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Wrist and Hand STI Flashcards

1
Q

types of hand injuries

A

Ligament Sprains- Wrist, Skiers thumb
dorsal tendinopathy
tenosynovitis - De Quervain’s, Trigger finger
nerve entrapments - ulnar, median
finger injuries - Mallet Finger, PIP joint sprain, Rupture of FDS and FDP
dislocation - MCP, PIP

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2
Q

common sources of injuries in dorsal region of hand

A

Fracture Carpal bone of distal radius
Extensor Tenosynovitis
Ganglion
ligament sprain

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3
Q

common sources of injuries in volar region of hand

A

Ligament Sprain

Carpal Tunnel Syndrome

Fracture Carpal bone of distal radius

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4
Q

common sources of injuries in ulnar region of hand

A

Ligament Sprain
TFCC tear
Ulnar nerve Compression
Flexor Carpi ulnaris Tendinopathy

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5
Q

common sources of injuries in radial region of hand

A 
De Quervain’s
Intersection syndrome
Scapholunate Dissociation 
Flexor Carpi Radialis Tendinopathy 
* Missed scaphoid #
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6
Q

generis common sources of pain in hand

A

Ligament Sprain
Inflammatory Arthritis
Fracture Carpal bone of distal radius

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7
Q

common sources of injuries in thumb

A

Skiers thumb
Avulsion fracture
Osteoarthritis
Bennett’s fracture

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8
Q

causes of wrist sprain

A

Falls on flexed or extended wrist or contusions

Overload injury seen in gymnasts/ weightlifters

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9
Q

what structures are included in wrist sprain

A

Collateral ligaments

Scapholunate ligament

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10
Q

signs of wrist sprain

A

Tenderness over specific wrist ligaments.
Swelling, loss of motion, and weakness.
Certain special tests are suggestive of specific ligament injuries

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11
Q

symptoms of wrist sprain

A

Pain, swelling, or weakness in the wrist.
Can occasionally be a sense of ‘popping’ or ‘slipping’ inside the wrist.
Symptoms generally worse with activity, such as gripping, squeezing, and lifting.

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12
Q

triangular fibrocartilage complex (TFCC) location

A

Lies between the ulna and carpus

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13
Q

function of TFCC

A

Takes 20% of compressive load of the wrist

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14
Q

ulnar wrist pain is indicative of

A

TFCC tear

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15
Q

causes of TFCC tear

A

ulnar deviation with compression e.g diving, gymnastics, racket sports

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16
Q

signs and symptoms of TFCC tear

A

Pain on ulnar side of wrist –associated with pronation and ulnar deviation movements
Tender on ulnar aspect on palpation
Pain +/-Clicking sensation with wrist movement esp. Flexion /extension in ulnar deviation
TFCC load test: axial compression and ulnar deviation
Pain on resisted extension and ulnar deviation
Reduced and painful grip strength

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17
Q

conservative management of TFCC tear

A 
Relative rest
Protecting bracing /splint
Strengthening’ 
Isometric. Grip strength,  
ROM/ Manual therapy? 
Caution with high grades if unstable
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18
Q

surgical treatment of TFCC tear

A

Excision of torn cartilage under arthroscopy
Ulnar shortening – if it is longer than radius and can impinge on radius
(Ulnar Impaction Syndrome)

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19
Q

cause of carpal instability

A

from a Grade 3 ligament sprain to any of the carpal ligaments

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20
Q

what carpal bone is key to carpal stability

A

scaphoid

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21
Q

most common carpal instability

A

scaphoid-lunate instability-may lead to dislocation

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22
Q

what other carpal bone is also commonly injured

A

capitate

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23
Q

signs and symptoms of carpal instability

A 
Pain 
increase ROM 2 pain 
‘clicking sensation’
increased mobility on accessory motion testing e.g. Kaltenborn
decreased grip strength
Tenderness on palpation 
Positive Scaphoid Shift (Watson) test
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24
Q

management of carpal instability if sprain only

A

with no dislocation, then managed as a usual ligament sprain

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25
management of carpal instability if minor subluxation
may reduce spontaneously. Otherwise reduced with traction and immobilised to allow healing surgery if detected early
26
strengthening exercises for carpal instability for what muscles
Esp FCR, ECRL and APL muscles Isometric in acute stage Progression to conc/ecc and through range ‘Dart throwing movement’
27
exercises to avoid with carpal instability and why
Avoid exercising Extensor and Flexor Carpi Ulnaris (ECU/FCU)- can increase the Scaph-lunate distance
28
cause of skiers thumb
Rupture of the Ulnar Collateral Ligament of the Thumb | Caused by fall on the outstretched thumb
29
grades of skiers thumb
I-tearing of fibres with no loss of continuity II-partial tear III-complete rupture
30
symptoms of skiers thumb
Pain and swelling at the base of the thumb | Pain using the thumb for pinching and gripping, opening jars, car door handles, etc.
31
signs of skiers thumb
Tenderness along the UCL Instability and discomfort with stress testing of the ligament-thumb in extension. Apply abduction (valgus) stress to the MCP joint X-rays to out-rule avulsion fracture
32
non operative treatment of skiers thumb
Casting/Splinting the wrist and thumb for several weeks
33
de quervains tenosynovitis source of pain
Inflammation of the APL and EPB tendons as they pass in their synovial sheath at the level of the radial styloid
34
cause of de quervains tenosynovitis
Overuse injury –ulnar deviation, thumb abduction
35
signs and symptoms of de quervains tenosynovitis
``` Pain along APL and EPB tendons Tenderness on palpation Crepitus Thickening along tendon Difficulty gripping Finklestein’s test ```
36
finkelstein test
The test involves ulnar deviation of the wrist with the thumb adducted in the palm. Positive if reproduces the pain over radial styloid
37
management of de quervains tenosynovitis
``` Relative rest/ Activity modification POLICE ROM/Strength Resting Splint Steroid Injection Electro modalities for healing (e.g. laser/US) ```
38
intersection syndrome
irritation and swelling of radial side of wrist
39
source of pain in intersection syndrome
Bursitis where APL and EPB tendons cross over the ECR tendons
40
cause of intersection syndrome
May be due to friction as they exert tension in different directions or due to De Quervains tenosynovitis
41
signs and symptoms of intersection syndrome
Tenderness dorsally on the radial side of the wrist Swelling and crepitus (usually proximal to site for De Quervain’s) Differential DX: De Quervain’s
42
management of intersection syndrome
similar to de quervains
43
source of pain in carpal tunnel syndrome
Compression of the median nerve as it passes through the carpal tunnel
44
cause of carpal tunnel syndrome
inflammation or swelling within the carpal tunnel or reduction of the size of the tunnel
45
activities that cause carpal tunnel syndrome
Trauma (fractured distal radius), repetitive strain-keyboard use, repeated gripping, excess vibration from heavy machinery
46
symptoms of carpal tunnel syndrome
Aching, burning sensation with P+N’s in median nerve distribution. Symptoms can wake at night and can be eased by vigorously shaking/rubbing the hand. Loss of sensitivity and dexterity of hand ‘Clumsiness’
47
what nerves must be ruled out in carpal tunnel syndrome
``` Cervical Spine ( nerve root) Thoracic Outlet Syndrome (brachial plexus) ```
48
tests for the carpal tunnel syndrome
Phalen’s test Tinel’s test Neural Tissue Provocation Test of Median Nerve
49
phalens test
Hold wrist in maximum flexion x1 minute to compress the nerve. Positive if p+n’s are reproduced within 3 mins
50
tinels test
Tap the nerve over the flexor retinaculum. Positive if p+n’s are reproduced in the radial 3 digits
51
Neural Tissue Provocation Test of Median Nerve
Tests the sensitivity of the brachial plexus and median nerve
52
aim of management of carpal tunnel syndrome
to reduce swelling and pressure on the nerve
53
management of carpal tunnel syndrome
If overuse, address e.g ergonomics- keyboard position, regular movement If reduced ROM (e.g. post fracture)-restore ROM Night/resting splint Manual therapy: joint/median nerve mobilisation NSAIDs /Corticosteroid injection
54
ulnar nerve entrapment causes
``` Trauma (fracture at wrist) FC Ulnaris tendinitis at pisiform. Cyclists (handle bar palsy), Using crutches/walking stick May occur with Cubital Tunnel Syndrome (ulnar nerve entrapment at elbow) ```
55
signs and symptoms of ulnar nerve entrapment
May not complain of pain P+n’s over the ring and little fingers Loss of sensation at the tip of the little finger
56
ulnar nerve entrapment causes weakness in what muscles
``` flexor carpi ulnaris flexor digitorum profundus. palmaris brevis, lumbricals hypothenar interossei muscles ```
57
duputyrens contracrue
Insidious thickening and contracture of the palmar fascia | Readily observed and palpable in the palm
58
location of duputyrens contracture
Usually effects the 4th or 5th digits or both
59
aetiology duputyrens contracture
``` Unknown Common Middle-aged men Familial Progressive and recurring Often bilateral ```
60
management of duputyrens contracture
Corticosteroid injection of some benefit Collagenase injection Conservative Treatment-Splinting, stretching, ultrasound, laser - relatively ineffective, No evidence.
61
ganglions
Synovial cyst communicating with the joint space
62
way to diagnose ganglion
palpation
63
cause of ganglions
Most frequently from FCR tendon sheath, digital extensors, roof of the first dorsal compartment
64
treatment of ganglions
rest, splinting; surgical excision if unsuccessful
65
mallet finger
Avulsion of extensor mechanism (tendon)
66
cause of mallet finger
: Can occur with basketball, cricket, baseball
67
what must be out ruled when diagnosing mallet finger
fracture of distal phalanx
68
treatment of mallet finger
Splinted for 6-8 weeks with mallet splint | Physio to restore ROM and strength after immobilisation
69
trigger finger source of pain
Tenosynovitis of the FPL or other deep flexor tendon
70
cause of trigger finger
Overuse injury | May have painful nodules
71
trigger finger is common in..
Common in musicians, gardeners and construction workers due to repetitive gripping
72
trigger finger is associated with
RA/ Diabetics
73
signs of trigger finger
Tenderness along the flexor tendon sheath, especially at the A1 pulley in the palm. A nodule may be felt moving under the pulley, with finger motion. Locking or catching is classic.
74
symptoms of trigger finger
Pain in the finger. Often a sensation of catching, or 'triggering' of the involved digit. The finger may actually lock in flexion or extension. Symptoms are usually worse in the morning, and improve during the day.
75
treatment of trigger finger
Important for physio to identify BUT physio intervention not useful NSAIDS Corticosteroid injection Surgical release of tendon
76
rupture of flexor digitorum mechanism of injury
: Forceful hyperextension of DIP joint with FDP in maximal contraction
77
FDP function
flexes the wrist, MCP , PIP and DIP joints
78
in what finger does rupture of flexor digitorum profundus mostly occur
in ring finger
79
FDP rupture treatment
surgery

NMSKI (38 decks)

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