Wrist and Hand Pathologies 2 Pt 2 Flashcards
TFCC injury subjective findings (First 2/4)
Ulnar sided wrist pain, usually worse with pronation/supination motions
Pain with rotation and tight grip
TFCC injury objective findings (first 3/5)
Tenderness common between ulnar head and pisiform “soft spot” of the wrist
Wrist ROM loss may be present
Positive special tests
TFCC injury objective findings (Last 2/5)
Pain with grip testing
Possible DRUJ Hypermobility
TFCC Injury subjective findings (Last 2/4)
Often complains of painful clicking with wrist movement
May complain of constant variable pain with hand function
Special tests for TFCC injury
Load test
Shear test
Piano key
Non-operative management of TFCC for the first 4-6 weeks post injury
Long arm cast or orthosis
How is the arm placed in the orthosis or long arm cast in those with TFCC injury
Elbow at 90 deg
Forearm/wrist in neutral. In some cases placed in ulnar deviation and wrist extension
Non-operative management of TFCC starting 6 weeks post injury
AAROM and AROM w/ emphasis on flexion and extension
Wrist orthosis for comfort and protection
Non-operative management of TFCC starting 8 weeks post injury
Progress ROM to pronation/supination fb radial/ulnar deviation
Strengthening (avoid rotation initially)
Gradual return to activities
Operative management of TFCC
Arthroscopic- central debridement
Open surgical repair- peripheral tear
Post-operative therapeutic management of TFCC
Individual physician protocols
Indiana protocol
Byrk, Savoie, Field protocol (Brotzman and Wilk)
Munster/Sugar Tong Orthosis
What type of wrist and hand fractures are mentioned during lecture?
Distal radius
Carpals
Metacarpals
Types of distal radius fractures
Colles Reverse Colles "Smith's fracture" Barton's Buckle Galeazzi
Types of carpal fractures
Scaphoid
Types of metacarpal fractures
Bennett’s
Colles fracture
Dorsal displacement of the distal radius
Incidence of Colles fracture
Historically more common in middle aged females
Mechanism of injury for colles fracture
FOOSH
Wrist hyper-extended with pronated hand
More extension of wrist more distal the fracture site
Most common medical management of Colles fracture for the elderly
Closed reduction and casting
Common medical management of Colles fracture for the young
ORIF and external fixators
What is typically a more complicated repair for colles fractures?
External fixators
Common postoperative complication of colles fractures
Loss of forearm supination and pronation
