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Boards Prep - MSK > Wrist and Hand > Flashcards

Wrist and Hand Flashcards

1
Q

What is carpal Tunnel

A
  • compression of the median n at the carpal tunnel of the wrist due to inflammation of the flexor tendons and/or median n
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2
Q

causes of carpal tunnel

A
  • known causes: trauma, pregnancy, repetitive wrist motions or gripping, diabetes, RA
  • unknown causes: collagen disease, heredity
  • tightening of transverse carpal ligament
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3
Q

what must you rule out in carpal tunnel syndrome

A
  • c spine dysfunction, TOS, peripheral nerve entrapment
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4
Q

common clinical findings of carpal tunnel syndrome

A
  • pain or numbness on radial side of palm
  • sensory changes aggravated by prolonged hand use
  • worse at night due to positioning or activity during day
  • decreased prehension/clumsiness of hands
  • inability to perform sustained Or repetitive wrist or finger motion
  • long term compression causes atrophy and weakness of thenar mm and lat two lumbricals
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5
Q

CTS CPG outcome measures

A
  • Boston Carpal Tunnel Questionnaire Symptom Severity Scale (II)
  • Purdue Pegboard or Dellon-modified Moberg Pick Up Test (III)
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6
Q

CTS CPG Physical Impairments Measures

A
  • SHOULD NOT USE LAERAL PINCH STRENGTH AS AN OUTCOME MEASURE (I)
  • don’t use grip strength (II)
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7
Q

CTS CPG Diagnosis/Classification

A
  • use Semmes Weinstein Monofilament testing (I) –> assess middle finger with 2.83 or 3.22 monofilament as threshold normal for light touch and static 2PD (use any radial finger with 3.22 in suspected moderate to severe)
  • Katz hand diagram, Phalens, Tinels, carpal compression test (II)
  • combination of two: age >45, shaking hands relieves symptoms, sensory loss in thumb, wrist ratio index > 0.67, CTQ-SSS score >1.9
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8
Q

CTS CPG Interventions- Assistive Technology

A
  • educate pts on effect of mouse use (III)
  • recommend keyboards with reduced strike force (III)
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9
Q

CTS CPG Orthoses

A
  • neutral wrist orthoses worm at night (II)
  • daytime use when night time isnt effective (III)
  • recommend for pregnant women (III)
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10
Q

CTS CPG Biophysical Agents

A
  • heat, shortwave diathermy, IFC (III)
  • phonophoresis (III)
  • do not use low level user therapy to iontophoresis or recommend magnets (III)
  • do not use thermal ultrasound (III)
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11
Q

CTS CPG manual therapy

A
  • c spine and UE (III)
  • contradictory evidence on neurodynamics (IV)
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12
Q

CTS CPG orthotic/stretching program

A
  • may use combined orthotic/stretching program in individuals with mild to mod without thenar atrophy and normal 2PD (III)
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13
Q

Pt education for CTS

A
  • keep wrist in neutral
  • avoid forceful prehension
  • protect areas with decreased sensitivity
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14
Q

improving muscle performance in CTS

A
  • start with multi-angle isometrics
  • progress to endurance/strengthening
  • speed coordination, manual dexterity with symptoms not longer provoked
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15
Q

Ulnar nerve compression in the wrist

A
  • compression within Guyon’s canal
  • parasthesias of ulnar 1 1/2 digits
  • weakness in ulnar innervated muscles of hand
  • degree of sensory/motor loss depend on n derange
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16
Q

What is DeQuervain’s Tenosynovitis

A
  • inflammation/ degeneration of synovial lining of common sheath of APL and EPB in first dorsal compartment
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17
Q

Etiology of DeQuervain’s Tenosynovitis

A
  • often insidious
  • direct trauma
  • repetitive irritation
  • swelling from pregnancy
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18
Q

presenting symptoms of DeQuervain’s Tenosynovitis

A
  • tenderness of radial styloid/anatomical snuffbox
  • pain with active thumb movements and resisted thumb ext and abd
  • swelling
  • decreased grip and ping strength
  • +Finkelstein’s
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19
Q

diagnostic test for DeQuervain’s Tenosynovitis

A
  • MRI but usually not necessary to make diagnosis
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20
Q

DeQuervain’s Tenosynovitis treatment

A
  • conservative treatment
  • rest –> AROM –> gentle resistive motions
  • tendon gliding techniques
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21
Q

What is Colles fracture

A
  • fracture of distal radius with dorsal displacement of fragments
  • most common wrist fracture
    “dinner fork displacement”
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22
Q

Etiology of Colles fracture

A
  • primary affects older adults
  • F>M
  • typically due to FOOSH
  • lunate acts as wedge
  • distal radius is sheered
  • fragment displaces radially and posteriorly
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23
Q

Immobilization of Colles fracture

A

typically for 5-8 weeks

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24
Q

complications of Colles fracture

A
  • median n compression
  • loss of motion
  • decreased grip strength
  • CRPS
  • CTS
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25
Q

Treatment considerations of Colles fracture

A
  • ROM goals (full ROM may not be appropriate due to malalignment)
  • joint mobs, ROM, strengthening, functional activities
  • check vascular supply
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26
Q

What is Smith Fracture

A
  • distal radius fracture with volar displacement of fragments
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27
Q

what deformity is associated with Smith Fracture

A
  • “garden spade” deformity
28
Q

Scaphoid/Lunate fracture etiology

A
  • 20-30 yo; M>F
  • FOOSH
  • strong radius, so fall tends to fracture scaphoid or dislocate lunate in palmar direction
  • poor blood supply to scaphoid –> delayed healing
29
Q

complications of Scaphoid/Lunate fracture

A

-avascular necrosis of proximal fragment of scaphoid
- immobilized for 4-8 weeks

30
Q

Scaphoid/Lunate fracture presenting symptoms

A
  • pain/localized tenderness swelling in anatomical snuffbox
  • long compression of thumb painful
  • possible loss of thumb function
  • muscle spasms with PROM
  • palpation changes for lunate dislocation
31
Q

Scaphoid/Lunate fracture treatment

A
  • treat swelling caressively
  • A/PROM after immobilization
  • watch X rays for healing
  • stretch right after they come out of cast
32
Q

What is Swan Neck Deformity

A
  • construction of intrinsic hand mm
  • common with RA or after trauma
  • PIP hyperextension and DIP Flexion
33
Q

What is Boutonniere Deformity

A
  • rupture/ avulsion of central tendinous slip of the extensor hood
  • common in RA
  • MCP and DIP ext
  • PIP flex
34
Q

What are claw fingers

A
  • paralysis of ulnar nerve
  • loss of intrinsic mm action –> “intrinsic minimus”
  • MCP hyperextension
  • PIP and DIP flexion
  • arch disappears
35
Q

ape hand deformity

A
  • wasting of thenar eminence due to median/ulnar nn palsy
  • Pt unable to flex or oppose thumb
  • ## thumb falls in line with fingers due to pull of ext mm
36
Q

Mallet finger

A
  • rupture/avulsion of ED tendon at insertion on distal phalanx
  • DIP rests in flexion
  • occurs from trauma forcing DIP into flexed positing
37
Q

Trigger finger

A
  • “sticking” of tendon with finger flexion
  • thickening of flexor tendon sheath
  • usually 2-3rd fingers
  • worse in AM
  • pt flexes finger which “gets caught” in flexion and lets go with snap
  • Rx: surgical release, tendon gliding
38
Q

Dupuytren’s Contracture

A
  • contracture of palmar fascia
  • usually seen in 3-4th digits
  • M>F
  • 40-70yo
  • increased incidence in people with gout, epilepsy, alcoholism
  • painless, sometimes surgically released
39
Q

what is Jersey Finger

A
  • flexor digitorum profundus tendon rupture/avulsion
  • typically ring finger
40
Q

MOI jersey finger

A
  • forced hyperextension of DIP with max finger flexion contraction
  • may rupture from insertion, avulse from bone, or rupture at musculotendinous junction
41
Q

key finding of Jersey finger

A

inability to produce isolated flexion of DIP

42
Q

treatment of jersey finger

A

immediate referral to hand surgeon

43
Q

What is Gamekeepers thumb

A
  • sprain/rupture of UCL of MCP joint of 1st digit
  • caused by abduction stress to thumb while MCP is ext
  • AKA Skiiers thumb
44
Q

what does gamekeepers thumb result in

A

medial instability
- typically immobilized

45
Q

What is boxers fracture

A

fracture of neck of 5th MC

46
Q

treatment boxers fracture

A

casted for 2-4 weeks

47
Q

fingers flex/ext convex/concave rule

A

concave on convex

48
Q

MCP abduction/adduction convex/concave rule

A

concave on convex

49
Q

wrist convex/concave rule

A

capitate, scaphoid, lunate triquetrum: convex on concave
triquetrum: concave on convex

50
Q

wrist flexion normal ROM

A

80-90 degrees

51
Q

wrist extension normal ROM

A

70-90 degrees

52
Q

MCP normal flexion

A

85-90 degrees

53
Q

MCP normal extension

A

30-45 degrees

54
Q

PIP normal flexion

A

100-115 degrees
0 degrees extension

55
Q

DIP normal flexion

A

80-90 degrees

56
Q

DIP normal extension

A

30-45 degrees

57
Q

1st CMC normal flexion

A

45-50 degrees

58
Q

1st CMC normal abduction

A

60-70 degrees

59
Q

1st CMC normal adduction

A

30 degrees

60
Q

1st MCP normal flexion

A

50-55 degrees
0 degrees extension

61
Q

1st IP normal flexion

A

85-90 degrees
0-5 degrees extension

62
Q

radio/ulnocarpal OPP

A

neutral with slight ulnar deviation

63
Q

radio/ulnocarpal CPP

A

full extension with radial deviation

64
Q

mid carpal joint OPP/CPP

A

OPP: neutral or slight flexion with ulnar deviation
CPP: extension with ulnar deviation

65
Q

carpometacarpal joint OPP/CPP

A

OPP: midway between abduction-adduction and flexion-extension
CPP: full opposition and full flexion

66
Q

MCP OPP/CPP

A

OPP: slight flexion
CPP: full opposition; full flexion

67
Q

IP joint OPP/CPP

A

OPP: slight flexion
CPP: full extension

Boards Prep - MSK (29 decks)

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