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NMSKI > Wrist and Hand STI > Flashcards

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
Q

management of carpal instability if minor subluxation

A

may reduce spontaneously. Otherwise reduced with traction and immobilised to allow healing
surgery if detected early

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26
Q

strengthening exercises for carpal instability for what muscles

A

Esp FCR, ECRL and APL muscles
Isometric in acute stage
Progression to conc/ecc and through range
‘Dart throwing movement’

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27
Q

exercises to avoid with carpal instability and why

A

Avoid exercising Extensor and Flexor Carpi Ulnaris (ECU/FCU)- can increase the Scaph-lunate distance

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28
Q

cause of skiers thumb

A

Rupture of the Ulnar Collateral Ligament of the Thumb

Caused by fall on the outstretched thumb

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29
Q

grades of skiers thumb

A

I-tearing of fibres with no loss of continuity
II-partial tear
III-complete rupture

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30
Q

symptoms of skiers thumb

A

Pain and swelling at the base of the thumb

Pain using the thumb for pinching and gripping, opening jars, car door handles, etc.

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31
Q

signs of skiers thumb

A

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

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32
Q

non operative treatment of skiers thumb

A

Casting/Splinting the wrist and thumb for several weeks

33
Q

de quervains tenosynovitis source of pain

A

Inflammation of the APL and EPB tendons as they pass in their synovial sheath at the level of the radial styloid

34
Q

cause of de quervains tenosynovitis

A

Overuse injury –ulnar deviation, thumb abduction

35
Q

signs and symptoms of de quervains tenosynovitis

A 
Pain along APL and EPB tendons
Tenderness on palpation 
Crepitus
Thickening along tendon 
Difficulty gripping
Finklestein’s test
36
Q

finkelstein test

A

The test involves ulnar deviation of the wrist with the thumb adducted in the palm.
Positive if reproduces the pain over radial styloid

37
Q

management of de quervains tenosynovitis

A 
Relative rest/ Activity modification
POLICE
ROM/Strength 
Resting Splint
Steroid Injection
Electro modalities for healing (e.g. laser/US)
38
Q

intersection syndrome

A

irritation and swelling of radial side of wrist

39
Q

source of pain in intersection syndrome

A

Bursitis where APL and EPB tendons cross over the ECR tendons

40
Q

cause of intersection syndrome

A

May be due to friction as they exert tension in different directions or due to De Quervains tenosynovitis

41
Q

signs and symptoms of intersection syndrome

A

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
Q

management of intersection syndrome

A

similar to de quervains

43
Q

source of pain in carpal tunnel syndrome

A

Compression of the median nerve as it passes through the carpal tunnel

44
Q

cause of carpal tunnel syndrome

A

inflammation or swelling within the carpal tunnel or reduction of the size of the tunnel

45
Q

activities that cause carpal tunnel syndrome

A

Trauma (fractured distal radius), repetitive strain-keyboard use, repeated gripping, excess vibration from heavy machinery

46
Q

symptoms of carpal tunnel syndrome

A

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
Q

what nerves must be ruled out in carpal tunnel syndrome

A 
Cervical Spine ( nerve root)
Thoracic Outlet Syndrome (brachial plexus)
48
Q

tests for the carpal tunnel syndrome

A

Phalen’s test
Tinel’s test
Neural Tissue Provocation Test of Median Nerve

49
Q

phalens test

A

Hold wrist in maximum flexion x1 minute to compress the nerve. Positive if p+n’s are reproduced within 3 mins

50
Q

tinels test

A

Tap the nerve over the flexor retinaculum. Positive if p+n’s are reproduced in the radial 3 digits

51
Q

Neural Tissue Provocation Test of Median Nerve

A

Tests the sensitivity of the brachial plexus and median nerve

52
Q

aim of management of carpal tunnel syndrome

A

to reduce swelling and pressure on the nerve

53
Q

management of carpal tunnel syndrome

A

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
Q

ulnar nerve entrapment causes

A 
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
Q

signs and symptoms of ulnar nerve entrapment

A

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
Q

ulnar nerve entrapment causes weakness in what muscles

A 
flexor carpi ulnaris
flexor digitorum profundus. palmaris brevis,
lumbricals
hypothenar
interossei muscles
57
Q

duputyrens contracrue

A

Insidious thickening and contracture of the palmar fascia

Readily observed and palpable in the palm

58
Q

location of duputyrens contracture

A

Usually effects the 4th or 5th digits or both

59
Q

aetiology duputyrens contracture

A 
Unknown 
Common
Middle-aged men
Familial
Progressive and recurring
Often bilateral
60
Q

management of duputyrens contracture

A

Corticosteroid injection of some benefit
Collagenase injection
Conservative Treatment-Splinting, stretching, ultrasound, laser - relatively ineffective, No evidence.

61
Q

ganglions

A

Synovial cyst communicating with the joint space

62
Q

way to diagnose ganglion

A

palpation

63
Q

cause of ganglions

A

Most frequently from FCR tendon sheath, digital extensors, roof of the first dorsal compartment

64
Q

treatment of ganglions

A

rest, splinting; surgical excision if unsuccessful

65
Q

mallet finger

A

Avulsion of extensor mechanism (tendon)

66
Q

cause of mallet finger

A

: Can occur with basketball, cricket, baseball

67
Q

what must be out ruled when diagnosing mallet finger

A

fracture of distal phalanx

68
Q

treatment of mallet finger

A

Splinted for 6-8 weeks with mallet splint

Physio to restore ROM and strength after immobilisation

69
Q

trigger finger source of pain

A

Tenosynovitis of the FPL or other deep flexor tendon

70
Q

cause of trigger finger

A

Overuse injury

May have painful nodules

71
Q

trigger finger is common in..

A

Common in musicians, gardeners and construction workers due to repetitive gripping

72
Q

trigger finger is associated with

A

RA/ Diabetics

73
Q

signs of trigger finger

A

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
Q

symptoms of trigger finger

A

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
Q

treatment of trigger finger

A

Important for physio to identify
BUT physio intervention not useful

NSAIDS
Corticosteroid injection
Surgical release of tendon

76
Q

rupture of flexor digitorum mechanism of injury

A

: Forceful hyperextension of DIP joint with FDP in maximal contraction

77
Q

FDP function

A

flexes the wrist, MCP , PIP and DIP joints

78
Q

in what finger does rupture of flexor digitorum profundus mostly occur

A

in ring finger

79
Q

FDP rupture treatment

A

surgery

NMSKI (38 decks)

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