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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
What are 3 conservative treatments for DeQuervain's disease?
- Refrain from aggravating postures/ motions - Thumb spica splint ( covers CMC and MCP joint of thumb, but not IP) - Physical Agents for inflammation (iontophoresis)
26
What are more aggressive procedures for DeQuervain's disease?
- Steroid injection | - Surgical release of first dorsal compartment
27
What is a Dupuytren's Contracture?
- Plamar fascia thickens with nodules and adheres to flexor tendons and skin
28
What are 4 predisposing factors for a Dupuytren's contracture?
- Men - Northern European origins - Drinkers and smokers - Autosomal dominance (maybe)
29
Which digits are most often affected by a dupuytren's contracture?
- Digits IV and V
30
What are 4 conservative treatments that slow progression of Duputren's contracture?
- Heat or paraffin - Stretching - Splints - Maintain joint ROM
31
What are 2 surgical treatments of Dupuytren's contracture?
- Injection of steroids or enzymes | - Surgical relase (make functional gains before scarring begins)
32
What is carpal tunnel syndrome?
- Compression of median nerve under flexor retinaculum
33
What is the cutaneous innervation of the median nerve?
- Palmer skin of digits I - III and 1/2 of 4.
34
What is the motor innervation of the median nerve in the hand?
- Lumbricales I and II | - All intrinsic thumb muscles except adductor pollicis.
35
What are 5 contributing factors to carpal tunnel syndrome?
- Trauma - Prolonged wrist extension w/gripping - Repetitive wrist flexion and extension - Lunate dislocation - Fluid retention (pregnancy)
36
What are 4 clinical signs of carpal tunnel syndrome?
- Toothache pain progressing to numbness along median nerve distribution in hand - Thenar weakness/ atrophy - Night pain - Hand flicking
37
What are 5 conservative treatments for carpal tunnel syndrome?
- 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
What are the surgical procedures for carpal tunnel syndrome?
- Open or endoscopic surgical release of the transverse carpal ligament
39
What is ulnar tunnel syndrome?
- Compression of the ulnar nerve as it passes into the wrist.
40
What is the location of zone 1, zone 2, and zone 3 ulnar tunnel syndrome?
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
What is the cutaneous innervation of the ulnar nerve in the hand?
- Skin of half of 4th and all of 5th digit
42
What is the motor innervation of the ulnar nerve in the hand?
- Hypothenar eminence - All interossei - 3rd and 4rh lumbricales - Adductor pollicis - Flexor pollicis brevis
43
What pathology is ulnar tunnel syndrome treated similar to?
Carpal tunnel.
44
.What modality can be used to improve nerve conduction velocity in tunnel syndromes?
Low-level laser with splinting.
45
What deformities are caused by terminal tendon ruptures?
- Mallet finger | - Swan neck
46
What deformity is caused by a central slip rupture?
- Boutonniere
47
Why are finger flexor tendon injuries more difficult to treat?
- Complex anatomy - Cruciate and annular pulleys - Vincula - FDS splits - FDS/ FDP sliding
48
What zone is no man's land, and what anatomy is found there?
- Zone 2 | - Underside of digits
49
What is post surgical rehab based on?
- Tissue healing | - Functional anatomy
50
Who determines the specific post-op ROM allowed?
- The surgeon
51
What are the 3 focuses of the PT during rehab following tendon injuries?
- HEP and Pt Ed - Move anything not immbolized - Deal with sensory problems as well
52
What are 5 treatments for partial tears and fractures?
- Splinting - Isometric contractions ASAP - Adjunctive interventions - PROM/ AAROM/ AROM - Strengthening exercises
53
What other issues should be considered with hand pathology? (Other anatomical areas/ problems)
- Upper quarter screen - Comorbidities - Medical history
54
What are 5 relevant scales for wrist and hand pathology?
- 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
What are 7 general observations that should be considered with wrist and hand pathology?
- 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
What are 8 unusual resting positions of the hand?
- 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
What pathology is related to an ulnar drift resting position?
- Rheumatoid Arthritis
58
What pathology are clubbed fingers indicative of?
- Clubbed fingers | - Low levels of oxygen due to lung or heart problems
59
What pathology are associated with claw fingers?
- Ulnar nerve lesions | - Tendon lascerations
60
What joints should be cleared with hand and finger pathology?
- Elbow - C-spine - Distal finger joints
61
What are the two methods of expressing overall finger ROM? What is their relationship?
- TAM and TPM - Total active/passive motion - If TAM < TPM, tendon gliding problems are implicated
62
What are 3 methods of measuring Wrist and Hand muscle performance?
- MMT - Grip and Pinch force measurements - Performance Based Functional Measures
63
What are 3 specific performance based functional measures?
- Arthritis hand function test - Hand mobility in scleroderma test - Keitel functional test
64
What is the hand grip testing protocol using a JAMAR unit?
- 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
What determines normal readings for Jamar grip testing?
- Age | - Gender
66
What tests besides muscle strength can be performed at the wrist and hand? (list 4)
- Ligament stability - Soft tissue mobility - Neurologic status - Functional status
67
What are special tests for instability of the hand and/or wrist?
- Gamekeeper's Thumb Test - Varus/ Valgus Stress - Watson Scaphoid Test - Ulnomeniscotriquetral Dorsal Glide
68
What a test for arterial filling of the hand?
- Allen test
69
What are 6 tests/ signs of carpal tunnel syndrome?
- Katz Hand Diagram - Phalen's test - Reverse phalen's test - Flick maneuver - Tinel's sign - Median nerve compression
70
What is a test for an ulnar nerve lesion?
- Froment's Sign
71
What test is used to test intrinsic and ORL shortening?
- Bunnel- Littler Test

Musculoskeletal I (8 decks)

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