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PTRS 745 Exam 1 > Wrist and Hand > Flashcards

Wrist and Hand Flashcards

1
Q

Joint type: Distal/Proximal radioulnar

A

Pivot

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2
Q

Joint type: Radiocarpal

A

Diarthrodial ellipspoid

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3
Q

Anatomy: stabilizes the RU joint and protects against compressive forces

A

Triangular fibrocartilage complex (TFCC)

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4
Q

Arthrokinematics: Radiocarpal flexion

A

Carpals glide dorsally

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5
Q

Arthrokinematics: Radiocarpal extension

A

Carpals glide volarly

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6
Q

Arthrokinematics: Radiocarpal RD

A

Carpals glide ulnarly

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7
Q

Arthrokinematics: Radiocarpal UD

A

Carpals glide radially

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8
Q

Closed pack position: Radiocarpal

A

Extension with radial deviation

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9
Q

Loose pack position: Radiocarpal

A

10 wrist flexion and slight UD

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10
Q

CPR: Radiocarpal

A

Equal loss of flexion and extension

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11
Q

Content: Intercarpal joint (4)

A
  1. Articulation between proximal and distal rows 2. Articulation between individual carpals 3. Flexion: mid carpal joints 4. Extension: RC joint
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12
Q

Joint type: MCP

A

Diarthrodial condyloid joint

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13
Q

Joint type: IP

A

Hinge joint

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14
Q

Arthrokinematics: MCP/IP flexion

A

surfaces glide volarly

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15
Q

Arthrokinematics: MCP/IP extension

A

surfaces glide dorsally

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16
Q

CPR: MCP/IP

A

Equal loss of flexion/extension

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17
Q

Closed pack position: MCP

A

full flexion

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18
Q

Closed pack position: IP

A

full extension

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19
Q

Joint type: CMC Thumb

A

Saddle/Sellar

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20
Q

Arthrokinematics: CMC Thumb flexion

A

CMC glides volarly/ulnar

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21
Q

Arthrokinematics: CMC Thumb extension

A

CMC glides dorsally/radial

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22
Q

Arthrokinematics: CMC Thumb ABD

A

CMC glides dorsally

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23
Q

Arthrokinematics: CMC Thumb ADD

A

CMC glides volarly

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24
Q

T/F: Convex portion of CMC glides in same direction of motion

A

False: Opposite

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25
Q

CPR: CMC Thumb

A

Limitation of ABD and slight limitation of extension

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26
Q

Closed pack postiion: CMC Thumb

A

Full opposition

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27
Q

Loose pack position: CMC Thumb

A

Midrange Abd/Add and Flexion/Extension

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28
Q

Q: Which muscle group is stronger, flexor or extensor?

A

Flexors

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29
Q

Q: Where do IP joints have the most force?

A

Extension

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30
Q

Q: Where do IP joints have the least force?

A

Flexion

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31
Q

Q: What is the difference between intrinsic and extrinsic hand muscles

A

Intrinsic = originate and insert within hand Extrinsic = originate in forearm and insert on wrist/hand

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32
Q

Q: Who has strongest intrinsic hand muscles?

A

Climbers

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33
Q

Q: Name the carpal bones

A

Prox: Scaphoid, lunate, triquetrum, pisiform, Distal: Trapezium, trapezoid, capitate, hamate

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34
Q

Content: Areas of symptoms in the hand (4)

A
  1. Palmar 2. Dorsal 3. Radial 4. Ulnar
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35
Q

Q: As you flex your fingers they __________ rotate, as you extend your fingers they __________ rotate

A

External, internal

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36
Q

Content: SE (6)

A
  1. Age 2. Occupation 3. Recreation 4. History/MOI 5. Past History 6. Special questions
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37
Q

Content: SE questions (6)

A
  1. ADL’s 2. Hand dominance 3. Lifting/pushing/pulling 4. Opening a door 5. Writing 6. N/T and pattern
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38
Q

Content: Acute or traumatic MOI (2)

A
  1. FOOSH 2. Radius, ulna, or carpal fx
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39
Q

Content: Overuse MOI (2)

A
  1. Repetitive 2. Tendinopathies or neuropathies
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40
Q

Content: OE (7)

A
  1. Observation 2. ROM 3. Strength 4. Palpation 5. Special tests 6. Neuro/segmental exam 7. Nerve mobility
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41
Q

Content: Observations (5)

A
  1. Deformity 2. Swelling 3. Atrophy 4. Color 5. Scars
42
Q

Content: Clinical syndromes caused by traumatic/FOOSH (7)

A
  1. Colles and smith fractures 2. Scaphoid fracture 3. Boxer’s fracture 4. Mallet finger 5. Lunate dislocation 6. Scaphoid-lunate dissociation 7. Kienbock’s disease
43
Q

Content: SE - first things first (2)

A
  1. What is the origin of the pts complaint? (cervical/shoulder/forearm) 2. Co-existing conditions with overlapping symptoms
44
Q

Content: Clinical syndromes caused by overuse

A

Carpal tunnel syndrome

45
Q

Q: What FOOSH MOI causes radius fracture?

A

Wrist extended < 35

46
Q

Q: What FOOSH MOI causes carpal fracture?

A

Wrist extended > 80

47
Q

Q: What FOOSH MOI causes scaphoid fracture?

A

Wrist extension with RD

48
Q

Q: What FOOSH MOI causes radius or ulnar fracture?

A

wrist flexion

49
Q

Q: What is the most important part of the SE?

A

The body chart

50
Q

Fracture type: Description: Fracture of distal radius with dorsal displacement

A

Colles’

51
Q

Q: If pt. can point out pain with one finger than it is probably __________ in the _______, if not, then is may be __________ from __________.

A

locally, wrist, referred, elsewhere

52
Q

Fracture type: MOI: Extension plus compression

A

Colles’

53
Q

Fracture type: Description: Fracture of distal radius with volar displacement

A

Smith’s

54
Q

Fracture type: MOI: Flexion plus compression

A

Smith’s

55
Q

Content: OE (fracture) (4)

A
  1. Deformities (ex. dinner fork) 2. Girth measurement (edema) 3. PROM/AROM 4. Functional tests (ex. grip strength)
56
Q

Fracture type: MOI: Fall with extension plus RD

A

Scaphoid

57
Q

Fracture type: OE/Diagnostics: Pain in anatomical snuffbox, painful/limited wrist movement, painful compression/load

A

Scaphoid

58
Q

Q: What is the conservative tx for scaphoid fx?

A

Immbolization and US

59
Q

Fracture type: Description: Fx of neck of 5th MC

A

Boxer’s

60
Q

Fracture type: MOI: boxing or punching

A

Boxer’s

61
Q

Fracture type: OE: swelling and pain with MMT

A

Boxer’s

62
Q

Fracture type: Description: Avulsion of extensor tendon from DIP

A

Mallet finger

63
Q

Fracture type: MOI: direct force causing forced flexion

A

Mallet finger

64
Q

Fracture type: OE: deformity of DIP

A

Mallet finger

65
Q

Q: What is the intervention for Mallet finger?

A

Volar splint or surgical fixation with exercises

66
Q

Content: Scaphoid-Lunate Disassociation: MOI (2)

A
  1. Fall 2. Trauma
67
Q

Q: What are the 2 most important parts of intervention?

A

Edema management and scar formation

68
Q

Content: Scaphoid-Lunate Disassociation: Symptoms (4)

A
  1. Localized pain, 2. Swelling 3. Clicking 4. Pain with extension
69
Q

Q: What is important about the quantity for intervention?

A

High repetition throughout the day

70
Q

Content: Scaphoid-Lunate Disassociation: Watson’s test/scaphoid shift test (5)

A
  1. Seated, elbow flexed 90 2. forearm pronated 3. Passively move from UD to RD while stabilizing scaphoid 4. + = increase movement, pain or clunk into dorsal direction 5. 70% sensitivity and specificity
71
Q

Q: In which direction does lunate typically dislocate?

A

Volarly

72
Q

Content: Lunate dislocation OE (4)

A
  1. Pain with palpation 2. Limited/painful motion 3. Positive xray 4. N/T median n. distribution
73
Q

Content: Lunate dislocation Intervention (3)

A
  1. Surgical reduction 2. Immob 3-4 wks 3. Limit wrist extension ~2mo
74
Q

Content: Description: Osteonecrosis/AVN of lunate following a fx.

A

Kienbock’s disease

75
Q

Content: Kienbock’s disease Intervention (5)

A
  1. Goal to restore blood supply/revascularization 2. Initial immob 3. Thermal modality 4. ROM/glide 5. Sx - bone graph or prosthetic lunate
76
Q

Content: Description: Median n. compression in carpal tunnel

A

Carpal tunnel syndrome

77
Q

Describe: Floor of carpal tunnel

A

Carpal bones and palmar ligaments

78
Q

Describe: Roof of carpal tunnel

A

Flexor retinaculum

79
Q

Describe: Radial border of carpal tunnel

A

Trapezium

80
Q

Describe: Ulnar border of carpal tunnel

A

Hook of hamate

81
Q

Content: Carpal tunnel syndrome: History (2)

A
  1. Trauma 2. Over use of flexors/posture of hand
82
Q

Q: What is the main goal of hand interventions?

A

Function, function, function

83
Q

Q: What does compression of the median n. lead to? (4)

A
  1. Ischemia 2. Edema 3. Reduced nerve gliding 4. Eventually fibrosis
84
Q

Content: Carpal tunnel syndrome: SE (5)

A
  1. Pain and paresthesia 2. Numbness 3. Noctural pain 4. Hand falling asleep 5. Thenar atrophy
85
Q

Content: Carpal tunnel syndrome: OE (6)

A
  1. Electrophysiology 2. ROM 3. Palpation 4. Grip strength 5. Special tests 6. Rule out cervical / shoulder / elbow involvement
86
Q

Q: What are two tests for Carpal tunnel syndrome?

A
  1. Tindel’s test (at the wrist) 2. Phalen’s and Reverse
87
Q

Content: Carpal tunnel syndrome: Education

A

Modify activity and ergonomics

88
Q

Content: Carpal tunnel syndrome: AD

A

Wrist splint

89
Q

Content: Carpal tunnel syndrome: Exercises

A

nerve and tendon glides

90
Q

Content: Carpal tunnel syndrome: Manual therapy

A

carpal bone mobilization

91
Q

T/F: There is little evidence supporting the efficacy of conservative treatments for carpal tunnel syndrome.

A

True

92
Q

T/F: Nerve glides have no effect on symptoms of carpal tunnel syndrome.

A

False: some

93
Q

Q: What is the success rate of surgical treatment of carpal tunnel syndrome?

A

70-90%

94
Q

Content: Complex regional pain syndrome (3)

A
  1. Unusual pain in a arm or leg due to injury or surgery 2. Pain out of proportion to the severity of the injury 3. more common in women ages 30-60
95
Q

Idenfity the stage of CRPS: skin and temp changes, muscle spasms, joint pain, intense burning and aching

A

Stage ; 1-3 mo

96
Q

Idenfity the stage of CRPS: continue skin changes, worsening pain, hair loss, limited joint mobility, muscle weakness

A

Stage 2; 3-6 mo

97
Q

Idenfity the stage of CRPS: chronic and irreversible, joint contractures, muscle wasting, extreme pain

A

Stage 3; > 6 mo

98
Q

Content: Complex regional pain syndrome - SE (5)

A
  1. Sensitive to touch 2. Guarded movement 3. Painful movement 4. Increased sensitivity to temp 5. Emotional and behavioral changes
99
Q

Content: Complex regional pain syndrome - OE (4)

A
  1. Pitting edema 2, Skin changes 3. Lack of wrist/elbow motion 4. Muscle weakness
100
Q

Content: Complex regional pain syndrome - Differential diagnosis (3)

A
  1. RA 2. Peripheral neuropathy 3. Vascular disease

PTRS 745 Exam 1 (9 decks)

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