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Musculoskeletal > Wrist and Hand > Flashcards

Wrist and Hand Flashcards

1
Q

5 areas from subjective history that are super important for wrist and hand:

A

Occupation
Sensory changes
Functional changes
Age
MOI

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2
Q

Three red flags to consider with wrist and hand:

A

Sudden swelling - infection
Pain not responsive to movement
Excessive pain worsened with treatment

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3
Q

4 areas that refer pain to the wrist and hand

A

cervical spine
upper thoracic spine
shoulder
elbow

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4
Q

What is the most common cause of hand pain?

A

Carpal tunnel syndrome

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5
Q

With carpal tunnel syndrome, which nerve is compressed?

A

median nerve

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6
Q

How is early carpal tunnel syndrome classified?

A

S/S present for less than a year
S/S intermittent and mild
Axons not damaged
Negative Tinel

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7
Q

How is intermediate carpal tunnel syndrome classified?

A

Varying intensity of s/s
No atrophy present
Axons injured
Weakness and positive Tinel

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8
Q

How is advanced carpal tunnel syndrome classified?

A

Intensifying s/s
Thenar muscle atrophy
weakness with pinch and grip
constant numbness

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9
Q

The most bothersome S/Sx with __________ is pain, N/T or loss of sensation

A

carpal tunnel syndrome

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10
Q

What are some important Pt history flags for carpal tunnel syndrome (6):

A

Over 45 yrs
N/T or loss of sensation
Dropping objects
Shaking hands improve S/Sx
S/Sx exacerbated by gripping tasks
S/S at night

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11
Q

6 predisposing factors for carpal tunnel syndrome:

A

Diabetes
Increased BMI
OA, RA
Pregnancy
Thyroid disorders
Excessive alcohol use

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12
Q

What fracture can lead to carpal tunnel syndrome?

A

Colles’ fracture

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13
Q

With carpal tunnel syndrome is numbness and tingling worse during the day or at night?

A

at night

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14
Q

To manage carpal tunnel syndrome, should a splint be used during the day or at night?

A

At night

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15
Q

What is the gold standard for CTS prediction?

A

EMG

tells you about the integrity of the nerve and muscle.

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16
Q

5 CPR items give you ___% certainty of CPS

A

90%

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17
Q

4 CPR items give you ___% certainty of CTS

A

70%

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18
Q

CPR list for Carpal tunnel syndrome (5):

A

Shake hand for symptom relief?
Reduced median sensory field of digit 1
Age >45 yrs
Symptom severity scale score >1.9
Wrist-ratio index >.70

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19
Q

Instrinsic minus hand involves which two nerves?

A

Median and ulnar

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20
Q

Management of intrinsic minus hand:

A

Tendon transplants

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21
Q

S/S of Intrinsic minus hand (3):

A

MCP hyperextension, DIP and PIP flexion
Loss of arches
Atrophy of intrinsics

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22
Q

Drop wrist deformity is caused by what nerve?

A

Radial nerve palsy

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23
Q

S/S of drop wrist deformity (1):

A

Paralysis of wrist and finger extensors (inability to extend).

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24
Q

Management of drop wrist deformity:

A

Repair/decompress radial nerve if able
Splinting in functional position

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25
Q

Pronator Teres syndrome involves the compression of what nerve?

A

Median nerveA

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26
Q

Anterior interosseus nerve syndrome is a ________ nerve pathology without _______ deficit.

A

Median; sensory

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27
Q

Posterior interosseus nerve syndrome involves which nerve?

A

radial nerve

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28
Q

Which carpal is involved in about 10% of wrist injuries?

A

The Lunate

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29
Q

Avascular necrosis of the lunate is called _______ disease.

A

Kienbock’s

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30
Q

Two things that can lead to Kienbock’s disease

A

Trauma or repetitive stress
Short ulna (excessive radial/lunate pressure)

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31
Q

S/S of Kienbock’s disease (4):

A

Aching, stiffness with wrist flexion
Tender over lunate
Decreased grip strength
Degeneration on radiograph

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32
Q

What patient population is most prone to Kienbock’s disease?

A

Young men, 18-40 y.o.

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33
Q

PT management of Kienbock’s disease (3):

A

Pain control
Maintain ROM of uninvolved joints
Progressive ROM, strengthening

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34
Q

Identify the stage of Kienbock’s disease:

Aching, stiffness
Ischemia of lunate
No radiographic changes

A

Stage I

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35
Q

Identify the stage of Kienbock’s disease:

Density changes: trabecular necrosis. Reactive cortical bone growth (Sclerosis)

A

Stage II

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36
Q

Identify the stage of Kienbock’s disease:

Collapse of lunate: Pathologic fracture (not due to outside mechanism). Deformity.

A

Stage III

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37
Q

Identify the stage of Kienbock’s disease:

Pancarpal arthrosis - ALL carpals involved. Degenerative changes and instability at wrist.

A

Stage III A and B

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38
Q

Two types of management for Kienbock’s disease:

A

Conservative or surgical

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39
Q

Describe the conservative approach to Kienbock’s disease:

A

Immobilization for 1-3 months to decrease stress on the lunate.

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40
Q

Colles’ fracture is most likely to be seen in which patient population?

A

Elderly women

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41
Q

Two causes of Colles’ fracture:

A

Falls (FOOSH)
OA

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42
Q

What is the ratio of colles’ fracture seen in women as compared to men?

A

6:1 women > men

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43
Q

Describe what happens in a colles’ fracture:

A

Dorsal displacement of distal fragment (named for where the fragment goes)

Silver fork deformity

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44
Q

What may also occur with a Colles’ fracture (5)?

A

Fracture of ulnar styloid
Shattering of distal radius
Injury to radiocarpal or distal radioulnar jt
TFCC tear
Scapholunate dissociation

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45
Q

S/S of Colles fractures (3):

A

Silver fork deformity
Pain with ALL wrist and hand movements
Local tenderness

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46
Q

Management of Colles fracture (4):

A

Closed reduction and immobilization
ORIF and external fixation if unstable or complex

Maintain ROM and strength of uninvolved joints

Progressive ROM and strengthening

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47
Q

What is a common complication seen in elderly women due to Colles fracture?

A

Adhesive capsulitis

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48
Q

Four additional complications associated with Colles fracture:

A

Adhesive capsulitis
CRPS
Malunion
Rupture of EPL tendon

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49
Q

A reverse Colles’ fracture is termed ___________ fracture.

A

Smith’s fracture

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50
Q

MOI for Smith’s fracture:

A

Fall onto flexed wrist

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51
Q

The management for a Smith’s fracture is the same as what?

A

Colles’ fracture

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52
Q

Radial styloid fracture is also called a __________ fracture.

A

Chauffeur’s fracture

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53
Q

What occurs in a radial styloid fracture?

A

Radial styloid is displaced laterally

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54
Q

MOI for Smith’s fracture

A

FOOSH with forced radial deviation

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55
Q

Management for Smith’s fracture:

A

Closed reduction, immobilization in UD. Fixation with K wires if necessary.

Progressive ROM and strengthening

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56
Q

What is the most common carpal fracture?

A

Scaphoid

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57
Q

MOI for a scaphoid fracture:

A

Fall onto fully extended wrist

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58
Q

S/S of scaphoid fracture (3):

A

Pain with extension, flexion and radial dev.
Weak/pain grip, pain with compression
Tender anatomical snuffbox (CLASSIC SIGN)

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59
Q

Management of a scaphoid fracture (3):

A

Immobilization, including thumb
Possible ORIF
Progressive ROM and strengthening

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60
Q

Possible complications of a scaphoid fracture (3):

A

Delayed union
non-union
Avascular necrosis

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61
Q

What location of a scaphoid fracture lead to avascular necrosis?

A

fractures in proximal 1/3

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62
Q

What occurs with a Boxer’s fracture?

A

Transverse fracture of the neck of MC 2-5

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63
Q

Which metacarpal is most commonly involved in a Boxer’s fracture?

A

5th

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64
Q

MOI of a Boxer’s fracture:

A

Compressive force through metacarpals

65
Q

S/S of a Boxer’s fracture (3):

A

Flattening of knuckle
pain
swelling

66
Q

Management of a Boxer’s fracture (3):

A

Reduction
Immobilization
K-wire if unstable

67
Q

What occurs during a Bennet’s fracture?

A

Oblique fracture of base of 1st MC

68
Q

Bennet’s fracture is NEVER/ALWAYS a complex fracture

A

Always!!! as it extends into the joint

69
Q

MOI for Bennet’s fracture:

A

Punching
Martial arts

70
Q

S/S of Bennet’s fracture (2):

A

Edema
Short-appearing thumb

71
Q

Management of Bennet’s fracture (2):

A

ORIF, immobilization
Progressive ROM and strengthening

72
Q

Transverse fractures are common in which phalanges?

A

Proximal and middle

73
Q

In which phalanx is a phalangeal fracture considered complex?

A

Distal phalanx

74
Q

MOI for proximal and middle phalangeal fractures:

A

Bending, jamming

75
Q

MOI for distal phalangeal fractures:

A

Crushing

76
Q

Management for phalangeal fractures (undisplaced vs displaced):

A

Undisplaced: Splint, buddy taping
Displaced: Closed reduction, immobilization

Progressive ROM and strengthening

77
Q

What often occurs with a phalangeal fracture?

A

dislocation

78
Q

MOI for a phalangeal dislocation:

A

Forced bending usually with twisting or compression

79
Q

S/S of a phalangeal dislocation:

A

Deformity
pain
swelling

80
Q

Management of a phalangeal dislocation:

A

Closed reduction
Splinting

81
Q

What is the location of fracture in a night stick fracture?

A

Mid-portion of the ulna

82
Q

Describe a greenstick fracture:

A

Incomplete fracture of young bones due to flexibility.

83
Q

A greenstick fracture is common in what body part?

A

Forearm

84
Q

If a patient cannot fully, actively extend their elbow, what should be recommended?

A

Go in for imaging if acute trauma to elbow.

85
Q

With carpal instability, the focus is mainly on which two carpals?

A

Scaphoid and Lunate

86
Q

Two causes of carpal instability:

A

Fracture/Trauma
RA

87
Q

S/S of carpal instability (4):

A

Wrist pain, stiffness
Tenderness over lunate/scaphoid
clicking, snapping
weakened grip

88
Q

What is the most common carpal instability?

A

Scapholunate dissociation

89
Q

A gap between the scaphoid and lunate greater than 3 mm is considered what?

A

Scapholunate dissociation

90
Q

Clinical presentation of Scapholunate dissociation:

A

Increased PA and AP movement between the two bones.

91
Q

What is the result of scapholunate dissociation?

A

Lateral carpal instability

92
Q

Describe ulnar translocation of the carpals

A

Proximal row of carpals migrate toward the ulna (hand deviates to radial side).

93
Q

Ulnar translocation of the carpals occurs with which pathology?

A

RA

94
Q

Ulnar dislocation of the carpals leads to PROXIMAL/DISTAL carpal instability.

A

Proximal

95
Q

Define arthrodesis:

A

Fusion of bones

96
Q

An arthrodesis provides wrist _________ at the cost of ________.

A

stability; mobility

97
Q

Describe a ganglion Cyst

A

Cystic degeneration of capsule, tendon sheath, or bursa. Leaves distended sac filled with viscous fluid.

98
Q

What patient population are associated with ganglion cysts?

A

Young adults

99
Q

S/S of a ganglion cyst:

A

Painless soft lump usually on dorsal wrist

100
Q

Management of a ganglion cyst

A

None

Can aspirate/excise, but recurrence is common.

101
Q

Describe Dupuytren’s contracture

A

Hypertrophy and contracture of palmar fascia (flexion contracture).

102
Q

Dupuyren’s contracture usually involves these fingers:

A

4th or 5th fingers

103
Q

Dupuyten’s contracture is often BILATERAL/UNILATERAL.

A

Bilateral

104
Q

What happens at the PIP and MIP with Dupuytren’s contracture?

A

they are pulled into flexion

105
Q

T/F Dupuyten’s contracture may be genetic

A

True!!

106
Q

Management of Dupuytren’s contracture:

A

Can slow progression but not stop it
Stretching, friction massage
Surgical excision of thickened fascia

107
Q

Arterial or venous insufficiency: Decreased or absent pulse.

A

Arterial

108
Q

Arterial or venous insufficiency: Pale with elevation, increased redness with dependency.

A

Arterial

109
Q

Arterial or venous insufficiency: Cool to touch

A

Arterial

110
Q

Arterial or venous insufficiency: Shiny, thin, pale, thick nails, hair loss.

A

Arterial

111
Q

Arterial or venous insufficiency: Increased pain with elevation, decreased pain with dependence, paresthesia

A

Arterial

112
Q

Arterial or venous insufficiency: WNL pulses

A

Venous

113
Q

Arterial or venous insufficiency: Pink progressing to cyanotic and brown at ankles.

A

Venous

114
Q

Arterial or venous insufficiency: Warm temp

A

Venous

115
Q

Arterial or venous insufficiency: Edema

A

Venous

116
Q

Arterial or venous insufficiency: Discolored, scaly, ulcers, varicosities.

A

Venous

117
Q

Arterial or venous insufficiency: Increased pain with dependence, decreased with elevation

A

Venous

118
Q

Important cardiopulmonary observations when examining wrist and hand

A

Edema
Clubbing
Skin color
Nail beds

119
Q

Neurologic observations to check for during the systems review:

A

Hand deformity
Atrophy
Trophic changes
Tremor

120
Q

White discolorations observed on the nails are termed what?

A

Leukonychia

121
Q

When the nails have an indented shape, like a spoon, they are termed what?

A

Kilonychia

122
Q

CRPS stands for what?

A

Complex regional pain syndrome

123
Q

RSD stands for what?

A

Reflex sympathetic dystrophy

124
Q

6 specific diagnoses to rule out when assessing wrist and hand:

A

CRPS/RSD
RA
Gout
Septic bursitis
MI/Angina (can refer to UE)
Cervicogenic pain (radiculopathy)

125
Q

Pathology characterized primarily by increased sensitivity.

A

RSD/CRPS

126
Q

How do you treat CRPS/RSD?

A

Focus on desensitization of the area. Need to retrain the brain.

127
Q

Ulnar drift is an indication of what pathology?

A

RA

128
Q

Peak incidence of RA is __-__ years old.

A

30-50

129
Q

Which gender is RA more likely in?

A

Women (3:1)

130
Q

Which gender is OA more likely in?

A

Equal

131
Q

Does OA or RA also include systemic symptoms (fever, fatigue)

A

RA

132
Q

What causes gout?

A

The buildup of uric acid in the joints

133
Q

List postoperative management of CTS (6):

A

Immobilization
Edema control
Scar tissue mobilization
Nerve gliding
Progressive ROM and strengthening
Work simulation

134
Q

How does anterior interosseus syndrome differ from CTS, Pronator Teres syndrome, and cervical radiculopathy?

A

Sensation is normal; unable to make the “ok” sign

135
Q

How is pronator teres syndrome different from CTS, Pronator Teres syndrome, and cervical radiculopathy?

A

Forearm pain is increased with pronation

136
Q

Functions of the TFCC (5):

A

Dissipates compressive loads with ulnar WB
Connects ulna with radius
protects head of ulna
assists forearm pronation
stabilizes distal radioulnar joint

137
Q

TFCC is usually caused by MICRO/MACRO trauma.

A

Macro; almost always FOOSH

138
Q

Management of DeQuervain’s disease

A

NSAIDS, immobilization, iontophoresis, modification of activity, progressive exercise, surgical splitting of sheath.

139
Q

S/S of tenosynovitis (3):

A

Marked edema
Increased temperature
PAin

140
Q

What is the most common form of carpal instability?

A

Scapholunate dissociation

141
Q

Ulnar translocation of carpals is common in what pathology?

A

RA (as distal radius erodes)

142
Q

Define arthrodesis:

A

Fusion of bones

143
Q

Two causes of swan neck deformity:

A

Contracture of intrinsic muscles
Tearing of volar plate

144
Q

S/S of swan neck deformity (2):

A

Flexion of MCP and DIP
Hyperextension of PIP

145
Q

How do you manage swan neck deformity?

A

Stretching

146
Q

Cause of Boutonniere deformity:

A

Rupture of extensor hood

147
Q

Describe Boutonniere deformity:

A

Extension of MCP and DIP
Flexion of PIP

148
Q

What causes mallet finger?

A

Rupture avulsion of extensor hood

149
Q

S/S of mallet finger (1):

A

Inability to extend distal phalanx

150
Q

Management of mallet finger:

A

Acute = splint
Chronic = none, not functionally limiting

151
Q

Trigger finger/thumb is associated with what pathologies (3)?

A

RA, DM, Gout

152
Q

What happens in trigger finger?

A

Stenosing - nodule or swelling in tendon prevents gliding through sheath.

153
Q

S/S of trigger finger (1):

A

Discomfort at base of digit
locking of finger/thumb

154
Q

Management for trigger finger:

A

NSAIDS, Injection, splint, surgical splitting of sheath.

155
Q

What occurs with a skier’s/gamekeeper’s thumb?

A

Rupture of 1st MCP ulnar collateral

156
Q

MOI for skier’s/gamekeeper’s thumb:

A

Repeated twisting
Falling with thumb hooked in ski pole strap

157
Q

S/S of skier’s thumb (incomplete vs complete):

A

Complete tear: unstable pinch
Incomplete tear: Positive valgus stress test

158
Q

Management of Skier’s thumb (complete vs incomplete):

A

Complete: surgical repair, immob.
Incomplete: Immob. but freq. gentle ROM

Gradual return to activity

Musculoskeletal (11 decks)

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