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DPT 730: MSK > Wrist and Hand pt. 2: Final > Flashcards

Wrist and Hand pt. 2: Final Flashcards

1
Q

what does fibrocartilage do

A

provides stability/deepens articulation
resists tension (type I)
resists some compression (type II)

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2
Q

what is the articular disc in the wrist

A

aka Triangular Fibrocartilage Complex (TFCC)

located on distal ulna

attached to triquetrum and lunate

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3
Q

how is the TFCC inflamed or damaged

A

sprains/fractures

repetitive ulnar dev

prolonged ulnar dev (i.e. cycling)

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4
Q

PT Rx for articular disc

A

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

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5
Q

what is Dupuytren’s contracture

A

a disease process that affects collagen formation of the palmar fascia or aponeurosis

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6
Q

describe the palmar fascia

A

thick/triangular shaped

superficial in palm

covers tendons of extrinsic muscles

provides protection

distal attachment for palmaris longus

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7
Q

S&S of Dupuytren’s contracture

A

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

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8
Q

MT for Dupuytren’s contracture

A

emphasize mobility

improve ROM and function within 8 weeks of 2 min each of multi plant TFM and maximum finger ext stretch

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9
Q

MET for Dupuytren’s contracture

A

emphasize tissue elasticity and mobility

also may possibly brace for mobility

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10
Q

Terminal n branches that are most commonly entrapped in the hand

A

median and ulnar

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11
Q

functional questionaires for carpal tunnel

A

Katz hand diagram

boston carpal tunnel syndrome questionnaire symptom severity scale

Hems questionnaire

DASH

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12
Q

prevalence of carpal tunnel

A

2.7& with clinical and electrophysiological confirmation

most common entrapment neuropathy

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13
Q

risk factors for carpal tunnel

A

obesity

> 45 years

female gender

forceful hand activity with work

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14
Q

lesser linked risk factors for carpal tunnel

A

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

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15
Q

etiology of carpal tunnel

A

decreased axonal transport

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16
Q

possible causes of decreased axonal transport with carpal tunnel

A

local inflammation at wrist
-repetitive/forceful use
-ARJC
-trauma (lunate dislocation)

Systemic inflammation
-auto immune conditions
-circulatory conditions

benign ganglion cyst

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17
Q

tendons contained in the carpal tunnel

A

FCR
FPL
FDS
FDP

10 tendons total

also contains the nerve under the transverse carpal ligament

18
Q

palmar digital branches of the median n do what

A

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)

19
Q

superficial branch of the median nerve provides motor input to what

A

1st and 2nd lumbricals

opponens pollicis

abductor pollicis brevis

flexor pillicis brevis

20
Q

symptoms of carpal tunnel

A

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

21
Q

functional limited dexterity tests for carpal tunnel

A

Purdue pegboard

dellon - modified Moberg pick up test

22
Q

signs of carpal tunnel

A

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

23
Q

special tests for carpal tunnel

A

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

24
Q

PT Rx for carpal tunnel

A

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

25
Q

PT prognosis for carpal tunnel

A

3 weekly sessions + HEP

better pain relief and functional report at 1-3 months

equal to sx with pain and function at 6-12 months

26
Q

MD Rx for carpal tunnel

A

nerve conduction study

85% sens.

95% spec.

27
Q

usefulness of cortisone injections for CTS

A

helpful in 1/3 pts

28
Q

describe CTS surgery

A

carpal tunnel release = cutting transverse ligament

similar effects to 3 MT treatments following 12 months of symptoms
-Rx from neck to hand

-improved symptoms and pinch tip grip force

29
Q

what is ape hand

A

damage to median nerve

weakness in thenar muscles

thenar atrophy = thumb held more in plane of hand

inability to flx, oppose, or abduct thumb

30
Q

where does ulnar n run

A

Guyon’s canal

31
Q

what is claw hand

A

damage to ulnar n

atrophy of hypothenar

deficient interossei muscles

claw like deformity

32
Q

what is a colles fracture

A

distal radius within 2.5 cm of wrist and is displaced dorsally resulting in “dinner fork” deformity

most common of all fractures

primarily in women via FOOSH

33
Q

most common fractured carpal

A

scaphoid

34
Q

injury mechanism of scaphoid injury

A

wrist hyperextension

pain in snuff box

AVN may be issue in proximal and distal poles

35
Q

special tests for scaphoid fractures

A

p! with thumb to index pinch

P! with wrist ext and pronation

stethescope tests

36
Q

what is a boxers fracture

A

neck of 2nd, 3rd, 4th, or 5th metacarpals

most common of fingers

37
Q

what is a bennett’s fracture

A

most common of thumb

sublux of proximal 1st MC

38
Q

mechanism of carpal dislocations

A

FOOSH with possible fracture

39
Q

most commonly involved carpal with dislocations

A

lunate or scapho-lunate complex

most common instability as well

40
Q

special tests for scapo-lunate instability

A

watson’s = dorsal glide of scaphoid moving from U dev and ext to R dev and FLX

DPT 730: MSK (14 decks)

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