Wrist and Hand- thru Dupuytrens Flashcards
Most ADLs require ______ & _______________.
Extension and ulnar deviation
What amount of extension is required for drinking activities?
6-24˚
What amount of extension is required for using a phone?
40˚ extension
What amount of ROM is necessary for turning a doorknob?
40˚ extension, 40˚ flexion, 30˚ ulnar deviation
What is the ideal functional ROM?
30-50˚ flexion
60˚ extension
20˚ radial deviation
40˚ ulnar deviation
What is the functional position of the hand the optimal position for?
Strength and precision
What is the position of the wrist in the functional position of the hand?
Slightly hyperextended
What is the position of the 2nd - 5th fingers in the functional position of the hand?
Slightly flexed
What is the position of the thumb in the functional position of the hand?
In opposition
What us the etiology of De Quervain’s Tenosynovitis?
Repetitive thumb use with ulnar deviation and gripping
What is De Quervain’s Tenosynovitis?
Tendinopathy of snuff box tendons
What is De Quervain’s related directly to?
Personal device use
What is inflamed and likely thickened with De Quervain’s?
The extensor policis brevis and abductor policis longus tendons and sheath causing pain just proximal to the anatomical snuff box
What happens at the thumb with De Quervains?
Decreased grip and pinch strength
What are S&S of De Quervain’s?
Tendinopathy
Special tests positive - Finkelstein’s
What is the PT rx for De Quervain’s?
POLICED
Reduce typing and dictate
Tendinopathy MET
Tendon Glides
Thumb Splint
What is the MD RX?
anti-inflammatory Injections
Injections for De Quervain’s are __ % successful but may require….
75% successful; may require two injections
What is the issue with injections for De Quervains?
Doesn’t address problem
What is the extensor expansion ligament?
Also known as the extensor hood- a small triangular-shaped aponeurosis of connective tissue
What is the shape of the extensor expansion ligament?
Wider at base, narrow distally
Where is the extensor expansion ligament?
Dorsum and side of the proximal phalanx of the fingers, inserts distally at base of distal phalanx
What does the extensor expansion ligament allow?
Fine motor movements
What does the extensor expansion ligament over the MCP joint do?
Hood over the MCP joint and holds extensor tendons in midline and close to bone
Where does the extensor expansion ligament attach when over the MCP joint?
Middle and/or distal phalanx
-attachment site for many muscles
What is the etiology for mallet finger?
Trauma or disease (possibly RA)
What is Mallet finger?
Tendon rupture or avulsion fracture of the extensor hood mechanism at DIP
What does Mallet finger result in if untreated?
DIP Joint flexion and possible contracture if untreated
What is the etiology for boutonniere deformity?
Trauma or disease
What is a Boutonniere deformity?
Rupture or stretch of extensor tendon at PIP
What does a Boutonniere deformity result in if untreated?
PIP flexion with DIP extension and possible contracture if untreated
What is the etiology of a swan neck deformity?
Trauma or disease
What is a swan neck deformity?
Rupture of volar plate at PIP
What does a swan neck deformity result in if untreated?
Hyper extension at PIP
Flexion at DIP and possible contracture if untreated
What is the general Rx for tendon deformities?
Splinting
Address consequences of immobilization
- Tendon integrity / proliferation and mobility
What does a wrist sprain involve?
Flexor retinaculum and associated ligaments
What causes a wrist sprain?
Primarily hyperextension mechanism with FOOSH
What is the flexor retinaculum?
Fibrous band on volar wrist
Where does the flexor retinaculum attach?
From pisiform and hamate to scaphoid and trapezium
What is the function of the flexor retinaculum??
Holds flexor tendons, supports carpal arch as most activities performed with wrist extended, limits hyperextension
What do the collateral ligaments support at the wrist?
Radiocarpal, Ulnotriquetral, MCP, and IP joints medially and laterally
What do medial collateral ligaments limit?
Valgus stresses
What are medial collateral ligaments also known as in the hand?
Ulnar collateral ligaments
What do lateral collateral ligaments limit?
Varus stresses
What is another name for lateral collateral ligaments in the wrist?
Radial collateral ligaments
What is a skier’s / gamekeeper’s thumb?
Excessive valgus stress with hyperextension and abduction during a FOOSH
What does the skier’s / gamekeeper’s thumb involve?
Ulnar collateral ligament at 1st MCP joint
What are S&S of sprains?
- trauma, immediate onset
- inflammation, TTP right on it
- Swelling
- Painful AROM/PROM with lengthening ligament
- Weak and painful with resisted tests
- pain with distraction, impulse if acute, compression relieving
- weakness of affected muscle
What is the PT Rx for sprains?
- Stabilization and tissue integrity
- immobilize for brief period
- POLICED
- bracing / taping PRN
What are the sets and reps for sprains?
Start 1-2 sets of 10-15 reps with light resistance, increase as tissues can handle, we want to get to a heavy load
Where is the triangular fibrocartilage complex?
Articular disc
-Located distal to ulna
- attached to triquetrium and lunate
What is the function of fibrocartilage?
Manage compression
What is the triangular fibrocartilage complex inflamed or damaged by?
- FOOSH sprains/fractures
- Repetitive ulnar deviation (such as hammering)
- Prolonged Ulnar deviation (such as cycling)
What are S&S for articular disc?
- Pain with compression
- AROM - ulnar deviation and radial deviation painful, extension possibly painful and provoking
- Resisted tests not unique
- hyper mobility = abnormal end feels
What is the etiology of dupuytren’s contracture?
A disease process that affects collagen formation of palmar fascia or aponeurosis
What is the palmar facia?
Thick, triangular shaped fascia, superficial in palm of the hand, covers tendons of extrinsic muscles, provides protection, distal attachment of palmaris longus
What are S&S of Dupuytren’s Contracture?
- flexion contractures of MCPs and IPs
- limited ROM and accessory motion into extension particularly
- elastic and firm end feels
- more often involved 4th and 5th digits
- usually have non painful modules found with palpation
What is the PT rx for Dupuytren’s contracture?
MT
- emphasizing mobility
- improved ROM and function with 8 weeks of 2 mins each of multi-planar TFM and maximal finger extension stretch
MET
- for tissue elasticity and mobility
* Splinting and bracing to assist mobility
What does splinting and bracing do for Dupuytren’s contracture?
Assists mobility and prevents from getting worse
