Wrist and Hand Tendon Injuries Flashcards
Most ADLs require what two movements?
Extension and ulnar deviation
Drinking activities require what degree of extension?
6 to 24 degrees
Using a phone requires what degree of extension?
40 degrees
Turning a doorknob requires what degree of extension, flexion, and ulnar deviation?
- 40 degrees of extension
- 40 degrees of flexion
- 30 degrees of ulnar deviation
What are the ideal functional ranges of motion for the wrist? (flexion, extension, radial deviation, ulnar deviation)
- Flexion: 30-50 degrees
- Extension: 60 degrees
- Radial Deviation: 20 degrees
- Ulnar Deviation: 40 degrees
What is the functional/optimal position of the hand?
- Wrist: slightly hyperextended
- 2nd - 5th fingers: slightly flexed
- Thumb in opposition
What are the 4 tendon injuries in the wrist/ hand?
- De Quervain’s Tenosynovitis
- Mallet Finger Deformity
- Boutonniere Deformity
- Swan Neck Deformity
What is the etiology of De Quervain’s Tenosynovitis?
Repetitive thumb use with ulnar deviation and gripping
De Quervain’s Tenosynovitis is directly related to what daily action?
Personal device use
De Quervain’s Tenosynovitis is inflammation and likely thickening of what tendons?
- Extensor Pollicis Brevis
- Abductor Pollicis Longus
- Sheath causing pain just proximal to the anatomical snuff box
De Quervain’s Tenosynovitis will cause a decreased what?
Grip and pinch strength at the thumb
What are signs and symptoms of De Quervain’s Tenosynovitis?
- Tendinopathy
- Special tests (+) Finkelstein’s: minimal to no clinical support
What is the PT Rx for De Quervain’s Tenosynovitis?
- POLICED
- Reduce typing and dictate
- Tendinopathy MET
- Tendon Glides
- Thumb Splint
What is the MD Rx of De Quervain’s Tenosynovitis?
Injections are 75% successful but may require two
What is another name for the extensor expansion ligament?
Extensor hood
The extensor expansion ligament is what shape?
Small triangular shaped aponeurosis of connective tissue
Is the extensor expansion ligament wider at the base or the distal end?
- Wider at the base, narrow at the distal end
- Dorsum and sides of the proximal phalanx of the fingers
- Inserts distally at the base of the distal phalanx
The extensor expansion ligament creates a hood over the MCP joint and holds what?
The extensor tendons in midline and close to the bone
The extensor expansion ligament is the attachment to the middle and or distal what for many muscles?
Phalanx
What is the cause of mallet finger?
trauma or disease
What is mallet finger?
Tendon rupture or avulsion fracture of the extensor hood mechanism at DIP
What does a mallet finger result in?
DIP joint flexion and possible contracture if untreated
What is the cause of boutonniere deformity?
Trauma or disease
What is a boutonniere deformity?
Rupture or stretch of extensor tendon at the PIP
What does a boutonniere deformity result in?
Results in PIP flexion with DIP extension and possible contracture if untreated
What is the cause of a swan neck deformity?
Trauma or disease
What is a swan neck deformity?
Rupture or volar plate at PIP
What does a swan neck deformity result in?
Results in hyper extension at the PIP and flexion at the DIP and possible contracture if untreated
What is the general Rx for tendon deformities in the hand/wrist?
- Splinting
- Address consequences of immobilization
- Tendon integrity/ proliferation and mobility
