Wrist and hand pathology Flashcards
common pathologies of the wrist and hand
1: colle’s/smith’s fx
2: scaphoid fx
3: MC/phalanx fx
4: DeQuervain’s disease
5: Dupuytren’s contracture
6: carpal tunnel/ulnar tunnel
7: tendon injuries
colle’s/smiths fx
- FOOSH
- fracture of distal radius
- difference=angulation
- closed reduction if stable
- ORIF (pins, plates) if unstable
-rehab for impairments: strength, ROM, flexibility
Common complications of colle’s/smith’s fx
carpal tunnel
RSD
colle’s fx
distal segment angulated dorsally
smith’s fx
distal segment angulated ventrally
scaphoid fx
- most common carpal fx
- FOOSH- esp w/ radial deviation
- pain on palpation in snuffbox
- pain on overpressure- radial/ulnar deviation
- requires imaging to dx
- closed reduction if stable
- ORIF (screw fixation) if unstable
-rehab for impairments: strength, ROM, flexibility
common complications of scaphoid fx
AVN
scapho-lunate advanced collapse (SLAC)
-OA and lunate subluxation
MC and phalanx fractures
- trauma
- pain on: distal end tapping, palpation over bone
- closed reduction if stable
- ORIF (screw fixation) if unstable, intra-articular
- MC often unites in 6 wks; phalanx in 3wks
-rehab for impairments: strength, ROM, flexibility
common complications of MC and phalanx fractures
carpal tunnel
fixed ROM loss
DeQuervain’s disease
- stenosing tenosynovitis of the APL & EPB at radial styloid
- overuse (friction syndrome)- thumb and wrist
- most common in women 30-50
- tender, thickened sheath
- (+) Finklestein’s test
DeQuervain’s disease treatment
Conservative Rx:
- refrain from aggravating postures/motions
- thumb spica splint
- physical agents for inflammation
- steroid injection
- surgical release of first dorsal compartment
Dupuytren’s contracture
-palmar fascia thickens with nodules; adheres to flexor tendons and skin
Most common:
- digits 4 & 5
- in men
- Northern European origins
- drinkers and smokers
- autosomal dominance??
Dupuytren’s contracture treatment
Conservative tx to slow progression:
- heat-paraffin
- stretching
- splints
- maintain joint ROM (constant length)
- steroid injection or enzymes
- surgical release
Carpal tunnel syndrome (CTS)
=compression of medial nerve under flexor retinaculum
median nerve
- innervates palmar skin of 1-3 and 1/2 of 4
- innervates lumbricales 1 & 2 and thenar ms. except for Adductor pollicis
CTS caused by:
- trauma
- prolonged wrist extension
- repetitive wrist flex/ext
- lunate dislocation
- fluid retention (pregnancy)
clinical presentation of CTS
- “toothache” pain progressing to numbness in medial distribution
- thenar weakness/atrophy
- night pain- hand “flicking”
conservative tx for CTS
- splinting in neutral- night splints
- refrain from aggravating postures/motions
- agents for inflammation reduction
- posture from c-spine distally
- nerve gliding
surgical tx for CTS
open or endoscopic surgical release (incision on carpal ligament to release pressure)ulnar
post op PT: based on impairments
- scar mobilization
- strengthening
- ROM
- flexibility
ulnar tunnel syndrome
=compression of the ulnar nerve as it passes into the wrist
- similar to CTS but in ulnar distribution
- similar txs
ulnar nerve
innervates skin of digit 5 and 1/2 of 4
innervates hypothenar, all interossei, lumbricales 3 & 4, adductor pollicis, FPB
zone 1: motor and sensory (over pisiform and med side)
zone 2: motor (lateral to 1)
zone 3: sensory (distal to 1)
tendon injuries
-finger posture depends on balance of forces
terminal tendon affects..
mallet finger and swan neck
Swan neck:
- synovitis of the flexor tendon sheath.
- increased flexion pull on the MP ioint causes an imbalance to the extensor central slip through the long extensor tendons and the intrinsic muscles
- stretch to the volar plate at the PIP jt causes hyperextension of the PIP
- the lateral intrinsic tendons shift dorsally and reciprocal flexion occurs at the DIP jt
central slip affects..
boutonniere deformity
-can result from an injury or disease which ruptures the central slip, subluxing the lateral bands volarly to the axis of the middle joint (PIP). may develop over several days or many months after injury as the lateral bands drift volubly
finger flexor tendon injuries
complex anatomy:
- cruciate and annular pulleys
- vincula
- FDS splits
- FDS/FDP sliding
5 zones:
zone 2=”no man’s land”
treatment of tendon injuries
post surgical rehab:
- clinical specialty (CHT)
- based on tissue healing and functional anatomy
- protocols as guidelines specifics from surgeon: protected motion to prevent ripping repair (PROM, AAROM, AROM, RROM)
- key is HEP and pt ed
- move anything not immobilized-constant length principles
- often sensory problems as well as musculoskeletal