Wrist and Hand Conditions

Question 1

Carpal Tunnel Syndrome:

Answer 1

• compression of the median nerve at the carpal tunnel due to inflammation of the flexor tendons and/or median nerve
• Causes:
  
  • repetitive wrist motions or gripping
  • pregnancy
  • diabetes
  • RA
• Must r/o cervical spine dysfunction, TOS, or peripheral nerve entrapment

Question 2

Carpal Tunnel Syndrome: Dx

Answer 2

• CLinical findings
  
  • exacerbation of burning/tingling/pins & needles and numbness into med nerve distribution at night
  • (+) tinels sign
  • phalen’s test
  • long term compression = atrophy/weakness of thenar muscles and lat 2 lumbricals & Abductor pollicis brevis
• Electrodiagnostic testing

Question 3

Carpal Tunnel Syndrome: PT

Answer 3

Biomechanical Faults

soft tissue techniques

Question 4

De Quervain’s Tenosynovitis:

Answer 4

• Inflammation of extensor pollicis brevis and abductor pollicis longus at 1st dorsal compartment
• Results from repetitive microtrauma or complication of swelling during pregnancy
  *

Question 5

De Quervain’s Tenosynovitis: Dx

Answer 5

• MRI, but usually not necessarry
• Clinical Signs
  
  • p! at anatomical snuff box
  • swelling
  • decreased grip and pinc strength
  • (+) finkelsteins test

Question 6

De Quervain’s Tenosynovitis: PT

Answer 6

biomechanical faults

soft tissue techniques

Question 7

Colle’s Fracture:

Answer 7

• most common wrist fracture
• from FOOSH
• Immobilized for 5-8 wks
• complication of median nerve compression can occur w/ excessive edema
• characteristic “dinner fork” deformity of wrist and hand results from dorsal or posterior displacement of distal fragment of radius w/ radial shift of wrist and hand

Question 8

Colle’s Fracture: Dx

Answer 8

plain film imaging

Question 9

Smith’s Fracture:

Answer 9

• similar to colles fx except distal segment of radius dislocates in volar direction
• characteristic “garden spade” deformity

Question 10

Smith’s Fracture: Dx

Answer 10

plain film imaging

Question 11

Colles Fracture & Smith’s Fracture: Treatment

Answer 11

• early PT intervention that focuses on normalizing flexibility is paramount to functional recovery of wrist and hand
• Biomechanical Faults
• soft tissue mobilization

Question 12

Scaphoid Fracture:

Answer 12

• FOOSH in younger person
• most commonly fractured carpal
• complications
  
  • high incidence of avascular necrosis of prox fragment of scaphoid second to poor vascular supply
• imobilized for 4-8 wks

Question 13

Scaphoid Fracture: Dx

Answer 13

plain film

Question 14

Scaphoid Fracture: PT

Answer 14

• maintanence of flexibility of distal/proximal joints while UE is casted
• later intervention emphasizes strengthening, stretching, and joint soft tissue for full funx

Question 15

Duputren’s Contracture:

Answer 15

• observed as banding on palm and digit flexion contractures resulting from contracture of palmar fascia to skin
• affects men > women
• contracture effects:
  
  • MCP and PIP of 4/5th digits non diabetic
  • MCP and PIP of 3rd/4th in diabetic

Question 16

Duputren’s Contracture: PT

Answer 16

• flexibility exercise to prevent further contracture
• splint fabrication
• normal hand funx after contracture is under control
• post-op = wound management, edema control and progression of funx

Question 17

Boutonniere’s Deformity

Answer 17

• results from rupture of central tendonous slip of extensor hood
• observed deformity is extension of MCP/DIP and flexion of PIP
• Causes:
  
  • trauma, RA w/ degen of central tendon

Question 18

Boutonniere’s Deformity PT

Answer 18

• edema management
• flexibilty exercises of involved joints
• funx strength
• splinting or taping

Question 19

Swan Neck Deformity:

Answer 19

• results from contracture of intrinsice ms w/ dorsal sublux of lateral extensor tendons
• observed deformity = flexion of MCP and DIP w. extension of PIP
• Causes
  
  • trauma, RA w/ deg of lat extensor tendons

Question 20

Swan Neck Deformity: Dx

Answer 20

plain films, but may not be necessary

Question 21

Swan Neck Deformity: PT

Answer 21

edema management

flexibilty exercises of involved joints

funx strength

splinting or taping

Question 22

Ape Hand Deformity:

Answer 22

• thenar ms wasting with first digit moving dorsally until it is in line w. second digit
• results from median nerve dysfunction
  *

Question 23

Ape Hand Deformity: Dx

Answer 23

electrodiagnostic testing

Question 24

Ape Hand Deformity: PT

Answer 24

edema management

flexibilty exercises of involved joints

funx strength

splinting or taping

Question 25

Mallet Finger:

Answer 25

* rupture or avulsion of extensor tendon at its insertion into the distal phalanx of digit * observed deformity = flexion of DIP * Causes * trauma, forcing distal phalanx into flex

Question 26

Mallet Finger: Dx

Answer 26

MRI

Question 27

Mallet Finger: PT

Answer 27

edema management flexibilty exercises of involved joints funx strength splinting or taping

Question 28

Gamekeeper's Thumb:

Answer 28

* a sprain/rupture of ulnar collateral ligament of MCP in 1st digit * results in medial instability of thumb * frequently occurs during fall while skiing when increased forced are placed on thumb through ski pole * immobilized for 6 wks

Question 29

Gamekeeper's Thumb: Dx

Answer 29

possibly MRI

Question 30

Gamekeeper's Thumb: PT

Answer 30

edema management flexibilty exercises of involved joints funx strength splinting or taping

Question 31

Boxer's Fracture:

Answer 31

* fracture of neck of 5th MC * freq during a fight or from punching a wall * casted 2-4 wks

Question 32

Boxer's Fracture: Dx

Answer 32

plain film imaging

Question 33

Boxer's Fracture: PT

Answer 33

* edema management * flexibility exercises * flex at joint once sufficient healing has occured * initiation of funx strength etc when flexibility is restored