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MS Test 2: Upper Quarter > Wrist and Hand Complex > Flashcards

Wrist and Hand Complex Flashcards

(58 cards)

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1
Q

What bones are in the proximal bones of carpals?

A

schaphoid, lunate, triquetrum, pisiform

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2
Q

What bones are in the distal row of carpals?

A

trapezium(1st MC saddle), trapezoid, capitate, hamate

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3
Q

During supinaton and pronation how does the distal radialulnar joint move?

A

primarily radius moving over ulna

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4
Q

What comprises the Triangular Fibrocartilage complex?

A

articular disc, UCL, ECU tendon sheath, meniscus homologue, radioulnar liagments

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5
Q

What is the normal ranges for wrist flexion?

A

65-80 but 40 in functional

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6
Q

What are norms for wrist extension?

A

68-80 but 40 is functional

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7
Q

What are norms for radial deviation?

A

10-20

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8
Q

What are norms for ulnar deviation?

A

20-35

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9
Q

What are norms for thumb joint?

A

ext- 55
abduction- 50
rotation- 17

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10
Q

Why are the extrinsic flexor muscles important in hand/wrist function?

A

they act as pulley restrain function, prevent bowstrings and optimizes function

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11
Q

Where does the median nerve enter the hand?

A

crosses wrist deep to flexor retinaculum and through carpal tunnel

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12
Q

Where does ulnar nerve enter hand?

A

superficial to flexor ret. and enters ulnar tunnel between pisiform and hook of hamate

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13
Q

What are the two branches of radial nerve?

A

sensory- superficial doral

motor- posterior interosseus nerve

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14
Q

What are important questions to ask during an evaluation?

A

what is your dominant hand?
are you involved in sports?
do you do any repetitive motions
how are you doing at home?

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15
Q

What is De Quervain Tenosynovitis?

A

thickening of tendon sheaths of APL and EPB

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16
Q

What is typical mechanism of injury for DQT?

A

repetitive wrist and thumb motion like using scissors, opening jars, lifting toddlers

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17
Q

What is patient presensation for DQT?

A

pain and swelling around radial styloid process, painful thumb movement

positive finkelsteins and pain with thumb ABD and EXT

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18
Q

What are interventions for DQT?

A

dcrease pain, increase tendon excursiob, modalities, splint for rest, activity modification, progress to AROM and endurance activities

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19
Q

What is an overview of fracture management?

A

minimize duration of immobilization, consider healing times of all involved structures besides just bone

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20
Q

What are goals for fracture management?

A

maintain appropriate reduction, restore jt congruence, optimize pain free ROM and strength, work on surrounding soft tissue

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21
Q

What are two kinds of distal radius fractures?

A

colles- dorsal angulated

smith- apex volar displacement

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22
Q

In weeks 0-6/8 weeks what is interventions for distal radius fractures?

A

immediate motion of uninvolved (elbow, fingers, shoulders) joints and edema management

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23
Q

What is important to remember about weeks 6/8-12 for DRF?

A

must be presence of callus formation to begin wrist ROM, gentle jt mob, and forearm rotation if good healing is shown

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24
Q

When can strengthening begin for DRF?

25
What carpal bone is most frequently fractured in hand?
scaphoid
26
What is rehab of scaphoid fracture?
carpal mobs, soft tissue mob, strengthening if good healing, focus on endurance in ROM
27
What is 2nd most common bone fractured in hand?
triquetrum and usually from fall on ulnar side of hand and forceful wrist flexion
28
What is Boxer's fracture?
most common MC fracture displaced apex dorsal fracture through 5th MC neck
29
What is rehab for weeks 0-3 of Boxer's fracture?
ROM to promote tendon gliding | prevent adhesions
30
What is rehab for weeks 4-6 of Boxer's fracture?
if adequate healing then strengthening, dexterity, and endurance
31
What is a common mechanism of injury for distal radial ulnar ligaments?
FOOSH, forceful twisting, forced hyperpronation or supination
32
What are symptoms for wrist ligament injuries?
ulnar sided wrist pain with forearm rotation, ulnar head prominence, instability with jt play (patient may also describe this)
33
What is typical mechanism of injury with TFCC?
axial load to extended pronated wrist, twisting the ulnarly deviated wrist (golf swing)
34
What are symptoms with TFCC injury?
deep ulnar sided pain typically with pronation, supination and gripping
35
What are typical interventions for carpal instabilities?
protection, examine associated regions and stabilize with isometric and gripping
36
What is the most common hand injury in sports?
ulnar collateral ligament in thumb caused by hyperextension with radial deviation ex: skiers thumb (acute) or gamekeepers (chronic)
37
What is important to do during thumb special tests?
stabilization of trapezium
38
What is key principle of rehab for UCL?
stability over motion
39
What is rehab for grade 1 or 2 UCL sprain?
thumb splint for 2-4 weeks key pinch and gentle thumb strengthening for next 3-4 weeks avoid tip pinch or grasping for 8 weeks
40
What is complex regional pain syndrome?
a hyperactive response and is a shoulder, wrist hand syndrome a common injury will not follow the regular course of recovery
41
What is phase 1 of CRPS?
acute 10days -2-3 months and is reversible sx: flushed, warm, dry, diffuse, severe pain, edema and hair growth increase
42
What is phase 2 of CRPS?
dystrophic phase 3-6 months vasomotor instability- cool limb, pale, severe pain, nails crack, osteoporosis
43
What is phase 3 of CRPS?
atrophic phase- 6 months and beyond cold end phase, less movement, slightly less pain, permanent changes
44
What is important in an exam for CRPS?
Mcgill, VAS scale, ROM, skin temp, edema measurment, function scale
45
What are interventions for CRPS?
tens, meds, splint, ROM in WB, adl training, psychological support
46
Who should be screened for CRPS?
all patients recently out of cast or injured pts prevention is best approach, normalize sympathetic response
47
What is carpal tunnel syndrome?
most common peripheral nerve entrapment syndrome caused by sustained flexion/extension posture, external pressure on volar wrist, prolonged hand vibration
48
What are sx of carpal tunnel syndrome?
pain, parathesia (tingling), numbness
49
What are special tests for carpal tunnel?
phalen's, tinel sign of median nerve, MMT of APB, APB atrophy, monofilament
50
What are differential diagnosis for CTS?
cervical spine involvement, TOS, diabetic neuropathy, pronator teres syndrome
51
What is conservative managment for CTS?
eliminate aggravating factors, neutral wrist position, avoid vibration, avoid forceful gripping, bracing
52
What is rehab after surgical release of CTS?
early mobilization, refrain from gripping lifting, full activity in 4-6 weeks, strength occurs though daily use
53
What factors will work against patient healing?
DM, poor health status, smoking, ETOH, TOS, double crush injuries, workers comp cases
54
What are associated injuries with RA?
ulnar drift, boutonniere deformity, swan neck
55
What are interventions during an acute flare of RA?
pain reduction, gentle ROM, dont overstress tissues
56
What are interventions of RA after a flare?
teach joint conservation tecnniques, splints/ AD, balance mobility and strength
57
Where is OA of wrist and hand most common?
1st CMC and scaphoid
58
What are interventions for OA of wrist and hand?
ROM exercises, joint mobs (distraction), theraputty to focus on radial muscles, joint conservation

MS Test 2: Upper Quarter (5 decks)

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