Wrist and Hand: Final Flashcards
ideal ROM for wrist
30-50 flexion
60 ext
20 radial dev
40 ulnar dev
ROM for drinking, using phone, turning doorknob, and rising from chair
drinking = 6-24 ext
phone = 40 ext
door = 40 ext, 40 flx, 30 ulnar dev
rise = 60 ext, 25 ulnar dev
optimal hand position for strength and precision
wrist slightly hyper extended
2nd-5th fingers slightly flexed
thumb in opposition
soft tissue injuries include
tendons
sprains
fascia
articular disc
etiology of tendon injuries
trauma
RSI
overuse
disease
what is de quervain’s tenosynovitis (etiology and pathogenesis)
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
special tests for de quervains tenosynovitis
Finkelstein’s
minimal to no clinical support but works in clinic
PT Rx for de quervains tenosynovitis
POLICED
reduce typing and dictate
tendinosis MET
tendon glides
thumb splint
tendinosis Rx
MD Rx for de quervains tenosynovitis
injections are 73% successful
may require 2 injections
one of the areas of the body that injections are decently successful
what is the extensor expansion ligament
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
extensor hood is an attachment for what
extensor digitorum
lumbricals
interossei
why is the extensor expansion ligament called the extensor hood
it is a hood over the MCP jt and holds the extensor tendons in midline and close to the bone
what is mallet finger
tendon rupture or avulsion fracture of the extensor hood mechanism at DIP with trauma or disease
can result in DIP joint flexion contracture
Rx for mallet finger
splinting and possible PT to help mobility after mobilization
what is a boutonniere deformity
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)
what is a swan neck deformity
rupture of palmar plate at PIP with trauma or disease
results in hyper ext at PIP and flx of DIP
hand posturing for ruptured flexion tendon
in resting position involved digits will remain in an extended position
Rx for ruptured tendon
address consequences of immobilization and focus on tendon repair/remodeling
most common wrist sprain
involves flexor retinaculum and associated ligaments
primary mechanism = hyperextension with FOOSH
what us flexor retinaculum
fibrous band on polar wrist
runs mediolaterally
palmar carpal ligament + transverse carpal ligament
functions of flexor retinaculum
holds flexor tendons down
supports the carpal arch as mist activities performed with wrist extended
what is extensor retinaculum
fibrous band on posterior wrist in a mediolateral direction
holds extensor tendons close to wrist
where does the extensor retinaculum attach
ulnar stylodi process/pisiform/triquetrum
radius
what is the dorsal radoiocarpal ligament
not as string as palmar radoiocarpal ligament
attaches to posterior distal radius and posterior surface of scaphoid, lunate, and triquetrum
limits wrist flexion
