Wrist and Hand: Final

Question 1

ideal ROM for wrist

Answer 1

30-50 flexion

60 ext

20 radial dev

40 ulnar dev

Question 2

ROM for drinking, using phone, turning doorknob, and rising from chair

Answer 2

drinking = 6-24 ext
phone = 40 ext
door = 40 ext, 40 flx, 30 ulnar dev
rise = 60 ext, 25 ulnar dev

Question 3

optimal hand position for strength and precision

Answer 3

wrist slightly hyper extended
2nd-5th fingers slightly flexed
thumb in opposition

Question 4

soft tissue injuries include

Answer 4

tendons
sprains
fascia
articular disc

Question 5

etiology of tendon injuries

Answer 5

trauma
RSI
overuse
disease

Question 6

what is de quervain’s tenosynovitis (etiology and pathogenesis)

Answer 6

from repetitive thumb use with ulnar deviation and gripping

direct relation to smartphone use

inflammation and likely thickening of the extensor pollicis brevis and abductor pollicis longus tendons and sheath causing pain just proximal to anatomical snuff box

decreased grip and pinch strength at thumb

Question 7

special tests for de quervains tenosynovitis

Answer 7

Finkelstein’s

minimal to no clinical support but works in clinic

Question 8

PT Rx for de quervains tenosynovitis

Answer 8

POLICED
reduce typing and dictate
tendinosis MET
tendon glides
thumb splint

tendinosis Rx

Question 9

MD Rx for de quervains tenosynovitis

Answer 9

injections are 73% successful

may require 2 injections

one of the areas of the body that injections are decently successful

Question 10

what is the extensor expansion ligament

Answer 10

aka extensor hood

small triangular shaped aponeurosis of connective tissue

wide base, narrows distally

on dorsal side/sides of proximal phalynx

inserts on base of distal pharynx

Question 11

extensor hood is an attachment for what

Answer 11

extensor digitorum

lumbricals

interossei

Question 12

why is the extensor expansion ligament called the extensor hood

Answer 12

it is a hood over the MCP jt and holds the extensor tendons in midline and close to the bone

Question 13

what is mallet finger

Answer 13

tendon rupture or avulsion fracture of the extensor hood mechanism at DIP with trauma or disease

can result in DIP joint flexion contracture

Question 14

Rx for mallet finger

Answer 14

splinting and possible PT to help mobility after mobilization

Question 15

what is a boutonniere deformity

Answer 15

rupture or stretch of extensor tendon at the PIP with trauma or disease

results in PIP flexion (b/c it extends PIP so damage results in flexion) with DIP extension (b/c tension is not kept to allow attaching structures to act/pull normally = deformity)

Question 16

what is a swan neck deformity

Answer 16

rupture of palmar plate at PIP with trauma or disease

results in hyper ext at PIP and flx of DIP

Question 17

hand posturing for ruptured flexion tendon

Answer 17

in resting position involved digits will remain in an extended position

Question 18

Rx for ruptured tendon

Answer 18

address consequences of immobilization and focus on tendon repair/remodeling

Question 19

most common wrist sprain

Answer 19

involves flexor retinaculum and associated ligaments

primary mechanism = hyperextension with FOOSH

Question 20

what us flexor retinaculum

Answer 20

fibrous band on polar wrist

runs mediolaterally

palmar carpal ligament + transverse carpal ligament

Question 21

functions of flexor retinaculum

Answer 21

holds flexor tendons down

supports the carpal arch as mist activities performed with wrist extended

Question 22

what is extensor retinaculum

Answer 22

fibrous band on posterior wrist in a mediolateral direction

holds extensor tendons close to wrist

Question 23

where does the extensor retinaculum attach

Answer 23

ulnar stylodi process/pisiform/triquetrum

radius

Question 24

what is the dorsal radoiocarpal ligament

Answer 24

not as string as palmar radoiocarpal ligament

attaches to posterior distal radius and posterior surface of scaphoid, lunate, and triquetrum

limits wrist flexion

Question 25

what do the collateral ligaments of the hand do

Answer 25

support MCP and IP joints on medial and lateral aspects of the head of one bone to the base of the other

Question 26

medial or ulnar collateral ligaments limit

Answer 26

valgus stress

Question 27

lateral or radial collateral ligaments limit

Answer 27

varus stresses

Question 28

what is skiers/gatekeepers thumb

Answer 28

involves ulnar collateral ligament at MCP jt

excessive valgus stress with hyperextension abduction during a FOOSH