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Musculoskeletal I > Wrist and Hand > Flashcards

Wrist and Hand Flashcards

1
Q

What is a colle’s fracture?

A

Fracture of the distal radius with the distal segment angulated dorsally.

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2
Q

What is a Smith’s fracture?

A

Fracture of distal radius with the distal segment angulanted ventrally.

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3
Q

What a common mechanism of injury for a colle’s/ smith fracture?

A
  • Falling on an outstretched hand
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4
Q

What are typical surgical procedures for Colle’s and Smith’s fractures?

A
  • Closed reduction if stable

- Open reduction/ Internal fixation (pins, plates) if unstable.

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5
Q

What is the rehab focused on post-surgery for Colle’s/ Smith’s Fractures?

A
  • Strength
  • ROM
  • Flexibility
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6
Q

What are common complications of Colle’s/ Smith’s fractures?

A
  • Carpal tunnel

- Reflex sympathetic dystrophy

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7
Q

What is the most common carpal fracture?

A

Scaphoid fracture.

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8
Q

What is the common mechanism of injury for a scaphoid fracture?

A
  • FOOSH with radial deviation.
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9
Q

What are 2 common clinical signs of a scaphoid fracture?

A
  • Pain on snuffbox palpation

- Pain on radial/ulnar deviation overpressure

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10
Q

What is required to diagnose a scaphoid fracture?

A
  • Imaging
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11
Q

What are surgical procedures for scaphoid fractures?

A
  • Closed reduction

- ORIF

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12
Q

What is rehab for scaphoid fractures post-op?

A
  • Strength
  • ROM
  • Flexibility
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13
Q

What are common complications of scaphoid fractures?

A
  • AVN

- Scapholunate Advanced Collapse

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14
Q

What is SLAC?

A

OA of the scaphoid, and lunate subluxation.

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15
Q

Why is AVN of the scaphoid common secondary to fracture?

A

It is an island of bone with a limited blood supply.

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16
Q

What are 2 clinical signs of MC and phalanx fractures?

A
  • Pain on distal end tapping

- Pain on bone palpation

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17
Q

What are common surgical procedures for MC and Phalanx fractures?

A
  • Closed reduction

- ORIF

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18
Q

How does it take for MC and Phalanx to typically reunite?

A

MC: 6 weeks
Phalanx: 3 weeks

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19
Q

What is common post-op rehab for MC and Phalanx fractures?

A
  • Strength
  • ROM
  • Flexibility
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20
Q

What are 2 common complications of MC and phalanx fractures?

A
  • Carpal tunnel

- Fixed ROM loss

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21
Q

What is dequervain’s disease?

A
  • Stenosising tenosynovitis of the APL and EPB at radial styloid
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22
Q

What causes DeQuervain’s disease?

A
  • Overuse of the thumb in wrist causing a thickened, tender sheath
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23
Q

In what age group and gender is DeQuervain’s disease most prominent?

A
  • Women (30 - 50)
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24
Q

What is a common test for DeQuervain’s disease?

A
  • Finklestein’s Test
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25
Q

What are 3 conservative treatments for DeQuervain’s disease?

A
  • Refrain from aggravating postures/ motions
  • Thumb spica splint ( covers CMC and MCP joint of thumb, but not IP)
  • Physical Agents for inflammation (iontophoresis)
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26
Q

What are more aggressive procedures for DeQuervain’s disease?

A
  • Steroid injection

- Surgical release of first dorsal compartment

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27
Q

What is a Dupuytren’s Contracture?

A
  • Plamar fascia thickens with nodules and adheres to flexor tendons and skin
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28
Q

What are 4 predisposing factors for a Dupuytren’s contracture?

A
  • Men
  • Northern European origins
  • Drinkers and smokers
  • Autosomal dominance (maybe)
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29
Q

Which digits are most often affected by a dupuytren’s contracture?

A
  • Digits IV and V
30
Q

What are 4 conservative treatments that slow progression of Duputren’s contracture?

A
  • Heat or paraffin
  • Stretching
  • Splints
  • Maintain joint ROM
31
Q

What are 2 surgical treatments of Dupuytren’s contracture?

A
  • Injection of steroids or enzymes

- Surgical relase (make functional gains before scarring begins)

32
Q

What is carpal tunnel syndrome?

A
  • Compression of median nerve under flexor retinaculum
33
Q

What is the cutaneous innervation of the median nerve?

A
  • Palmer skin of digits I - III and 1/2 of 4.
34
Q

What is the motor innervation of the median nerve in the hand?

A
  • Lumbricales I and II

- All intrinsic thumb muscles except adductor pollicis.

35
Q

What are 5 contributing factors to carpal tunnel syndrome?

A
  • Trauma
  • Prolonged wrist extension w/gripping
  • Repetitive wrist flexion and extension
  • Lunate dislocation
  • Fluid retention (pregnancy)
36
Q

What are 4 clinical signs of carpal tunnel syndrome?

A
  • Toothache pain progressing to numbness along median nerve distribution in hand
  • Thenar weakness/ atrophy
  • Night pain
  • Hand flicking
37
Q

What are 5 conservative treatments for carpal tunnel syndrome?

A
  • Splinting in neutral/ night splints
  • Refraining from aggravating postures and motions
  • Physical agents for inflammation control
  • Adjusting posture from c-spine –> distally
  • Nerve gliding
38
Q

What are the surgical procedures for carpal tunnel syndrome?

A
  • Open or endoscopic surgical release of the transverse carpal ligament
39
Q

What is ulnar tunnel syndrome?

A
  • Compression of the ulnar nerve as it passes into the wrist.
40
Q

What is the location of zone 1, zone 2, and zone 3 ulnar tunnel syndrome?

A

Zone 1: By pisiform: motor and sensory
Zone 2: Towards radial aspect on palmar side: motor only
Zone 3: By hook of hamate: Sensory

41
Q

What is the cutaneous innervation of the ulnar nerve in the hand?

A
  • Skin of half of 4th and all of 5th digit
42
Q

What is the motor innervation of the ulnar nerve in the hand?

A
  • Hypothenar eminence
  • All interossei
  • 3rd and 4rh lumbricales
  • Adductor pollicis
  • Flexor pollicis brevis
43
Q

What pathology is ulnar tunnel syndrome treated similar to?

A

Carpal tunnel.

44
Q

.What modality can be used to improve nerve conduction velocity in tunnel syndromes?

A

Low-level laser with splinting.

45
Q

What deformities are caused by terminal tendon ruptures?

A
  • Mallet finger

- Swan neck

46
Q

What deformity is caused by a central slip rupture?

A
  • Boutonniere
47
Q

Why are finger flexor tendon injuries more difficult to treat?

A
  • Complex anatomy
  • Cruciate and annular pulleys
  • Vincula
  • FDS splits
  • FDS/ FDP sliding
48
Q

What zone is no man’s land, and what anatomy is found there?

A
  • Zone 2

- Underside of digits

49
Q

What is post surgical rehab based on?

A
  • Tissue healing

- Functional anatomy

50
Q

Who determines the specific post-op ROM allowed?

A
  • The surgeon
51
Q

What are the 3 focuses of the PT during rehab following tendon injuries?

A
  • HEP and Pt Ed
  • Move anything not immbolized
  • Deal with sensory problems as well
52
Q

What are 5 treatments for partial tears and fractures?

A
  • Splinting
  • Isometric contractions ASAP
  • Adjunctive interventions
  • PROM/ AAROM/ AROM
  • Strengthening exercises
53
Q

What other issues should be considered with hand pathology? (Other anatomical areas/ problems)

A
  • Upper quarter screen
  • Comorbidities
  • Medical history
54
Q

What are 5 relevant scales for wrist and hand pathology?

A
  • VAS
  • DASH (Disabilities of the Arm, Shoulder, and Hand)
  • PSFS (Patient Specific Functional Scale)
  • UEFS (Upper Extremity Functional Scale)
  • Boston Questionnaire (for carpal tunnel)
55
Q

What are 7 general observations that should be considered with wrist and hand pathology?

A
  • Posture - head and neck
  • Muscle tone
  • Quality, color, temperature of skin
  • Quality of the nails
  • Swelling
  • Resting position of the hand
  • Ability to use the limb
56
Q

What are 8 unusual resting positions of the hand?

A
  • Swan-neck deformity
  • Boutonniere deformity
  • Ulnar drift
  • Clubbing of DIPs
  • Heberden’s or Bouchard’s nodes
  • Claw fingers
  • Dupuyten’s contracture
  • Mallet or trigger finger
57
Q

What pathology is related to an ulnar drift resting position?

A
  • Rheumatoid Arthritis
58
Q

What pathology are clubbed fingers indicative of?

A
  • Clubbed fingers

- Low levels of oxygen due to lung or heart problems

59
Q

What pathology are associated with claw fingers?

A
  • Ulnar nerve lesions

- Tendon lascerations

60
Q

What joints should be cleared with hand and finger pathology?

A
  • Elbow
  • C-spine
  • Distal finger joints
61
Q

What are the two methods of expressing overall finger ROM? What is their relationship?

A
  • TAM and TPM
  • Total active/passive motion
  • If TAM < TPM, tendon gliding problems are implicated
62
Q

What are 3 methods of measuring Wrist and Hand muscle performance?

A
  • MMT
  • Grip and Pinch force measurements
  • Performance Based Functional Measures
63
Q

What are 3 specific performance based functional measures?

A
  • Arthritis hand function test
  • Hand mobility in scleroderma test
  • Keitel functional test
64
Q

What is the hand grip testing protocol using a JAMAR unit?

A
  • Measure each hand grip with a maximal for 2 - 3 seconds in positions 1 - 5, averaging 3 different measurements at each position if possible to ensure a proper reading. (Readings should be different at different positions)
  • Compare bilaterally
65
Q

What determines normal readings for Jamar grip testing?

A
  • Age

- Gender

66
Q

What tests besides muscle strength can be performed at the wrist and hand? (list 4)

A
  • Ligament stability
  • Soft tissue mobility
  • Neurologic status
  • Functional status
67
Q

What are special tests for instability of the hand and/or wrist?

A
  • Gamekeeper’s Thumb Test
  • Varus/ Valgus Stress
  • Watson Scaphoid Test
  • Ulnomeniscotriquetral Dorsal Glide
68
Q

What a test for arterial filling of the hand?

A
  • Allen test
69
Q

What are 6 tests/ signs of carpal tunnel syndrome?

A
  • Katz Hand Diagram
  • Phalen’s test
  • Reverse phalen’s test
  • Flick maneuver
  • Tinel’s sign
  • Median nerve compression
70
Q

What is a test for an ulnar nerve lesion?

A
  • Froment’s Sign
71
Q

What test is used to test intrinsic and ORL shortening?

A
  • Bunnel- Littler Test

Musculoskeletal I (8 decks)

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