Wrist and Hand pt. 2: Final Flashcards
what does fibrocartilage do
provides stability/deepens articulation
resists tension (type I)
resists some compression (type II)
what is the articular disc in the wrist
aka Triangular Fibrocartilage Complex (TFCC)
located on distal ulna
attached to triquetrum and lunate
how is the TFCC inflamed or damaged
sprains/fractures
repetitive ulnar dev
prolonged ulnar dev (i.e. cycling)
PT Rx for articular disc
improve tissue integrity, stability, and proliferation
POLICED
don’t want to add more pain
possibly brace until tissue can become more stabilized
want to eventually get to high reps to increase circulation and healing
what is Dupuytren’s contracture
a disease process that affects collagen formation of the palmar fascia or aponeurosis
describe the palmar fascia
thick/triangular shaped
superficial in palm
covers tendons of extrinsic muscles
provides protection
distal attachment for palmaris longus
S&S of Dupuytren’s contracture
results in flexion contractors of MCPs and IPs
= limited ROM/AM and elastic/firm end feel
more often in 4th/5th digits
may have non-painful nodules found with palpation
MT for Dupuytren’s contracture
emphasize mobility
improve ROM and function within 8 weeks of 2 min each of multi plant TFM and maximum finger ext stretch
MET for Dupuytren’s contracture
emphasize tissue elasticity and mobility
also may possibly brace for mobility
Terminal n branches that are most commonly entrapped in the hand
median and ulnar
functional questionaires for carpal tunnel
Katz hand diagram
boston carpal tunnel syndrome questionnaire symptom severity scale
Hems questionnaire
DASH
prevalence of carpal tunnel
2.7& with clinical and electrophysiological confirmation
most common entrapment neuropathy
risk factors for carpal tunnel
obesity
> 45 years
female gender
forceful hand activity with work
lesser linked risk factors for carpal tunnel
circulatory conditions (i.e. CPD or diabetes)
ARJC
hypothyroid
family hx of CTS
sedentary lifestyle
wide hand
short stature
work involving repetitive activitties and vibration
etiology of carpal tunnel
decreased axonal transport
possible causes of decreased axonal transport with carpal tunnel
local inflammation at wrist
-repetitive/forceful use
-ARJC
-trauma (lunate dislocation)
Systemic inflammation
-auto immune conditions
-circulatory conditions
benign ganglion cyst
tendons contained in the carpal tunnel
FCR
FPL
FDS
FDP
10 tendons total
also contains the nerve under the transverse carpal ligament
palmar digital branches of the median n do what
supplies sensation to volar surface of first 3 and 1/2 fingers and dorsal tips
palm over scaphoid and 1st CMC is innervated by palmar branch of the median nerve (prior to croak tunnel)
superficial branch of the median nerve provides motor input to what
1st and 2nd lumbricals
opponens pollicis
abductor pollicis brevis
flexor pillicis brevis
symptoms of carpal tunnel
gradual onset that can become numb (first 3 and 1/2 digit)
worse at night and with other prolonged positions; especially flexion
shaking hands = relief
weak grip, tip, or pinch strength
functional limited dexterity tests for carpal tunnel
Purdue pegboard
dellon - modified Moberg pick up test
signs of carpal tunnel
obs = possible thenar eminence atrophy
ROM = symptoms with prolonged wrist flex and ext
RST/MMT = weak pinch, tip, and pinch strength
Neuro = diminished sensation; fast progress to cutaneous n pattern; possible + median n ULTT
AM = hypo or hyper with carpal, RC, or distal RU its
special tests for carpal tunnel
carpal tunnel compression: inconsistent
Wainners CPR
2 pt discrimination: on involved fingers
Tinel’s: inconsistent
Wrist ratio index
decreased sensation on involved fingers
Phalen’s and reverse Phalen’s
PT Rx for carpal tunnel
POLI ED (no C)
pt edu: pathology, wrist factors, and aggravating factors
Modalities: conflicting evidence; come short term pain control
less use of computer mouse
lower strike fore for keyboards
orthoses: neutral wrist splint
possibly immobilize MCP
joint mobilizations to neck, forearm, and wrist
neural glides
