Wrist and hand overuse

Question 1

What can get compressed in carpal tunnel syndrome/what makes up the carpal tunnel

Answer 1

• carpal bones
• flexor retinaculum
• FPL, FDP, FDS
• median Nerve

Question 2

Causes of carpal tunnel

Answer 2

• OA, RA of carpals
• tenosynovitis of tendons that help tendons glide in the tunnel
• colles fracture: distal radius fracture with the distal portion displaced dorsally in a dinner fork deformity (heals maligned)

Question 3

Altered sensation without palm involvement vs whole palm median nerve distribution

Answer 3

• altered sensation without the palm part of the median nerve distribution means that it is carpal tunnel syndrome (there is a branch of median nerve that goes above the carpal tunnel)
• if they have symptoms in the palm = compression of median nerve further up the chain

Question 4

Signs and symptoms of carpal tunnel syndrome

Answer 4

• paresthesia > anesthesia median nerve distribution (palm is spared)
• difficulty fine motor = decreased sensation
• median nerve paresis (thumb flexion, abduction, opposition) = thenar

Question 5

Carpal tunnel syndrome examination

Answer 5

• sensation in the specific median nerve pattern
• strength of thenars
• ROM: wrist
• Function: how well do they preform fine motor skills

Question 6

Interventions for carpal tunnel syndrome

Answer 6

• rest from function
• mobilization (carpals,retinaculum)
• splint
• extension or wrist = Carpal tunnel pressure jumps 16-21
• tendon/nerve glides
• modalities
• surgery

Question 7

Tenosynovitis extensor compartment syndromes types

Answer 7

• DeQuervain’s compartment 1 - EPB and APL
• Compartment 2 - ECRL, ECRB
• Compartment 3: EPL
• Compartment 4: ED, EI
• Compartment 5: EDM
• Compartment 6: ECU

Question 8

DeQuervain’s causes/signs and symptoms

Answer 8

• overuse
• pain with passive thumb flexion and ulnar deviation
• pain with resisted thumb extension
• tender to palpation

Question 9

finkelstein test

Answer 9

• DeQuervains tenosynovitis
• have them flex the thumb (make a fist around thumb) and ulnarly deviate

Question 10

DeQuervain’s intervention

Answer 10

• rest from function
• splint
• modalities: US, iontophoresis, transverse friction massage
• gentle exercise

Question 11

dupuytren disease

Answer 11

• anatomy: thickening of palmar aponerosis (4th/5th)
• deformity: MCP flexion

Question 12

causes of dupuytren disease

Answer 12

• unknown etiology
• genetic?
• 50-70 year old most common
• males > females
• assoicated with ETOH (alcohol use), DM, epilepsy, COPD

Question 13

Signs and symptoms of dupuytren disease

Answer 13

loss of passsive and active finger extension

Question 14

dupuytren disease examination

Answer 14

• ROM
• palpate cords/nodules

Question 15

dupuytren disease interventions

Answer 15

• splints
• stretching (generally unsuccessful)
• surgery

Question 16

Ganglion or cyst

Answer 16

• herniation of synovial sheath containing fluid
• excessive fluid in weakened joint capsule
• common over dorsum of wrist

Question 17

Ganglion or cyst signs and symptoms

Answer 17

• swelling in dorsum of hand
• pain with motion
• tenderness
• soft when palpated
• weakening ED tendon most common

Question 18

Ganglion or cyst examination

Answer 18

• observation
• palpation

Question 19

Ganglion or cyst intervention

Answer 19

• PRICE
• US
• Drain
• Surgery