and unstable
  • X-rays show the characteristic features of osteoporosis and bony erosions
    • Tel-tale signs are usually more obvious in the metacarpophalangeal joints
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73
Q

WRIST AND HAND - RHEUMATOID ARTHRITIS - PROGNOSIS

A
  • Management in the early stages consists of splintage and local injections of corticosteroids combined with systemic treatment
  • Persistent synovitis may call for synovectomy and soft-tissue stabilisation of the wrist
  • In the late stage, tendon ruptures at the wrist, joint destruction, instability, and deformity may require reconstructive surgery
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74
Q

WRIST AND HAND - KEINBOCKS DISEASE

A
  • Quite uncommon
  • Always a worry when someone fractures their lunate
  • After injury or stress the lunate bone sometimes develops a patchy avascular necrosis
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75
Q

WRIST AND HAND - KEINBOCKS DISEASE - RISK FACTORS

A
  • Relative shortening of the ulna - Negative ulnar variance
  • Injury
  • Stress
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76
Q

WRIST AND HAND - KEINBOCKS DISEASE - POPULATION AFFECTED

A
  • Young adult
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77
Q

WRIST AND HAND - KEINBOCKS DISEASE - CLINICAL PRESENTATIONS

A
  • Ache and stiffness in the wrist
  • Tenderness is localised to the centre of the wrist on the dorsum
  • Wrist extension may be limited
  • Earliest signs of osteonecrosis can be detected only by MRI
  • Typical x-ray signs are increased density in the lunate and later, flattening and irregularity of the bone
  • There may also be features of osteoarthritis of the wrist
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78
Q

WRIST AND HAND - TEARS OF THE TRIANGULAR FIBROCARTILAGE

A
  • The TFCC (triangular fibrocartilage complex) fans out from the base of the ulnar styloid process to the medial edge of the distal radius
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79
Q

WRIST AND HAND - TEARS OF THE TRIANGULAR FIBROCARTILAGE - RISK FACTORS

A
  • People who are active
  • People who frequently use - Racquet, Bat, Club, Gymnastics
  • Over 50 = Degenerative tear
  • Chronic inflammation - Rheumatoid arthritis, Gout
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80
Q

WRIST AND HAND - TEARS OF THE TRIANGULAR FIBROCARTILAGE - POPULATION AFFECTED

A
  • Affects about 50% of people over 70 years
  • Uncommon in people under 30
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81
Q

WRIST AND HAND - TEARS OF THE TRIANGULAR FIBROCARTILAGE - CLINICAL PRESENTATION

A
  • Chronic pain in the wrist may be related to an old ‘sprain’ in which a more serious injury to the TFCC was overlooked
  • Symptoms are
    • Pain
    • Loss of grip strength
    • Clicking in supination of the forearm
82
Q

WRIST AND HAND - ULNOCARPAL IMPACTION AND TFCC DEGENERATION

A
  • Chronic degeneration of the TFCC may be associated with a relatively long ulna, impaction of the ulnar head against the ulna side of the lunate and ulnocarpal arthritis
  • Positive ulna variance in the wrist means the TFCC is stretched and thin
83
Q

WRIST AND HAND - ULNOCARPAL IMPACTION AND TFCC DEGENERATION - RISK FACTORS

A
  • Positive ulna variance - Increased ulna length relative to the radius
  • Risk factors for developing positive ulnar variance
    • Congenital positioning of the ulnar articular surface more distally than the radial articular surface
    • Acquired radial shortening secondary to trauma
      • Eg. a malunion of the radius after a distal radius fracture
    • Excessive dynamic ulnar variance greater than normal distal movement of the ulna during forearm pronation and gripping
84
Q

WRIST AND HAND - ULNOCARPAL IMPACTION AND TFCC DEGENERATION - POPULATION AFFECTED

A
  • Over 70 normally
85
Q

WRIST AND HAND - ULNOCARPAL IMPACTION AND TFCC DEGENERATION - CLINICAL PRESENTATION

A
  • X-ray exam shows a relatively long ulna
  • In late cases there may be arthritic changes in the ulnolunate articulation
  • Tenderness dorsally just distal to ulnar head
  • Tenderness just volar to the ulnar styloid process
  • Positive ulnar variance while static or dynamic
  • Painful passive ulnar deviation and forceful pronation
  • Decreased flexion, extension, radial and ulnar deviation
  • Decreased grip strength
86
Q

WRIST AND HAND - CHRONIC CARPAL INSTABILITY

A
  • The wrist functions as a system of intercalated segments stabilised by ligaments and by the scaphoid which bridges the 2 rows of carpal bones
87
Q

WRIST AND HAND - CHRONIC CARPAL INSTABILITY - RISK FACTORS

A
  • Acute traumatic events
  • Chronic repetitive stress
  • Microcrystal deposits secondary to another underlying disease
88
Q

WRIST AND HAND - CHRONIC CARPAL INSTABILITY - POPULATION AFFECTED

A
  • Young and middle-aged people
89
Q

WRIST AND HAND - CHRONIC CARPAL INSTABILITY - CLINICAL PRESENTATION

A
  • Following trauma to the carpus, there may be partial collapse of the ‘bridge’ structure
    • This is not always recognised at the time
  • Some years after the trauma pt complains of progressive pain and weakness in the wrist
  • Most easily spotted example of carpal instability is a rupture of the scapho-lunate ligament
    • This appears on the x-ray as an unusual gap between the scaphoid and lunate and foreshortening of the scaphoid image
90
Q

WRIST AND HAND - CHRONIC CARPAL INSTABILITY - PROGNOSIS

A
  • The best form of treatment is prevention
  • Acute wrist sprains should be carefully assessed for signs of carpal displacement and instability
91
Q

WRIST AND HAND - TENOSYNOVITIS AND TENOVAGINITIS

A
  • The extensor retinaculum contains 6 compartments which transmit tendons lined with synovium
92
Q

WRIST AND HAND - TENOSYNOVITIS AND TENOVAGINITIS - RISK FACTORS

A
  • Sex - Women
  • Middle age
  • Childbirth
93
Q

WRIST AND HAND - TENOSYNOVITIS AND TENOVAGINITIS - POPULATION AFFECTED

A

De Quervain’s disease

  • 30 – 40 years
94
Q

WRIST AND HAND - TENOSYNOVITIS AND TENOVAGINITIS - CLINICAL PRESENTATION - TENOSYNOVITIS

A

Tenosynovitis

  • Can be caused by unaccustomed movement
  • Can also occur spontaneously

Other types of extensor tenosynovitis

  • Tenosynovitis of extensor carpi radialis brevis or extensor carpi ulnaris may cause pain and point tenderness just medial to the anatomical snuffbox or immediately distal to the head of the ulna
95
Q

WRIST AND HAND - TENOSYNOVITIS AND TENOVAGINITIS - CLINICAL PRESENTATION - DE QUERVAIN’S DISEASE

A

De Quervain’s disease

  • May be a history of unaccustomed activity
  • Pain and sometimes swelling are localised to the radial side of the wrist
  • Tendon sheath feels hard and thick
  • Tenderness is most acute at the very tip of the radial styloid
  • Occasionally pt will describe triggering, snapping or catching that occurs with motion of the thumb
  • The pathognomonic sign is elicited by Finkelstein’s test
96
Q

WRIST AND HAND - TENOSYNOVITIS AND TENOVAGINITIS - PROGNOSIS

A
  • Early treatment including rest, anti-inflammatory medication and injection of corticosteroids may break the cycle

Other types of extensor tenosynovitis

  • Splintage and corticosteroid injections are usually effective

De Quervain’s disease

  • In the early stages symptoms can be relieved by ultrasound therapy or a corticosteroid injection into the tendon sheath
  • Resistant cases need an operation
97
Q

WRIST AND HAND - GANGLION

A
  • 50% to 70% of soft tissue masses of the hand and wrist are diagnosed as ganglion cysts
  • A ubiquitous ganglion is seen most commonly on the back of the wrist
98
Q

WRIST AND HAND - GANGLION - RISK FACTORS

A
  • Sex - Women 3 times more likely than men
  • Injury to the wrist or finger joint
  • Inflammation or irritation in the tendons or joints
  • Repetitive activities that use the rest and fingers
  • Chronic illness - Arthritis
99
Q

WRIST AND HAND - GANGLION - POPULATION AFFECTED

A
  • Young adult
100
Q

WRIST AND HAND - GANGLION - CLINICAL PRESENTATION

A
  • Pt presents with a painless lump usually on the back of the wrist but sometimes on the front
  • Occasionally there is a slight ache
  • The lump is well defined, cystic, and not tender
  • About 10% of pt will give a history of trauma
101
Q

WRIST AND HAND - GANGLION - PROGNOSIS

A
  • Often disappears after some months so there is no rush with treatment
  • If the lesion continues to be troublesome, it can be aspirated; if it recurs, excision is justified
    • Pt should be told there is a 30% risk of recurrence even after careful surgery
102
Q

WRIST AND HAND - CARPAL TUNNEL SYNDROME

A
  • Commonest and best known of all the nerve entrapment syndromes
  • In the normal carpal tunnel, there is barely room for all the tendons and median nerve, so any swelling is likely to result in compression and ischaemia of the nerve
103
Q

WRIST AND HAND - CARPAL TUNNEL SYNDROME - RISK FACTORS

A
  • Sex - Women affected more than men
  • Menopause
  • Myxoedema
  • Anatomic factors
  • Metabolic factors
  • Inflammatory causes
  • Postural changes
104
Q

WRIST AND HAND - CARPAL TUNNEL SYNDROME - POPULATION AFFECTED

A
  • 40 – 50 years
105
Q

WRIST AND HAND - CARPAL TUNNEL SYNDROME - CLINICAL PRESENTATION

A
  • History is most helpful in diagnosis
  • Pain and paresthesia occur in the distribution of the median nerve in the hand
    • In mild to moderate stages of the syndrome, pt will note the paresthesias are intermittent
    • Numbness will become more constant as the syndrome progresses
  • Pt will present with complaints of numbness and tingling of the hand
  • Pt will often note diffuse hand numbness
  • Night after night pt is woken with burning pain, tingling and numbness
  • Pt tend to seek relief by hanging the arm over the side of the bed or shaking the arm
    • However just changing the position of the wrist will usually help
  • Early on there is little to see but there are two helpful tests
    • Tinel’s sign
    • Phalen’s test
  • In late cases there is wasting of the thenar muscles, weakness of thumb abduction and sensory dulling in the median nerve territory
106
Q

WRIST AND HAND - CARPAL TUNNEL SYNDROME - PROGNOSIS

A
  • Light splints that prevent wrist flexion can help those with night pain or with pregnancy related symptoms
  • Steroid injection into the carpal canal provides temporary relief
107
Q

FLEXOR CARPI RADIALIS - ORIGIN

A

Medial epicondyle via common flexor tendon

108
Q

FLEXOR CARPI RADIALIS - INSERTION

A

Base of 2nd and 3rd metacarpals (anterior side)

109
Q

FLEXOR CARPI RADIALIS - ACTION

A

Flexion of wrist
Radial flexion (abduction) of wrist

110
Q

FLEXOR CARPI RADIALIS - INNERVATION

A

Median nerve (C6-C7)

111
Q

FLEXOR CARPI RADIALIS - TRIGGER POINT REFERRAL

A

Referral is pain and tenderness that centers in the radial aspect of the anterior wrist

112
Q

FLEXOR CARPI RADIALIS - STRETCH

A

Elbow straight, extend wrist and use opposite hand to ulnar deviate wrist

113
Q

FLEXOR CARPI RADIALIS - STRENGTHEN

A

Resisted wrist flexion
Wrist curls

114
Q

PALMARIS LONGUS - ORIGIN

A

Medial epicondyle via common flexor tendon

115
Q

PALMARIS LONGUS - INSERTION

A

Palmar aponeurosis
Flexor retinaculum

116
Q

PALMARIS LONGUS - ACTION

A

Flexion of wrist

117
Q

PALMARIS LONGUS - INNERVATION

A

Median nerve (C7-C8)

118
Q

PALMARIS LONGUS - TRIGGER POINT REFERRAL

A

Referral pattern is superficial needle-like prickling pain over the palm extending to the base of the thumb and the distal palm, but not intot he digits

119
Q

PALMARIS LONGUS - STRETCH

A

With elbow straight, extend wrist and use opposite hand to spread palm

120
Q

PALMARIS LONGUS - STRENGTHEN

A

Resisted wrist flexion
Wrist curls

121
Q

FLEXOR CARPI ULNARIS - ORIGIN

A

Humeral head - medial epicondyle via common flexor tendon
Ulnar head - medial aspect of olecranon and proximal 2/3 of medial ulna

122
Q

FLEXOR CARPI ULNARIS - INSERTION

A

Pisiform and hamate bones via pisohamate ligament
Base of 5th metacarpal via pisometacarpal ligament

123
Q

FLEXOR CARPI ULNARIS - ACTION

A

Flexion of wrist
Ulnar flexion of wrist

124
Q

FLEXOR CARPI ULNARIS - INNERVATION

A

Ulnar nerve (C7-C8)

125
Q

FLEXOR CARPI ULNARIS - TRIGGER POINT REFERRAL

A

Referral pattern is pain and tenderness to the ulnar side of the anterior aspect of the wrist with some similar spillover in the same general area

126
Q

FLEXOR CARPI ULNARIS - STRETCH

A

With elbow straight, extend wrist and use opposite hand to radially deviate wrist

127
Q

FLEXOR CARPI ULNARIS - STRENGTHEN

A

Resisted wrist flexion
Wrist curls

128
Q

FLEXOR DIGITORUM SUPERFICIALIS - ORIGIN

A

Humeral-ulnar head - medial epicondyle via common flexor tendon and coronoid process of ulna, medial collateral ligament
Radial head - oblique line of radius along its upper anterior border

129
Q

FLEXOR DIGITORUM SUPERFICIALIS - INSERTION

A

Base of middle phalanges of fingers 2-5

130
Q

FLEXOR DIGITORUM SUPERFICIALIS - ACTION

A

Flexion of fingers 2-5

131
Q

FLEXOR DIGITORUM SUPERFICIALIS - INNERVATION

A

Median nerve (C7-C8)

132
Q

FLEXOR DIGITORUM SUPERFICIALIS - TRIGGER POINT REFERRAL

A

Referral pattern is shooting pain and tenderness over the anterior forearm and fingers that correspond to the area of the muscle belly

133
Q

FLEXOR DIGITORUM SUPERFICIALIS - STRETCH

A

Elbow straught wrist extended, use opposite hand to pull middle phalanges posteriorly

134
Q

FLEXOR DIGITORUM SUPERFICIALIS - STRENGTHEN

A

Resisted finger flexion
Wrist curls with finger extension
Finger curls
Grip strength exercises

135
Q

FLEXOR DIGITORUM PROFUNDUS - ORIGIN

A

Anterior and medial surface of ulna
Interosseous menbrane

136
Q

FLEXOR DIGITORUM PROFUNDUS - INSERTION

A

Base of distal phalange of fingers 2-5

137
Q

FLEXOR DIGITORUM PROFUNDUS - ACTION

A

Flexion of fingers

138
Q

FLEXOR DIGITORUM PROFUNDUS - INNERVATION

A

Median nerve (C8-T1)
Ulnar nerve (C8-T1)

139
Q

FLEXOR DIGITORUM PROFUNDUS - TRIGGER POINT REFERRAL

A

Referral pattern is shooting pain and tenderness to the anterior forearm and fingers that correspond to the area of the muscle belly

140
Q

FLEXOR DIGITORUM PROFUNDUS - STRETCH

A

Elbow straight, wrist extended, use opposite hand to pull distal phalanges posteriorly

141
Q

FLEXOR DIGITORUM PROFUNDUS - STRENGTHEN

A

Resisted finger flexion
Wrist curls with finger extension
Finger curls
Grip strength exercises

142
Q

FLEXOR POLLICIS LONGUS - ORIGIN

A

Radius (middle anterior surface)
Interosseous membrane

143
Q

FLEXOR POLLICIS LONGUS - INSERTION

A

Base of distal phalanx of thumb (anterior aspect)

144
Q

FLEXOR POLLICIS LONGUS - ACTION

A

Flexion of thumb

145
Q

FLEXOR POLLICIS LONGUS - INNERVATION

A

Median nerve (C7-C8)

146
Q

FLEXOR POLLICIS LONGUS - TRIGGER POINT REFERRAL

A

Referral pattern is shooting pain and tenderness over the anterior thumb and thenar region

147
Q

FLEXOR POLLICIS LONGUS - STRETCH

A

Elbow straight, wrist extended, use opposite hand to pull distal phalanx of thumb into extension

148
Q

FLEXOR POLLICIS LONGUS - STRENGTHEN

A

Resisted thumb flexion
Stress ball
Grip strength exercises

149
Q

EXTENSOR CARPI RADIALIS LONGUS - ORIGIN

A

Lower lateral supracondylar ridge

150
Q

EXTENSOR CARPI RADIALIS LONGUS - INSERTION

A

Base of 2nd metacarpal

151
Q

EXTENSOR CARPI RADIALIS LONGUS - ACTION

A

Extension of wrist
Radial flexion (abduction) of wrist

152
Q

EXTENSOR CARPI RADIALIS LONGUS - INNERVATION

A

Radial nerve (C5-C6)

153
Q

EXTENSOR CARPI RADIALIS LONGUS - TRIGGER POINT REFERRAL

A

Referral pattern is initially pain over the lateral epicondyle and followed by pain radiating down toward the forearm, wrist and posterior hand

154
Q

EXTENSOR CARPI RADIALIS LONGUS - STRETCH

A

Elbow straight, wrist flexed and pronated, use opposite hand to apply flexion pressure over the shaft of 2nd metacarpal

155
Q

EXTENSOR CARPI RADIALIS LONGUS - STRENGTHEN

A

Resisted wrist extension
Wrist roller
Reverse wrist curl

156
Q

EXTENSOR CARPI RADIALIS BREVIS - ORIGIN

A

Lateral epicondyle via common extensor tendon

157
Q

EXTENSOR CARPI RADIALIS BREVIS - INSERTION

A

Base of 3rd metacarpal

158
Q

EXTENSOR CARPI RADIALIS BREVIS - ACTION

A

Extension of wrist
Radial flexion (abduction) of wrist

159
Q

EXTENSOR CARPI RADIALIS BREVIS - INNERVATION

A

Radial nerve (C7-C8)

160
Q

EXTENSOR CARPI RADIALIS BREVIS - TRIGGER POINT REFERRAL

A

Main referral pattern is pain over the posterior forearm, wrist, and posterior hand that may eventually involve the lateral epicondyle

161
Q

EXTENSOR CARPI RADIALIS BREVIS - STRETCH

A

Elbow straight, wrist flexed and pronated, use opposite hand to apply flexion pressure over the shaft of 3nd metacarpal

162
Q

EXTENSOR CARPI RADIALIS BREVIS - STRENGTHEN

A

Resisted wrist extension
Wrist roller
Reverse wrist curl

163
Q

EXTENSOR DIGITORUM - ORIGIN

A

Lateral epicondyle of humerus via common extensor tendon

164
Q

EXTENSOR DIGITORUM - INSERTION

A

Phalanges 2-5 (dorsal expansion hood)

165
Q

EXTENSOR DIGITORUM - ACTION

A

Extension of fingers 2-5
Extension of wrist

166
Q

EXTENSOR DIGITORUM - INNERVATION

A

Radial nerve (C7-C8)

167
Q

EXTENSOR DIGITORUM - TRIGGER POINT REFERRAL

A

Referral pattern is over the distal posterior forearm and to the digits that correspond to that area of the muscle

168
Q

EXTENSOR DIGITORUM - STRETCH

A

Elbow straight, wrist flexed and hand in a fist, use opposite hand to apply flexion pressure

169
Q

EXTENSOR DIGITORUM - STRENGTHEN

A

Resisted wrist extension
Wrist roller
Reverse wrist curl
Elastic band exercise

170
Q

EXTENSOR DIGITI MINIMI - ORIGIN

A

Lateral epicondyle of humerus via common extensor tendon

171
Q

EXTENSOR DIGITI MINIMI - INSERTION

A

Middle and distal phalanges of 5th digit

172
Q

EXTENSOR DIGITI MINIMI - ACTION

A

Extension of little finger
Extension of wrist

173
Q

EXTENSOR DIGITI MINIMI - INNERVATION

A

Radial nerve (C6-C8)

174
Q

ABDUCTOR POLLICIS LONGUS - ORIGIN

A

Posterior surfaces of ulna, radius and interosseous membrane

175
Q

ABDUCTOR POLLICIS LONGUS - INSERTION

A

Base of 1st metacarpal

176
Q

ABDUCTOR POLLICIS LONGUS - ACTION

A

Abduction of thumb
Radial deviation

177
Q

ABDUCTOR POLLICIS LONGUS - INNERVATION

A

Radial nerve (C7-C8)

178
Q

ABDUCTOR POLLICIS LONGUS - TRIGGER POINT REFERRAL

A

Referral pattern is pain and tenderness over the distal posterior forearm, wrist and thumb

179
Q

ABDUCTOR POLLICIS LONGUS - STRETCH

A

Curl thumb into fist and ulnar deviate wrist (Finklestein’s test)

180
Q

ABDUCTOR POLLICIS LONGUS - STRENGTHEN

A

Resisted wrist abduction
Wrist hammer curl
Elastic band exercises

181
Q

EXTENSOR POLLICIS BERVIS - ORIGIN

A

Posterior distal 1/3 surfaces of radius
Interosseous membrane

182
Q

EXTENSOR POLLICIS BERVIS - INSERTION

A

Base of proximal phalanx of thumb

183
Q

EXTENSOR POLLICIS BERVIS - ACTION

A

Extension of proximal phalanx

184
Q

EXTENSOR POLLICIS BERVIS - INNERVATION

A

Radial nerve (C7-C8)

185
Q

EXTENSOR POLLICIS BERVIS - TRIGGER POINT REFERRAL

A

Referral pattern is shooting pain and tenderness over the posterior wrist and thumb

186
Q

EXTENSOR POLLICIS BERVIS - STRETCH

A

Ulnar deviate wrist and use opposite hand to flex thumb

187
Q

EXTENSOR POLLICIS BERVIS - STRENGTHEN

A

Resisted wrist extension
Wrist roller
Reverse wrist curl
Elastic band exercises

188
Q

EXTENSOR POLLICIS LONGUS - ORIGIN

A

Posterior middle 1/3 of ulna
Interosseous membrane

189
Q

EXTENSOR POLLICIS LONGUS - INSERTION

A

Distal phalanx of thumb

190
Q

EXTENSOR POLLICIS LONGUS - ACTION

A

Extension of thumb

191
Q

EXTENSOR POLLICIS LONGUS - INNERVATION

A

Radial nerve (C7-C8)

192
Q

EXTENSOR POLLICIS LONGUS - TRIGGER POINT REFERRAL

A

Referral pattern is pain and tenderness over posterior wrist and thumb

193
Q

EXTENSOR POLLICIS LONGUS - STRETCH

A

Ulnar deviate wrist and use opposite hand to flex thumb

194
Q

EXTENSOR POLLICIS LONGUS - STRENGTHEN

A

Resisted wrist extension
Wrist roller
Reverse wrist curl

195
Q

EXTENSOR INDICIS - ORIGIN

A

Posterior distal 1/3 of ulna
Interosseous mambrane

196
Q

EXTENSOR INDICIS - INSERTION

A

Base of middle and distal phalanx of index finger

197
Q

EXTENSOR INDICIS - ACTION

A

Extension of index finger
Extension of hand at wrist

198
Q

EXTENSOR INDICIS - INNERVATION

A

Radial nerve (C7-C8)

199
Q

EXTENSOR INDICIS - TRIGGER POINT REFERRAL

A

Referral pattern is pain and tenderness over the posterior forearm, wrist and index finger

200
Q

EXTENSOR INDICIS - STRETCH

A

Wrist flexed, with index finger curled into fist

201
Q

EXTENSOR INDICIS - STRENGTHEN

A

Resisted wrist extension
Wrist roller
Reverse wrist curl

ANATOMY (10 decks)

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