Wrist and Hand Flashcards
wrist & hand
Which muscles does the ulnar nerve innervate?
- FCU
- 1/2 FDP
- innervates 15/20 muscles:
- 4 DABS
- 4 PADS
- 3 hypothenars
- APB
- Lumbricles 3-5
wrist & hand
Compression of the ulnar nerve at the wrist affects the innervation of
most intrinsic hand muscles. When the patient attempts to form a fist, it results in a deformity known as a “claw hand”—the metacarpophalangeal joints are hyperextended due to the loss of the interossei muscles, and the interphalangeal joints are flexed.
wrist & hand
The median nerve is most sensitive to the increased pressure, and signs of carpal tunnel syndrome reflect the nerve’s distribution. These include:
tingling or numbness on the palmar surface of the lateral three and a half digits and weakness and eventual atrophy of the thenar muscles. The palmar cutaneous branch of the median nerve arises proximal to the canal and passes over the flexor retinaculum, so sensation of the palm remains intact.
wrist & hand
when an object hits the distal phalanx of the finger or thumb, and the force of the blow tears the contracted extensor tendon. In some cases, a small piece of bone is pulled away along with the tendon.
Tx?
Mallet finger AKA baseball finger
Tx: splint 8 weeks or ORIF
wrist & hand
finger gets caught in jersey trying to make a tackle rupturing the flexor digitorium profundus:
Tx?
Jersey Finger
Tx: surgery
wrist & hand
Triangular Fibrocartilage Complex:
What is it?
Blood supply?
- Like the menisici of the knee:
- Good blood supply in the periphery, not blood supply in the center.
wrist & hand
Triangular Fibrocartilage Complex:
provides cushion between wich 2 bones?
MOI?
S & S?
Special Test?
Tx?
- Cushion between ulna and triquetrum
- MOI: traumatic or degenerative
- Pain, clicking
- Press test
- Tx: conservative or
- Surgical repair if distal, removal if central
wrist & hand
Wich is the most common entrapment neuropathy?
carpal tunnel syndrome
wrist & hand
Wich is the second most common entrapment neuropathy of the UE?
Ulnar nerve compression in the cubital tunnel
wrist & hand
IP collateral injury:
MOI?
Tx?
Time of recovery?
- MOI: abb ir add force
- Partial tear: immobilization in extension 3 weeks
- Dislocation: reduction by traction, immobilization in extension 3 weeks
- recovery takes 3 months to one year
wrist & hand
What is the immobilization position of a IP collateral ligament partial tear?
in extension
wrist & hand
inflammation of Abductor Pollicis Longus and Extensor Pollicis Brevis
What is the dorsal compartment of these muscles?
De Quervain Tenosynovitis
Comparment 1 (anterior border of the snuff box)
wrist & hand
Test for De Quervain Tenosynovitis:
Finkelstein test
wrist & hand
De Quervain Tenosynovitis
- Inflammation of APL and EPB
- Finkelstein test
- Tx: Splinting, steroid injection, surgical release, DFM, manual therapy, eccentric strengthening
- Pt education: stop doing whatever causes pain
wrist & hand
Pt presents with pain in the first compartment of the extensor retinaculum, including the thumb and radial styloid, Aggravating factors include pinching, gripping, radial deviation of the wrist, abduction of the thumb, and resisted thumb extension.
de Quervain’s Tenosynovitis
wrist & hand
What is the gold standart splinting for the tx of De Quervain Tenosynovitis?
Thumb spica splint
wrist & hand
compression of brachial plexus
Thoracic Outlet Syndrome
wrist & hand
Thoracic Outlet Syndrome is an entrapment disorder that occurs inside the “thoracic outlet” which is the space between
the clavicle and the first rib
wrist & hand
Carpal tunnel formed by…
carpal bones and transverse carpal ligament,
wrist & hand
Special tests for Thoracic outlet syndrome:
- Roos test: bilaterla shoulder 90 abb,, elbow flexion, open and close hands for 60 sec
- Adson test: positive when radial pulse changes when pt ipsilateral rotation and extension of the neck + extension, add, andext rotation of the arm
wrist & hand
Carpal Tunnel Syndrome:
tests?
- leads to thenar atrophy and sensory loss
- +Tinnel
- +Phalens
- NT to 1-3 volar side
- Thenar weakness
- APB, FPB, opponens, lumbricles
- +compression test
wrist & hand
Contracture of palmar fascia
Dupuytren’s Contracture
wrist & hand
Dupuytren’s Contracture:
- Contracture of palmar fascia
- Unknown etiology
- Stretching (splint)
- Surgical removal of involved fascia
wrist & hand
Middle and Proximal Phalanges injuries:
Tx?
- Undisplaced: “buddy taping”
- Displaced: closed reduction, aluminum splint or ORIF
- Displaced intra-articular: ORIF
wrist & hand
Boxer’s Fx:
Tx?
- Fx of 5th MC
- MC head is depressed and posteriorly angulated
- Closed reduction
- Immobilization in flexion for 3 wks.
- If unstable: ORIF
wrist & hand
Bennett’s Fx
- Fx-dislocation of 1st CMC
- Closed reduction and cast providing compression to base of MC or ORIF
- Articular incongruity can lead to DJD
wrist & hand
Pt presents c is a fracture of the base of the first metacarpal bone. Signs include pain, swelling, and ecchymosis around the base of the thumb and thenar eminence, and especially over the CMC joint of the thumb. Physical examination demonstrates instability of the CMC joint of the thumb,
Bennett’s Fx
wrist & hand
Tear of ulnar collateral 1st MCP ligament
Gamekeeper’s Thumb
wrist & hand
Gamekeeper’s Thumb test:
UCL stress test:
- Place the patient in a seated position
- Extend the patient’s thumb
- Apply a valgus force to the MCP joint
- +ve test is laxity and/or pain
wrist & hand
CARPAL INSTABILITY
- Dorsal intercalated segment instability (DISI):
- Scapholunate dissociation
- Ventral intercalated segment instability (VISI):
- Lunato-triquetrum dissociation
osteoarthritis
wrist & hand
PIP nodes:
Bouchard’s
OA
wrist & hand
DIP nodes:
Herberden’s
OA
wrist & hand
flexed PIP extended DIP is what type of deformity?
Boutonniere deformity
RA
wrist & hand
Hyperextended PIP and flexed DIP deformity:
Swan Neck deformity
RA
wrist & hand
OA hand deformities:
- Herberden’s nodes – DIP
- Bouchard’s nodes – PIP
wrist & hand
RA hand deformities:
- Boutonniere deformity
- Swan neck deformity
- Ulnar drift
wrist & hand
WATSON’ TEST is for…
Procedure?
–Scaphoid instability
- Place the patient in a seated position
- Grasp the scaphoid tubercle
- With the other hand grasp the metacarpals
- Starting in ulnar deviation and slight wrist extension, move into radially deviation and slight flexion
- +ve test is the report of pain or a clunk.
wrist & hand
Special test for OA:
CMC GRIND TEST
- Patient is sitting
- Examiner grabs the first digit using a pincer grip
- Examiner provides a compression load to the CMC joint and then add rotation
- +ve test is pain and/or crepitus
wrist & hand
TINEL’S TEST
- Patient is seated while the examiner taps 5 times over the carpal tunnel with his/her finger or reflex hammer
- +ve test is reproduction of symptoms in the median nerve distribution.
wrist & hand
Phalen’s test:
carpal tunnel syndrome
- pt seated
- +ve test is the reproduction of symptoms in the median nerve distribution
wrist & hand
FINKELSTEIN’S TEST
Dequervain’ s (Inflammation of APL and EPB)
- pt seated
- fist with thumb inside fingers
- active ulnar deviation of the wrist
wrist & hand
Cubital tunnel syndrome – also known as
ulnar neuropathy
wrist & hand
Pregnant woman over 50 y/o, works in an office. Presents with sensory changes in the median nerve distribution (may or may not be accompanied by pain) and atrophy in the thenar
carpal tunnel syndrome
