Wrist and Hand Flashcards
1
Q
Joint type: Distal/Proximal radioulnar
A
Pivot
2
Q
Joint type: Radiocarpal
A
Diarthrodial ellipspoid
3
Q
Anatomy: stabilizes the RU joint and protects against compressive forces
A
Triangular fibrocartilage complex (TFCC)
4
Q
Arthrokinematics: Radiocarpal flexion
A
Carpals glide dorsally
5
Q
Arthrokinematics: Radiocarpal extension
A
Carpals glide volarly
6
Q
Arthrokinematics: Radiocarpal RD
A
Carpals glide ulnarly
7
Q
Arthrokinematics: Radiocarpal UD
A
Carpals glide radially
8
Q
Closed pack position: Radiocarpal
A
Extension with radial deviation
9
Q
Loose pack position: Radiocarpal
A
10 wrist flexion and slight UD
10
Q
CPR: Radiocarpal
A
Equal loss of flexion and extension
11
Q
Content: Intercarpal joint (4)
A
- Articulation between proximal and distal rows 2. Articulation between individual carpals 3. Flexion: mid carpal joints 4. Extension: RC joint
12
Q
Joint type: MCP
A
Diarthrodial condyloid joint
13
Q
Joint type: IP
A
Hinge joint
14
Q
Arthrokinematics: MCP/IP flexion
A
surfaces glide volarly
15
Q
Arthrokinematics: MCP/IP extension
A
surfaces glide dorsally
16
Q
CPR: MCP/IP
A
Equal loss of flexion/extension
17
Q
Closed pack position: MCP
A
full flexion
18
Q
Closed pack position: IP
A
full extension
19
Q
Joint type: CMC Thumb
A
Saddle/Sellar
20
Q
Arthrokinematics: CMC Thumb flexion
A
CMC glides volarly/ulnar
21
Q
Arthrokinematics: CMC Thumb extension
A
CMC glides dorsally/radial
22
Q
Arthrokinematics: CMC Thumb ABD
A
CMC glides dorsally
23
Q
Arthrokinematics: CMC Thumb ADD
A
CMC glides volarly
24
Q
T/F: Convex portion of CMC glides in same direction of motion
A
False: Opposite
25
CPR: CMC Thumb
Limitation of ABD and slight limitation of extension
26
Closed pack postiion: CMC Thumb
Full opposition
27
Loose pack position: CMC Thumb
Midrange Abd/Add and Flexion/Extension
28
Q: Which muscle group is stronger, flexor or extensor?
Flexors
29
Q: Where do IP joints have the most force?
Extension
30
Q: Where do IP joints have the least force?
Flexion
31
Q: What is the difference between intrinsic and extrinsic hand muscles
Intrinsic = originate and insert within hand Extrinsic = originate in forearm and insert on wrist/hand
32
Q: Who has strongest intrinsic hand muscles?
Climbers
33
Q: Name the carpal bones
Prox: Scaphoid, lunate, triquetrum, pisiform, Distal: Trapezium, trapezoid, capitate, hamate
34
Content: Areas of symptoms in the hand (4)
1. Palmar 2. Dorsal 3. Radial 4. Ulnar
35
Q: As you flex your fingers they __________ rotate, as you extend your fingers they __________ rotate
External, internal
36
Content: SE (6)
1. Age 2. Occupation 3. Recreation 4. History/MOI 5. Past History 6. Special questions
37
Content: SE questions (6)
1. ADL’s 2. Hand dominance 3. Lifting/pushing/pulling 4. Opening a door 5. Writing 6. N/T and pattern
38
Content: Acute or traumatic MOI (2)
1. FOOSH 2. Radius, ulna, or carpal fx
39
Content: Overuse MOI (2)
1. Repetitive 2. Tendinopathies or neuropathies
40
Content: OE (7)
1. Observation 2. ROM 3. Strength 4. Palpation 5. Special tests 6. Neuro/segmental exam 7. Nerve mobility
41
Content: Observations (5)
1. Deformity 2. Swelling 3. Atrophy 4. Color 5. Scars
42
Content: Clinical syndromes caused by traumatic/FOOSH (7)
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
Content: SE - first things first (2)
1. What is the origin of the pts complaint? (cervical/shoulder/forearm) 2. Co-existing conditions with overlapping symptoms
44
Content: Clinical syndromes caused by overuse
Carpal tunnel syndrome
45
Q: What FOOSH MOI causes radius fracture?
Wrist extended \< 35
46
Q: What FOOSH MOI causes carpal fracture?
Wrist extended \> 80
47
Q: What FOOSH MOI causes scaphoid fracture?
Wrist extension with RD
48
Q: What FOOSH MOI causes radius or ulnar fracture?
wrist flexion
49
Q: What is the most important part of the SE?
The body chart
50
Fracture type: Description: Fracture of distal radius with dorsal displacement
Colles'
51
Q: If pt. can point out pain with one finger than it is probably __________ in the \_\_\_\_\_\_\_, if not, then is may be __________ from \_\_\_\_\_\_\_\_\_\_.
locally, wrist, referred, elsewhere
52
Fracture type: MOI: Extension plus compression
Colles'
53
Fracture type: Description: Fracture of distal radius with volar displacement
Smith's
54
Fracture type: MOI: Flexion plus compression
Smith's
55
Content: OE (fracture) (4)
1. Deformities (ex. dinner fork) 2. Girth measurement (edema) 3. PROM/AROM 4. Functional tests (ex. grip strength)
56
Fracture type: MOI: Fall with extension plus RD
Scaphoid
57
Fracture type: OE/Diagnostics: Pain in anatomical snuffbox, painful/limited wrist movement, painful compression/load
Scaphoid
58
Q: What is the conservative tx for scaphoid fx?
Immbolization and US
59
Fracture type: Description: Fx of neck of 5th MC
Boxer's
60
Fracture type: MOI: boxing or punching
Boxer's
61
Fracture type: OE: swelling and pain with MMT
Boxer's
62
Fracture type: Description: Avulsion of extensor tendon from DIP
Mallet finger
63
Fracture type: MOI: direct force causing forced flexion
Mallet finger
64
Fracture type: OE: deformity of DIP
Mallet finger
65
Q: What is the intervention for Mallet finger?
Volar splint or surgical fixation with exercises
66
Content: Scaphoid-Lunate Disassociation: MOI (2)
1. Fall 2. Trauma
67
Q: What are the 2 most important parts of intervention?
Edema management and scar formation
68
Content: Scaphoid-Lunate Disassociation: Symptoms (4)
1. Localized pain, 2. Swelling 3. Clicking 4. Pain with extension
69
Q: What is important about the quantity for intervention?
High repetition throughout the day
70
Content: Scaphoid-Lunate Disassociation: Watson's test/scaphoid shift test (5)
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: In which direction does lunate typically dislocate?
Volarly
72
Content: Lunate dislocation OE (4)
1. Pain with palpation 2. Limited/painful motion 3. Positive xray 4. N/T median n. distribution
73
Content: Lunate dislocation Intervention (3)
1. Surgical reduction 2. Immob 3-4 wks 3. Limit wrist extension ~2mo
74
Content: Description: Osteonecrosis/AVN of lunate following a fx.
Kienbock's disease
75
Content: Kienbock's disease Intervention (5)
1. Goal to restore blood supply/revascularization 2. Initial immob 3. Thermal modality 4. ROM/glide 5. Sx - bone graph or prosthetic lunate
76
Content: Description: Median n. compression in carpal tunnel
Carpal tunnel syndrome
77
Describe: Floor of carpal tunnel
Carpal bones and palmar ligaments
78
Describe: Roof of carpal tunnel
Flexor retinaculum
79
Describe: Radial border of carpal tunnel
Trapezium
80
Describe: Ulnar border of carpal tunnel
Hook of hamate
81
Content: Carpal tunnel syndrome: History (2)
1. Trauma 2. Over use of flexors/posture of hand
82
Q: What is the main goal of hand interventions?
Function, function, function
83
Q: What does compression of the median n. lead to? (4)
1. Ischemia 2. Edema 3. Reduced nerve gliding 4. Eventually fibrosis
84
Content: Carpal tunnel syndrome: SE (5)
1. Pain and paresthesia 2. Numbness 3. Noctural pain 4. Hand falling asleep 5. Thenar atrophy
85
Content: Carpal tunnel syndrome: OE (6)
1. Electrophysiology 2. ROM 3. Palpation 4. Grip strength 5. Special tests 6. Rule out cervical / shoulder / elbow involvement
86
Q: What are two tests for Carpal tunnel syndrome?
1. Tindel's test (at the wrist) 2. Phalen's and Reverse
87
Content: Carpal tunnel syndrome: Education
Modify activity and ergonomics
88
Content: Carpal tunnel syndrome: AD
Wrist splint
89
Content: Carpal tunnel syndrome: Exercises
nerve and tendon glides
90
Content: Carpal tunnel syndrome: Manual therapy
carpal bone mobilization
91
T/F: There is little evidence supporting the efficacy of conservative treatments for carpal tunnel syndrome.
True
92
T/F: Nerve glides have no effect on symptoms of carpal tunnel syndrome.
False: some
93
Q: What is the success rate of surgical treatment of carpal tunnel syndrome?
70-90%
94
Content: Complex regional pain syndrome (3)
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
Idenfity the stage of CRPS: skin and temp changes, muscle spasms, joint pain, intense burning and aching
Stage ; 1-3 mo
96
Idenfity the stage of CRPS: continue skin changes, worsening pain, hair loss, limited joint mobility, muscle weakness
Stage 2; 3-6 mo
97
Idenfity the stage of CRPS: chronic and irreversible, joint contractures, muscle wasting, extreme pain
Stage 3; \> 6 mo
98
Content: Complex regional pain syndrome - SE (5)
1. Sensitive to touch 2. Guarded movement 3. Painful movement 4. Increased sensitivity to temp 5. Emotional and behavioral changes
99
Content: Complex regional pain syndrome - OE (4)
1. Pitting edema 2, Skin changes 3. Lack of wrist/elbow motion 4. Muscle weakness
100
Content: Complex regional pain syndrome - Differential diagnosis (3)
1. RA 2. Peripheral neuropathy 3. Vascular disease
