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Semester 4 PM Exam 4 > Wrist and Hand Pathology > Flashcards

Wrist and Hand Pathology Flashcards

1
Q

Carpal tunnel syndrome - define

A

Compression of the median nerve in the carpal tunnel

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2
Q

What makes up the carpal tunnel

A

Transverse ligament - pisiform and hook to the trapezium and scaphoid - forms the volar portion of the tunnel
Flexor retinaculum
Carpal bones - top of the carpal tunnel

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3
Q

Contents of the carpal tunnel

A 
FDS
FDP
Flexor pollicis longus
Median n. 
Flexor carpi radialis (travels in the retinaculum)
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4
Q

Etiology of CTS

A
  1. Incongruence between size of tunnel and contents of it
  2. Dec gliding of flexor tendons - n. irritation/swelling
  3. Miscellaneous reasons
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5
Q

Miscellaneous causes of CTS

A 
Repetitive wrist motions
Prolonged improper wrist position
Wrist trauma (fracture)
Pregnancy
Arthritis
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6
Q

Presentation with CTS

A 
Pain and paresthesias in hand (m.n distribution)
Weakness
Atrophy (ape hand)
Dropping items
Night discomfort
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7
Q

CTS - what will their hand look like

A

Atrophy of median nerve innervated mm - ape hand
Mainly thenar mm - except adductor pollicis (innervated by ulnar)
Their thumb will be adducted

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8
Q

Colles’ Fracture - define

A

Fracture of the distal radius (sometimes radius and ulna)

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9
Q

Colles’ Fracture - etiology

A

Usually from fall backwards landing on an extended wrist (FOOSH with extended wrist)

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10
Q

Opposite of Colles’ fracture =

A

Smith’s fracture

Radial fracture in a wrist flexion position

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11
Q

Presentation of Colles’ fracture

A
  1. Stiffness and dec ROM
  2. Dec strength (prolonged immob)
  3. Pain and paresthesia
  4. Dec functional use of wrist and hand
  5. CTS, Complex regional pain syndrome
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12
Q

Who is more likely to end up with a Colles fracture

A

Women more than men

More common in senior adults

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13
Q

People with a Colles fracture might end up with what deformity

A

Dinner fork deformity - can heal improperly and leave patient with slight angulation

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14
Q

Wrist and finger sprains - define

A

Trauma resulting in various degrees of ligamentous involvement

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15
Q

Wrist and finger sprain - etiology

A

Direct blow - “jam”

Fall

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16
Q

Presentation of wrist and finger sprain

A 
Pain in joint when stretch ligament
Instability or possible hypomobility 
Dec func. use of joint
Limited ROM and strength
Possible joint deformity
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17
Q

What else can happen if the finger/wrist sprain turns into a dislocation

A

Volar ligament plate - rupture

Collateral ligaments - rupture

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18
Q

What else needs to be ruled out with a wrist/finger sprain

A

Need to rule out a fracture, subluxation, dislocation

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19
Q

DeQuervain’s Tenosynovitis - tenosynovitis of what muscles

A

Abductor pollicis longus

Extensor pollicis brevis

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20
Q

Etiology of DeQuervains Tenosynovitis

A
  1. Overuse of thumb

2. Forceful thumb injury

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21
Q

Presentation of DeQuervains Tenosynovitis

A
  1. Tenderness of swelling over 1st dorsal extensor compartment
  2. Pain with resisted thumb extension and abduction
  3. Localized edema
  4. Possible dec strength of thumb ext and abd
  5. Dec func use of thumb
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22
Q

Miscellaneous things with DeQuervains Tenosynovitis - may mimic what

A

Scaphoid fracture

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23
Q

Miscellaneous things with DeQuervains Tenosynovitis - may involve what nerve

A

Radial

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24
Q

Dupuytren’s Contracture - etiology

A

Result of a disease of the palmar fascia resulting in thickening and contracture of the fascia
Adheres to tendons, bidns them down and shortens them
Cause is UNKNOWN

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25
Q

Dupuytren’s Contracture - Presentation

A
  1. usually effects 4th and 5th digits
  2. Finger flexion contracture (AROM and PROM limitations)
  3. Presence of adhesions and dec palmar tissue mobility
  4. May result in non functional hand
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26
Q

Miscellaneous with Dupuytren’s contracture

  • What if left untreated
  • Bilateral or unilateral
  • Where else does it occur
A
  1. Progressive if left untreated
  2. Can be bilateral or reoccur
  3. May occur in plantar fascia
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27
Q

Thumb Ulnar Collateral Ligament Sprain - AKA

A

Gamekeepers Thumb

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28
Q

Gamekeepers thumb - define

A

Injury to the ulnar collateral ligament of the thumb MCP

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29
Q

Gamekeepers thumb - etiology

A
  1. Forceful radial deviation of thumb MCP
  2. Falling on outstretched thumb
  3. End result of repetitive strain of UCL
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30
Q

Presentation of Gamekeepers thumb

A
  1. Swelling around thumb MCP
  2. Painful and dec ROM
  3. Dec thumb strength
  4. Dec func use of thumb
  5. Possible thumb instability
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31
Q

Miscellaneous with Gamekeepers thumb -
Tear can be __ or __
Integrity of lig. - what is indicative of rupture

A

Tear can be partial or complete rupture of UCL

More than 30 joint laxity is indicative of a rupture

32
Q

RA - etiology

A

Disease process causing synovial inflammation and tissue proliferation

33
Q

RA - presentation

A
  1. Pain, limitation, swelling and warmth in joint bilaterally
  2. Usually present in wrist, MCP, and PIP
  3. Tendon sheath inflammation causing mm imbalance in length and strength agonist and antagonist relationship
  4. Fatigue
  5. Joint capsule weakening, bone erosion, tendon ruptures, subluxations
34
Q

Subluxations that may occur with RA

A
  1. Ulnar subluxation of carpals - radial deviation

2. Radial subluxation of prox phalanx - ulnar drift of fingers

35
Q

What deformities may you see with RA

A
  1. Swan neck deformity - PIP hyperextension and DIP flexion
    Volar lig. rupture
  2. Boutonniere - PIP flexion and DIP ext - typically an ext tendon slip
36
Q

Miscellaneous - RA - may develop ___

A

CTS from lack of motion

37
Q

OA - etiology

A

Overuse of joints

Poor biomechanics

38
Q

OA - presentation

A
  1. Swelling and pain in joints
  2. Reduced ROM
  3. Possible strength deficits
  4. Possible joint deformity and loss of joint integrity
39
Q

OA is commonly noted at which joints

A

1st CMC joint and the DIPs

40
Q

Compression of Guyon’s tunnel - define

A

Ulnar nerve compression resulting in irritation and swelling of ulnar nerve

41
Q

Etiology of compression at guyon’s tunnel

A
  1. Sustained pressure on hypothenar eminence
  2. Repetitive gripping
  3. Trauma (fall)
42
Q

Presentation - compression at guyon’s tunnel

A
  1. Pain and paresthesias along ulnar border of palm, 4th and 5th digits
  2. Weakness and possible atrophy of hypothenar, interossei, medial lumbricals
  3. Dec ROM and strength
43
Q

What might be seen in someone with compression at guyon’s tunnel

A

Ulnar claw

44
Q

Differentials with compression at guyon’s tunnel

A

If present with ulnar claw, could be D contracture

Differentiate with ROM and palpation

45
Q

Wrist drop is associated with what nerve

A

Radial nerve palsy knocking out extensors

46
Q

Claw hand/Intrinsic Minus Hand associated with

A

Ulnar and Median n. compromise

47
Q

Ape hand is associated with

A

Median nerve - pulling thumb into adduction

48
Q

Bishop’s deformity is associated with

A

Knocking out of lumbricals and thenar eminence

49
Q

Scaphoid fracture - etiology

A

Trauma - direct blow to region
Forceful thumb stretch
Fall

50
Q

Presentation - Scaphoid fracture

A
  1. Localized swelling
  2. Dec and painful thumb ROM
  3. Dec func use of thumb/hand
51
Q

Indications for arthroplasty

A
  1. Severe joint instability and deterioration of joint surfaces
  2. Dec loss of ROM at joint
  3. Chronic subluxing and dislocating joint
  4. Severe joint pain
52
Q

Raynaud’s Syndrome - what is it

A

Vasospasm of the small cutaneous and subcutanous arteries and arterioles
Idiopathic in nature

53
Q

Raynaud’s syndrome - description

A

Produces phasic changes in skin color possible perception of coolness
Pallor (VC), Cyanosis, Rubor (VD)
Precipitated by cold or emotion

54
Q

Volkmann’s Ischemic Contracture - what is it

A

Contracture, fibrosis and atrophy of muscles resulting from dec blood supply

55
Q

Volkmans ischemic contracture - usually due to what

A

obstruction of blood supply to forearm mm typically due to cast being too tight
In as little as 6 hrs mm will begin to necrose - fibrose and result in flexor mm contracture

56
Q

Presentation with Volkmans ischemic contracture

A
  1. Wrist and finger flexor contracture
  2. Diminished radial pulse
  3. Circulatory and neuro sx
57
Q

Intervention for Volkmans Ischemic Contracture

A
  1. Medical emergency
  2. ROM, muscle re-ed
  3. Edema and inflammation relief
58
Q

Etiology of Volkmans Ischemic Contracture

A

Erbs palsy or other brachial plexus injury
Compression from not fitting splint properly
Lymphedema
Significant trauma

59
Q

Ganglion cysts - description

A 
Soft, movable cyst (benign)
Repetitive motion may exacerbate
Typically not painful
Can be surgically removed or aspirated 
Usually no PT
60
Q

Complex regional pain syndrome - Cause

A

Sympathetic dysfunction of unknown origin - most of the time is a precipitating factor that leads to it

61
Q

What is complex regional pain syndrome

A

Hypo-vascularity to a portion of the body due to abnormal sympathetic activity which results in changes to neuromusculoskeletal system

62
Q

Precipitating factors with complex regional pain syndrome

A
  1. Direct trauma to peripheral nerve
  2. Edema from prolonged immobilization
  3. Psychological predisposition
  4. Low pain tolerance
63
Q

Phases with complex regional pain syndrome - name them

A

Acute
Dystrophic
Atrophic

64
Q

Acute phase of complex regional pain syndrome - time

A

1 to 3 months

You want to catch it early in this phase

65
Q

Dystrophic phase of complex regional pain syndrome - time frame

A

3 to 9 months

Skin and mm are deteriorating

66
Q

Atrophic phase of complex regional pain syndrome - time frame

A

Can be permanent - can be dry, flaky skin, loss of hair

67
Q

Presentation of complex regional pain syndrome

A
  1. Hyperalgesia (loss of motion very quickly)
  2. Capsular restrictions
  3. Hyperhydrosis
  4. Atrophy
  5. Trophic changes
  6. Osteoporosis
  7. Edema
68
Q

Interventions for complex regional pain syndrome

A
  1. ROM - maintain
  2. Desensitization
  3. Splinting
  4. Modalities
  5. Joint loading
  6. Stellate ganglion block
  7. Emotional management
69
Q

What is a bennetts fracture

A

metacarpal fracture

70
Q

Triangular fibrocartilatge complex injury

A

Ulnar disc and carpals
Allow for closed chain rotary components (gymnast)
Can become damaged or town

71
Q

Trigger finger

A

Irritation in one of the flexor tendons

If not addressed can lead to rupture

72
Q

FOOSH =

A

fall on outstretched hand injury

73
Q

FOOSH - Does not signify

A

a specific injury or location of injury - just describes the mechanism

74
Q

FOOSH - pertinent to

A

Shoulder, elbow, forearm, wrist, and hand

75
Q

Wrist extensor compartments - what are they held in place by

A

Held in place by extensor retinaculum

Semester 4 PM Exam 4 (10 decks)

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